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14 Specialist Interventional Radiology and
15 Interventional Neuroradiology Range of Practice
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18 Clinical Radiology
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20 Position Paper
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32 Name of document and version:
33 Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice, Version 1.0
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35 Approved by:
36 Click and type: approval body, e.g. Council CONSULTATION VERSION
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38 Date of approval:
39 Click and type: day month and year, e.g. 12 February 2010
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41 ABN 37 000 029 863
42 Copyright for this publication rests with The Royal Australian and New Zealand College of
43 Radiologists ®
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45 The Royal Australian and New Zealand College of Radiologists
46 Level 9, 51 Druitt Street
47 Sydney NSW 2000 Australia
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49 New Zealand Office: Floor 6, 142 Lambton Quay, Wellington 6011, New Zealand
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51 Email: ranzcr@ranzcr.com
52 Website: www.ranzcr.com
53 Telephone: +61 2 9268 9777
54
55 Disclaimer: The information provided in this document is of a general nature only and is not intended as a
56 substitute for medical or legal advice. It is designed to support, not replace, the relationship that exists between a
57 patient and his/her doctor.
58 TABLE OF CONTENTS
59

60 1. Introduction 4
61 2. Interventional Radiology Practice 5
62 3. Interventional Neuroradiology Practice 6
63 4. Changes to the Specialist Interventional Radiology and Interventional Neuroradiology Range of
64 Practice document 8
65 5. Related documents 8
66 6. Acknowledgements 8
67 7. References 9
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Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice

© The Royal Australian and New Zealand College of Radiologists®
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83 About RANZCR
84 The Royal Australian and New Zealand College of Radiologists (RANZCR) is committed to improving
85 health outcomes for all, by educating and supporting clinical radiologists and radiation oncologists.
86 RANZCR is dedicated to setting standards, professional training, assessment and accreditation, and
87 advocating access to quality care in both professions to create healthier communities.

88 RANZCR creates a positive impact by driving change, focusing on the professional development of its
89 members and advancing best practice health policy and advocacy, to enable better patient outcomes.
90 RANZCR members are critical to health services: radiation oncology is a vital component in the
91 treatment of cancer; clinical radiology is central to the diagnosis and treatment of disease and injury.

92 RANZCR is led by clinicians who are democratically elected by the membership. The ultimate
93 oversight and responsibility for RANZCR is vested in the Board of Directors. The work of the RANZCR
94 is scrutinised and externally accredited against industry standard by the Australian Medical Council
95 and the Medical Council of New Zealand.

96 Our Vision

97 RANZCR as the peak group driving best practice in clinical radiology and radiation oncology for the
98 benefit of our patients.

99 Our Mission

100 To drive the appropriate, proper and safe use of radiological and radiation oncological medical
101 services for optimum health outcomes by leading, training and sustaining our professionals.

102 Our Values

103 Commitment to Best Practice

104 Exemplified through an evidence-based culture, a focus on patient outcomes and equity of access to
105 high quality care; an attitude of compassion and empathy.

106 Acting with Integrity

107 Exemplified through an ethical approach: doing what is right, not what is expedient; a forward thinking
108 and collaborative attitude and patient-centric focus.

109 Accountability

110 Exemplified through strong leadership that is accountable to members; patient engagement at
111 professional and organisational levels.

112 Code of Ethics

113 The Code defines the values and principles that underpin the best practice of clinical radiology and
114 radiation oncology and makes explicit the standards of ethical conduct the College expects of its
115 members.

116

Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice

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117 1. INTRODUCTION

118 1.1 Purpose and scope

119 (a) This RANZCR Specialist Interventional Radiology and Interventional Neuroradiology
120 Range of Practice document is intended to assist The Royal Australian and New Zealand
121 College of Radiologists® (ABN 37 000 029 863) (the College), its staff, Fellows,
122 Members and other individuals to identify the range of practice of a specialist
123 Interventional Radiologist and Interventional Neuroradiologist in Australia and New
124 Zealand. It is important to note that the term ‘range of practice’ in this document refers to
125 the full range of clinical interventional radiology or interventional neuroradiology practice
126 rather than an individual specialist's scope of practice as determined by a local hospital
127 or health care facility. The latter will vary from site to site and is dependent upon factors
128 such as local staffing and expertise, available equipment and other facilities required to
129 support a given clinical practice.

