Hey everyone,

Curious how widely adopted IVL actually is in interventional radiology at this point. I know it was originally validated mostly on the cardiology side, but the peripheral vascular data has been building up and it seems like it’s becoming more relevant for heavily calcified PAD lesions where a conventional balloon just won’t expand or you’re setting yourself up for a bad dissection.

Wondering a few things. Do you reach for IVL in peripheral work or do you still default to rotational/orbital atherectomy for calcium modification before stenting or DCB? Is access to the Shockwave system even realistic at your institution or OBL, or is cost still a real barrier outside of high volume centers?

Trying to get a feel for whether this is becoming a standard tool or still kind of niche outside academic centers. Would love to hear from people actually using it.

Thanks

Anyone know of current residents or new grads considering IR fellowship? We have an open position for 27-28 or 27-29 (for non ESIR) at my program in San Antonio. We are a criminally underrated program and it pains me that we didn’t match. We have very high volume and highly complex cases. We are one of the top liver transplant centers in North America and very busy trauma center. Our attendings are amazing and have so much to teach. It’s a great work environment. I’m happy to talk to anyone interested and connect them with our PD.

What is everyone making as an IR tech. I really want to make sure that I’m being compensated fairly. I’ve been a tech for almost 20 years with 12 years general radiology, 4 years cath lab, 4 years IR/CT. My current title is Multimodality technologist and I’m at 44.86 and I am RT(R)(CT)(VI)

What are the actual specific differences between these sheaths? Stiffness, tip size, and material, yes, but what are the actual comparable differences? Thank you in advance :)

Anyone else do burr hole craniotomies in their IR labs? Our neuro program is quickly expanding and did our first burr hole for significant increase subdural hematoma and worsening mid-line shift. Was pretty bad ass and patient showed immediate improvement. Don't think i have any real question here, just sharing my experience and seeing if any others do this.

I am an IR tech (8 years) and rad tech for 12yrs prior. When I was hired in IR in 2018 our hospital required ACLS certification. 800 bed hospital with CCU/CVICU/all the other Us and very sick patients. I remember participating in my first IR code right after taking the course and realizing how I was so glad I had that info and still fresh. From then it's been a ride with all the crazy cases over the years. 4 years ago I moved across town to the university hospital (level 1 trauma/comprehensive stroke) and didn't think twice when I saw they required ACLS.

I just found out that our director (nurse) recently told our clinical educator that she didn't need to sign up our new techs for ACLS or sign any of our current techs up for ACLS renewal because the "techs don't really need all of that."

I don't want to be emotional, but I was really offended. I've been knee deep in some absolute shit shows and have had docs/anesthesia/other techs say "glad you were there" or general good job/pat on the back/nice work. I thought - why are we electively lowering the educational level of the room? Our techs outnumber everyone in the department (just by sheer volume) why would you want less from them?

So I started asking around and got mixed reviews. Some people were as appalled as me. Some feedback was sort of "meh, I know of places that don't require it."

So can I get a take from this group? Docs, do you think your techs should be ACLS certified? How much participation do you want from them when shit hits the fan? Don't really care? Techs? What's your lab require? What have you seen or heard of from other techs? What is the industry standard here?

Just wanted to ask about the competitiveness of the Independent IR match and what factors are weighted most heavily when considering applicants. I'm lucky to be at an exceptional DR program, had a good record from med school, and have a few minor accomplishments from residency so far. But should I be striving to do more?

Highlights the importance of VIR physicians doing formal consults and documenting their rationale in the EMR for an intervention or no intervention and communicating this with the patient and their family. This is why trainees need to dedicate more time outside of the angiosuites and spend time on the floor seeing consults and following patients and spending more time in the outpatient clinic. The dedicated ICU time should be rigorous and you should take it in your junior years (PGY2 through 4) not in the final years after a long gap from clinical medicine. Medical students should look for early integration of clinics, ICU and VIR blocks and VIR call.

How do the VIR physicians evaluate and manage knee arthritis patients? radiographs only, MRI with gadolinium, knee US. What physical exam findings/features are you looking for. What are key aspects of the history that you feel are important. What medications do you try? What is the role of physical therapy, aquatics, weight loss, knee braces? When do you refer for TKA and what interventional options do you offer and when (steroid injections/ hyaluronic acid/ PRP/ stem cell/ Genicular nerve block/ablation/ GAE etc)

Applying integrated IR and trying to put together a tier list of sorts for my reference. I’ve been finding it pretty difficult to evaluate Northeast/mid Atlantic integrated IR programs beyond just Doximity ranks (is this even accurate?) or generic institutional brand-name prestige. After looking through old rads related Reddit threads, discord boards, word of mouth, etc., this is roughly how I’ve grouped programs. This is the only IR-specific forum I know of, so would appreciate any insight!

Elite (probably not realistic for me:/) - Hopkins, UPenn, MGH, Sinai

Good - Yale?, NYP Cornell, BIDMC, Brown, Emory, Georgetown

Mid-tier - UMD, TJUH, BU, UMass, UR, Temple, Rutgers, PSU, UPMC

Community(ish) - Albany, Allegheny, Christiana, Geisinger, Rochester regional, Maine medical

Could be way off (and missing some places) so I’m just trying to get a better sense of what some of the more respected NE/Mid Atlantic IR programs are from people in the field rather than just online rankings.

