International Physician Update

An Interview with J. F. Geschwind: The director of cardiovascular and interventional radiology

J. F. Geschwind, M.D., is the director of cardiovascular and interventional radiology.

Radiology’s focus is rapidly shifting from diagnosis to image-guided treatment—and Jeff Geschwind is at the forefront of that change. In the last few years, he has helped refine a treatment for advanced liver cancer. Called chemoembolization, the catheter-driven treatment kills liver tumors by delivering chemotherapeutic drugs directly to the tumor site.

Interventional radiology is not only changing how cancer is treated but is also affecting other specialties. As more patients choose minimally invasive procedures over traditional surgeries, some surgeons are struggling to adapt. Geschwind discusses the impact of the new techniques and offers his suggestions for easing the transition.

Question: How has interventional radiology evolved since you began your career?

Dr. Geschwind: When I started my career, interventional radiology was primarily a field of diagnosis. The majority of studies were performed to establish a diagnosis. Now, most of the procedures are done for a therapeutic purpose. There has been an explosive growth and interest in minimally invasive image-guided therapeutic techniques. In fact, some of these techniques have totally replaced more traumatic surgical procedures. So as a field, we’ve become much more aggressive.

Question: How so?

Dr. Geschwind: We’re constantly treating tumors and aneurysms, draining fluid and shrinking fibroids. Our sophisticated technology tells the story, and then we move right in with a treatment.

Question: In which areas have you seen the most change?

Dr. Geschwind: Three areas stand out—venous diseases, which include varicose veins and dialysis; gynecology, specifically fibroid disease; and oncology. Many of these new procedures or those yet to be launched can be done on an outpatient basis.

Question: So what would you say are the top five new interventional radiology treatments at Hopkins?

Dr. Geschwind: We’re treating more patients for advanced liver cancer using chemoembolization and radiofrequency ablation. The other top treatments include endovenous laser therapy for varicose veins, uterine fibroid embolization, high- intensity focused ultrasound for fibroid disease, and embolotherapy for arteriovenous malformations. 

Question: What do you see as the biggest challenge facing the field?

Dr. Geschwind: I’d have to say the toughest challenge is being accepted by clinicians in other specialties. That is less a problem in academic centers like ours, where relations with colleagues are excellent. But in private practice, things may not be as collegial. That’s going to have to change. We need to keep in mind our common goal: to treat patients using the most effective procedures.

Question: Any other obstacles?

Dr. Geschwind: Yes—training remains insufficient. Surgical, Ob-Gyn, oncology and, of course, radiology residencies should have more exposure to the latest interventional techniques.

First and foremost, the educational focus must shift toward a more clinically oriented approach because interventional radiologists have clearly become involved in managing complex diseases. In short, interventional radiologists must become true clinicians.

Question: And how do you think you can gain wider acceptance in other specialties?

Dr. Geschwind: We’ve got to blur the lines a little. What we need to stress is a disease-oriented vs. a specialty-oriented approach. I know that’s easier said than done, but it’s not impossible. Again, it begins with training. Interventional radiology rotations should be mandatory for clinical subspecialties.

Question: What has Hopkins done to foster this approach?

Dr. Geschwind: Hopkins has been visionary—we have one of the oldest programs in the United States. We see pretty complex cases all the time. And we have good interactions between our division and the rest of the clinical world.

Vascular surgical fellows have the ability to rotate through interventional radiology and participate with us in image-guided procedures. We also have weekly multidisciplinary conferences focusing on patients with vascular disease, liver cancer and fibroid disease. And we all benefit from the different perspectives.

Question: What can doctors overseas expect to gain through Hopkins’ training program in image-guided procedures?

Dr. Geschwind: Most interventional radiologists in other countries don’t have our experience and the clinical approach we’ve adopted. Our international training program educates interventional radiologists and makes sure they understand what’s required in setting up a first-rate department.

Focusing only on the technical aspect of procedures is no longer acceptable. Nowadays, interventional radiologists must be more like surgeons and not only master the technical aspect of each procedure but also the pre- and post-procedure care.

Question: Are more people going into this field?

Dr. Geschwind: Absolutely. Since I started in 1996, the department at Hopkins has grown from four to seven fellows, and we now have eight full-time faculty members. Nationally, when The Society of Cardiovascular and Interventional Radiology debuted in the late 1970s, there were only 175 members. Now it has 4,200 members.
And our national meeting is one of the best-attended radiology meetings, with over 6,000 participants. The field’s exploding with new developments, and our research is pushing new frontiers.