130 (b) The RANZCR Specialist Interventional Radiology and Interventional Neuroradiology
131 Range of Practice document is not designed to be a measure to:

132 (i) Restrict a suitably qualified and experienced individual’s practice

133 (ii) Inappropriately seek to restrict another practitioner’s practice
134 (iii) Assert a right to practice
135 (iv) Unfairly demand resources
136 (v) Engender an expectation that every interventional radiologist or interventional
137 neuroradiologist be able to do everything within it.

138 1.2 Definitions

139 In this Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice
140 document:

141 Range of practice is the full range of interventional radiology or interventional neuroradiology
142 that an interventional radiologist or interventional neuroradiologist may practice based on their
143 training, qualifications, competency, performance, and professional experience. This differs
144 from an individual’s scope of practice as defined below.

145 Scope of practice refers to the extent of an individual specialists’ practice based on their
146 training, qualifications, competence, currency of practice, performance and professional
147 experience, and importantly, the needs and the capability of the environment (e.g. local staffing
148 and expertise, available equipment and other facilities) to support that clinical practice.

149 College means The Royal Australian and New Zealand College of Radiologists.

150 Member means a member of the College.

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151 2. INTERVENTIONAL RADIOLOGY PRACTICE

152 2.1 What is Interventional Radiology?

153 Interventional Radiology is a clinical specialty that integrates core principles of image-guided
154 diagnosis, treatment, and clinical management across a wide range of medical conditions and
155 procedures that span the peripheral and central vasculature, hollow viscera and solid organs,
156 the musculoskeletal system including vertebral column and the peripheral nervous system, in
157 adults and children.

158 Specialist Interventional Radiology practice requires advanced clinical knowledge, behaviours
159 and skills with image interpretation and technical competencies across all imaging modalities to
160 manage a wide range of conditions and to perform complex image-guided diagnostic and
161 therapeutic procedures beyond those acquired during core clinical radiology training (link to CR
162 curriculum once published).

163 Interventional Radiology encompasses elective and emergency inpatient and outpatient
164 services. Specialist Interventional Radiology practice provides high quality patient-centred care
165 that can benefit patients, the health system and the broader society, usually with lower
166 treatment costs. Minimally-invasive, image-guided procedures and treatments are associated
167 with improved treatment outcomes, shorter recovery times, earlier return to daily activities and
168 reduced morbidity and mortality compared to more invasive surgical and other active medical
169 treatments. Interventional Radiology also provides diagnosis and treatment options for disease
170 that is surgically inaccessible, or where no other alternative treatment options are viable.

171 2.2 Who is a Specialist Interventional Radiologist?

172 A Specialist Interventional Radiologist is a Clinical Radiologist i who has completed additional
173 specialty training to diagnose, manage diseases of the peripheral and central vasculature, the
174 hollow viscera and solid organs, the musculoskeletal system including vertebral column and the
175 peripheral nervous system, both in adults and children. They perform more advanced
176 diagnostic and therapeutic minimally invasive image-guided procedures beyond the core
177 training provided in the RANZCR clinical radiology training program (link to core procedural
178 skills once published).

179 2.2.1 Attributes of a Specialist Interventional Radiologist

180 A Specialist Interventional Radiologist is a RANZCR Fellow, or equivalent, who has completed
181 training in an advanced interventional radiology program. They have a professional and ethical
182 multidisciplinary approach to patient care; demonstrate good communication with patients,
183 referrers and other clinical colleagues. As a Specialist Interventional Radiologist, they
184 participate in wholistic clinical care, in pre-procedural assessment, clinical management and
185 follow-up of their patients, including appropriate complication avoidance, assessment and
186 management.
187
188 Specialist Interventional Radiologists apply advanced knowledge in anatomy, pathology,
189 pharmacology and physiology. Advanced training and understanding of applied physics and
190 imaging technology, including radiation and magnetic resonance safety, advanced
191 radiodiagnosis incorporating angiography, ultrasound, radiography, computed tomography,
192 magnetic resonance imaging and nuclear medicine enhances the overall accuracy and safety of
193 the treatments delivered. Their expertise includes clinical assessment of patients, ward-based
194 care, minimally-invasive image-guided techniques, peri-procedural care and outpatient
195 management of conditions and pathologies included in a clinical range of Interventional
196 Radiology practice.
197

