by Erica Alexander, Brown University Class of 2015 & Andrew Marsala, Baylor College of Medicine – Dept of Radiology, Class of 2016

The American Board of Medical Specialties’ approval of the American Board of Radiology’s Dual Primary Certificate in Interventional Radiology (IR) and Diagnostic Radiology (DR) signifies the recognition of IR as a unique field of medicine. As such, it will require a distinct approach to training. The traditional pathway, consisting of a 1-year internship, 4-year DR residency and 1-year IR fellowship, will be phased out. It will be replaced by a combined 6-year residency consisting of training in both DR and IR, with increased emphasis placed on clinical medicine, as compared to the traditional pathway. The 6-year residency in interventional radiology will allow future interventional radiologists to acquire the necessary clinical acumen to manage patients throughout their treatment course.

As IR training evolves and we usher in a new era, it is crucial that trainees appreciate the importance of DR and the critical role our DR colleagues will play. We know that minimally invasive, image-based techniques are the future of procedural medicine. Accordingly, we see a variety of image-based therapies offered by practitioners not trained in imaging. Our knowledge of imaging, however, is what sets IR apart, and the importance of imaging should not be underestimated. A good IR must be able to interpret the images and determine the best course of action. As trainees, we are acutely aware of the nuanced nature of diagnostic radiology and the incredible volume of knowledge we must master to earn our DR certificates. We’ll need to master this information in just 3 years, and so will our DR colleagues. They will pursue specialized training, as will we, during our final years of residency, to become experts in our respective fields. We will rely on their expertise, as they will often be the first physicians to visualize the pathology we will treat. Similarly, they will rely on us to intervene in the course of disease. In this way, IR and DR are very complimentary fields.

As residencies in interventional radiology roll out over the next decade, we sincerely hope DR and IR continue their close collaboration. DR and IR are kin, for we share a core knowledge base in imaging, which is just as critical to an interventional radiologist performing a TIPS as it is to a neuroradiologist interpreting an MRI of the brain. Young trainees, particularly medical students, must appreciate this fact. And, even though we go into IR for the clinical care and cutting-edge procedures, IR trainees must embrace image interpretation skills as the foundation of their technical abilities if they are to successfully practice image-based, minimally invasive medicine.