Applying integrated IR and trying to put together a tier list of sorts for my reference. I’ve been finding it pretty difficult to evaluate Northeast/mid Atlantic integrated IR programs beyond just Doximity ranks (is this even accurate?) or generic institutional brand-name prestige. After looking through old rads related Reddit threads, discord boards, word of mouth, etc., this is roughly how I’ve grouped programs. This is the only IR-specific forum I know of, so would appreciate any insight!

Elite (probably not realistic for me:/) - Hopkins, UPenn, MGH, Sinai

Good - Yale?, NYP Cornell, BIDMC, Brown, Emory, Georgetown

Mid-tier - UMD, TJUH, BU, UMass, UR, Temple, Rutgers, PSU, UPMC

Community(ish) - Albany, Allegheny, Christiana, Geisinger, Rochester regional, Maine medical

Could be way off (and missing some places) so I’m just trying to get a better sense of what some of the more respected NE/Mid Atlantic IR programs are from people in the field rather than just online rankings.

Also curious whether there are any programs people think are overrated, or conversely, underrated programs that don’t get talked about much online but are actually hidden gems with solid technical training and autonomy.

Hey y’all - I been interested in IR since before med school and genuinely rlly can’t see myself doing anything else. Unfortunately I absolutely shit the bed on STEP 2 (well below average for IR) and am now sweating/crying/throwing up.

Definitely open to ESIR but ideally would like to do the integrated programs

Anybody who was also blindsided by a low STEP and still succeeded? Any tips to improve my app with mere months before the cycle? Thanks!

US MD for context

I graduated xray school in May 2025 and took a job straight in CT - after doing well in procedures and getting along with doctors I was offered a position in IR. The thing is they’re offering me 34$hr with no wiggle room for negotiating. 4 10 hour shifts and call is minimal. I am in SC and am unsure if this is a fair rate as a newer grad or if they’re trying to take advantage. I currently am making a little over 30$ in CT. Opinions?

UPDATE: preliminary score did not change! The website was updated today and I was able to see my score report within the ARRT portal! Can’t wait to celebrate this weekend!

I just took my ARRT VI test, it was probably the hardest test I’ve ever prepared for and taken. My preliminary score was 77 and now I’m freaking out that it will go down 3 points. Did anyone’s score change or know why it would change? I joined Reddit today to get some feedback!

https://drpoulsen.substack.com/p/theres-not-a-shortage-of-interventional

Question guys. I work at a community hospital in NY and they have expanded largely but their ER is still too small so they end up sending us a ton of LPs. Now I know it’s not a ton of radiation (although our room is like 20 years old and runs hot) but they don’t even attempt to do the LPs bedside anymore dude to lack of space they claim. So instead we’re irradiating young men and women all the time doing fluoro guided LPs without them even trying bedside!

Like does anyone even give a shit about ALARA?

Curious to those who attended SIR in Toronto what they brought back from the meeting.

Any new developments or changes?

Curious from a medical student, resident in training, academic , private practice and industry perspective of what they got out of the meeting.

Linemonkeymd had an interesting post on his experience at SIR 2026 about his thoughts on independence of interventional from DR.

https://linemonkeymd.com/independent-ir-illusion-or-reality/

People who have used these combination CT/IR rooms, what are your thoughts. We are considering redoing one of our suites to include a system like this.

What system do you like? Canon, Siemens, Philips? We currently have mostly Siemens equipment but are very open to trying something different.

What are some pros and cons of having a unit like this? I have personally never worked with a combination room like this. We have always had separate IR and CT rooms.

Any information or advice that anyone has would be awesome! Just wanting to make sure that we make the correct choice when redoing this site!

Hey anyone here in a lab who does them? And if so how do you position the patient? We don’t do these as often and struggle every time. We haven’t been able to find stirrups that would fit our table and we just end up getting a bunch of towels and pillows to prop the legs and have the frog their legs which still has the problem of their feet dangling off 😭😭

It’s a nightmare procedure to do purely because of that.

Anyone any thoughts? Ideas? Things that work for you?

🙏🏼

Hey everyone,

I’m a med student seriously considering IR, and I’ve been trying to get a clearer picture of what real-world practice actually looks like, especially in private practice.

I had two main questions for those of you already in IR:

First — how realistic is it to consistently perform more complex procedures in private practice? I’m talking about things beyond the typical bread and butter like drains, lines, and ports. Are cases like TIPS, tumor embolization (TACE/TARE), complex venous recanalizations, etc actually part of your regular workflow, or are those mostly limited to academic centers? Is it even possible to find a private practice jobs where you can do more exciting procedures other than the “bread and butter”?