Specialist Interventional Radiology and Interventional Neuroradiology Range of Practice

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198 Specialist Interventional Radiology practice involves lifelong continuing medical education and
199 professional development, ongoing competency of practice, and quality control including audit,
200 follow-up and attendance at multidisciplinary meetings. Specialist Interventional Radiologists
201 engage in advancing academia, interventional radiology teaching, training, and research, and
202 continual invention and innovation of new techniques, devices, and procedures.
203

204 2.3 Specialist Interventional Radiology Range of Practice

205 Specialist Interventional Radiology range of practice includes diagnosis, image-guided

206 treatments and non-interventional management of congenital and acquired diseases in adults
207 and children affecting the peripheral and central vasculature, the hollow viscera and solid
208 organs, and the musculoskeletal system including vertebral column and the peripheral nervous
209 system.
210
211 Advanced peripheral and central vascular diagnostics includes, but is not limited to diagnostic
212 angiography including arteriography, venography and lymphangiography, endovascular vessel
213 wall imaging including IVUS and OCT and non-invasive imaging including US, Doppler US,
214 CTA, MRA and Nuclear Medicine.
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216 Image-guided endovascular, endoluminal, percutaneous, hollow viscus, visceral and solid
217 organ interventions include, but are not limited to:
218
219 • central and peripheral arterial, venous and lymphatic interventions
220 • thoracic interventions
221 • abdominal interventions
222 • gastrointestinal interventions
223 • hepatobiliary interventions
224 • genitourinary interventions
225 • gynaecological interventions
226 • musculoskeletal interventions
227 • orthopaedic interventions
228 • pain interventions
229 • Interventional Oncology.

230

231 3. INTERVENTIONAL NEURORADIOLOGY PRACTICE

232 3.1 What is Interventional Neuroradiology?

233 Interventional Neuroradiology is a clinical specialty that integrates core principles of diagnosis,
234 management and image-guided endovascular, endoluminal and percutaneous treatment of
235 patients with diseases of the neurovasculature, brain, sensory organs, meninges, cerebrospinal
236 fluid (CSF), head and neck, spinal cord, vertebral column and the peripheral nervous system, in
237 adults and children.

238 Specialist Interventional Neuroradiology practice requires advanced clinical knowledge,

239 behaviours and skills with image interpretation and technical competencies across all imaging
240 modalities to manage a wide range of conditions and to perform complex image-guided
241 diagnostic and therapeutic procedures beyond those acquired during core clinical radiology
242 training (link to curriculum once published).

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243 Interventional Neuroradiology encompasses elective and emergency inpatient and outpatient
244 services. Specialist Interventional Neuroradiology practice provides high quality patient-centred
245 care that can benefit patients, the health system and the broader society, usually with lower
246 treatment costs. Minimally-invasive, image-guided procedures and treatments are associated
247 with improved treatment outcomes, shorter recovery times, earlier return to daily activities and
248 reduced morbidity and mortality compared to more invasive surgical and other active medical
249 treatments. Interventional Neuroradiology also provides diagnosis and treatment options for
250 disease that is surgically inaccessible, or where no other alternative treatment options are
251 viable.

252 3.2 Who is a Specialist Interventional Neuroradiologist?

253 A Specialist Interventional Neuroradiologist is a Clinical Radiologisti who has completed

254 additional specialty training to diagnose, manage and treat conditions of the neurovasculature,
255 brain, sensory organs, meninges, CSF, head and neck, spinal cord, vertebral column and
256 adjacent structures and the peripheral nervous system. They perform a range of advanced
257 diagnostic and therapeutic, minimally-invasive, image-guided procedures beyond the core
258 radiology training program (link to CR training program once published).

