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In conversation with interventional radiologist Professor Robert Morgan

Professor Robert Morgan has been at the forefront of interventional radiology for more than 30 years. He caught up with Helen Gilbert to reflect on key moments that have shaped his career as an interventional radiologist, his future plans and his hopes for the profession.

It has been 30 years since Professor Robert Morgan chose to pursue a career in interventional radiology (IR) and the clinical director of St George’s Hospital’s internationally renowned IR department certainly has no plans to slow down yet.

Over the past few months, the vascular specialist has co-authored and published a high-profile report into radiology services, been appointed president of the British Society of Interventional Radiology (BSIR) and awarded the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) Gold Medal for his ‘outstanding contribution’ to the practice and science of IR worldwide.

Not to mention the day job where he and his 25-strong team perform a myriad of minimally invasive vascular and non-vascular imaging procedures from angioplasty and stenting to embolisation.

This is just a tiny glimpse into the professional life of the Swansea-born consultant whose desire to study medicine was partly ignited by his mother, who worked as a midwifery sister, as well as with the family GP.

However, the IR flame only sparked when Professor Morgan began working as a junior doctor after graduating from medical school in 1983.

‘I enjoyed going to radiology departments and seeing how interventional radiologists worked,’ he explains.

‘I was very impressed with the atmosphere and thought that this looks like a cool thing to do.’

The IR training trajectory

Back then IR – sometimes referred to as image guided surgery – was in its infancy, yet Professor Morgan was captivated by it.

He completed his radiology training in Plymouth and St George’s Hospitals, obtaining his Membership of the Royal Colleges of Physicians (MRCP) and Fellowship of the Royal College of Radiologists diplomas in 1988 and 1991 respectively, before penning his first peer-reviewed radiology paper ‘Pancreatic and renal mobility’ in 1992.

There followed a stint at the University of Texas in 1993, where the vascular disease specialist learned his skills in IR, before returning to the UK as a lecturer in IR at Guy’s and St Thomas’ Hospitals.

He joined St Mary’s Imperial NHS Trust in 1996 as a renal and interventional radiology consultant before returning to St George’s in 1999 as a consultant in interventional radiology and the rest – as they say – is history.

Beyond the hospital

To date, Professor Morgan has authored 201 peer-reviewed papers, written 47 book chapters, edited five books and delivered more than 330 guest lectures on topics such as the treatment of endoleaks and the management of multiple pathological conditions by embolisation.

In 2010, he played an instrumental role in creating the European Board of Interventional Radiology exam, which evaluates interventional radiologists on their clinical and technical knowledge worldwide.

‘I was asked to set the examination up by the president of CIRSE at the time,’ he explains. ‘Since 2010, the exam has matured and expanded to be open to interventional radiologists anywhere in the world. It can be taken digitally and in more than one language.’

During his time as CIRSE president between 2017 and 2019, Professor Morgan was also instrumental in establishing the European Conference on Embolotherapy – an annual congress that brings together interventional radiologists from across the globe to discuss the most recent data on embolotherapy and review the latest devices and materials.

Professor Morgan’s passion for research, analysing and sharing information to educate and inspire colleagues is evident at St George’s, too, where he leads an Imaging Research Group, something he admits that he is ‘very proud of’.

‘This was set up a couple of years ago and involves all disciplines – radiologists, radiographers, nurses and physicists. We have meetings twice a year where people come and present their work and they seem to be very popular,’ he says.

‘Some topics presented at the recent meeting included trialing an abbreviated MRCP protocol for gallstones and quasi-diffusion MRI for the imaging of traumatic brain injuries.’

Establishing an imaging network

Professor Morgan is also imaging lead of the South West London Integrated Care System and is working to join up imaging services between the five trusts in the area: St George’s University Hospitals NHS Foundation Trust, Kingston Hospital NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, Croydon Health Services NHS Trust and the Royal Marsden NHS Trust.

The imaging network project began in 2020 and Professor Morgan estimates that they are halfway to the stage of maturation of an imaging network, which is expected to occur by March 2025.

The aim of this network is to increase efficiency and to give patients quicker access to diagnostic facilities.

Some of the key features of an imaging network will be the ability to view each trust’s images without having to physically transfer them, and to share scanning and reporting workloads. ‘For example, if there is a backlog of reporting in one trust and people available to report in another trust, then you may be able to actually enlist people in the second trust to tackle the backlog in the first trust,’ Professor Morgan explains.

