Dr. Ravi Jhaveri: Raising the Bar of Interventional Radiology

Dr. Jhaveri: I enjoyed the basic sciences in high school and majored in genetics during college at Texas A&M University. It was a natural progression to enter medical school. Medicine is an incredible field with something in it for almost every type of person. I chose to specialize in interventional radiology because it is very technical and full of innovation.

Fibroids1: What was the basic trajectory of your career?

Dr. Jhaveri: I went to Baylor College of Medicine in Houston for medical school and continued my residency at Baylor in diagnostic radiology. At Baylor, I had some particularly good mentors; specifically, Dr. Cliff Whigham had the largest influence on me to go into IR and to pursue my fellowhip training. I did my vascular interventional radiology fellowship at the University of California in San Francisco. All of my attendings there were incredible both as academicians and as role models. I think Drs. Gordon and Kerlan had the greatest influence on me while I was there. I’ve been working in Austin, Texas ever since. The IR section at Austin Radiological Association is very diverse. We have some elder statesmen that never did fellowships to the younger generation like myself, who are all fellowship trained. I am lucky to be in such a good group with guys who are both excellent technically and a lot of fun to work with.

Fibroids1: Can you describe your current focus in patient care? What are some procedures that an interventional radiologist would normally perform?

Dr. Jhaveri: Interventional radiologists specialize in minimally invasive treatment procedures as opposed to open surgeries, relying on imaging tools for guidance. We normally perform outpatient interventional angioplasty/stents, uterine fibroid embolizations, biliary/urologic interventions as well as radiofrequency ablation and needle biopsies. Throughout the day, we use different imaging tools like MRIs, CT and ultrasound to treat an assortment of medical conditions, ranging from uterine fibroids to cancer to peripheral vascular disease.

Interventional radiology is a major advance in the delivery of medical care, because it allows radiologists to better see inside the body without the high risk of open surgeries by using advanced imaging technology. The field of Interventional Radiology has been around for greater than thirty years, but the last 15 years has seen an outpouring of fellowship-trained Interventionalists. This has dramatically increased our practice and visibility.

Fibroids1: How is diagnostic radiology different from interventional radiology?

Dr. Jhaveri: The two are separate but codependent fields. Diagnostic Radiology is the use of imaging for the diagnosis of disease. MRI, CT, ultrasound, nuclear medicine and plain film are all tools Radiologists use for diagnosis. Though many Interventionalists have considered splitting from their Diagnostic counterparts, I believe this is not in our best interest. Diagnostic Radiology is our core training and the further advancement of Interventional Radiology largely depends on our basic Diagnostic Radiology abilities. Our practice sees a lot of growth from our diagnostic side. All of the Interventionalists in my practice do heavy loads of both diagnostic and interventional radiology. Interventional radiologists are experienced in using fluoroscopy, ultrasound and other imaging to guide small tools like catheters or stents through blood vessels to treat disease. These procedures have low invasion of the body and are often much less costly and have a shorter recovery time than the traditional surgery. The one thing that stands out about Interventional radiology is the ability to have direct patient contact and the ability to give therapeutic options. I really believe that it is one of the best fields in medicine from an intellectual standpoint and from patient therapy.

Fibroids1: What do you find particularly rewarding about interventional or diagnostic radiology?

Dr. Jhaveri: It’s very satisfying to be able to use the new technology that’s involved in interventional radiology to treat patients who, thirty years ago, would not be able to be treated without undergoing a much more invasive procedure. Also, we have created new treatments for previously untreated disease processes.

We have a very good working relationship with various subspecialties in medicine and it is these subspecialties that drive our practice.

Fibroids1: Are there any specific technologies that are particularly interesting to you?

Dr. Jhaveri: Magnetic resonance imaging (MRI) is a real advance in diagnostic angiography. Most of our angiographic interventions come to us because of our large role in diagnostic Magnetic Resonance Angiography (MRA). The idea that a patient can be screened with a small IV contrast enhanced MRI has changed the game. We have a large outpatient MRA program that directly feeds our interventions. The days of screening catheter angiography are over. With both MRI and CT, most vascular problems can be diagnosed. For a woman with fibroids, an MRI allows us to identify the number, size, location, and type of fibroid with higher accuracy than a pelvic ultrasound. With this information, we can determine what treatment methods should be used and how to plan our embolizations.

Fibroids1: What about uterine fibroid embolization? Does the procedure have a lot of potential as an innovating treatment for fibroids?

Dr. Jhaveri: UFE is a great option for most women with symptomatic fibroids. The procedure has a very high success rate and is effective for women with single or multiple fibroids. In Austin, we have had a very good response from our OB/GYN colleagues. After much education and work, we have created a fairly broad network of OB/GYNs who directly refer to us. But by no means are we done. There is still a significant population of OB/GYNs who still do not inform their patients about the procedure. This is, in a nutshell, the real issue with women. Once they find out about the procedure, either through word of mouth or via the web, they lose a lot of respect and trust in their OB/GYN. It is unfortunate but very real.

As far as potential, I believe that UFE would rise even more in popularity if more data was published proving its efficacy in treating fibroids for women who are of childbearing age. This population would greatly benefit.

Fibroids1: Can you speak more about fibroid treatments and fertility?

Dr. Jhaveri: Our current recommendation for patients is that they seek all the options that are available to them in terms of treatment for fibroids. We currently do not perform UFE as a first line treatment in women of child-bearing age. Until more data comes out, we still refer these patients out of our care. UFE does look promising for women who wish to retain their fertility, but the hard science is not there to proceed forward just yet.

Fibroids1: In your opinion, what is your greatest contribution to interventional radiology—is it the day-to-day work? What’s the big picture for your practice, the long-term goals?

Dr. Jhaveri: I would like to see our practice become more self-sufficient and less reliant on OB/GYNs to refer patients to us. Interventional radiology is a cutting-edge field, and I feel that our field could raise its visibility to patients. We’d like to see women with fibroids come to an interventional radiologist that her gynecologist trusts and benefit from the minimally invasive procedures that we have to offer, both diagnostic and for treatment of her fibroids symptoms. I hope this interview would be able to move us toward that goal.

My greatest contribution is in my day-to–day work. Our goal is a free-standing interventional practice. We already have a clinic for our patients, but the next step is to actually move towards an independent outpatient practice, which we are in the process of doing.

Fibroids1: How do you think interventional radiology will change as a field in the next five years?

Dr. Jhaveri: The basis of the field is innovation. In the span of five years, our procedures and imaging tools can be even more fine-tuned and we can offer a whole range of minimally invasive procedures for patients with fibroids, vascular diseases, etc. We, as private practice Interventionalists, owe much to our academic counterparts. They drive the field with research and innovation. We push it further into the mainstream of medicine because we are very visible— but without the academic interventionalists, we would wither away.

What we did five years ago is not what we do today; in five years from now we will be doing many very different procedures. The creative process is what pushes us further.

Fibroids1: Do you have any final thoughts that Fibroids1 users could benefit from?

Dr. Jhaveri: Interventional radiology is a very rewarding field, and I have a lot of fun. My patients benefit from my group’s expertise and mine, and we enjoy providing a high level of care. Most Interventionalists can be found in the hospital setting or via the web. I want to encourage Fibroids1 users to consider an interventional radiologist for opening up treatment options that would improve their quality of life.