Current status of angiography and interventional radiology in Japan: survey results

Global and Japanese regional variations in radiologist potential workload for computed tomography and magnetic resonance imaging examinations

PURPOSE

To investigate the global variation in radiologist potential workload for CT and MRI examinations, and the regional variation in potential workload and extent of radiologists' involvement in CT and MRI examinations in Japan.

METHODS

"Radiologist potential workload" was defined as the annual number of CT plus MRI examinations divided by the total number of diagnostic radiologists. The extent of radiologists' involvement was measured as the proportion of CT and MRI examinations to which "Added-fees for Radiological Managements on Imaging-studies (ARMIs)" were applied among eligible examinations. Maximum variation was computed as the ratio of the highest-to-lowest values among the countries or Japanese prefectures.

RESULTS

The radiologist potential workload in Japan was 2.78-4.17 times higher than those in other countries. A maximum prefecture-to-prefecture variation was 3.88. The average percentage of CT plus MRI examinations with ARMI applied was 43.3%, with a maximum prefecture-to-prefecture variation of 3.97. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement.

CONCLUSIONS

Japan had a far greater radiologist potential workload compared with other countries, with a large regional variation among prefectures. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement in CT and MRI examinations.

Anesthesia Practices for Interventional Radiology in Europe

PURPOSE

The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.

METHODS

Anonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.

RESULTS

Predictable differences between countries and national regulations were confirmed, showing how significantly many "local" factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care.

CONCLUSION

Significant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

Admission privileges and clinical responsibilities for interventional radiologists

Although clinical involvement by interventional radiologists in the care of their patients was advocated at the inception of the specialty, the change into the clinical paradigm has been slow and patchy for reasons related to pattern of practice, financial remuneration or absence of training. The case for the value of clinical responsibilities has been made in a number of publications and the consequences of not doing so have been manifest in the erosion of the role of the interventional radiologists particularly in the fields of peripheral vascular and neuro intervention. With the recent recognition of interventional radiology (IR) as a primary specialty in the USA and the formation of IR division in the Union of European Medical Specialists and subsequent recognition of the subspecialty in many European countries, it is appropriate to relook at the issue and emphasize the need for measures to promote the clinical role of the interventional radiologist.