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Current Status of Interventional Radiology Research: Results of a CIRREF Survey and Implications for Future Research Strategies

2003; Elsevier BV; Volume: 14; Issue: 9 Linguagem: Inglês

10.1097/01.rvi.0000088283.26875.58

1535-7732

John H. Rundback, Kenneth C. Wright, Gordon McLennan, Elvira V. Lang, Kevin L. Sullivan, Michael A. Bettmann, Swati Bansal, Wendy J. Landow, Nella Bloom,

Radiation Dose and Imaging

MEDICAL research forms the foundation for health-care advancement and the development of nascent therapies. The specialty of vascular and interventional radiology has been characterized by a rich history of new technology development, validation, and adoption of new procedures into medical practice. Despite this, the level of participation of practicing interventional radiologists in basic science and clinical research remains poorly defined and has lagged behind other subspecialties as well as diagnostic radiology (www.search.nih.gov).To better determine the demographics of interventional radiology research practices, a survey was commissioned by the Cardiovascular and Interventional Radiology Research and Education Foundation (CIRREF) and distributed to the membership of the Society of Interventional Radiology (neé SCVIR). The objectives of this project were to provide insights for the development of an intellectual foundation for the creation of a vascular and interventional radiology research infrastructure. Specifically, the survey sought to identify (i) research experience and training, (ii) current research activity, (iii) individual and institutional research support, (iv) reasons that limit interventional radiologists' participation in or development of research initiatives, and (v) vascular and interventional and radiology research priorities.SURVEY INSTRUMENTThe survey was created by the research committee cochairs and staff with input from research committee and CIRREF leadership and comprised of four main groups of questions: practice demographics, research experience, research support, and research priorities. An initial draft version of the survey was piloted in April 2001 to selected Society of Cardiovascular and Interventional Radiology committee members. This initial version contained additional questions about the survey scope and content, and feedback from these questions was used to modify the survey vehicle and create a final version. The final version (Figure) was distributed by broadcast fax, surface mail, and e-mail to U.S. members of the Society of Cardiovascular and Interventional Radiology (now named the Society of Interventional Radiology). With a Dillman approach (1Dillman DA Mail and telephone surveys: the total design method. Wiley-Interscience, New York1978Google Scholar), the survey was disseminated three times (fax: May; mail: June; e-mail: July). Data were collected and collated on an Excel spreadsheet (Microsoft, Redmond, WA) for subsequent review and analysis. Due to the variable number of responses to individual questions, the calculated percentage of a given response to any particular question was determined by the response rate to that question rather than the overall survey response. When evaluating questions that were tabulated by site (rather than individual) responses, sites that did not provide identification and that could possibly represent duplicate response sites were not counted.FigureCIRREF research survey questionnaire.View Large Image Figure ViewerDownload (PPT)FigureCIRREF research survey questionnaire.View Large Image Figure ViewerDownload (PPT)SURVEY RESPONSESThe overall response rate was 13% (420 of 3351), with responses received from 311 different institutions. Seventy-nine percent (332 of 420) responded that they had completed an interventional radiology fellowship. Practice demographics were academic (34%), private practice (58%), government (3%), managed care (3%), and other (1%). Just more than two-thirds were single specialty.Research Training and ExperienceForty-three percent of respondents (182 of 420) have had formal training in research methodology. This included specific training or didactics in biostatistics (30% of overall respondents), experimental design (31%), data collection and management (25%), literature synthesis and review (24%), grant writing (19%), and regulatory issues related to research (15%).Fifty-eight percent have participated in either basic science (n = 91, 22%) or clinical research trials (n = 230, 55%), whereas 24% have not (n = 99). Nineteen percent have participated in both clinical and basic science investigations. Only 3% have performed basic science research only. For those with research experience, the mean and median numbers of clinical trials participated in were seven and four, respectively, with 83 (35%) having been involved with one to two trials, 78 (33%) with three to five trials, and 76 (31%) with more than five trials. With regard to basic science research, 37 (37% of 102 responses to this question) have been involved with one to two trials, 35 (35%) with three to five, and 30 (30%) in more than five, with a median of four basic science projects.To assess the role of interventional radiologists as lead investigators, questions were asked regarding experience with protocol authorship, U.S. Food and Drug Administration (FDA)–sponsor investigations and funding record. Fifty-four percent (n 225) have authored research protocols, with an average of four protocols written by these individuals. Sixteen percent (n = 67) have been FDA–sponsored investigators by securing investigator device exemption or investigational new drug status for their research.Funding