Interventional radiology (IR) is a subspecialty of diagnostic radiology that uses image-guided radiological techniques to perform minimally invasive procedures that substitute some major open surgical procedures. Furthermore, an interventional radiologist uses needles, fine catheter tubes and wires to reach the target area. Benefits of interventional radiology can range from shorter hospital stays, faster return to work and reduced risks. ^{1 , 2} With the development of medicine in recent years, IR became involved with multiple systems in regard to the diagnosis and treatments such as angioplasty, drainage, embolization, stent insertion and ablation treatment of thrombus. ^{3 – 5} However, there is an overlap between other specialties for procedures and IR. This may lead to an unclear perception among medical students about the tasks of an interventional radiologist. ⁶ There are a few studies that evaluate medical students' knowledge of IR in the literature. Particularly, there is no research that has been published in the eastern part of Saudi Arabia. As a result, our goal is to assess how well-aware medical interns and medical students enrolled in clinical years at KFU in Al-Hasa region are of the value and necessity of IR.

Medical interns and clinical-year medical students at KFU in the province of Al-Hasa participated in this cross-sectional study conducted in eight months between 24/01/2021 to 09/09/2021. This study included 246 participants in all. An online survey that was delivered to the target demographic contained a self-administered questionnaire. ⁷ The only participants in this study at KFU were clinical medical students and interns. Incomplete surveys, KFU preclinical medical students, medical students from other universities, and the general population were disqualified. Microsoft Excel was used to tabulate and arrange the data in a neat and straightforward manner (Microsoft Corporation, Redmond, WA).

A total of 246 participants fulfilled our study inclusion criteria and completed the study questionnaire. A total of 134 (54.5%) students were males. As for students’ clinical grade, 135 (54.9%) were in their fourth year, 85 (34.6%) were in their fifth year, and 26 (10.6%) were interns. Around 115 (46.7%) students think their knowledge regarding interventional radiology is poor as compared to other subjects, while 110 (44.7%) think that they had adequate to excellent knowledge. Furthermore, 67 (27.2%) students said they had taken or planned to finish a radiology elective rotation. Only 62 (25.2%) of the students said they would contemplate diagnostic radiology as a job in terms of their future plans. For those who would not consider the specialty, the most reported causes were lack of information regarding the specialty 75 (40.3%), followed by being not an interesting specialty 72 (38.7%), unsuitable lifestyle 26 (14%), and fear of radiation exposure 13 (7%). Around 50 (20.3%) students reported that they had seen patients who were managed by an interventional radiologist ( Table 1).

This survey found that exactly 91 (37%) participants at KFU in the Al-Hasa region were aware of interventional radiology and understood that interventional radiologists should complete their training in the radiology specialty. A total of 114 (46.3%) participants believe interventional radiologists have separate outpatient clinics, while 130 (52.8%) believe they attend ward rounds in hospitals. However, 112 (45.5%) of the students believe that interventional radiologists shouldn't be allowed to admit patients to hospitals. A total of 209 (85%) students agree that interventional radiologists treat people with major diseases while only 101 (41.1%) think that they treat minor illnesses as well. Only 40 (16.3%) presumed interventional radiologists don’t treat patients at all. Regarding procedures that can be done by interventional radiologist, 205 (83.3%) of the students correctly reported lower limb angioplasty and stenting, followed by 192 (78%) uterine artery embolization for fibroids, 173 (70.3%) venous access procedures, and 137 (55.7%) arteriovenous fistulas for dialysis ( Table 2).

On the other hand, all the data regarding the perception of medical intern and clinical-year medical students at KFU in Al-Hasa province for interventional radiology are mentioned in Table 3. Around 182 (74%) students were familiar with a procedure called angioplasty. The most reported source of knowledge for that procedure was from a vascular surgeon (59.9%), followed by cardiologist (59.3%), interventional radiologist (30.2%) while 6.6% reported - other - as the source of their knowledge. If a 2-week elective rotation in interventional radiology is made available during the internship's 3-month surgery rotation, a total of 146 students (59.3%) expressed interest in attending.

In relation to the information sources for interventional radiology, lectures were the most often cited information source 82 (33.3%), followed by radiology elective rotations 59 (24%), self-directed research 45 (18.3%), problem-based learning tutorials 36 (14.6%), ward rounds 30 (12.2%), meetings 24 (9.8%), and colleges 5 (2%). About 104 (42.3%) students mentioned that they had had no exposure to interventional radiology ( Figure 1).

Similarly, overall awareness level regarding IR amidst medical intern and clinical-year medical students at KFU in Al-Hasa province is shown in Figure 2. Around 118 (48%) students had good awareness level while 128 (52%) had poor awareness regarding interventional radiology.

Finally, all the data in relation to the distribution of medical students and interns’ awareness regarding interventional radiology by their personal data and perception are reported in Table 4. Amongst participants with a good level of IR awareness, 35 (56.5%) students consider a career in diagnostic radiology compared to 25 (37.3%) students who are not sure about that with detected statistical significance (P=0.048). Additionally, a good degree of perception was detected in 22 (84.6%) of medical interns in contrast to 51 (37.8%) of fourth year students and 45 (52.9%) of fifth year group with statistical significance (P=0.001). Also, 59 (64.6%) of the students and interns who consider a career in interventional radiology had high degree of awareness level regarding the specialty versus 97 (35.4%) of those who are not sure (P=0.009). When it came to the participating students who had a high level of awareness of IR, 96 (52.7%) were familiar with the procedure called ‘angioplasty’ compared to 22 (34.4%) who were not (P=0.011).

