Interventional radiology establishes itself in South Africa

Dr. Duncan is a radiologist with the Unitas Interventional Unit in Lyttelton, Centurion, South Africa. He can be reached at .

Interventional radiology (IR) is not a formally recognized subspecialty in South Africa. Other than the basic training received during the four to five-year registrarship at each of the seven university academic departments, no formal fellowship or other postgraduate training program has been available in this field until recently. Despite this, a number of individual radiologists in the country are "recognized" as IR specialists by their peers by virtue of skills acquired through their own experience or through training overseas.

In 2002, a formal one-year postgraduate training program was established at the University of the Orange Free State in Bloemfontein, which confers a diploma in interventional radiology. This program, the first of its kind in South Africa, was created under the auspices of Professor Coert de Vries, head of radiology at the UOFS.

The provision of IR services in the public sector is severely limited by a shortage of funds and expertise in several areas. The availability of such services is somewhat better in the private sector: Several of the larger private practices in the major cities in South Africa offer IR and conventional angiography.

One such private practice went a step further to create the Unitas Interventional Unit in Lyttelton, Centurion, just south of Pretoria. This is the only stand-alone dedicated unit of its sort in South Africa, possible even in the whole of Africa. Two interventional radiologists are in full-time employ at the unit, which offers 24-hour service seven days a week. The full spectrum of interventional techniques is covered at the unit including vascular, hepatobiliary, urogenital, and neurointerventional procedures.

In addition to providing services for private patients, the unit performs cases for the Medical University of Southern Africa (MEDUNSA), the University of Pretoria, and the University of the Witwatersrand. The unit employs a Philips V5000 monoplane angiography unit with full anesthetic backup. The theater itself is a sterile environment to allow joint open and interventional procedures such as endovascular aneurysm repair. An average of 100 patients are seen at the Unitas Interventional unit every month. This includes both diagnostic angiographic and interventional cases.

The unit also jointly hosts the multidisciplinary Pretoria Vascular Malformation Group with the University of Pretoria. This group consists of specialists from a number of disciplines: pediatric surgery, plastic surgery, vascular surgery, radiology, interventional radiology, pathology, maxillofacial surgery, and ENT surgery. It meets every three months to see patients referred to the group. After presentation of each case, a consensus is reached by all members of the group concerning the diagnosis and treatment of these difficult conditions. The Pretoria Vascular Malformation Group is currently assessing the use of bleomycin for the treatment of low-flow vascular malformations and hemangiomas.

Neurointerventional expertise is offered in the four major centers in South Africa: Cape Town, Durban, Bloemfontein, and Pretoria. A total of five interventional radiologists and one neurosurgeon perform neurointerventional procedures in the country, with a population in excess of 45 million.

Because of the IR expertise in South Africa, referrals are also received from other countries throughout sub-Saharan Africa. The relative lack of IR specialists in many areas of the country, however, means many local patients do not have access to interventional expertise. This reflects the skewed distribution of the provision of medical services throughout South Africa, in turn a reflection of this country's developing status.

Despite a previous lack of formal training programs, the quality of IR practice in South Africa, where available, is very high. The IR fraternity remains active, with ongoing annual conferences and training sessions, papers presented at overseas meetings, and numerous recent publications in the peer-reviewed literature.

There is an Interventional Radiological Society of South Africa (IRSSA), itself a subgroup of the Radiological Society of S.A (RSSA). The current president of IRSSA is Pieter A. Fourie. Three years ago, IRSSA created its own Web site, which can be viewed at

The interventional theater at the Unitas Interventional Unit near Pretoria.