RecordThirty-two percent (130 of 413) have applied for extramural funding. Of these, 95% of responders from academic practices have sought extramural funding compared with 43% of physicians from private practices. However, the timing of funding within the individuals' career was not assessed, and it is thus not clear whether this reflects activity at the current job position or funding secured during prior employment (eg, physicians who made the transition from academic to private practices). The source of funding is shown in Table 1. The greatest amount of research funding was from industry, with 76 (18%) of responding interventional radiologists having sought and 15% having obtained industry support for research (an 86% funding success; 281 funded projects). According to the survey results, CIRREF has awarded grants for 18 projects by 15 interventional radiologists (not all CIRREF grants are accounted for in the survey results). Federal research funding has been pursued for 132 projects by 50 interventional radiologists (12% of total survey response and 38% of those with research grant experience), with successful funding in 47% of projects and 44% of applicants.Table 1Sources of Vascular Interventional Radiology Research Funding Based on Responses to Question 6 of Survey (Fig)SourceNumber of Individuals AppliedNumber of Individuals Funded%Number of Projects Applied forNumber of Projects Funded%Industry76668632828185Radiology241458322062CIRREF261557311858Private362158613557Federal5022441326347National261350411741Other13861241458 Open table in a new tab Research ActivityForty-one percent (172 of 420) responding interventional radiologists are actively participating in clinical or basic science research. Overall, an average of 6% of work time was spent performing or supervising research (mean: 13.5% of academic time; 1.7% of private practice time). Eight percent (32 of 420) reported 20% or more of their work time to be dedicated to research activities. Forty-four percent (141 of 420) are currently involved in the training of residents or fellows. Of responding institutions, 37% (115 programs) and 40% (124 programs) provide residency and fellowship training, respectively. Fellowship programs described an average of 8% of the fellow's time being spent doing research; 13 programs (4%) reported at least 20% of the fellow's time to be spent on research.Research Resources and LimitationsNinety-three responding institutions (23%) have a clinical research coordinator or other dedicated research staff: clinical nurse specialists were the most common research staff employed, reported at 60 institutions, compared with 23 institutions having nurse practitioners, 22 with physician assistants, and nine with research fellows. Eleven sites reported having a dedicated clinical research coordinator, although the overlap of the responsibilities served by this position versus other research staff was not clearly delineated.Available research facilities included a research-dedicated angiography suite at 54 institutions (17%), magnetic resonance (MR) imaging in 34 (11%), computed tomography (CT) in 12 (4%), laboratory space in 60 (19%), animal facilities in 86 (28%), and veterinary assistance in 65 (21%). An additional 141 (45%), 185 (59%), and 190 (61%) reported research access to a clinical unit angiography laboratory, MR imaging, and CT, respectively.When queried as to the major limitations to conducting research, the following responses were obtained: time (87%), lack of support staff (58%), facilities (25%), interest (28%), and low patient volume (15%). With regard to the perceived institutional climate for conducting research, 45% reported that their practice environment was either highly or somewhat supportive of research activities, whereas 44% reported indifference and 10% reported the environment to be not supportive.Respondents were asked whether they or their institutions would be interested in participating in a clinical research trial if that trial was already prepared and funded. Eighty-three percent stated that they would participate in funded clinical trials (95% for academic practices, 75% for private practices).Research Interests and PrioritiesResearch priorities were queried by global groups representing potential research project areas or procedures, as well as by subcategories within these groups. Perceived research priorities are shown in Table 2.Table 2Research Priorities (Lowest to Highest)TopicNumber of ResponsesTIPS5Veins7Biomaterials7Cardiovascular imaging19Spine interventions19Research methods21Thrombolysis22Hemodialysis/venous access27Miscellaneous30New technologies34Aneurysm therapies44Gene therapies63Uterine fibroid embolization69Peripheral vascular disease71Restenosis98Neurovascular interventions111Cancer therapies179TIPS = transjugular intrahepatic portosystemic shunt. Open table in a new tab LESSONS LEARNED: HOW CAN WE SECURE THE FUTURE OF INTERVENTIONAL RADIOLOGY RESEARCH?The history of interventional radiology is replete with innovation and technology that have enhanced the practice and understanding of medicine. The conceptualization, investigation, and development of techniques such as peripheral angioplasty (2Dotter CT Judkins MP Transluminal treatment of arterio-sclerotic obstruction: description of a new technic and a preliminary report of its application.Circulation. 1964; 30: 654-670Crossref PubMed Scopus (1276) Google Scholar, 3Seldinger SI Catheter replacement of the needle in percutaneous arteriography.Acta Radiol. 