‘Similarly, if there is a scanning capacity issue at one or more trusts, this can be shared with the other trusts who will be able to address some of the backlog by scanning patients from the trusts with the backlog.’

Another bonus, he says, is shared employment as ‘people may be able to move from one trust to another without having to get separate contracts.

This allows for ‘increased accuracy in demand and capacity modelling so that you can assess the demand of the whole sector and try and increase your capacity to meet that demand’, explains Professor Morgan. ‘There are all sorts of things that you can do better in theory as a group than you can as individual trusts.’

Recruitment and retention

As with all specialties in the NHS, Professor Morgan admits that there is a nationwide shortage of interventional radiologists due to a range of factors.

‘We have increased demand in all hospitals, we do not have enough IRs to cope with the demand and people seem to be retiring earlier from the specialty than they did 10 years ago. I think that this has a lot to do with burnout and excess work due to excess demand so it is a little bit of a catch 22 situation.’

Indeed, some of these findings were highlighted in the ‘Provision of Interventional Radiology Services 2023’ report, which was co-authored by Professor Morgan and published in November 2023.

It showed that in 2022, 39 whole time equivalent consultants left the IR workforce, compared with 19 consultants in 2021. The mean age of departing consultants was also shown to have reduced over a five-year period from 55 years in 2018 to 44 years in 2022.

So, what is the solution?

‘There has been great progress made in the last few years by the Royal College of Radiologists (RCR) to make it easier for people to go into IR by having what we call run-through training,’ Professor Morgan explains.

This means that instead of going into radiology training in year one and then starting IR training at year four, run-through IR training can be entered from the start.

‘This is now in its third year, and it seems to be going well, although more needs to be done to highlight the availability of this, both to radiologists and heads of schools who are in charge of allocating posts, and also to potential applicants who may not know about the existence of this stream,’ he says.

IR as a speciality or faculty

Ultimately, increased promotion of this training route will be key to bolstering the IR workforce for the future.

Another factor that could support this is the reassessment of IR being a subspeciality of radiology under the RCR.

Indeed, the Provision of Interventional Radiology Services 2023 report found drawbacks with this current demarcation, stating: ‘A change of this model to an interventional radiology speciality or a separate IR faculty within the RCR would provide substantial benefits for interventional radiology, not least by establishing the autonomy to increase the IR workforce to meet the demands of patients.’

Professor Morgan wholeheartedly agrees with this statement, saying: ‘I think that a faculty for the IRs would be very beneficial for interventional radiology in the UK in general.’

And particularly, as he points out, IR as a speciality ‘does not really have control over its workforce or training numbers’ because of this existing design.

‘We do not know how many people we have doing IR. If we were a faculty or speciality, we would know because you would have to sign up to become an IR member of a faculty or speciality.’

It will be a case of watching this space as Professor Morgan supports this agenda going forwards.

As part of his new role as president of the BSIR – a two-year position he commenced in November 2023 – Professor Morgan will be responsible for representing interventional radiologists in the UK before other clinical bodies including the Royal College of Surgeons and the Vascular Society.

The possibilities are endless.

Latest developments and future priorities

Professor Morgan’s dedication to the profession over the past three decades has not gone unnoticed.

In October, he received the highest honour an interventional radiologist can achieve in Europe when he was awarded the CIRSE Gold Medal.

The equivalent of a lifetime achievement award, this marked his outstanding contribution to the practice and science of IR worldwide, and he says ‘it is a great privilege to be awarded it’.

With that accolade under his belt, cementing the role of research and academia in college policy, and promoting research and academic careers for radiologists in the UK, will be a key focus of his going forwards.

And much of that is likely to be connected to the subject of artificial intelligence (AI).

Professor Morgan is encouraged by emerging technology such as AI, which although in its early stages, has already made ‘great steps’ with diagnostic radiology, he says.

Although Professor Morgan expects ‘similar progress’ to be made with AI in interventional radiology, he believes that robots could play a greater role.

The ‘full potential’ of robotics has yet to be explored ‘because the technology is quite expensive’, he says, but with new innovations constantly evolving, the possibilities are endless.

It is a whole new world from 1993 when Professor Morgan first dipped his toe into the world of interventional radiology, and many of the developments over the years have seen his valuable involvement or support.

As one of the most innovative and fastest-growing specialities in the field of medicine, there will be much more to come, and it will certainly be a promising and fascinating area to watch and be part of.