The Dr. Charles T. Dotter Lecture honors one of the founding fathers of interventional radiology. Selection by the SIR president is based on extraordinary contributions to the field, dedicated service to the society and distinguished career achievements in interventional radiology. The Dotter lecture is made possible with funding from SIR Foundation.
The 2023 Dotter Lecturer will be William S. Rilling, MD, FSIR. His lecture, titled “The embarrassment of riches,” will be discuss how the diversity and growth of modern IR practice, along with the subsequent increase in subspecialization, is both an opportunity and a challenge. Read Dr. Rilling’s full bio.
SIR Today recently spoke with Dr. Riling about his background, the lecture and the role of subspecialization in IR.
What first drew you to interventional radiology?
William S. Rilling, MD, FSIR
William S. Rilling, MD, FSIR: I got exposed to imaging and radiology when I was in undergraduate because my father worked for GE Medical Systems as an engineer. As an undergrad and in medical school at University of Wisconsin–Madison, I did some early research in MRI and MRI spectroscopy, so I saw a lot of the growth and power of advanced imaging. As I did my clinical rotations in medical school, I loved being in the operating room and liked the surgical mindset much more than other specialties. IR is a natural combination of both of those things, so I was fortunate to have good examples of IR in medical school and residency. That helped me solidify the choice to pursue IR.
You’re certainly well-known for your work in the interventional oncology space. Are you specifically interested in other areas of the IR domain as well?
WR: I also do a lot of vascular malformation work, which is obviously pretty niche. But it’s a complex group of patients that require high-level multidisciplinary expertise to take good care of, and I think it’s certainly part of IR’s domain. It’s the same with hereditary hemorrhagic telangiectasia (HHT) patients—both are rare disease states in which patients need a tremendous multidisciplinary team to provide the best care for them—and it’s great to work in those teams. Medicine has become so much more of a team sport now than it was when I first started practicing 26 years ago. It’s really cool to see how a lot of those barriers have been broken down over the last couple decades.
You completed your term as president of the Society of Interventional Oncology just a few years ago. What lessons or takeaways did you gain from that experience?
WR: Of course, I served as president during COVID and all the adjustments that everybody—not just in medicine but from all walks of life—had to make posed a number of unique challenges. Trying to help run a new society, navigate the pandemic, be nimble and switch everything to virtual education events while still trying to provide resources for membership was one of our needs at the time. It was fascinating and challenging and, at the end of the day, I think we did a pretty decent job getting through that as a community.
What does being named the 2023 Charles T. Dotter Lecturer mean to you?
WR: It’s an incredible honor, and I’m extremely grateful to Parag Patel for asking me. When you consider all those who have presented the Dotter Lecture in the past, it’s very intimidating and amazing to be part of that group. I see people who are the giants and the founders of the specialty, people who were my mentors and now many people who are my friends are on the list of Dotter Lecturers. I’m extremely grateful to be given the opportunity.
How did you arrive at the topic and the title?
WR: I’ve actually seen the majority of the Dotter Lectures since I finished my training in ‘96. The titles over the years represent an amazing mix of topics and thought processes. You catch a lot of different moods and the psyche of IR that was going on at all these different times.
Personally, I feel like I was very much affected by the doom and gloom of the early 2000s, because of turf battles with vascular disease and a lot of negativity at that time about where IR was going. I’m so amazed and happy that we’ve gotten through that with flying colors, and now IR is more diverse and healthier than it’s ever been.
But with that diversity comes a lot of challenges. I would argue that we as interventional radiologists care for the broadest range of patient populations of any specialty in medicine at this point in time. That is great from the standpoint of professional satisfaction and choices, but it also creates a lot of challenges when it comes to establishing the depth needed within the all the practice areas we’re blessed to have as IRs.
How do you feel a society like SIR should work to not only meet the needs of a diverse membership, but serve as a leader across subspecialties?
WR: That’s certainly a difficult task, but overall I think SIR has always done a phenomenal job with advancing the field and giving IRs the resources that we need to continue to grow and foster the growth of the field itself.
But it’s challenging from the lens of the subspecialties. It’s great that we have eight different Clinical Specialty Councils. I was part of the prior SIR Service Line infrastructure and leadership, which worked in some ways better than others. This new infrastructure was designed to help mitigate some of the Service Lines’ shortcomings. I hope it does, though it’s probably a little too early to tell at this point. But needless to say, it’s really challenging to have all those subspecialties feel like all their needs are being met and everything is going smoothly all the time. Also, all the difficulties and challenges vary tremendously from one subspecialty to another. For an umbrella organization like SIR, it’s hard to manage all the challenges inherent to the diversity across its membership.
If subspecialization is integral to the growth of the specialty, do you feel that SIR should work to foster that subspecialization or focus on the general needs of its membership?
WR: think it’s an inevitability that subspecialization will continue. And I’m not taking away from the need to have people who can do everything in different practice environments. But as the specialty grows and as this diversification continues, the only way we’ll make the necessary research gains will be by people who concentrate on and subspecialize in one or two of these areas.
In our practice right now, there’s not one person who does everything across the board. It’s such an amazing challenge to do all this at a high level—I think it’s impossible. Hopefully, people are seeing that SIO has done some positive work in the field of interventional oncology. I think initially there was some anxiety about whether its presence as an organization would detract from SIR, though the society and SIO are now working closely together to make sure that doesn’t happen.
At the same time, there are things that SIO doesn’t have to do because SIR does them really well and vice versa. I don’t think we can have a subspecialty society for every single subspecialty counsel—it’s just not feasible for that to happen—but I do think that as these areas mature, it’s something to embrace and realize as part of the natural evolution of IR.
As someone who has held a number of education-related leadership positions at SIR, do you feel that graduate or postgraduate education needs to better reflect the diversity of today’s practice of IR?
WR: Our very first class of IR residents is graduating this year, and it was a huge lift by dozens and dozens of people to get to this point. And now that we have a residency, I think it’s a natural evolution to have the subspecialty fellowships that are already being developed. I don’t think that those necessarily will be ACGME type of fellowships, at least not initially. They’ll be sort of organic fellowships at different places that allow people to have extra training so that they can focus their practice. It’s hard to say how it will develop over time, but I would say that it’s already happening—and I think it’s a good thing.
Don’t miss this year’s Dotter Lecture, held during SIR 2023’s Opening Plenary Session, Sunday, March 5, 10:30 a.m.–noon.
