Since its genesis in the ‘60 s when the first cases of trans-luminal angioplasty were reported [1], interventional radiology (IR) has considerably developed, with a growing number and variety of image-guided procedures. Nowadays, IR covers minimally invasive interventions in nearly every organ, and such rapid flourishing has even resulted in the birth of three further IR sub-specialties, namely neuro-IR, interventional oncology (IO), and vascular IR (VIR). This means that as interventionalists we are succeeding in rapidly structuring our clinical involvement in patients’ care. This is also witnessed by our increasing commitment in establishing IR outpatients’ clinics (IROC) allowing consultations before and after IR treatments [2]. Moreover, with many of our procedures being lifesaving, it is evident that IR will become unavoidable in nearly every hospital. And the good news is that our clinical future continues to look bright if one considers the environment toward which medicine is evolving to, and which is mainly characterized by the huge need for minimally invasive procedures granting very short in-hospital stays. Therefore, all the stars seem to be aligned for a bright future of our specialty. Nevertheless, we are still facing some old and well-known challenges that may delay or even impede the development that IR deserves. These challenges are multiple, and their declination and impact largely vary according to the local playground. To us, the main defies are: (i) the lack in several countries of a well-structured education pathway allowing radiologists being trained in IR to be well-recognized, and subsequently well-equipped for their work; (ii) the persistence of a slow, reduced, and gender-unbalanced IR recruitment due to terrific under-representation of IR lectures in many undergraduate medical cursus; (iii) the lack in many areas of IR-tailored reimbursement for our treatments mainly due to specialty invisibility to regulatory authorities, as well as due to lack of robust data derived from prospective (ideally randomized!) trials; (iv) the lack in many areas of direct patients’ referral to IR due to lack of specialty visibility to non-IR physicians and patients.

Solutions to these issues are undoubtedly complex, especially if one considers that many of these issues can be regulated only at a national level following the adoption of specific policies by national governments. Nevertheless, we believe that common views and actions shared among interventionalists across Europe and beyond may drive and favor drastic changes. For instance, the adoption of the European Board of Interventional Radiology (EBIR) examination, which reflects the perspective of the European Curriculum and Syllabus for Interventional Radiology [3], as an official tool for interventionalists to be accreditated at the end of their residency/fellowship, may dramatically increase the visibility of our specialty at several different levels, and may, therefore, contribute to facilitate national IR-dedicated education pathways and interventionalists’ recruitment, promote direct patients’ referral, as well as the introduction of IR-tailored reimbursements. Furthermore, this would increase IR awareness among medical students, which is still very low [4], and increase and ameliorate the interventionalists’ recruitment. Moreover, promoting national and international prospective, multi-centric studies could definitively contribute in building-up robust evidence supporting IR treatments, which in turn could facilitate the introduction of IR-tailored reimbursements. In this perspective, the « Next Research» platform recently established by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and the adoption of high-quality practices assessed through dedicated labels (i.e., International Accreditation System for Interventional Oncology Services—IASIOS), may for sure play a crucial role in the upcoming years.

In conclusion, since its origins in the ‘60 s, IR has done a lot; nevertheless, many issues still deserve our utmost attention since they are crucial in determining the evolution of our specialty. We believe that adoption of common “cross-border” views and actions could definitively help interventionalists in overcoming all the aforementioned challenges, thus favoring IR allocation to the bright place it deserves in the medical scenario of the next decades.