The Next Generation: A New Beginning for Interventional Radiology
Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month’s column is written by Liwei Jiang, MD, BWH’s first interventional radiology resident. You can learn more about BWH’s Integrated Interventional Radiology Residency Program, which was established last year as one of the first integrated interventional radiology residency programs in the country, in this story.
It is quite a privilege to be chosen as BWH’s first interventional radiology resident. Being on the forefront of change is very exciting! My year thus far has been immersed in the general surgery experience – no different than the first year of those who are ultimately going into surgery as a specialty. I very much appreciate the valuable surgical foundation of this training program.
My friends, especially those not in health care, often ask why I chose interventional radiology. It is not a specialization that readily comes to mind when picturing a doctor, and I struggle to recall any mainstream TV show that depicts an interventional radiologist.
In medical school, I had a lot of interests, which made choosing a specialty difficult. I like technology. I adore pictures. I like fixing things. I love physics. I enjoy talking with patients. Only after I did a year of research at the National Institutes of Health with a team of interventional radiologists did I realize that just about everything I enjoy is captured in the specialty of interventional radiology. I had found my home in a field that employs an ever-growing array of technologies to expand what is possible for patients.
An innovative promise
Interventional radiology uses medical imaging to diagnose conditions and perform minimally invasive procedures. What that actually involves is constantly changing, as mind-blowing innovations are happening all the time. Some of the latest exciting examples include techniques to deliver targeted gene therapy to cells, reconnect the gastrointestinal tract without surgery, and close arteries and veins from the inside. I am particularly interested in a technique called image fusion, which aligns imaging data from multiple imaging modalities (such as an MRI and an ultrasound) to harness each modality’s advantages to better visualize and treat tumors and other conditions.
One reason I so wanted to train at BWH was its state-of-the-art Advanced Multimodality Image Guided Operating (AMIGO) suite, impressively well-equipped for the development and practice of new procedures that leverage image fusion. For example, radiofrequency ablation is a technique in which a special current-carrying needle is inserted into a tumor to destroy it using electrical energy. In the AMIGO’s PET-CT scanner, one can take radiofrequency ablation to the next level using fused information derived from both CT and PET. The CT image ensures correct needle position, while the PET image (which lights up any active tumors) ensures that none of the targeted tumor is missed. All this translates to potentially delivering a longer-lasting cure for patients struggling with cancer.
An active role
The modus operandi of the interventional radiologist is changing. In today’s era, where conditions are treated by increasingly sophisticated means, where we provide our patients with comprehensive care, where hospital services are assessed by the value they provide, it is not adequate for interventional radiologists to perform a procedure and walk away. As interventional radiologists are more frequently becoming patients’ go-to doctor for certain conditions, they are beginning to change their role from that of a pure consultant to that of a core provider, seeing their patients at admission, during procedure, in post-procedural recovery and at follow-up.
The new integrated interventional radiology training pathway aims to nurture a generation of interventional radiologists who not only are excellent proceduralists but also are competent in taking care of patients throughout their hospital stay. At BWH, interventional radiology maintains a primary admitting service that manages its own patients, and the new training program will further improve the care patients receive at our hospital.
At the same time, the value of the interventional radiologist as a team player is also increasing, particularly in cancer care. He or she has an invaluable role on multi-disciplinary tumor boards, where experts from multiple specialties come together to discuss the best way forward for cancer patients. In such a setting, the interventional radiologist is uniquely qualified to offer diagnosis, interpret images in context and propose primary and adjunct treatment plans. In time, interventional radiology will prove its worth as the fourth pillar of oncology, standing shoulder-to-shoulder with the existing pillars of surgery, radiation and medical therapy.
A grateful journey
As the first resident in a new training program, I am indebted to the many departments and divisions at BWH that make it all work: the surgery program and its affiliates for providing the foundational training in anatomy and clinical decision-making, as well as insight into the vast multidisciplinary resources available to an interventionalist; the diagnostic radiology program for imparting the image interpretation skills, as imaging is the lifeblood of the interventional radiologist; and the interventional radiology program for reinventing itself and looking toward the future. All of you work together to cultivate the next generation – my generation – of physicians, each a competent combination of clinician, diagnostician and proceduralist. It is truly an honor to be here. Thank you for investing in me!