European Journal of Cardiovascular Medicine

The origin of radiology in 1895 is marked by discovery of the X-ray by Physicist Wilhelm Conrad Röntgen (Roentgen) on November 8^th  is highlighted in the history of radiology timeline (^1,2). On 8 November 1895 professor Rontgen discovered the X-ray and referred to them as “X” on not knowing the origin of these radiations. This day each year is celebrated as the International day of radiology (IDOR) marking the anniversary of discovery of X-rays with the motive of spreading awareness and value of radiology in safe patient care.

The year 1953 marked by innovation of Seldinger technique by Sven Ivar Seldinger, a Swedish radiologist (²). The Seldinger technique represents safe, less invasive ways to obtain vascular and non-vascular/luminal access for both diagnostic and therapeutic IR procedures.

Interventional radiology (IR), pioneered by Charles Theodore Dotter in 1964 (³) who is regarded as the 'Father of Interventional Radiology,'  by performing first femoral angioplasty has become an integral part of patient care; long before coronary angioplasty PTCA off-shooted as interventional cardiology. (^4,5,6)

Interventional radiology (IR) is recognized as an advanced specialty within radiology, having various clinical applications utilizing different imaging modalities such as fluoroscopy, Digital subtraction angiography (DSA) and its applications, computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI) are utilized to diagnose as well as treat a wide range of medical conditions in complex clinical scenarios (^7,8). Small skin punctures, rather than larger surgical incisions, are used for the majority of IR treatments, emphasizing their minimally invasive nature. With recent jump leap in  advancements  in technology of both hardware and  modern Cath Lab  with AI technology as well as  imaging technology,  IR treatments aids to offer umbrella care  encompassing critical and complex intervention feasibility and in few situations  facilitating quicker recovery, earlier mobilization, and the possibility of day-care treatments in  Interventional Radiology Clinic (IRC) for  simple procedures ; there is huge potential of growth for  the specialty currently and evolving future in best of patient care. (^9,10)

Our research study was aimed to assess the awareness, perception and knowledge of interventional radiology (IR) among medical students & evaluate their understanding of its applications and scope via survey questionnaire which was conducted among 50 medical students in Bharati Vidyapeeth (Deemed to be university) medical college and hospital Sangli, Maharashtra, India. The participants were assigned a questionnaire for evaluation with ethical consideration. Each participant received the questionnaire directly from the researcher team, who stayed present during the entire session & to clarify any doubts. The questionnaire was filled by participants based on their current knowledge. Once it was complete, responses recorded were evaluated and appropriate statistics methods were applied and results derived by research team, and charts prepared with help of statistician

• Score obtained by various students regarding general awareness about branch of Radiology in the questionnaire (minimum - 3/10, maximum -10/10)

Group A (less than 5)      20%

Group B (intermediate)   32%

Group C (more than 7)    48%

• Students who were aware about specialty of Interventional Radiology

• Preference for IR and Non-IR specialty (Subspeciality)

• Awareness about pathways for Interventional radiology – Fellowships and DM Interventional Radiology / DrNB Endovascular radiology

• Students who were aware regarding feeder qualification to pursue Interventional radiology

• Students who were aware regarding management of various clinical conditions by Interventional Radiologist / Endovascular specialist

Awareness about Interventional radiology (IR) and its clinical applications is highly  unrecognised amongst not only  the undergraduate medical students but also post graduate medicos and broad specialty consultants owing to lack of exposure during their training and general  awareness about specialty and limited centres in academic institutions with specialty.

 This survey was conducted among various undergraduate batches (MBBS batch 2010 to batch 2024) with the higher frequency of participants being from the 2019- 2020 batch. Our study found that 52 % of students were aware about the specialty of Interventional Radiology.

On Assessing awareness regarding the pathways to pursue (feeder qualifications) specialty of Interventional Radiology (SIR); 68% were aware that SIR is chosen post MD/DNB Radiology. One can choose pathway of Interventional radiology (IR) after completing post-graduation 3-year MD / DNB course in diagnostic radiology & basic foundational MBBS medical degree graduation. Dedicated fellowships and Doctorate of medicine (DM) are advanced training programs available across the world to pursue the same. Only 42% were aware about different pathways – fellowships and DM Interventional Radiology/ DrNB Endovascular Radiology. The duration of the fellowship course is 1-2 years (varies depending on the institution and scope of fellowship) while DM/DrNB is a super specialty program offering a 3 year course in India. Other exclusive pathways, Interventional Radiology Integrated Residency Program (IR-I residency) spans for 5 years (training of Diagnostic radiology for the first 3 years and IR for next 2 Years) in United States of America (USA) DR-IR programme. (^11-16)

Some of the Common Interventional Radiology procedures and treatments are Image guided drainage procedures & biopsies, Angio plasty and stenting ,angio-embolisation, catheter directed thrombolysis and thrombectomy for arterial and venous thrombosis , IVC filter placement and its retrieval at follow-up, Onco-interventions, neuro interventions ,  varicose vein ablations , bronchial artery embolisation for haemoptysis, uterine artery embolization, hepatobiliary interventions etc. to mention a few.