Recent studies have suggested that interventional radiology (IR) is a radiology sub-specialty with components for IR-based education that have not been included in the undergraduate medical curriculum. ⁸ Interventional specialties are expanding swiftly and are influencing various surgical and medical fields. ⁹ The rapid advancement in the field has encouraged the improvement of imaging modalities, which are now crucial in the diagnosis and treatment of various illnesses in a variety of unrelated disciplines. ¹⁰ This advancement has made it possible to develop a less intrusive therapy and offered interventional specialty practitioners in the fields of surgery and medicine access to new opportunities. ¹¹ The current study intended to evaluate the awareness of IR among medical intern and clinical-year medical students at KFU in Al-Hasa province.

The outcome indicated that almost half of the students (48%) had good awareness level regarding interventional radiology in total. In more detail, about one-third of the students understand that radiology training is necessary for becoming an interventional radiologist. In addition, more than half of the students (52.8%) think that interventional radiologists attend the hospital's wards but less than half (46.3%) believe that interventional radiologists have outpatient clinics. As for interventional radiologist role in treating patients, the vast majority of students (85%) think that interventional radiologists treat patients with major diseases but about 41.1% think that interventional radiologists attend to patients with minor diseases. Furthermore, only about 16.3% of students believed that interventional radiologists do not provide any patient care at all, and less than half of students (45.5%) believe that interventional radiologists should not admit patients to hospitals. Regarding procedures that can be done by an interventional radiologist, 83.3% of the students correctly reported lower limb angioplasty and stenting, followed by 78% uterine artery embolization for fibroids, 70.3% venous access procedures, and 55.7% arteriovenous fistulas for dialysis. This average level of awareness may be explained by many factors. First, about 42% of the students had no previous exposure to intervention radiology while only one-third of them (33.3%) had information from lectures. Second, only 27% of the students finished, or did plan to complete an elective rotation in radiology, which may play a role in providing them with information regarding the specialty. Third, only one-quarter of the students will consider diagnostic and interventional radiology for their future careers, which lessens their motive to know more about the specialty. Fourth, only one-fifth claimed to have observed patients who received care from an interventional radiologist. This clearly declares a vague picture regarding this new specialty.

Many studies found that medical students reported poor knowledge of IR as a result of suboptimal teaching and exposure levels. Agrawal D et al. ¹² reported that 60% of medical students knew very little or nothing about IR. Remarkably, 91.5% of students expressed interest in obtaining IR-based instruction as part of their undergraduate bachelor degree, which is significantly more than the amount assumed in the present study. In Canada, O'Malley L et al. ¹³ found that more than half of the participants (53%) had “poor” knowledge of IR and only 18% reported that they would contemplate a career in IR. Lack of understanding (48%) or lack of interest (43%) are the main factors keeping them from considering IR as a career, which is consistent with our study findings. Additionally, 74% of students reported that a compulsory 2-week radiology rotation throughout clerkship would be helpful, and 71% said that a 2-week elective IR rotation during their required core surgery rotation would be intriguing. In England, a higher awareness level among medical students has shown that 75.9% knew that interventional radiologists performed angioplasty and stenting of arteries as reported by Atiiga PA et al. ¹⁴ More than half (54.5%) thought cardiac procedures are done by IR. Also, 31.4% of the students knew IR procedures included the treatment of tumors. In Saudi Arabia, similar findings were reported by Alshumrani GA et al. ¹⁵ where 52% of final-year students had poor knowledge of IR. Only 40% of the participants either finished or are planning to complete an elective rotation in radiology. A career in IR was something that roughly 38% of students were willing to consider. The most frequent excuse given for not contemplating a career in IR was not having enough knowledge (43%). Only 33% correctly acknowledged the method of training of interventional radiologists. Another study in Riyadh ⁶ found that only 16 participants thought they understood IR well, whereas 83% said they knew very little. Half of the participants believe that interventional radiologists (IRs) must complete training in radiology. However, 42% believed that radiology and surgery were the correct paths of training for IRs. 71% and 73% of the final-year medical students correctly acknowledged that both uterine artery embolization and lower limb angioplasty are performed by IRs, respectively. There are many studies which confirm the lack of knowledge regarding IR among medical students and interns. ^{16 – 18} The scope of this study is limited by the sample size as well as its restriction to one university in one region and should preferably be applied to various universities in the kingdom or in a larger view the middle east to improve the policy regarding IR education in universities.

The current study found that final-year medical students and medical interns had relatively poor awareness and knowledge toward IR. There are several methods that can be used to address this problem, including early introduction of IR course into the curriculum, launching IR awareness campaigns, and IR symposiums. This will contribute to better understanding of this important medical specialty that is of great advantage to healthcare.

The 1975 Helsinki Declaration and its later amendments or comparable ethical standards were followed in all procedures involving human subjects, as well as the ethical requirements of the institutional and/or national research committee. King Faisal University granted the ethical endorsement (reference number: KFU-REC-2022-SEP–ETHICS171).

All participants in the study provided their informed permission.