259 3.2.1 Attributes of a Specialist Interventional Neuroradiologist

260 A Specialist Interventional Neuroradiologist is a RANZCR Fellow, or equivalent, who has

261 completed training in advanced interventional neuroradiology program. They have a
262 professional and ethical multidisciplinary approach to patient care; demonstrate good
263 communication with patients, referrers and other clinical colleagues. As a Specialist
264 Interventional Neuroradiologist, they participate in wholistic clinical care, in pre-procedural
265 assessment, clinical management and follow-up of their patients, including appropriate
266 complication avoidance, assessment and management.
267
268 Specialist Interventional Neuroradiologists apply advanced knowledge of the anatomy and
269 physiology of the neurological system, pathology, pharmacology including coagulation
270 pathophysiology and use of anticoagulant, antiplatelet and procoagulant medications and
271 clinical management of common neuroradiological diagnoses. Advanced training and
272 understanding of applied physics and imaging technology, including radiation and magnetic
273 resonance safety, advanced radiodiagnosis incorporating angiography, ultrasound,
274 radiography, computed tomography, magnetic resonance imaging and nuclear medicine
275 enhances the overall accuracy and safety of the treatments delivered. Their expertise includes
276 clinical assessment of patients, ward-based care, minimally-invasive image-guided techniques,
277 peri-procedural care and outpatient management of conditions and pathologies included in a
278 clinical range of Interventional Neuroradiology practice.
279
280 Specialist Interventional Neuroradiology practice involves lifelong continuing medical education
281 and professional development, ongoing competency of practice and quality control including
282 audit, follow-up and attendance at multidisciplinary meetings. Specialist Interventional
283 Neuroradiologists engage in advancing academia, interventional neuroradiology teaching,
284 training, and research, and continual invention and innovation of new techniques, devices, and
285 procedures.
286

287 3.3 Specialist Interventional Neuroradiology Range of Practice

288 Specialist Interventional Neuroradiology range of practice includes diagnosis, image-guided

289 treatments and non-interventional management of congenital and acquired diseases in adults
290 and children affecting the neurological system, principally the neurovasculature, brain, sensory
291 organs, meninges, CSF, head and neck, spinal cord, vertebral column and adjacent structures,
292 as well as the peripheral nervous system.
293

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294 Advanced neurodiagnostics include, but is not limited to cranial, head and neck, and spinal
295 diagnostic angiography, endovascular vessel wall imaging including IVUS and OCT and non-
296 invasive imaging and functional imaging with CT, MRI, Doppler US, US and TCD, and Nuclear
297 Medicine.
298
299 Image-guided endovascular, endoluminal, percutaneous interventions of the neurological
300 system and supporting structures include, but are not limited to:
301
302 • neurovascular interventions, including but not limited to intracranial aneurysms, ischaemic
303 stroke, vascular malformations and steno-occlusive lesions
304 • CSF intervention, including sampling, therapeutic infusion, diversion, drain insertion,
305 treatment of leakage and fistula
306 • cranial, head and neck, and spinal oncology interventions
307 • neurophysiological testing, mapping and device implantation
308 • spinal orthopaedic interventions including axial skeleton and pelvis
309 • pain interventions.

310

311 4. CHANGES TO THE SPECIALIST INTERVENTIONAL RADIOLOGY AND

312 INTERVENTIONAL NEURORADIOLOGY RANGE OF PRACTICE
313 DOCUMENT

314 The College may amend the RANZCR Specialist Interventional Radiology and Interventional
315 Neuroradiology Range of Practice document at any time and will ensure that future
316 amendments comply with applicable law.

317

318 5. RELATED DOCUMENTS

319 • RANZCR Clinical Radiology Range of Practice document
320 • RANZCR Clinical Radiology Trainee Curriculum
321

322 6. ACKNOWLEDGEMENTS
323 The Faculty of Clinical Radiology Council gratefully acknowledges the extensive work undertaken by
324 the Interventional Radiology and Interventional Neuroradiology Training Pathway Working Group for
325 the development of version 1 of the RANZCR Specialist Interventional Radiology and Interventional
326 Neuroradiology Range of Practice document.

327 Members include:

328 A/Prof Dinesh Varma (Chief of Professional Practice)

329 A/Prof Andrew Holden (co-Chair)
330 Dr Andrew Cheung (co-Chair)
331 Dr Nicholas Brown (Chair, Interventional Radiology Committee)
332 A/Prof Gerard Goh (Representative, Interventional Radiology Society of Australasia)
333 A/Prof William McAuliffe (Representative, The Australian and New Zealand Society of
334 Neuroradiology)
335 A/Prof Laetitia de Villiers
336 Dr Hamed Asadi
337 Dr Nicholas Cheung

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338 7. REFERENCE
iThe Royal Australian and New Zealand College of Radiologists. Clinical Radiology Range of
Practice, Version 1.0. 6 May 2021. Accessed 10 June 2021 https://www.ranzcr.com/documents/5306-
clinical-radiology-range-of-practice/file

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