The Journey of Interventional Radiology in China

The first balloon angioplasty performed by Dr. Charles T. Dotter in 1964 marked the birth of a new discipline in radiology (1), which was initially named “interventional diagnostic radiology” by Dr. Alexander R. Margulis in 1967 (2), and later defined as “Interventional Radiology (IR)” by Dr. Sidney Wallace in 1976 (3). Along with the wide adaptation of Seldinger’s technique for percutaneous vascular access (4), interventional radiology expanded the horizon of traditional radiology, from being solely focused on diagnosis to being a common standard for treatment. At present, interventional radiology has largely come to replace traditional open surgeries with accurate, image-guided procedures that are minimally-invasive for patients. Interventional radiology has emerged a principal medical specialty in parallel to other traditional medical specialties, such as internal medicine and surgery, making a significant impact on the management of a wide spectrum of diseases.

In China, interventional radiology was initiated in the early 1980s by two Chinese radiologists, Dr. Gui Lin and Dr. Zijiang Liu, who completed their training in Sweden and Switzerland (5). They not only promoted interventional radiology in China, but also accelerated the growth of the numbers of Chinese interventional radiologists who would later become leaders in the field with various IR sub-specialties, such as Dr. Luping Dai with expertise in coronary interventions, Dr. Linsun Li in abdominal interventions, Dr. Gansheng Feng in peripheral interventions, Dr. Ke Xu in hepato-pancreato-biliary interventions, and Dr. Gaojun Teng in radioactive stents. These Chinese interventional radiologists have gone on to educate several generations of IR doctors in China, greatly facilitating the expansion of IR specialties throughout the country.

With the support of Dr. Yuqing Liu, an academician in radiology, Dr. Baoshu Xia organized the first academic conference of interventional radiology in China, held in Weifang in 1986. This historic meeting inspired many radiologists to give their input into this new field. In 1990, the Chinese Society of Medicine approved the establishment of the Chinese Society of Interventional Radiology (CSIR). Since then, CSIR has held 14 national conferences on interventional radiology, which were directed by Drs. Gui Lin, Zijiang Liu, Ruping Dai, Xiangsheng Xiao, Ke Xu, Gaojun Teng, Hong Shan, and Weijian Jiang. CSIR has played a key role in educating new IR doctors, defining best practice guidelines, and promoting international collaboration. In 1992, the Journal of Interventional Radiology [Chinese Edition] (JIR)was inaugurated in Shanghai, with the primary editorial team members being Drs. Gui Lin, Xingrong Chen, Yongde Cheng, Ke Xu, and Lingsun Li. Later, the journal became the official magazine of the CSIR, led by its current editor, Dr. Gaojun Teng, and co-editors, Drs. Yongde Cheng and Hong Shan. In 2017, Journal of International Medicine [English Edition] (JIM) is launched in Shanghai, via great efforts by Dr. Yongde Cheng with the JIR editorial team throughout the years. JIM provides a platform for global IR doctors to share their clinical and research results with the international IR community.

Over the last 30+ years, the advancement of interventional radiology in China has greatly benefited from international collaboration. Many IR specialists around the world have lectured in Chinese national and regional meetings, and have also taught new IR procedures in medical institutions throughout the country. In appreciation of their contributions to China, CSIR established several awards, including the CSIR award for outstanding international collaborations (awarded to Drs. Salvatore Sclafani, Ho-young Song, David Kumpe); CSIR honorable memberships (Drs. Kerian Murphy, John Kaufman, Michael Lee, Brian Stainken, Osamu Matrui, ZivHaskal, Sanjiv Sharma, Kyu-bo Sung, Berry Katzen, and Daniel Waigl);CSIR special awards (Dr. Weiping Wang and Mrs. Rosemarie Kumpe); and CSIR outstanding contribution awards by overseas Chinese physicians (Drs. Shiliang Sun and Xiaoming Yang). Similarly, many Chinese doctors have been recognized for their outstanding contributions to advances in global interventional radiology. For example, Drs. Linsun Li and Ke Xu received Gold Medals from the Asian-Pacific Congress of Cardiovascular & Interventional Radiology (APCCIR) in 2012 and 2016, respectively. Dr. Gaojun Teng was honored as a distinguished fellow by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) in 2016, as well as, being a Gold Medal recipient, the highest honor by the Society of Interventional Radiology (SIR) in 2017. In addition, a younger generation of Chinese interventional radiologists has demonstrated their scientific excellence in the global IR community. For example, in 2010, CIRSE recognized the scientific work of Dr. Maoqun Li from Shanghai 10^th Hospital, and in 2015, the SIR-Journal of Vascular & Interventional Radiology (JVIR) honored Dr. Bin Liang and his supervisor Dr. Chuansheng Zheng from the Wuhan Union Hospital with a Distinguished Laboratory Investigation Award.

Along with the advancement of global interventional radiology, a large number of Chinese doctors have gained scientific and/or clinical training abroad. These internationally trained doctors have become active members of the Chinese IR community, with overseas Chinese doctors playing an important role in “bridging” interventional radiology knowledge and practice across China and the rest of the world. For example, in promoting IR research in China, Dr. Xiaoming Yang, a professor and physician-scientist, has not only brought innovative IR concepts, such as “interventional imaging of gene and stem cell therapies” and “interventional molecular imaging,” to China (6, 7), but also trains a number of Chinese IR post-doctoral fellows as part of his research team in the United States. Many other overseas Chinese doctors have also worked tirelessly to share their global experience and expertise with the Chinese IR community, such as Dr. Weiping Wang by adapting a US resident education system and developing basic online training for young Chinese IR doctors; Dr. Zhuxing Kan by sharing a technique for using a functional CT for quantifying tumor perfusion pre-and post-interventions (8, 9); Dr. Yonghua Dong with a carbon dioxide (CO₂) angiography technique (10); Dr. Shiliang Sun with pre-operative embolization of bone metastasis (11); and Dr. Zishu Zhang sharing the American experience of managing patients before and after IR procedures.

Compared to other countries, developing IR specialty in China has unique advantages. First, many IR teams in China form independent departments or centers of excellence, which enable them to practice at their own outpatient clinics and inpatient wards. This gives Chinese IR doctors great autonomy in designing the scope and volume of IR services. Second, there is a large patient population in China suited for IR procedures, which offers a great opportunity for learning new techniques through practical application and accumulating valuable clinical experience. These unique infrastructural and caseload circumstances provide Chinese doctors with ideal conditions to develop new IR technologies, to standardize IR procedures for optimal patient care, and to advance both IR education and research.

The Chinese IR community has developed and contributed significantly to global IR practice since its inception. These achievements have only been possible due to the collective effort from all members of the Chinese IR community. Due to limited space, only a few names are mentioned in this article, but there are many more Chinese IR doctors who are working in advancing the field. With a continuous pursuit for clinical and technological advancement, the Chinese IR community will have a bright future, with the ultimate beneficiaries being patients in China and abroad. Moving forward, the Chinese IR community will aim high, that is, to become one of leaders in bringing the global IR community to the highest level of excellence in clinical service, teaching, and research.