Dr. William Rilling is a Professor of both Interventional Radiology and Surgical Oncology at the Medical College of Wisconsin, where he also directs the fellowship program in interventional radiology. In this interview, he discusses the future of his field and the promises of minimally invasive technology.
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Fibroids1: Was there a point in your life when you knew you wanted to be an interventional radiologist?
Dr. Rilling: I did some research in radiology in my undergraduate studies, and in medical school a little bit, but then I found that I was drawn to surgery. I loved being in the operating room, taking care of patients and using my hands, so it was a natural way to combine those two interests. When most people are going through medical school, they kind of have either a medicine personality or a surgery personality. I had a surgery personality.
I think, in general, surgeons like to see problems that they can fix. They like using their hands - they like seeing patients and dealing with problems head on; whereas medicine deals with more chronic problems, different and long-term problems that don’t provide as much immediate gratification. There are differences in philosophies and in how you spend your days.
Fibroids1: Speaking of surgical procedures, can you outline the differences between interventional radiology and diagnostic radiology for our readers?
Dr. Rilling: Diagnostic radiology is often the kind of radiology that people are familiar with. It involves the interpretation of imaging studies, such as CT scanning, MRIs, ultrasound, and mammography. Interventional radiology is a subspecialty that involves the treatment of disease with minimally invasive surgical technology.
Fibroids1: What kind of developments would you predict in your own field over the next five years or so?
Dr. Rilling: We’re going to continue to become more clinically-oriented physicians that have clinical offices. Traditionally, a "radiologist" has been thought of as sitting in front of a board. We’re going to have more clinical days. I think interventional treatments for cancer are going to be where a lot of our real advances are, which are going to have the biggest impact on society.
Fibroids1: What do you feel is your greatest contribution to interventional radiology?
Dr. Rilling: At the level of our society, the Society of Interventional Radiology, I’ve worked a lot on the educational aspect of our specialty. I’m the chairman of the resident education and training committee, so I’ve worked a lot with training issues and the evolution of the training pathways. Just as the technology has to evolve, so does the training. In the future, we will start to see more clinical training time - dedicated interventional time. There’s just a year or a year and a half right now, and that short time period doesn’t cut it anymore.
From a clinical perspective, my major emphasis has been on interventional oncology, or treatment for cancer. It’s a huge area of growth for interventional radiology. With the population demographics being what they are, the number of people needing and wanting minimally invasive treatments or image-guided treatments for cancer are going to be in very high demand. We’re seeing some very exciting developments.
Fibroids1: I notice that you direct an interventional radiology fellowship program. As your field is growing, do you see the number of fellowship applicants growing as well?
Dr. Rilling: Despite the fact that interventional radiology as a field is growing both in numbers of practitioners and breadth, our fellowship numbers have not been increasing. This is primarily because there’s a shortage of specialists across medicine. Hopefully, that pendulum will swing back. Right now, medical school students don’t need to do extra training in order to get a good job, so they just jump into the workforce. In interventional radiology, there’s an internship and four years of residency and then a year of fellowship after that.
Fibroids1: In particular, you’ve been instrumental in the advancement of a new treatment for uterine fibroids, known as uterine fibroid embolization (UFE). Can you tell us a little more about this development?
Dr. Rilling: This is a non-surgical alternative for patients who have symptomatic uterine fibroids, a very common benign tumor. Up to 50% of women have fibroids. Most are not symptomatic, but there are lots of women who get symptoms: typically very heavy periods, or pain and pressure and bulk symptoms from the size of the fibroid.
The embolization procedure is very helpful in treating both groups. The procedure is all done through a single catheter method in the femoral artery. A catheter is placed; we map out the blood supply, particularly the uterine artery which supplies the fibroid; then we guide a microcatheter into each of the arteries and inject tiny little particles that go out into the small vessel feeding the fibroids and block the blood flow. The fibroids start to shrink, which takes months. One thing we emphasize, especially if the patients have bulk symptoms, is that they have to be patient and wait, but the results are fantastic. About 90% are very satisfied.
Fibroids1: Do you find that this procedure is growing in acceptance?
Dr. Rilling: Yes; in acceptance from all aspects, from insurance, from ob-gyns, from the public — it’s got a lot of momentum.
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