The Society of Interventional Radiology (SIR) and the Society of Interventional Radiology Foundation (SIR Foundation) are committed to improving patient outcomes through image-guided therapy.  To limit the potential for bias in governance, operations and programs, SIR and SIR Foundation abide by a strict conflict of interest disclosure, review, and management policy. The principles governing conflict of interest and definitions are excerpted below to assist with completing the disclosure form.

PRINCIPLES OF CONFLICT OF INTEREST

The disclosures will pertain to the Volunteer Leader’s (and those of the Volunteer Leader’s immediate family members and/or business associates) relationships and activities for the past 36 months which relate to the practice of interventional radiology.  Annual disclosure statements must be signed and submitted to the Conflict of Interest Committee.  While SIR and SIR Foundation strive to engage leaders who are free from financial and/or intellectual conflict, the inclusion of experts in the field who have relationships that are deemed to be manageable will permit the inclusion of leading scientists and clinicians.

DEFINITIONS

Conflict of Interest: Any relationship or other known set of circumstances that has the potential to influence or might reasonably be perceived by others as influencing the member to act contrary to the interests of the Society or the Foundation and for the member’s own personal benefit or for the benefit of an immediate family member or business associate.  For the purposes of this policy: “an immediate family member” is defined as a member’s spouse, domestic or life partner, children, and parents; and a “business associate” is defined as any professional business partner.

• Financial COI:  Any relationship for which one receives remuneration or in-kind benefits that could be perceived to bias one’s judgement in the evaluation of specific recommendations.
• Intellectual COI:  Any activity that creates the potential for attachment to a specific predetermined point of view that could be perceived to affect one’s judgement, conduct or other actions in the evaluation of specific recommendations or suggestions.

Significant Financial Interest: According to the US Food and Drug Administration’s (FDA) Financial Disclosure by Clinical Investigators (21CFR 54) regarding interests requiring disclosure, a significant financial interest means a financial interest consisting of one or more of the following interests of the volunteer leader (and those of the volunteer leader’s immediate family member and/or business associate) that reasonably appear to be related to the volunteer leader’s responsibilities on behalf of SIR and SIR Foundation:

• With regard to any publicly traded entity, a significant financial interest exists if the value of any remuneration received from the entity in the twelve months preceding the disclosure and value of any equity interest in the entity as of the date of disclosure, when aggregated, exceeds $5,000.  For the purposes of this policy, remuneration includes salary and any payment for services not otherwise identified as salary (e.g. consulting fees, honoraria, paid authorship, reimbursed or sponsored travel); equity interest includes any stock, stock options, or other ownership interest, as determined through reference to public prices or other reasonable measures of fair market value; or
  
  
• With regard to any non-publicly traded entity, a significant financial interest exists if the value of any remuneration received from the entity in the twelve months preceding the disclosure, when aggregated, exceeds $5,000, or when the volunteer leader (or the volunteer leader’s immediate family member and/or business associate) holds any equity interest (e.g. stock, stock option, or other ownership interest); or
  
  
• Intellectual property rights and interests (e.g. patents, copyrights), upon receipt of income related to such rights and interests

• Remuneration (e.g. travel reimbursement) paid by SIR and SIR Foundation to the volunteer leader for activities conducted on behalf of SIR/SIR Foundation
• Income from investment vehicles, such as mutual funds and retirement accounts, as long as the volunteer leader does not directly control the investment decisions made in these vehicles
• Income, reimbursement, or sponsored travel from seminars, lectures, or teaching engagements sponsored by a Federal, state, or local government agencies, an institution of higher education, an academic teaching hospital, a medical center, or a research institute that is affiliated with an institution of higher education
• Income, reimbursement, or sponsored travel from service on advisory committees or review panels for a Federal, state, or local government agencies, an institution of higher education, an academic teaching hospital, a medical center, or a research institution that is affiliated with an institution of higher education

I hereby acknowledge that, as a volunteer leader or senior administrative employee of the Society of Interventional Radiology (SIR) or the SIR Foundation: 

• I occupy a position of trust and that I am expected to place the interests of the SIR/SIR Foundation first while performing the duties and responsibilities of my volunteer role
• I will avoid situations in which my personal and outside interests, whether perceived or actual, conflict with my responsibilities as a SIR/SIR Foundation volunteer

FINANCIAL CONFLICT OF INTEREST DISCLOSURE

Publicly Traded Entity: Income and Equity Interests - Have you or your immediate family member or business partner received income or payment for services (direct financial relationship) in the past 36 months or own equity interest in any publicly traded entity related to interventional radiology? This does not include interest in index funds, mutual funds or retirement funds in which you do not directly control investment decisions.

Examples:

•  Full-time/part-time employment arrangement with a for profit commercial entity that manufactures or sells products related to Interventional Radiology Practice
• Participation in a data-safety monitoring board or independent core imaging interpretation group
• Advisor/consultant to industry on study design, education, or focus group
• Consultant, advisory board member, owner, or spokesperson for pharmaceutical or medical device equipment companies. 
• Investments (e.g. stock holdings, stock options, warrants, shares, bonds, or any other form of direct investment; not as part of a mutual fund) in pharmaceutical companies, medical device companies or any other commercial entities  that manufacture or sell products related to interventional radiology practice.

Research

INTELLECTUAL CONFLICT OF INTEREST DISCLOSURE

1. Boards/Officer of Public or Academic Organizations, Professional Medical Society, or Government Affiliation.

Examples:

• Consultant, FDA or National Institutes of Health.
• Service as board member or officer of a competing organization with which SIR would compete for members, annual meeting attendance, or products.
• Service as board member or officer for another society provided that it is NOT an organization with which SIR would compete for members, annual meeting attendance, or products.
• Service as chair of a committee or chair of any major projects (such as guidelines or consensus statements) of a competing organization with which SIR would compete for members, annual meeting attendance, or products.
• Service as chair of a committee or chair of any major projects (such as guidelines or consensus statements) for another society provided that it is NOT an organization with which SIR would compete for members, annual meeting attendance, or products.
• Activities as a member of any committee of a competing organization with which SIR would compete for members, annual meeting attendance, or products.
• Activities as a member (*no leadership role) of any committee of another society provided that it is NOT an organization with which SIR would compete for members, annual meeting attendance, or products.

2.      Authorship and Publications.

3.      Public Statements.

I acknowledge I have reviewed the conflict of interest policy of the SIR and SIR Foundation.  I certify that this is a complete disclosure of all my significant financial and professional interests related to my SIR and SIR Foundation volunteer responsibilities. I also acknowledge that by signing my name below that it is my responsibility to disclose to the COI Committee, within 30 days, any new significant financial or professional interests obtained during my volunteer term.