Beyond Turf Wars: Redefining Boundaries and Building Consensus in Interventional Radiology

Abstract Interventional radiology (IR) has evolved from diagnostic angiography to a core therapeutic specialty addressing acute ischemic stroke, peripheral arterial disease, hepatobiliary obstruction, and cancer care. This expansion has blurred professional boundaries, leading to “turf wars” with diagnostic radiology, neurology, neurosurgery, vascular surgery, cardiology, and oncology. While many practitioners avoid discussing turf openly due to its controversial nature, a scientific approach reveals both challenges and constructive outcomes. Using a Delphi-style framework of consensus, disputes can be reframed as opportunities for growth. A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Databases searched included PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and DOAJ (2000–2025). Search terms combined “interventional radiology” with “turf wars,” “scope of practice,” “referral,” “outcomes,” “training,” and “policy.” Eligible studies included comparative outcomes analyses, registries, society guidelines, and policy reports. Data were synthesized narratively, emphasizing referral dynamics, outcomes parity, training, and society/policy roles. Seventy-three studies, including registry analyses, comparative cohorts, and society guidelines, were included. Five themes emerged: (1) Neurointervention—stroke thrombectomy outcomes are equivalent across IR, neurosurgery, and neurology when training is standardized, yet activation pathways remain contested. (2) Peripheral vascular intervention—IR procedures reduce complications and cost relative to surgery, although vascular surgeons often control referrals. (3) Interventional oncology/hepatobiliary IR—tumor boards with IR representation significantly increase ablation and TACE/TARE (transarterial chemoembolization/transarterial radioembolization utilization), but surgical colleagues often dominate early decision-making. (4) Intra-radiology dynamics—debates persist between IR and diagnostic radiology, and between neuro-IR and peripheral IR, reinforcing the importance of imaging literacy. (5) Society/policy roles—credentialing, coding, and advocacy (Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Radiology, Indian Society of Vascular and Interventional Radiology) remain pivotal to IR's recognition. Turf wars in IR are less markers of dysfunction than signs of maturation. When framed symmetrically—acknowledging the concerns of IR and surgical/clinical colleagues—they catalyze positive effects: protocolization, registry development, training harmonization, and policy traction. IR's future rests not on defending turf but on demonstrating measurable outcomes, building consensus, and delivering patient-centered care.