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Halt Interventional Radiology Turf Wars

Joe Cantlupe, for HealthLeaders Media, September 5, 2012

To continue overcoming turf wars, Russell says it is important that the hospital coordinate an enhanced training opportunity for both interventional radiologists and vascular surgeons. "We worked out a system where vascular surgeon trainees could come down to the interventional radiology team, and our trainees would go up to vascular surgery. Because we have radiologists and vascular surgeons who respect each other, we've been able to accomplish that," he says.

To thwart turf wars, the 570-staffed-bed Harbor-UCLA Medical Center has designated champions for specific aspects of care, either interventional radiologists or other physicians, to coordinate patient care and multidisciplinary surgical programs. "A decision is made upfront about what procedure is best for the patient, with the single person as the point person to determine what is equitable and honest," says Matthew Budoff, MD, director of Harbor UCLA BioMED CT Reading Center. Those champions could be an interventional radiologist or vascular surgeon or cardiologist, for instance, he adds. Various team champions are designated for areas of cancer or cardiac care, for instance. Patients are evaluated on a case-by-case basis, and champions determine whether interventional radiologists or other specialists should lead the procedures.

"When you have a motivated radiologist who wants to do a cardiac CT, he knows he's treading somewhere in the cardiac space, and knows he should reach out to cardiologists. And vice versa. When a cardiologist is in the interventional radiologist's space, he knows he should reach out to an interventional radiologist. I think there's motivation to work together. It's harder and harder for small radiology groups to own their own equipment. We have rotation of reading images. I think there's a motivation to work together. They can refer patients and control the patient flow. It's a win-win situation."

"I see the turf wars going away largely," he says. "I train quite a few cardiologists and radiologists for CT, and both groups are in my office working side by side."

Success key No. 2: Improved patient outcomes

Improvements in the technology used by interventional radiologists are advancing their status as well. For instance, implanting small radioactive beads that cause tumors to die are enhancing programs in the treatment of liver cancer for improved patient outcomes, says Brown of Thomas Jefferson University Hospital, which is stepping up the procedures. As patient outcomes improve, Thomas Jefferson is finding its results are drawing the attention of patients seeking interventional radiology treatment for their own cancer. Over the past four years, there has been a 35% increase in patients being treated by interventional radiology with a sizeable increase in cases for liver cancer at Thomas Jefferson University Hospital, with about 600 seen annually, Brown says. "It has grown so much. It's a huge part of our interventional radiology practice, a large chunk of what we do. It makes the hospital happy and gives us much professional satisfaction. We've had good results and the work has built itself up."

Primary liver cancer forms in the tissues of the liver, and secondary liver cancer spreads to the organ from other parts of the body. This year, an estimated 28,720 new cases are projected, along with 20,550 deaths, according to the National Cancer Institute. Brown says advances in interventional radiology for treatment of liver cancer use a technique that allows for a very high dose of radiation to be delivered without much impact to healthy tissues in the body.

In the Journal of Vascular and Interventional Radiology, the Jefferson team reported on improved results using yttrium-90 radioembolization, a treatment that consists of radioactive microspheres (tiny beads) that are injected through a catheter from the groin to an artery supplying the tumor. The beads cause tumor cells to die.

While radioembolization is not a cure for liver cancer, the treatment has fewer side effects than other cancer treatments and it extends life. Thomas Jefferson researchers found in a study of 81 patients treated for primary or metastic liver tumors that the radioembolization is not only a safe treatment, but 90% of the people in the study who received infusions showed no or few changes in liver function, according to Brown, who was the senior investigator on the study.

Northwestern Memorial Hospital also is performing the procedure, which allows for increased doses of radiation to the tumor while sparing nontargeted adjacent normal tissue. The beads, smaller in diameter than a human hair, are injected into the liver, and irradiate it for 12 days. A key element of the procedure for cancer patients is that it offers them the opportunity to be treated without facing radiation or chemotherapy side effects, such as loss of hair or nausea.

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