Interestingly 66% students were fully aware about applications of Interventional Radiology and its role in management of clinical conditions. (¹⁷)

Diagram Depicting Wide role of IR in management of various clinical conditions.

Medical schools play a vital role in ensuring that medical students acquire sufficient knowledge about interventional radiology (IR) before completing their final licensing. IR-related clinical activities, both as part of undergraduate education and through extracurricular opportunities are that which can have impact /influence on undergraduates or Post graduates MD / DrNB radiology students to consider IR as a career. Surprisingly 16% of students were interested to pursue IR as their career. On the contrary an early interest in IR during medical school is not a prerequisite for pursuing the specialty later, 26 % of the students among 2019 and 2020 batch were aware about the feeder qualification but were unaware regarding different pathways for Interventional Radiology. These groups of students were in need of sensitization; also, there remains an urgent need to improve the representation of IR in undergraduate medical curriculum. Incorporating interventional radiology (IR) education into the undergraduate curriculum and increasing early exposure for students can significantly promote interest and support the expansion of the specialty. Recently NMC (National Medical Commission) has introduced for both UG (under graduate)/ PG (post graduate) CBME modules (competency based medical education) and IR electives/ rotations respectively, as well as DM/DrNB courses IR super-specialty courses. Inclusion of research related to IR through intramural projects during UG, participation during internship postings, along with PG related IR postings can help in further awareness along with hospital management and panel consultants priming and sensitization and teamwork approach and thus aid in 360 degree (overall) patient care via IR clinical applications which can benefit the critical patients in long-term. (¹⁸)

Addendum: author’s perspective –

Reflecting back on my childhood memories, I vividly recall the fascinating angiographic images of the brain and lower limbs that I would observe in the late 1980s. This captivated me with the intricate art hidden within the unseen, internal structures, despite the varying external appearances of individuals. These images were produced by my grandfather, Dr. Ramprakash Santram Mohan, who was the pioneering radiologist in our town and also worked as a radiation therapist. In addition to performing diagnostic interventional angiograms using rapid angiography cassette changers, he also provided therapeutic brachytherapy and interstitial radioactive cobalt needle placements. My keen interest extended to the Geiger-Müller counter dosimeter, which was part of his regular work.

As I grew up, I witnessed the progression from the era of black-and-white sonography to the advent of color Doppler and invasive myelography, which all performed by my radiologist father, Dr. Amarnath Ramprakash Mohan, in the late 1990s and latter on his professional timeline he continued his practice with current era more advanced imaging technologies, including 3D and 4D anomaly scans with sophisticated ultrasound machines.

 I consider myself and my sister, Dr. Amarja Mohan-Lavekar, fortunate to have been trained in radiology in recent years at Centre’s of repute with high end tech, benefiting from the remarkable advancements in imaging technology, such as multislice 64-slice CT and 1.5T MRI with readily available 3D cross-sectional imaging during our training.

As a third-generation radiologist, I have been blessed with the opportunity to practice the art of interventional radiology. My 3.5 years of experience at my alma mater, DMIMS, where I served as an assistant professor in interventional radiology as well as training new gen fellows in craft of IR, which also allowed me opportunity to be part-of along with Lion’s share of my mentor & esteemed guide, Dr. Pankaj Banode in establishment of two DM IR seats at our institution with our teammates.

 Since I have returned back to my hometown and established a specialty in interventional radiology, opening the first exclusive stand-alone IR clinic in the modern era. In my current role as the in-charge of the interventional radiology specialty at our current institute, I have the privilege of working with two state-of-the-art catheterization laboratories, including a modern Cath lab with AI capabilities and zero-dose fluoroscopy, enabling complex interventions and exceptional patient care in critical clinical scenarios.

As I witness and envision the technological leaps not only in imaging technology and hardware but also in patient care and management, I am truly humbled by the remarkable progress from my grandfather's era, where limited technology and hardware were compensated by skilled precision, to the seamless delivery of our skills in the present-day 2025 era.                           

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