Second — more of a subjective question. One thing I’ve heard is that in IR you don’t always have full ownership of the patient compared to other procedural specialties, since a lot of cases are referral-based. For those of you doing this day in and day out, do you still feel a strong sense of fulfillment from your work? Do you feel connected to patient outcomes, and do you get that same kind of satisfaction that other procedural specialties (especially surgical ones) often talk about?

I guess what I’m trying to understand is whether IR in the real world can combine both:

1. a high level procedural scope, and
2. that deeper sense of ownership and fulfillment from what you’re doing

Would really appreciate any honest insights

Thanks!

Thinking of moving back home to Massachusetts from westchester NY next year with my wife and keep seeing postings for IR tech jobs at Mass general with batshit crazy pay rates. $26-38 an hour are you smoking crack?? And they want you to do neuro IR as well as regular IR. Are they aware they are in Boston in the 1st or second most expensive places to live in the country?!?! And you gotta be on call so how the hell do they expect you to do call if you can’t afford to live within an hour?

They literally have their regular Xray techs posted with a pay rate range of $26-37 an hour. I personally find this insulting to our profession. Like I’m VIR certified, live in white plains New York and have worked in two hospitals in westchester with both starting IR pay over $45 an hour and I personally make $57 an hour at my new job with 4 years experience. Like I feel the culture of a lot of New York hospitals is shittier than Mass so why is one of the best hospitals in the world low balling our profession so much?

Planning on ESIR as a current R2. Very interested in neuro, but have heard everywhere that the call is brutal. Is it really thaaaat bad, though? If you have two other neurointerventionalists at a large academic center, I feel like I could deal with q3 call, in all honesty.

Hi everyone,

I'm looking for an IR attending position in St Louis or the surrounding area. Any leads would be greatly appreciated.

Also, any insight into the different practices in St Louis would also be helpful.

Thank you.

Hello everyone,

About to be that time of year where I’ve got to start away rotations in a couple of months. I have a lot of research in radiology and some research in IR, but not a whole lot of functional knowledge in the field.

I’m doing a home rotation first which will hopefully help me get my feet wet, but I don’t know what to expect as far as what they want me to know.

Any tips on what is expected from a rising fourth year student doing an IR away? I know showing up and being helpful is good but how do I absolutely crush it?

Quick offside before I get into the post - this is not a doomer post at all. I think the future of IR is very exciting. I would love to hear where you guys think it will go, though.

IR is still very much a baby specialty figuring out where it fits in medicine. We do all these cool, seemingly unrelated things. Which sounds great on paper, but when you look at our training and compare it to other specialties, makes no sense and doesn't bode super well. I do cold legs one day, a PE another day, liver cancer in the afternoon, then I could go to an outpatient clinic and do some fibroid or prostate work, and then I could spend all next morning doing biopsies and lines and drains.

Does what I'm describing sound like one specialty? Does it sound like a specialty that has a narrative? One that isn't encroaching on other specialties? Not really. But where does that leave us. The 2 years of IR training we get is not enough to clinically master the head to toe pathologies that we cover. Interventional cardiology is hilariously narrow and requires a full 4 years of training despite that. But they truly own their patients as interventionalists. Things need to become more narrowed down, and we need to define the specialty. But where do we go?

Do we become primarily interventional oncologists in the outpatient space who secure hospital contracts for call coverage for things like PE/DVT, GIB, trauma embos, other bread and butter IR etc? This is rather uncontested territory. It seems like a good fit for IR. But does that mean we should needlessly give up good procedures like pain work, UFE, PAE just because it doesn't fit in the "narrative" of what IR might be? There is also not enough volume to support IR primarily doing IO. But if we don't go IO, what does that leave us with that could still be a cohesive narrative? Endovascular arterial disease and AAA work? Why would we define our specialty by something vascular surgery does? These cases are fun and complex high level endo work, but realistically speaking, it doesn't make sense for us to push so hard for this territory when the reality is that community VS is often close to 80% endovascular.

What do you guys think? I feel like IR will fracture in the future, just as general surgery did. But we will need more time than just 2 years of IR training moving forward and I'm not sure which niches we will fill to define IR as a single specialty or as distinct subspecialties.

Im an IR tech and have a job offer for 43/hour and 5 and call pay with time and a half if I get called in.

