Clinical IR in Canada: The Evolution of a Revolution

The Landscape of Rural and Remote Radiology in Canada: Opportunities and Challenges

Diagnostic and interventional radiology play a crucial role in healthcare, facilitating diagnosis of disease, treatment planning, interventional therapies, and assessment for response to treatment. However, many rural and remote regions are disproportionately limited in accessing high-quality radiological services. Challenges include limited imaging infrastructure in these communities, geographic isolation, and workforce shortages impacting provision of interventional image-guided procedures and subspecialty imaging in particular. However, a career in rural or remote radiology also presents unique opportunities including a deep sense of community, broad scope of practice, and immense benefit to patient care. This review aims to explore the landscape of rural and remote radiology with a focus on Canada, including opportunities, challenges, and potential strategies. Some of the challenges are shared by both rural and remote communities while others are distinct. Factors that have contributed to challenges in recruitment and retention of rural and remote radiologists include workload burden, inadequate or suboptimal imaging and interventional equipment, and limited exposure during training. Additionally, strategies to improve the provision of radiology services in rural and remote communities are highlighted, addressing both the workforce shortage and the lack of essential equipment and other resources.

Looking Into the Future: The Current and Future State of IR in Canada

This review explores the priorities and future opportunities of interventional radiology in Canada.

The Operational and Financial Value of an Interventional Radiology Clinic at a Large, Academic, Tertiary Public Hospital System

Purpose To evaluate the operational and financial impact of an interventional radiology (IR) clinic at a tertiary county hospital system.

Methods The IR clinic, which opened in January 2017, evaluates outpatient referrals and completes preprocedure workups, nonimage-guided procedures, and postprocedure follow-up visits. Procedural volumes, locations, start times, and end times were analyzed from September 2015 to June 2018, with comparison of pre- and postclinic values by t-tests.

Results Relative to the preclinic period, the number of IR cases completed each quarter has increased by an average of 12% (pre: 953 ± 63, post: 1063 ± 34, p = 0.01). Procedures that saw the largest quarterly growth included port placements (44% increase; pre: 82 ± 8, post: 118 ± 17, p = 0.002), inferior vena cava (IVC) filter placements (24% increase; pre: 33 ± 12, post: 41 ± 8, p = 0.20), IVC filter removals (72% increase; pre: 18 ± 7, post: 31 ± 8, p = 0.02), and treatments of lower extremity venous disease (100% increase; pre: 7 ± 2, post: 14 ± 6, p = 0.04). Completion of 119 cases/quarter in clinic (removal of tunneled catheters and infusion ports), as well as a reduction of emergent nephrostomy exchanges, reduced quarterly facility charges for these procedures by $350,000. Since the opening of the IR clinic, the first outpatient case started 36 minutes earlier (p < 0.001) and the last case finished 19 minutes earlier (p = 0.004).

Conclusion Opening an IR clinic resulted in a significant increase in case volume while reducing avoidable costs and improving efficiency of the angiography suite.

Interventional Radiology Outpatient Clinics (IROC): Clinical Impact and Patient Satisfaction

PURPOSE

To retrospectively analyze our interventional radiology outpatient clinics (IROC) for referral patterns, impact on interventional practice, and patient satisfaction.

MATERIALS AND METHODS

Consultations performed between 2011 and 2019 were extracted. The two consecutive years with the highest number of consultations (n₂₀₁₈ = 1426; n₂₀₁₉ = 1595) were compared for unattended consultations (i.e., scheduled consultations with patients not showing-up); initial/follow-up consultations; hospital clinician/general practitioner referrals; initial consultations with radiologists not recommending interventions; procedural conversion rate (PCR; i.e., No. initial consultations resulting in interventions over the total number of initial consultations performed for the same clinical indication). A survey was conducted in 159 patients to determine their satisfaction.

RESULTS

Consultations increased from 2011 to 2019 by 130%. In 2018-2019, the number of unattended consultations was stable (7.0% vs 6.6%; P = .68). The referrals were for back pain (42.2%), interventional oncology (40.5%), and arteriovenous malformations (9.0%). For back pain, in 2019, there were fewer consultations with radiologists not recommending interventions and increased PCR compared to 2018 (11.9% vs. 17.7%; 88.1% vs. 82.3%; respectively; P = .01). For interventional oncology, follow-up consultations and general practitioner referrals increased in 2019 compared to 2018 (43.0% vs 35.3%; P = .01; 24.4% vs. 12.7%; P < .01; respectively). No other changes were noted. Cumulative 2018-2019 PCR was ≥ 85.4%. 99.2% responders highly appreciated their IROC experience. Quality of secretarial and medical services were the main aspects evaluated to rate the experience with IROC.

CONCLUSION

IROC results in high PCR. Recent changes in referral/impact on IR practice were noted with patients referred for back pain and interventional oncology.

LEVEL OF EVIDENCE IV

Level 4, Case Series.

Interventional Radiology in Canada: Current Challenges and Future Directions

OBJECTIVE

We aim to define the practice of interventional radiology (IR) in Canada, barriers that have been faced by interventional radiologists, and ways in which the Canadian Interventional Radiology Association (CIRA) have attempted to address these issues.

CONCLUSION

IR has faced significant challenges in the Canadian setting. Recognizing the need to address these challenges, leaders in the field of IR in Canada founded the CIRA to serve as our national voice and lobby group.