The ‘Sic Vos non Vobis’ of Interventional Radiology – Rebranding and modernising the Interventional Specialities of Radiology in Australia and New Zealand

Abstract

Sic Vos Non Vobis (‘For You, But Not Yours’) were the words Vergil wrote on Emperor Augustus’ palace doorpost, when Bathyllus, another poet, had plagiarised his work lavishing praise on emperor Augustus.1 In his famous retribution, he quipped the bees do not produce the honey for themselves, but for others. But maybe it is time for a change? Interventional radiology (IR) and interventional neuroradiology (INR) have a recognition and branding problem. There is confusion about their identity not only amongst the public but also amongst our medical and surgical colleagues.2, 3 Even amongst radiologists, knowledge of the interventional specialties can be limited. Often, it is not realised that not all interventional radiologists provide the same service. These challenges have implications at many levels: future trainees cannot be inspired without appropriate knowledge of the specialties; challenges exist with accreditation and training; and advocacy of our profession for patients will ultimately suffer.4 The purpose of this opinion piece is to stimulate a discussion and reach a consensus on how we view ourselves as clinicians. To modernise the radiological specialities of IR and INR, a unified approach is necessary, without which our ability to influence the perception of others to our profession is limited. The term ‘radiology’ resonates with the public and medical fraternity primarily as a diagnostic specialty, recognised as X-rays, ultrasound, CT and MRI – essentially imaging modalities. The term ‘interventional radiology’ (or other variations) is insufficient for public recognition of what we truly do as interventional radiologists (IRs) and interventional neuroradiologists (INRs). This is particularly important as we transition from being consultants for other doctors to practice, like any other clinician, as consultants to our patients, similar to how Radiation Oncologists practice in the Royal Australian and New Zealand College of Radiologists (RANZCR). Interventional radiology was born more than five decades ago when the first therapeutic endovascular procedures were performed by Charles Dotter.5 Ever since, radiologists have been providing minimally invasive image-guided procedures for patients referred by other specialties, performing procedures such as corticosteroid injections and percutaneous biopsies. More subspecialised radiologists might provide direct clinical care to patients and perform advanced forms of treatment such as endovascular thrombectomy for acute ischaemic stroke, intracranial aneurysm treatment, prostatic artery embolisation for benign prostatic hypertrophy or ablation for bone metastases. A multidisciplinary approach where radiologists work intimately and collaboratively with their referrers is ideal for patient management. However, with little scope for self-referral and patient ownership for radiology, other specialties have increasingly offered minimally invasive image-guided therapies independent of radiologist input. Competing patient interests have added to turf battles with other specialties. Unfortunately, the lack of readily identifiable interventional specialty branding has meant that non-radiologist providers may be chosen by patients to receive minimally invasive treatment options. Surgeons have a branding that is well recognised. The Royal Australasian College of Surgeons has different surgical divisions, with each division providing a board for training in that subspecialty: including neurosurgery, orthopaedic, cardiothoracic, otolaryngology head and neck, paediatric, plastic and vascular surgery.6 Each subspecialty is a separate field of specialty practice under the umbrella of the speciality of Surgery, recognised by the public, the Medical Board of Australia, Australian Health Practitioner Regulation Agency, Medical Council of New Zealand, hospital administrators and health networks. Until IR and INR are recognised as fields of speciality practice, they will not fit into the systems