CIRSE: Do you think that clinical services are something that every IR should be providing in the future? What would be an ideal scenario?
Mahnken: I feel that’s the direction interventional radiology has to go in the future, because we need to become more independent as a specialty and as individual interventional radiologists, providing more clinical services, generating our own patients, dealing with our primarily radiology patients – that should be the ultimate goal of interventional radiology.
Ideally, IRs would have their own beds, their own outpatient clinics, and those not working in a hospital-based setting would have an outpatient clinic providing all the services on a day-care basis.
CIRSE: What are the main challenges in your opinion?
Mahnken: Generally speaking, there are two key challenges throughout Europe. Firstly, training – a lot of radiologists are not trained in clinical services, they are trained in procedures, they are trained in imaging, but they are not trained in dealing with the patient outside of the procedure itself.
The next challenge is staffing. At least if you work in a hospital-based setting, a lot of administrators don’t think about the professional time it takes to provide proper interventional services. Part of the staffing challenge, at least in Germany, is about the money. Staffing resources go with the money is. As long as radiology and IR departments don’t get the reimbursement for the procedures we provide, as long as we depend on our internal cost allocations, we will have a structural problem as interventional radiologists.
CIRSE: What are your observations about how clinical practice in IR has evolved in recent years? Are there big differences from place to place?
Mahnken: This particular question has different dimensions – first, interventional radiology is growing not only in numbers, but also in type of procedures, starting with simple vascular procedures 50 years ago up to very complex ablations. We do this from the brain to the toe. That’s one thing. The other thing is that clinical practice varies widely throughout Europe. It depends on the individual hospital. Some interventional radiologists are primarily providing pain management, while others do everything. Some IR´s work with an outpatient clinic, while for others it’s only inpatient-based; some are doing 100% IR, and others do a mixture with diagnostic radiology.
So, there can’t be a text textbook solution for how to develop and evolve your clinical practice. There’s a broad variety and we need flexibility in how to develop clinical practice, but for me the future direction is clear.
CIRSE: You are the chairperson of the Clinical Services in IR Task Force – what are the current priorities and projects of this working group?
Mahnken: We first conducted a survey as a baseline to see how clinical practice differs throughout Europe, and we are now focusing on training and education with different sessions during CIRSE and ECR. Moreover, we’re currently developing some microlearning lectures on clinical topics like how to an MDT meeting, how to do a ward round in order to provide information on clinical skills.
In parallel, we’re developing a three-level infrastructure showing what clinical practice could look like. The important part is that everyone can contribute, and we really want to motivate and inspire interventional radiologists to evolve their clinical practice
CIRSE: A Focus on clinical services and patient care is one of the pillars of CIRSE’s new vision. What is your recommendation to IRs who want to start developing their clinical practice?
Mahnken: No interventional radiologist has been trained in clinical services and inpatient management, so don’t be ashamed to make mistakes at first. The important thing is to try to do it, you will improve over time.
Click here to learn more about CIRSE’s Clinical Services in IR Task force.
