AIMS:There is no comprehensive data collection outlining the numbers and types of interventional radiology (IR) procedures in the United Kingdom. Similarly, limited data are available on the IR facilities and workforce within the National Health Services (NHS) trusts. The purpose of this study is to evaluate the number/type of IR procedures, facilities, and workforces across England and Wales. MATERIALS AND METHODS:This retrospective study used the 2000 Freedom of Information Act to obtain information regarding the IR procedures performed in NHS trusts in England and Wales from 2017 to 2021. We collected additional information on IR workforce and facilities, including the number of IR consultants, nurses, trainees, and angiographic suites and day case units; analysed procedures by complexity; and performed data analysis by region. RESULTS:A total of 1,340,352 IR procedures were analysed. An increasing trend was observed in the number of IR procedures from 2017 to 2021 (p=0.07, R=0.93). There were more intermediate and complex procedures than simple ones (p=0.0001). Notable geographical variation was observed in terms of IR facilities including angiographic suites and day case units, and the number of IR consultants, nurses, and trainees. CONCLUSIONS:The IR field continues to grow as evidenced by increasing trends in the number and complexity of the procedures over the years. There is an uneven IR workforce, services, and facilities distribution across England and Wales. Therefore, there is a crucial need for centralised data collection to evaluate and monitor interventions besides comprehensive revision of UK IR service provision.

We read with interest the commentary 'Physician associates in interventional radiology: a new paradigm' by Lewis et al.1 The paper relates to the experience of employing a physician associate (PA) within a busy interventional radiology (IR) department in London. This seems to have been a positive experience for the department and for those who work within it. We feel that this anecdotal experience should be taken with caution.

Acute ischaemic stroke due to occlusion of a large cerebral artery (LVO) is a major cause of disability and death in developed economies. Traditional care for the majority of patients has focused on prevention of secondary factors that may cause progression of a brain infarct and on rehabilitation following brain injury. Since 1995 patients that are eligible for treatment with intravenous thrombolysis (IVT), have received recombinant tissue plasminogen activator (rTPA) to break down the clot in the occluded artery and restore blood flow to the brain.

The British Society of Interventional Radiology (BSIR) defines an interventional radiologist (image-guided surgeon) as a “clinical doctor who performs image-guided procedures, fully interprets the imaging required to guide and monitor the response of those procedures, as well as providing the pre- and post-procedural care for those patients receiving imaged guided surgery procedures”.1 This definition implies that interventional radiologists are skilled not only in interventional radiology (IR) procedures, but also in diagnostic imaging and clinical practice.

The current pathway for men suspected of having prostate cancer [transrectal biopsy, followed in some cases by magnetic resonance imaging (MRI) for staging] results in over-diagnosis of insignificant tumours, and systematically misses disease in the anterior prostate. Multiparametric MRI has the potential to change this pathway, and if performed before biopsy, might enable the exclusion of significant disease in some men without biopsy, targeted biopsy in others, and improvements in the performance of active surveillance. For the potential benefits to be realized, the setting of standards is vital. This article summarizes the outcome of a meeting of UK radiologists, at which a consensus was achieved on (1) the indications for MRI, (2) the conduct of the scan, (3) a method and template for reporting, and (4) minimum standards for radiologists.

Introduction: Conventional management of high-flow vascular malformations involves embolisation of feeding vessels with occluding materials, including coils, microspheres or gelatin sponges. Frequently lesions develop a new blood supply via collaterals necessitating further treatment by surgical excision. More recently, it has been recognised that filing and obliterating the nidus of the lesion results in far lower risk of developing collaterals and, consequently a reduced requirement for surgical excision

Introduction: High flow vascular malformations (arteriovenous malformations) of the head and neck are some of the most challenging lesions to treat. Traditional management includes embolisation followed shortly afterwards by surgical excision. Incomplete excision inevitably leads to recurrence due to recruitment of collateral circulation. Surgery is often associated with massive haemorrhage; the literature has numerous reports of intraoperative deaths.

Liquid sclerotherapy, laser and surgery have been used in the treatment of head and neck vascular anomalies with variable success for many years. A multidisciplinary team consisting of plastic surgery, maxillofacial surgery and interventional radiology currently treats such lesions by converting liquid sclerosant into foam. Foam sclerotherapy is currently used successfully to treat varicosities of the lower limbs and in this study, we present four cases in which 3% sodium tetradecyl sulfate has been used to treat low-flow vascular malformations in the head and neck.

Introduction and Aims: Vascular malformations of the head and neck can have significant impact on quality of life. They can be disfiguring and cause functional problems depending on their location. Traditionally, surgical and other invasive methods have a poor outcome. A multidisciplinary team consisting of interventional radiologists, plastics and maxillofacial surgeons have been treating such lesions with a novel method of foam sclerotherapy. The aim of this study was to assess the patient's perspective of their condition and the treatment provided.

Vascular anomalies are common in all age groups from infants to adults. Not infrequently lesions present in the head and neck region. These range from simple skin discolorations to large devastating malformations. The complications that may arise are not insignificant and include haemorrhage, infection and tissue destruction, congestive heart failure all in addition to facial disfigurement.

Introduction: Conventional CT demonstrates pathology of the thoracic aorta. This study aimed to evaluate the additional contributions to surgical planning of multiplanar reformatting, maximum intensity projections and three-dimensional (3-D) reconstruction.Design: Retrospective.Subject and Methodology: Fifty-three patients with newly diagnosed pathology of the thoracic aorta were scanned over a 15-month period; 25 scans were spiral acquisitions. Scans were acquired during and following rapid injection of 100 ml of intravenous iopromide. The reconstructed data was displayed as axial images, oblique or other multiplanar reformats and shaded surface display 3-D reconstructions. Two radiologists and two surgeons reviewed the images. The axial images were assessed initially, subsequently the reformats and 3-D reconstructed views were examined looking particularly for additional information that might add to the surgical management.Results: Pathologies encountered were aortic dissection (21 patients including two with Marfan's syndrome), saccular aneurysms (eight), fusiform aneurysms (16), aortic root and ascending aortic dilatation (seven) and coarctation (one). The relationship of aneurysms and dissections to major vessels are better shown with 3-D reconstruction or oblique reformats. Morphology of saccular aneurysms, particularly the neck, is well shown with 3-D reconstruction. Coarctation was best demonstrated by oblique reformats. There was little additional information from 3-D reconstruction or reformats in assessment of type A dissection. Improved spatial orientation by visualization in varying projections was helpful for surgical planning in certain cases of type B dissection, fusiform aneurysms and aortic root and ascending aortic root dilatation. Spiral acquisitions have the advantage of speed and hence a greater anatomical coverage for a single breath-hold.Conclusion: Oblique reformats and 3-D reconstruction, although using identical data as the axial images, in specific cases were felt to aid surgical assessment of aneurysms and dissections, thus assisting pre-operative planning.