1953; 39: 368-376Crossref PubMed Scopus (1841) Google Scholar), transjugular intrahepatic portosystemic shunts (4Rosch J Hanafee W Snow H Barenfus M Gray R Transjugular intrahepatic portacaval shunt. An experimental work.Am J Surg. 1971; 121: 588-592Abstract Full Text PDF PubMed Scopus (117) Google Scholar), uterine fibroid embolization (5Ravina JH Herbreteau D Ciraru-Vigneron N Bouret JM Houdart E Aymard A et al.Arterial embolisation to treat uterine myomata.Lancet. 1995; 346: 671-672Abstract PubMed Google Scholar, 6Goodwin SC Vedantham S McLucas B Forno AE Perrella R Preliminary experience with uterine artery embolization for uterine fibroids.J Vasc Interv Radiol. 1997; 8: 517-526Abstract Full Text PDF PubMed Scopus (326) Google Scholar), and regional cancer therapy (7Wallace S Charnsangavej C Carrasco CH Bechtel W Infusion-embolization.Cancer. 1984; 54: 2751-2765Crossref PubMed Scopus (36) Google Scholar, 8McGahan JP Browning PD Brock JM Tesluk H Hepatic ablation using radiofrequency electrocautery.Invest Radiol. 1990; 25: 267-270Crossref PubMed Scopus (358) Google Scholar), all by interventional radiologists, have forever changed and continue to challenge the health-care landscape. Despite these contributions, emerging and confluent trends in the global medical environment threaten to marginalize the future potential of interventional radiologists as brokers of procedural innovation and translational research (Table 3). Increasing interest by other subspecialists in areas of research traditionally subsumed by interventional radiology is producing strong competition for industry support and extramural research funding (9Vogelzang RL Future directions in vascular and interventional radiology research.Radiology. 1998; 209: 17-18PubMed Google Scholar), and few interventional radiologists have the training, time, and resources necessary to effectively compete for research dollars. Of the $6.8 billion budgeted to the National Institutes of Health (NIH) in 2000, allocations to interventional radiology principal investigators accounted for small amounts compared with awards for cardiology, nephrology, and vascular surgery. Furthermore, organized interventional radiology has failed to inculcate a "culture of research" (ie, less than one-half of responding institutions support research). An insufficient number of interventional radiologists have training in or familiarity with the conduct of prospective, randomized, controlled trials, health-care impact assessment, and evidence-based outcome research necessary to support and preserve our techniques, and even fewer have experience with evolving transformative technologies such as genetics, robotics, and nanotechnology. This further results in an insufficient number of experienced mentors able to provide grant support, an important consideration in NIH evaluation of a grant submission.Table 3Factors Affecting the Future of VIR ResearchExternalInterest by other subspecialists in traditional areas of VIR researchIncreased competition for extramural research fundingLack of interventional radiologists on NIH study sectionsInternalLack of formal research trainingLimited departmental financial resources for VIR researchTime constraintsGroup structureInadequate support staffPoor facilities and administrationVIR = vascular interventional radiology. Open table in a new tab In a 1998 commentary in Radiology (10Kandarpa K Future directions in vascular and interventional radiology research: a commentary.Radiology. 1998; 209: 19-21Google Scholar), Dr. Krishna Kandarpa wrote "We can seldom control the motives and behavior of competitors, nor should we waste our time doing so. We can, however, take steps to ensure our own secure future." Furthermore, interventional radiology researchers must develop initiatives independent of those supported by industry, who in the future may no longer see interventional radiologists as the primary purveyors of new technology, and increasingly use principal investigators from other disciplines to oversee clinical trials. In fact, since Dr. Kandarpa's cogent commentary, organized radiology and interventional radiology have taken steps to enhance the research activities of its members. The CIRREF "IA 2000" campaign successfully secured $5 million for investigator-initiated interventional radiology research grants. CIRREF has to date sponsored more than a dozen pilot research grants, the uterine fibroids outcome registry and fibroid quality of life instrument, the RAND fibroid research agenda program, a skin-entry dose study for interventional radiologists, and several research-focused symposia. Through a $23-million grant from the National Cancer Institute, the American College of Radiology Imaging Network (11Hillman BJ The American College of Radiology Imaging Network (ACRIN): research educational opportunities for academic radiology.Acad Radiol. 2002; 9: 561-562Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 12Hillman BJ Opportunities for research with the American College of Radiology Imaging Network (ACRIN) image database.Acad Radiol. 