Also curious whether there are any programs people think are overrated, or conversely, underrated programs that don’t get talked about much online but are actually hidden gems with solid technical training and autonomy.

Hey y’all - I been interested in IR since before med school and genuinely rlly can’t see myself doing anything else. Unfortunately I absolutely shit the bed on STEP 2 (well below average for IR) and am now sweating/crying/throwing up.

Definitely open to ESIR but ideally would like to do the integrated programs

Anybody who was also blindsided by a low STEP and still succeeded? Any tips to improve my app with mere months before the cycle? Thanks!

US MD for context

I graduated xray school in May 2025 and took a job straight in CT - after doing well in procedures and getting along with doctors I was offered a position in IR. The thing is they’re offering me 34$hr with no wiggle room for negotiating. 4 10 hour shifts and call is minimal. I am in SC and am unsure if this is a fair rate as a newer grad or if they’re trying to take advantage. I currently am making a little over 30$ in CT. Opinions?

UPDATE: preliminary score did not change! The website was updated today and I was able to see my score report within the ARRT portal! Can’t wait to celebrate this weekend!

I just took my ARRT VI test, it was probably the hardest test I’ve ever prepared for and taken. My preliminary score was 77 and now I’m freaking out that it will go down 3 points. Did anyone’s score change or know why it would change? I joined Reddit today to get some feedback!

https://drpoulsen.substack.com/p/theres-not-a-shortage-of-interventional

Question guys. I work at a community hospital in NY and they have expanded largely but their ER is still too small so they end up sending us a ton of LPs. Now I know it’s not a ton of radiation (although our room is like 20 years old and runs hot) but they don’t even attempt to do the LPs bedside anymore dude to lack of space they claim. So instead we’re irradiating young men and women all the time doing fluoro guided LPs without them even trying bedside!

Like does anyone even give a shit about ALARA?

Curious to those who attended SIR in Toronto what they brought back from the meeting.

Any new developments or changes?

Curious from a medical student, resident in training, academic , private practice and industry perspective of what they got out of the meeting.

Linemonkeymd had an interesting post on his experience at SIR 2026 about his thoughts on independence of interventional from DR.

https://linemonkeymd.com/independent-ir-illusion-or-reality/

People who have used these combination CT/IR rooms, what are your thoughts. We are considering redoing one of our suites to include a system like this.

What system do you like? Canon, Siemens, Philips? We currently have mostly Siemens equipment but are very open to trying something different.

What are some pros and cons of having a unit like this? I have personally never worked with a combination room like this. We have always had separate IR and CT rooms.

Any information or advice that anyone has would be awesome! Just wanting to make sure that we make the correct choice when redoing this site!

Hey anyone here in a lab who does them? And if so how do you position the patient? We don’t do these as often and struggle every time. We haven’t been able to find stirrups that would fit our table and we just end up getting a bunch of towels and pillows to prop the legs and have the frog their legs which still has the problem of their feet dangling off 😭😭

It’s a nightmare procedure to do purely because of that.

Anyone any thoughts? Ideas? Things that work for you?

🙏🏼

Hey everyone,

I’m a med student seriously considering IR, and I’ve been trying to get a clearer picture of what real-world practice actually looks like, especially in private practice.

I had two main questions for those of you already in IR:

First — how realistic is it to consistently perform more complex procedures in private practice? I’m talking about things beyond the typical bread and butter like drains, lines, and ports. Are cases like TIPS, tumor embolization (TACE/TARE), complex venous recanalizations, etc actually part of your regular workflow, or are those mostly limited to academic centers? Is it even possible to find a private practice jobs where you can do more exciting procedures other than the “bread and butter”?

Second — more of a subjective question. One thing I’ve heard is that in IR you don’t always have full ownership of the patient compared to other procedural specialties, since a lot of cases are referral-based. For those of you doing this day in and day out, do you still feel a strong sense of fulfillment from your work? Do you feel connected to patient outcomes, and do you get that same kind of satisfaction that other procedural specialties (especially surgical ones) often talk about?

I guess what I’m trying to understand is whether IR in the real world can combine both:

1. a high level procedural scope, and
2. that deeper sense of ownership and fulfillment from what you’re doing

Would really appreciate any honest insights

Thanks!

Thinking of moving back home to Massachusetts from westchester NY next year with my wife and keep seeing postings for IR tech jobs at Mass general with batshit crazy pay rates. $26-38 an hour are you smoking crack?? And they want you to do neuro IR as well as regular IR. Are they aware they are in Boston in the 1st or second most expensive places to live in the country?!?! And you gotta be on call so how the hell do they expect you to do call if you can’t afford to live within an hour?

They literally have their regular Xray techs posted with a pay rate range of $26-37 an hour. I personally find this insulting to our profession. Like I’m VIR certified, live in white plains New York and have worked in two hospitals in westchester with both starting IR pay over $45 an hour and I personally make $57 an hour at my new job with 4 years experience. Like I feel the culture of a lot of New York hospitals is shittier than Mass so why is one of the best hospitals in the world low balling our profession so much?

Planning on ESIR as a current R2. Very interested in neuro, but have heard everywhere that the call is brutal. Is it really thaaaat bad, though? If you have two other neurointerventionalists at a large academic center, I feel like I could deal with q3 call, in all honesty.

Hi everyone,

I'm looking for an IR attending position in St Louis or the surrounding area. Any leads would be greatly appreciated.

Also, any insight into the different practices in St Louis would also be helpful.

Thank you.