Interventional Radiology and Radiation Oncology: Together Again?

Decades ago, radiology and radiation oncology decided to separate, giving rise to two distinct specialties. But times and technologies have changed, and it is, perhaps, time for two branches of radiology to consider a close relationship, said one industry expert.

During this year’s RSNA annual meeting last month in Chicago, Anthony L. Zietman, MD, MBBS, a radiation oncology professor at Harvard Medical School and director of the Radiation Oncology Residency Program at Massachusetts General Hospital, proposed a partnership between radiation oncology (RO) and interventional radiology (IR).

“With all our new training and new societies, perhaps we’ve gone too far away from each other,” he said. “To survive as a specialty, we must adapt and look at which areas could marry.”

But is such a pairing necessary? According to Zietman, yes. Both RO and IR are facing challenges that they could better weather together. A paradox exists in RO, he said. As the specialty has become for technologically advanced, it has ceded many of its duties to other types of providers. For example, medical oncologists and surgeons frequently conduct patient evaluations, ablation, and brachytherapy procedures. IR faces a similar concern - unless these providers assume clinical responsibility for patients, they will lose ground to physicians who can acquire and learn to use the same imaging equipment.

“There are remarkable parallels between interventional radiology and radiation oncology,” he said. “I believe they’re running on the same track and at the same gauge. It’s time for their train tracks to merge.”

RO and IR would still continue as separate specialties. The goal, he said, would be to create a new certification - image-targeted oncology - for those residents interested in mastering skills in both areas. There’s already a great deal of overlap. RO has already become more imaging based, mirroring IR with its use of 3D, 4D, and stereotactic imaging. In addition, both types of providers use the same technologies, such as needles and ultrasound equipment. And, both still hold to continuing the oral exam.

In order for this merger to work, RO and IR must both bring attributes to the table. According to Zietman, RO would bring model of training that includes cancer biology, staging, chemotherapy strategy, and a process of care that incorporates medical and surgical oncology. Conversely, IR would offer a broad portfolio of therapies, including an ablative therapy that is complementary to radiation therapy.

“Radiation oncology is very good at irradiating the microbes of small-volume disease. And, most ablative technologies handle larger tumors, but they don’t address microscopic disease,” Zietman said. “Imagine how powerful it could be if we put them together.”

The advantages of combining these two branches of radiology would extend beyond offering a new training track to medical students and residents, he said. Patients who need these services would also benefit.

“Patients would undoubtedly gain. This merger would bring all minimally invasive therapies into the multidisciplinary clinics,” Zietman said. “Patients would be presented with an increased range of options and choices in care.”

There would, however, be challenges to creating a new image-targeted oncology branch in radiology. The medical field - and radiology - have long-standing traditions, but this collaboration would only serve to strengthen the profession, he said. Many practicing radiologists might worry that new doctors with this training will woo away work. Not to worry, Shipley said, that reality would be at least 10 or more years away.

Earning this type of degree would also require additional training. Based on a survey of his own students, however, Zietman determined nearly one-third would’ve trained for more years to have additional certification. In addition, there could be some concern over where image-targeted oncologists will work in the hospital. But, he said, these providers would likely work in a cancer center.

As the Affordable Care Act begins to deconstruct and reshape the healthcare system, now is the right time to at least consider this possibility and start the discussion, he said.

“As interventional radiologists and radiation oncologists, we are not safe. We have to make changes to give aspiring and young physicians the secure future they desire,” Zietman said. “I suggest that we, the current generation, act like matchmakers and start marrying our children.”