2002; 9: 996-997Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar) has funded interventional radiologist–initiated projects on hepatic chemoembolization and radiofrequency ablation, with several additional projects in the pipeline. These are great first steps. However, the plethora of necessary scientific investigations remains unfulfilled by these limited resources, and competition by providers, institutions, and alternative technologies threaten to dilute patient enrollment in these trials. Furthermore, investigators participating in pilot research often do not publish their results, a necessary precursor to obtaining larger funding. Of the more than 25 individuals awarded CIRREF pilot grants, for example, only 10 have resulted in scientific publications (mostly within the interventional radiology literature) and only a few have gone on to procure federal grant support for additional research.How then can the results of this survey be used to expand vascular interventional radiology research in this new millennium? In fact, the results published herein help to identify strengths and weaknesses in the interventional radiology community that affect global strategies for research development. The data base created from the survey represents a unique collation of members' current research expertise and interests, providing a powerful resource for infrastructure development. Specifically, the data captured—institutional procedure volume, level of investigator training in research methodology, experience in basic and clinical trials, extramural funding record, and resources—provide the backbone for the identification of sites, investigators, and mentors suitable for participation in multicenter clinical trials. In addition, this information can be used to facilitate the creation of expert teams ("think tanks") capable of identifying research priorities within project areas and for developing specific protocols to address this research agenda. Teams can be created that consist of experience mentors, active sites, and grant writers and reviewers to enhance the likelihood of successful extramural funding. Finally, site and investigator data can be freely supplied to industry representatives to assist in the selection of interventional radiology investigators for relevant clinical trials.The results of this survey represent a snapshot of the current research climate, and when compared with the practice distribution of all Society of Interventional Radiology members, there is a threefold response bias from academic groups compared with private practices. Although internal Society of Interventional Radiology socioeconomic data have shown a demographic of 13% of interventional radiologists in academic groups and 79% in private groups, the survey responders were academic in 34% and private practice affiliated in 58%. In addition, the limited response likely represents a bias toward interventional radiologists interested in research. These biases are reflected in the unexpectedly high grant success rates seen in Table 1, particularly for federal funding, in which successful NIH support occurs in approximately 15%–20% of applications and is strongly affected by the prior grant experience of the applicant.Despite its deficiencies, this survey suggests that several organizational strategies may be valuable in nurturing interventional radiology research. Less than half of the respondents claimed to have formal training in research methodology, suggesting that the development of a research education curriculum as part of interventional radiology training may increase investigator development. Departmental and vascular interventional radiology financial and time limitations continue to represent a major constraint for research activities. The Society of Interventional Radiology and American College of Radiology need to continue to pursue initiatives to enhance support and time for research among interventional radiology faculty. Most interventional radiologists also lack the necessary fundamental support, ie, grant writers, biostatisticians, and research personnel, to allow successful participation in research activities. Despite this, most interventionalists would willingly participate in clinical trials that were already developed and funded. It is incumbent on the Society of Interventional Radiology and the CIRREF to actively develop centralized programs for presubmission grant review assistance as well as the independent internal development of strategically important protocols that can then be distributed to interested investigators. This latter program is currently being developed as part of the recently created CIRREF strategic initiative and can provide critical infrastructure for the future creation of multicenter trials within interventional radiology.Despite the bias toward academic practitioners, it is encouraging to note that a large number (43%) of responding physicians reported formal training in at least one area of research, with approximately one-third having education in biostatistics and study design, one-fourth having been educated in data analysis, and one-fifth exposed to grant writing courses. Nevertheless, research education and investigator development should remain organizational priorities to ensure a viable future pool of experienced scientists. Creative use of the time available during residency and interventional radiology fellowship could be the foundation for training radiologists to be clinician scientists. Current training options include The Holman Pathway (http://www.theabr.org/1_Ex41_Holman.html), which includes up to 24 months of research time during radiology residency, a dedicated interventional radiology pathway that includes 6 months of research and dedicated clinical training to become an effective interventional radiologist, and incorporating as much as 12 months of research into the 48 months of radiology residency training. The last option requires the most commitment on the part of residency programs but offers the option to tailor the research experience to each resident. One of the most important obstacles to any of these programs is the traditional role of the radiology resident in residency programs. Most radiology residencies focus the scheduling of radiology resident rotations based on clinical service needs of the practice that supervises the residents. This has resulted in a culture of hostility toward research time and insufficient guidance and