Current status and future prospects of interventional radiology in China

Abstract

The phrase “interventional radiology” (IR) was first coined by Margulis in 1967,[1] defining an emerging discipline that leverages image-guided modalities for the diagnosis and management of space-occupying lesions (such as tumors) and vascular pathologies (such as thrombosis and atherosclerosis). Since its establishment in mainland China in the late 1970s, dedicated efforts by Chinese interventionalists have established the discipline as the “third pillar” of clinical medicine, along with internal medicine and surgery.[2] Interventional therapies are indispensable in clinical practice because of their minimally invasive characteristics, high reproducibility, precise targeting, favorable safety profiles, potentiation of therapeutic efficacy when combined with other treatment strategies, societal benefits at low cost, and the rapid return of patients to the activities of daily living, including work. With advances in medical technology, novel interventional methodologies, devices, and clinical paradigms continue to emerge. IR has demonstrated significant advances in both basic scientific and clinical applications. The present article provides a systematic overview of the current status and future prospects of IR in China, focusing on innovation and translation, discipline development and transformation, and training and standardization. 1. IR innovation and translation Technological innovations have underpinned China’s global prominence in the field of IR. Several interventional therapies have been pioneered in China, including the early application of radioembolization and recent breakthroughs, such as endovascular denervation for cancer- or type 2 diabetes-related pain. Emerging cutting-edge technologies have revolutionized conventional interventional therapies. For example, histotripsy, a high-intensity, focused ultrasound modality that mechanically liquefies tissue into subcellular debris using high-amplitude, focused ultrasound pulses under real-time sonographic monitoring, has demonstrated promise in diminishing heat-sink effects, generating sharply demarcated lesions with tissue-selective preservation, and inducing immunomodulation.[3] The evolution and translation of IR products are intrinsically linked to innovations in scientific theory, biomedical engineering, and materials science. For example, the concept of thermophysical immunotherapy for metastatic solid tumors has contributed to the development of a device for multimode ablation treatment.[4] Irradiation stenting, an innovative engineering method for loading iodine-125 seeds onto self-expanding stents, has profoundly transformed the treatment landscape for malignant luminal obstruction, especially esophageal cancer, malignant biliary obstruction, and malignant airway obstruction.[5,6] Breakthroughs in materials science have resulted in novel embolic agents, including the advent of surface-functionalized Pickering emulsions, demonstrating enhanced stability and stimuli-responsive behavior for targeted drug delivery,[7,8] liquid metal microspheres,[9] and microspheres loaded with radioactive isotopes, such as yttrium-90,[10] significantly enhancing treatment efficacy. The development of molecular and functional imaging has enabled real-time image-guided interventions,[11,12] significantly improving the accuracy and efficiency of nonvascular IR procedures, such as biopsy and ablation, while reducing radiation exposure and complications.[13–16] Multimodal imaging (a combination of ultrasound, digital subtraction angiography [DSA], computed tomography, and magnetic resonance imaging for specific tasks) provides excellent visualization of the therapeutic target, feeding vasculature, and adjacent normal anatomy, thus facilitating planning, treatment delivery, and therapeutic assessment.[17,18] For example, with the combination of photon-counting computed tomography in the interventional suite, diagnostic-quality imaging, perfusion, and dual-energy imaging capabilities