The Rise of Interventional Radiology

As the child of two surgeons growing up in a loving family in Nagpur, India, Shantanu Warhadpande’s earliest memories are happy. In his family home were his older brother, his parents, his paternal grandparents, his uncle, his aunt, and a cousin. There was always someone around to play with.

But one night in 1992, the toddler awoke to the sound of crying. He found his mother and aunt in the living room, who told him his father, uncle, and grandparents had all been killed by a drunk driver on their way home from the airport.

That family tragedy set events in motion that would eventually bring Warhadpande to Michigan Medicine as the practitioner of a highly advanced but still relatively obscure branch of medicine: interventional radiology (IR).

Radiologists began using catheters to perform procedures in the 1960s, and IR became a practice at Michigan Medicine in the 1970s. But it didn’t spin off as its own medical specialty until 2012, and the cohort of IR residents who graduated from the U-M Medical School in 2018 were among the first in the country.

Warhadpande, a 2016 Ohio State medical school grad, did his own IR residency at the University of Pittsburgh—where he found time to coauthor what has become the top-selling IR textbook—followed by a diagnostic radiology fellowship at the Medical College of Wisconsin.

Warhadpande was one of many qualified applicants for a spot on Michigan Medicine’s IR team last year, but he came with a wholehearted recommendation from a physician he and U-M’s radiology chair Vikas Gulani both trained under. She told Gulani that the young physician is “one of the best” and urged, “If you can get him, get him.” 

Gulani took note of his normally reserved colleague’s words. Warhadpande joined the radiology faculty in 2022.

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Interventional radiologists use imaging methods like CT scans, MRI scans, and ultrasound to guide biopsies and diagnose problems. But they also use procedures that are more like surgery, in that they are changing things in the body. 

Doctors who choose such a highly specialized path “always have a story,” Warhadpande says, and “it’s always something personal. I’m no different. My passion for IR got started with my mom … with IR kind of swooping in and saving her.” 

In 2004, when Meenal Patwardhan was a researcher at Duke University’s School of Medicine, she started coughing up blood and collapsed. Doctors at Duke University Hospital discovered a ruptured blood vessel in her lungs.

The typical treatment would have been surgery to remove a portion of her lung. But as luck would have it, the hospital had an interventional radiology division that offered an alternative.

Warhadpande recalls the conversation with radiologist Mike Miller at his mother’s bedside in the ICU. A tall, dapper young doctor who exuded confidence, Miller described how he could use imaging guidance to navigate tiny wires and catheters through the artery in the groin all the way up to the lungs and cauterize the ruptured vessel, stopping the bleeding at the source.

The fifteen-year-old was extremely impressed. While IR’s terms and concepts were completely new to the family, he says, they felt it “checked off all the boxes” and decided to proceed.

With his stepfather traveling for work and his brother Devdutta away at college, Warhadpande was his mother’s primary caregiver. “It was just Shantanu and me,” recalls Patwardhan, now a vice president at drugmaker AbbVie. “He nursed me back to health.” 

One of Patwardhan’s research areas is patient experience, and she was struck by the many advantages of IR for her condition. Surgery would have required weeks of recovery time in the hospital, while IR allowed her to recover mostly at home and return to work within a month. “From a patient’s perspective,” she says, “the choice is obvious.” 

Patwardhan says she wanted Shantanu to go into medicine “because I thought he’d be good for his patients … He is a person who cares so much. I saw that care in him very early.” 

When he was considering going into IR, she told him that while it would not offer the “wow” factor of being a surgeon, “what is more challenging is taking an emerging branch of medicine because it’s better for the patients.”

His decision was reinforced during his fellowship in Wisconsin, when his stepfather underwent a life-changing IR procedure of his own.

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In India, his parents owned a private surgery center. Patwardhan had to leave to take care of patients the night of the devastating car accident, as she did many nights over the next several years to support her children, her sister-in-law, and her niece.

Those were dark times for the family. Patwardhan could see that her boys desperately needed a father, and so she came to a decision that was against the social mores of the time: She would remarry. “My mom met my stepdad, who is phenomenal,” says Warhadpande. “The only big wrinkle being that he lived in the U.S. So we moved here in ’97.” 

Warhadpande was eight and Devdutta was thirteen when they moved to Mishawaka, Indiana, a sleepy rural town where they were the only people of color in their school. “We were a couple of short, brown, scrawny kids,” he says. “That was a tough age to move to a new country.” 

Fitting in was made more difficult because the family moved frequently in the years that followed. He was forced to overcome cultural differences and make friends quickly in one small, mostly white town after another.

“My mom wanted me to be fully socially integrated,” he recalls. “And, frankly, as a physician, that helps me—that is how you connect with your patients. I want them to be able to know that I get where they’re coming from.” 

Because he can see patients in the hospital for only a few minutes at a time, he gives them all his cell phone number. “My wife hates it,” he says, but “they need to know that I’m there for them.”

Warhadpande admits that getting through medical school was a slog, in part because the material for his IR classes was “incredibly difficult to read.” He wanted a book that was written to his level, and because none existed, he coauthored it.

Going into a new specialty is a double-edged sword, he says. “On one end, you have this new and exciting field that is pushing the envelope in medicine.” On the other, people may shy away because they don’t understand it. “It’s a fun struggle,” he says. “This is why I went into IR—to tackle these problems.” This sense of responsibility inspired him to join the faculty at Michigan Medicine.