planning of "research electives." If radiology is to become a center of academic research activity, then the approach to research time must change. This will require excellent mentors and a large amount of planning of research electives. In fact, research time in residency should not be elective. It should be time that is assigned for specific activities that the radiology faculty has planned for the residents, and time doing research should be critiqued with as much vigor as their ability to read chest x-rays or an MR imaging of the shoulder. If radiologists plan to incorporate research into their residencies and are willing to support their residents' research activities, it is possible that we could build a cadre of individuals who have enough preliminary data by the third year of their residency to apply for funding for research fellowships from societies like the Radiological Society of North America and the American Heart Association. If we are able to successfully secure these fellowships for our research-oriented residents, we will ensure them 2-year fellowships with good salaries and will supply them with dedicated time and support during their fellowship to generate enough preliminary data for their first mentored training award (K-08 or K-23) or R-21 grant from the NIH as first- or second-year faculty in their first job. This is the pipeline for productive research that already exists in surgery and internal medicine programs.Future organizational efforts must maintain the objective of creating programs and clinical research networks accessible to and serving the majority of practicing interventional radiologists. As market forces continue to dynamically change the structure and focus of interventional radiology practices and as individuals change jobs, periodic updates of data obtained by this survey will be necessary. Thus, repeated polling of members will be critical to ensure longitudinal accuracy and completeness and to enable maximal representation of all interventional radiology practices and research interests. Only in this way can participation in future research trials be disseminated to a maximal number of sites and types of practices, reducing site selection bias and expanding the opportunity for new investigators in all clinical environments to become active in the research process. Smaller practices with significant procedural volumes can then have equal access to clinical trials.APPENDIX: CIRREF RESEARCH COMMITTEE MEMBERSJohn H. Rundback, MD, Cochair, Columbia Presbyterian Medical Center Milstein Pavilion, Vascular and Interventional Radiology, New York, NYKenneth C. Wright, PhD, Cochair, Diagnostic Radiology, M.D. Anderson Cancer Center, Houston, TXKamran Ahrar, MD, Department of Radiology, M.D. Anderson Cancer Center, Houston, TXCurtis W. Bakal, MD, MPH, Exofficio, Department of Radiology, St. Luke's–Roosevelt Hospital Center, New York, NYMichael A. Bettmann, MD, Dartmouth Hitchcock Medical Center, Lebanon, NHJohn F. Cardella, MD, SUNY Syracuse Health Science Center, Syracuse, NYJoseph Bonn, MD, CIRREF Vice Chair, Department of Radiology, Thomas Jefferson University Medical Center, Philadelphia, PAPatricia E. Cole, PhD, MD, Novartis Corporation, East Hanover, NJPaul M. Consigny, PhD, Guidant Vascular Intervention, Santa Clara, CAWilliam C. Culp, MD, Vascular and Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, ARJames R. Duncan, MD, PhD, Mallinckrodt Institute of Radiology, St. Louis, MORobert Donald G. Ferguson, MD, Department of Radiology, Forsyth Medical Center, Winston-Salem, NCJeff H. Geschwind, MD, Department of Radiology, Johns Hopkins Medical Institute, Baltimore, MDAntoinette S. Gomes, MD, Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CARichard J. Gray, MD, Department of Radiology, Washington Hospital Center, Washington, DCMatthew S. Johnson, MD, Department of Radiology, Indiana University Hospital, Indianapolis, INKrishna Kandarpa, MD, PhD, CIRREF Past Chair, Division of Radiology, University of Massachusetts Memorial Medical Center/University Campus, North Worcester, MAElvira V. Lang, MD, Harvard School of Medicine, Beth Israel Deaconess Medical Center, Boston, MAMatthew A. Mauro, MD, CIRREF Chair, Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NCGordon McLennan, MD, Department of Radiology, Indiana University Hospital, Indianapolis, INFranklin J. Miller, Jr., MD, Department of Radiology, UCSD Medical Center, San Diego, CASanjay Misra, MD, Mayo Clinic and Foundation, Rochester, MNKevin L. Sullivan, MD, Department of Radiology (CVIR), Thomas Jefferson University Hospital, Philadelphia, PAKarim Valji, MD, Ex-officio, Department of Radiology, UCSD Medical Center, San Diego, CA MEDICAL research forms the foundation for health-care advancement and the development of nascent therapies. The specialty of vascular and interventional radiology has been characterized by a rich history of new technology development, validation, and adoption of new procedures into medical practice. Despite this, the level of participation of practicing interventional radiologists in basic science and clinical research remains poorly defined and has lagged behind other subspecialties as well as diagnostic radiology (www.search.nih.gov). To better determine the demographics of interventional radiology research practices, a survey was commissioned by the Cardiovascular and Interventional Radiology Research and Education Foundation (CIRREF) and distributed to the membership of the Society of Interventional Radiology (neé SCVIR). The objectives of this project were to provide insights for the development of an intellectual foundation for the creation of a vascular and interventional radiology