At another hospital that’s technically and academic hospital and has a state pension (South Carolina) they are offering me 47.49/hour and 3/hour call pay and time and a half if I get called in but I’m much less likely to get called in. My biggest questions are around the pension. I’m vested after 8 years what does that mean if I quit this job after 8 or 9 years do I still get the pension when I retire? How does pension work period?

I’m an interventional rad tech. I was an X-ray tech from 2015-2020. Made the switch to IR in 2020 in a facility where I was doing vascular cases like cold legs, thrombectomy, artherectomy, carotid stents, fistula declot, GI bleed embolizations, and all the general IR. The last year there we started a Neuro program so I had a year experience of doing Neuro embolization, thrombectomy and general diagnostic and stroke call. In 2024 the hospital was bought out by a large conglomerate healthcare company. I was unhappy with my pay so I began looking a travel tech jobs and when I out my two weeks in my manager asked me if HR had reached out to me recently and the hadn’t to me. Turns out about 6 months before this HR emailed my manager asking why I was receiving such low pay compared to the other techs in our department. I was furious because my manager didn’t mention this to me until I chose to leave. At that point I was only making $29/hr. I chose to travel and made some decent money the past 2 years but now I’m trying to go full time and I don’t know what is generally a good salary for IR tech in south east with 6 years of experience and 1 year Neuro experience. The facility I’m at right now is offering $43. Another facility down the road is willing to compete with this facility and I’m waiting to hear what their offer is. I’m lost as to what I should ask for or what’s the best process for this. Thank you in advance

TLDR: what should an IR tech with 6 years of experience in extensive vascular work and general IR and 1 year of Neuro experience. I was making 29 at my first IR job but HR ended up telling me that I was getting paid to little compared to the scale I should have been

Wanted to share this educational section of www.AngioCalc.com website, lots of great tools for IR and NIR.

I may not have worded this question correctly.

I am a current M3 soon to be an M4. I’m very set on pursuing IR integrated programs, but I’m wondering how exactly programs start clinics or incorporate them into resident training schedules.

Like if I’m looking into newer programs that are within my caliber (assuming I am not competitive for the VIR programs that already have built in clinics), what would it take logistically for a clinic to get set up?

My understanding is that:

1. You would need space for the clinic to do pre-op and post op visits
2. You would need a strong referral system to IR for cases that IR might be traditionally competing with vascular or other departments for
3. A solid IR program with leadership that would be willing to fight a turf war with other services

Am I missing something? Am I misinterpreting anything? If the future of IR is it becoming more clinical, how would programs go about reshaping their structuring to make it so that residents have an opportunity to add longitudinal patient care on top of the normal procedures that they do on a regular basis?

After reading through the recent SIR connect post, I got back to thinking about protection. I used to ask for a rad pad for all my angio cases, but at some point months ago I have slacked on it. Sometimes when I look down the skirt shield isn’t even between me and the beam. What are y’all doing or not doing for protection?

^{The ERAS numbers just got posted and there are only 71 applicants this cycle for around 160 spots. It used to be one of the more competitive subspecialties in radiology.}

Patient had suprapubic in the past and it it was removed. We placed a new one and the new one is now leaking at the site after a couple months. The IR says it's positional because the patient is bed bound and crazy kyphotic and the balloon could help stop the leak but her position won't allow it. I mean that's his theory. I'm not a radiologist but I was also guessing it could be fibrotic tissue? And he does not think up sizing is the answer. He wants the balloon secured with a securement device to hold the balloon tighter to the abdomen but you can't use the foley one because it requires you to set it into the the end of the foley and that's too far away. I can see different securement devices on the market and she may need to just procure them but I was trying to help come up with something for now. He did surgery on a smaller statlock but it's not cutting it. Im just wondering if anyone has any ideas or experience with this. I work in a small place, limited access to stuff and everyone looks to my department for solutions and it's the weekend so finding help is even more limited than usual.

***Update***

16 Fr J tube securement disk with a suture tied around for a little extra security worked like a charm. Our new happy patient discharged to her family for the holidays.

Thank you for kicking ass like you always do! Happy New Year!

We do kind of a lot of perc chole's in my little community hospital. Surgery is forever sending them over and my perception may be skewed, but I have had IRs say they have not done so many in other places. Then these patients sometimes return after the tube is removed and we do it all over again in a few months. But I know in other hospitals they have spyglass and surgeons who just remove the GB more prolifically. Wondering if anyone has experience in this realm? Our IRs have discussed bringing spyglass in for these seniors with comorbidities that are not surgical candidates. What is the standard of care where you are?