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At ISET this year, Gary Becker, the executive director of the American Board of Radiology, prognosticated that interventional oncology would be the first subspecialty of IR. 

At SIR last month, one of the faculty was told that he could not refer to IO as a “subspecialty of IR” in the title of his talk. The reasoning for this was a little hard to follow, something solipsistic about IO being an intrinsic part of IR. (Nice to see that SIR is upholding the values of academic freedom.) 

Of course, both Gary and the SIR thought police are wrong. IO isn’t a subspecialty of IR. It’s a subspecialty of oncology, like medical, surgical, and radiation oncology. IO is a clinical discipline, requiring a broad and deep understanding of cancer, cancer treatment, and the care of cancer patients. The practitioners of IO in the US are largely interventional radiologists, though that definition is a slippery slope, given that some of our leading “ablationists” function outside the traditional IR universe. Both Nuclear Medicine and Radiation Oncology are making strides in image-guided targeted treatments for cancer, further blurring the lines. From a global perspective, IO procedures are done by many different medical specialists, reflecting practice patterns in different countries. For example, in Brasil, angiography is a surgical specialty, while non-vascular interventions are performed by radiologists. 

The evolution of IO as a clinical discipline is manifest in some leading US academic hospitals, where IO divisions have been established. This can be a service-line constructed to garner hospital resources while continuing to operate within the IR infrastructure, or a fundamentally separate division with its own staff and resources. Whether these pioneering centers reflect a new trend remains to be seen.

I mentioned this story to a Radiology department chairman, who replied with a snort, “IO is not a subspecialty of IR. If anything, it’s the other way around!”.