research infrastructure. Specifically, the survey sought to identify (i) research experience and training, (ii) current research activity, (iii) individual and institutional research support, (iv) reasons that limit interventional radiologists' participation in or development of research initiatives, and (v) vascular and interventional and radiology research priorities. SURVEY INSTRUMENTThe survey was created by the research committee cochairs and staff with input from research committee and CIRREF leadership and comprised of four main groups of questions: practice demographics, research experience, research support, and research priorities. An initial draft version of the survey was piloted in April 2001 to selected Society of Cardiovascular and Interventional Radiology committee members. This initial version contained additional questions about the survey scope and content, and feedback from these questions was used to modify the survey vehicle and create a final version. The final version (Figure) was distributed by broadcast fax, surface mail, and e-mail to U.S. members of the Society of Cardiovascular and Interventional Radiology (now named the Society of Interventional Radiology). With a Dillman approach (1Dillman DA Mail and telephone surveys: the total design method. Wiley-Interscience, New York1978Google Scholar), the survey was disseminated three times (fax: May; mail: June; e-mail: July). Data were collected and collated on an Excel spreadsheet (Microsoft, Redmond, WA) for subsequent review and analysis. Due to the variable number of responses to individual questions, the calculated percentage of a given response to any particular question was determined by the response rate to that question rather than the overall survey response. When evaluating questions that were tabulated by site (rather than individual) responses, sites that did not provide identification and that could possibly represent duplicate response sites were not counted.FigureCIRREF research survey questionnaire.View Large Image Figure ViewerDownload (PPT) The survey was created by the research committee cochairs and staff with input from research committee and CIRREF leadership and comprised of four main groups of questions: practice demographics, research experience, research support, and research priorities. An initial draft version of the survey was piloted in April 2001 to selected Society of Cardiovascular and Interventional Radiology committee members. This initial version contained additional questions about the survey scope and content, and feedback from these questions was used to modify the survey vehicle and create a final version. The final version (Figure) was distributed by broadcast fax, surface mail, and e-mail to U.S. members of the Society of Cardiovascular and Interventional Radiology (now named the Society of Interventional Radiology). With a Dillman approach (1Dillman DA Mail and telephone surveys: the total design method. Wiley-Interscience, New York1978Google Scholar), the survey was disseminated three times (fax: May; mail: June; e-mail: July). Data were collected and collated on an Excel spreadsheet (Microsoft, Redmond, WA) for subsequent review and analysis. Due to the variable number of responses to individual questions, the calculated percentage of a given response to any particular question was determined by the response rate to that question rather than the overall survey response. When evaluating questions that were tabulated by site (rather than individual) responses, sites that did not provide identification and that could possibly represent duplicate response sites were not counted. SURVEY RESPONSESThe overall response rate was 13% (420 of 3351), with responses received from 311 different institutions. Seventy-nine percent (332 of 420) responded that they had completed an interventional radiology fellowship. Practice demographics were academic (34%), private practice (58%), government (3%), managed care (3%), and other (1%). Just more than two-thirds were single specialty.Research Training and ExperienceForty-three percent of respondents (182 of 420) have had formal training in research methodology. This included specific training or didactics in biostatistics (30% of overall respondents), experimental design (31%), data collection and management (25%), literature synthesis and review (24%), grant writing (19%), and regulatory issues related to research (15%).Fifty-eight percent have participated in either basic science (n = 91, 22%) or clinical research trials (n = 230, 55%), whereas 24% have not (n = 99). Nineteen percent have participated in both clinical and basic science investigations. Only 3% have performed basic science research only. For those with research experience, the mean and median numbers of clinical trials participated in were seven and four, respectively, with 83 (35%) having been involved with one to two trials, 78 (33%) with three to five trials, and 76 (31%) with more than five trials. With regard to basic science research, 37 (37% of 102 responses to this question) have been involved with one to two trials, 35 (35%) with three to five, and 30 (30%) in more than five, with a median of four basic science projects.To assess the role of interventional radiologists as lead investigators, questions were asked regarding experience with protocol authorship, U.S. Food and Drug Administration (FDA)–sponsor investigations and funding record. Fifty-four percent (n 225) have authored research protocols, with an average of four protocols written by these individuals. Sixteen percent (n = 67) have been FDA–sponsored investigators by securing investigator device exemption or investigational new