IR has evolved from accessing the body through the blood vessels, called vascular IR, to directly accessing organs (visceral IR) and the brain (neuro IR). Incisions are less than half an inch in diameter, and equipment includes wires, catheters, stents, and needles. Most procedures are outpatient.

“I think we don’t do a very good job in marketing what we do,” says Diana Gomez-Hassan, vice chair of radiology and chief of operations. “Students applying to medical school think of radiologists as sitting in a dark X-ray room all the time and don’t realize how much patient care they do and how collaborative the work really is.” 

Part of the barrier to understanding may be the nomenclature. “When I say the words ‘interventional radiology’ to someone, it evokes no mental image of what that specialty is,” says Warhadpande.

Gomez-Hassan agrees that “the naming is confusing. It doesn’t always require radiation … It’s not always an X ray. We do intervene, but it’s much less invasive than a surgical procedure. Even within medicine, people don’t fully understand what we do.” 

Warhadpande describes a “hesitancy from other specialties” due in part to a paucity of published data on IR’s impact. He stresses the importance of “having that closer communication with other specialists, some of whom may not know what it is that you do.”

IR can perform many procedures that might otherwise require surgery, like washing out infection, removing fibroids, treating tumors, or performing embolizations. One key difference is that the radiologists see into their patients using guided imagery produced by X rays, called fluoroscopy, as well as ultrasound and CT scanning. Most surgery, including minimally invasive techniques using small incisions and robotic arms to access the body, require doctors to see with their eyes and with tiny cameras called laparoscopes.

“For the most part, it’s not an either-or” between surgery and IR, Gomez-Hassan says. “It’s actually both. They’re complementary.” For example, a diseased organ can only be removed surgically, but treating damaged blood vessels with IR prior to surgery can improve its chances of success. In other cases, “The guarantee of curing may be better surgically, but there are times where it may not be safe enough to do it surgically that [the patients] need IR,” she says.

Gomez-Hassan is amazed by the innovations in IR since she trained as a radiologist in the 1990s. “I firmly believe that IR contributes to helping reduce costs and length of stay. Every patient’s care is different, and choice of intervention is up to the team. IR has contributed greatly to facilitate care.” Fewer people are needed to perform IR, and reduced hospital stays represent huge savings.

But IR is not saving money everywhere—the equipment is exceedingly expensive and requires continual upgrades. Michigan Medicine has eight procedure rooms, and the newest cost $8 million to build.

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Reaching it reminds me a little of an IR procedure: Helpful staff lead the way through a long series of slim hallways deep into the entrails of the hospital. We emerge into a blindingly white room equipped with streamlined equipment. A large, jointed fluoroscopy arm bends down from the ceiling; there’s a nine-by-three-foot tube for performing CT scans and several enormous monitors.

The futuristic-looking suite is separated by a glass wall from a control room attended by a half dozen technologists, nurses, and PAs who assist procedures remotely. The suite looks as if it could just as easily be used for teleportation as for anything medical. Part of IR’s appeal for Warhadpande as an adolescent was its resemblance to a video game.

Being on the frontier of a fast-moving field that uses state-of-the-art technology to save lives is thrilling, but the life of an IR doctor in training is ripe for burnout. Warhadpande is relieved to be out of school and performing procedures, teaching, and doing research.

His wife Callie Drohan, a pulmonology critical care doctor, also found a place at Michigan Medicine. But falling in love with Ann Arbor was a joy the couple did not anticipate. Warhadpande has lived in twelve different places in the U.S., and says that being in Ann Arbor “is the happiest I’ve been.” 

Warhadpande was impressed by the city’s diversity, including the number of interracial couples. “My wife is white. And we definitely have lived in a lot of places that were predominantly white. So I’m acutely aware of this—I don’t know how else to describe it—wanting to feel ‘not-different’ … [not having to wonder,] ‘What are people looking at me and thinking?’”

He and Drohan told themselves they’d rent for a couple of years before deciding if they wanted to remain in Ann Arbor. Within six months, they had bought a house for themselves on the north side and picked one out for Warhadpande’s parents in the same neighborhood. He says they’re looking forward to getting more involved in the community once they have kids; they are expecting a baby in the spring.

His mom says the decision to move to Ann Arbor with her husband was easy. “I love Ann Arbor,” Patwardhan says. “Ann Arbor is a place where you could be anybody.” Regardless of culture, ethnicity, or gender, “you’d be fine because people look at you like a human being, not as a label for a human being. Nobody will ever say that, but you just feel it.”

“My family story is the immigrant story,” says Warhadpande. “I have vivid memories of India. So the notion that we should be curtailing immigration is to me sad, because as an immigrant, when you’re given an opportunity by an entity or a group or a country, you want to give back, and you want to work harder for those communities. But that can only happen if you are welcomed into that.” He feels tremendous gratitude to Michigan Medicine for giving him and his wife a chance.

The gratitude is mutual. Gulani, the radiology chair, loves the creativity and excitement of young doctors like Warhadpande because “they are going to invent new procedures that they can do,” adding to the armament of medicine.

At a meeting last year, Gulani ran into the physician who’d urged him to hire Warhadpande. “And I was like, ‘You were spot on,’” he told her. “‘He’s just doing great.’

“She had tears in her eyes.”