drug status for their research.Funding RecordThirty-two percent (130 of 413) have applied for extramural funding. Of these, 95% of responders from academic practices have sought extramural funding compared with 43% of physicians from private practices. However, the timing of funding within the individuals' career was not assessed, and it is thus not clear whether this reflects activity at the current job position or funding secured during prior employment (eg, physicians who made the transition from academic to private practices). The source of funding is shown in Table 1. The greatest amount of research funding was from industry, with 76 (18%) of responding interventional radiologists having sought and 15% having obtained industry support for research (an 86% funding success; 281 funded projects). According to the survey results, CIRREF has awarded grants for 18 projects by 15 interventional radiologists (not all CIRREF grants are accounted for in the survey results). Federal research funding has been pursued for 132 projects by 50 interventional radiologists (12% of total survey response and 38% of those with research grant experience), with successful funding in 47% of projects and 44% of applicants.Table 1Sources of Vascular Interventional Radiology Research Funding Based on Responses to Question 6 of Survey (Fig)SourceNumber of Individuals AppliedNumber of Individuals Funded%Number of Projects Applied forNumber of Projects Funded%Industry76668632828185Radiology241458322062CIRREF261557311858Private362158613557Federal5022441326347National261350411741Other13861241458 Open table in a new tab Research ActivityForty-one percent (172 of 420) responding interventional radiologists are actively participating in clinical or basic science research. Overall, an average of 6% of work time was spent performing or supervising research (mean: 13.5% of academic time; 1.7% of private practice time). Eight percent (32 of 420) reported 20% or more of their work time to be dedicated to research activities. Forty-four percent (141 of 420) are currently involved in the training of residents or fellows. Of responding institutions, 37% (115 programs) and 40% (124 programs) provide residency and fellowship training, respectively. Fellowship programs described an average of 8% of the fellow's time being spent doing research; 13 programs (4%) reported at least 20% of the fellow's time to be spent on research.Research Resources and LimitationsNinety-three responding institutions (23%) have a clinical research coordinator or other dedicated research staff: clinical nurse specialists were the most common research staff employed, reported at 60 institutions, compared with 23 institutions having nurse practitioners, 22 with physician assistants, and nine with research fellows. Eleven sites reported having a dedicated clinical research coordinator, although the overlap of the responsibilities served by this position versus other research staff was not clearly delineated.Available research facilities included a research-dedicated angiography suite at 54 institutions (17%), magnetic resonance (MR) imaging in 34 (11%), computed tomography (CT) in 12 (4%), laboratory space in 60 (19%), animal facilities in 86 (28%), and veterinary assistance in 65 (21%). An additional 141 (45%), 185 (59%), and 190 (61%) reported research access to a clinical unit angiography laboratory, MR imaging, and CT, respectively.When queried as to the major limitations to conducting research, the following responses were obtained: time (87%), lack of support staff (58%), facilities (25%), interest (28%), and low patient volume (15%). With regard to the perceived institutional climate for conducting research, 45% reported that their practice environment was either highly or somewhat supportive of research activities, whereas 44% reported indifference and 10% reported the environment to be not supportive.Respondents were asked whether they or their institutions would be interested in participating in a clinical research trial if that trial was already prepared and funded. Eighty-three percent stated that they would participate in funded clinical trials (95% for academic practices, 75% for private practices).Research Interests and PrioritiesResearch priorities were queried by global groups representing potential research project areas or procedures, as well as by subcategories within these groups. Perceived research priorities are shown in Table 2.Table 2Research Priorities (Lowest to Highest)TopicNumber of ResponsesTIPS5Veins7Biomaterials7Cardiovascular imaging19Spine interventions19Research methods21Thrombolysis22Hemodialysis/venous access27Miscellaneous30New technologies34Aneurysm therapies44Gene therapies63Uterine fibroid embolization69Peripheral vascular disease71Restenosis98Neurovascular interventions111Cancer therapies179TIPS = transjugular intrahepatic portosystemic shunt. Open table in a new tab The overall response rate was 13% (420 of 3351), with responses received from 311 different institutions. Seventy-nine percent (332 of 420) responded that they had completed an interventional radiology fellowship. Practice demographics were academic (34%), private practice (58%), government (3%), managed care (3%), and other (1%). Just more than two-thirds were single specialty. Research Training and ExperienceForty-three percent of respondents (182 of 420) have had formal training in research methodology. This included specific training or didactics in biostatistics (30% of overall respondents), experimental design (31%), data collection and management (25%), literature synthesis and review (24%), grant writing (19%), and regulatory issues related to research (15%).Fifty-eight percent have participated in either basic science (n = 91, 22%) or clinical research trials (n = 230, 55%), whereas 24% have not (n = 99). Nineteen percent have participated in both clinical and basic science investigations. Only 3% have performed basic science research only. For those with research experience, the mean and median numbers of clinical trials participated in were seven and four, respectively, with 83 (35%) having been involved with one to two trials, 78 (33%) with three to five trials, and 76 (31%) with more than five trials. With regard to basic science research, 37 (37% of 102 responses to this question) have been involved with one to two trials, 35 (35%) with three to five, and 30 (30%) in more than five, with a median of four basic science projects.To assess the role of interventional radiologists as lead investigators, questions were asked regarding experience with protocol authorship, U.S. Food and Drug Administration (FDA)–sponsor investigations and funding record. Fifty-four percent (n 225) have authored research protocols, with an average of four protocols written by these individuals. Sixteen percent (n = 67) have been FDA–sponsored investigators by securing investigator device exemption or investigational new drug status for their research. Forty-three percent of respondents (182 of 420) have had formal training in research methodology. This included specific training or didactics in biostatistics (30% of overall respondents), experimental design (31%), data collection and management (25%), literature synthesis and review (24%), grant writing (19%), and regulatory issues related to research (15%). Fifty-eight percent have participated in either basic science (n = 91, 22%) or clinical research trials (n = 230, 55%), whereas 24% have not (n = 99). Nineteen percent have participated in both clinical and basic science investigations. Only 3% have performed basic science research only. For those with research experience, the mean and median numbers of clinical trials participated in were seven and four, respectively, with 83 (35%) having been involved with one to two trials, 78 (33%) with three to five trials, and 76 (31%) with more than five trials. With regard to basic science research, 37 (37% of 102 responses to this question) have been involved with one to two trials, 35 (35%) with three to five, and 30 (30%) in more than five, with a median of four basic science projects. To assess the role of interventional radiologists as lead investigators, questions were asked regarding experience with protocol authorship, U.S. Food and Drug Administration (FDA)–sponsor investigations and funding record. Fifty-four percent (n 225) have authored research protocols, with an average of four protocols written by these individuals. Sixteen percent (n = 67) have been FDA–sponsored investigators by securing investigator device exemption or investigational new drug status for their research. Funding RecordThirty-two percent (130 of 413) have applied for extramural funding. Of these, 95% of responders from academic practices have sought extramural funding compared with 43% of physicians from private practices. However, the timing of funding within the individuals' career was not assessed, and it is thus not clear whether this reflects activity at the current job position or funding secured during prior employment (eg, physicians who made the transition from academic to private practices). The source of funding is shown in Table 1. The greatest amount of research funding was from industry, with 76 (18%) of responding interventional radiologists having sought and 15% having obtained industry support for research (an 86% funding success; 281 funded projects). According to the survey results, CIRREF has awarded grants for 18 projects by 15 interventional radiologists (not all CIRREF grants are accounted for in the survey results). Federal research funding has been pursued for 132 projects by 50 interventional radiologists (12% of total survey response and 38% of those with research grant experience), with successful funding in 47% of projects and 44% of applicants.Table 1Sources of Vascular Interventional Radiology Research Funding Based on Responses to Question 6 of Survey (Fig)SourceNumber of Individuals AppliedNumber of Individuals Funded%Number of Projects Applied forNumber of Projects Funded%Industry76668632828185Radiology241458322062CIRREF261557311858Private362158613557Federal5022441326347National261350411741Other13861241458 Open table in a new tab Thirty-two percent (130 of 413) have applied for extramural funding. Of these, 95% of responders from academic practices have sought extramural funding compared with 43% of physicians from private practices. However, the timing of funding within the individuals' career was not assessed, and it is thus not clear whether this reflects activity at the current job position or funding secured during prior employment (eg, physicians who made the transition from academic to private practices). The source of funding is shown in Table 1. The greatest amount of research funding was from industry, with 76 (18%) of responding interventional radiologists having sought and 15% having obtained industry support for research (an 86% funding success; 281 funded projects). According to the survey results, CIRREF has awarded grants for 18 projects by 15 interventional radiologists (not all CIRREF grants are accounted for in the survey results). Federal research funding has been pursued for 132 projects by 50 interventional radiologists (12% of total survey response and 38% of those with research grant experience), with successful funding in 47% of projects and 44% of applicants.