CIRSE Fellowship report: Dr. Petr Vorel

By Dr. Petr Vorel

The idea of applying for a CIRSE Fellowship came to me during a particularly strenuous period at our interventional radiology department last year. Due to unforeseen circumstances, we were operating with only two consultants instead of the usual four — with me being one of the two. As a result, we were forced to focus exclusively on completing essential procedures, leaving little room for professional development or the introduction of new techniques.

During that time, I felt strongly that the following year I would love to dedicate to advancing my skills. The CIRSE Fellowship, with its generous grant, offered an invaluable opportunity to do just that. While there were many potential host centres listed at the CIRSE website, it was clear to me that I wanted to go somewhere I could speak the local language. I believed that would allow me to benefit, not only from active learning, but also from passive learning through communication with the patients and staff, and by reading patient documentation.

Myself (Dr. Petr Vorel) and enthusiastic Dr. Cormac O’Brien

I reached out to three centres, but it was the enthusiasm and genuine interest of Dr. Cormac O’Brien that made Galway stand out immediately. I felt confident I would be welcomed there. Galway was not an unknown place to me from before; Prof. Gerard O’Sullivan is a prominent figure within CIRSE, and I had admired his presentations at previous congresses about venous interventions. Through those talks and my phone conversation with Dr. O’Brien, I knew Galway would offer exposure to procedures we are eager to develop at our own institution.

The first thing that struck me was how different the setup and workflow were compared to our hospital in Sweden. Digital image storage was well established, but I was surprised by the continued reliance on paper documentation. Each patient arrived with a paper chart and signed consent forms were carefully reviewed and discussed. While we receive exam requests digitally, in Galway, referring clinicians would come in person to consult directly with the interventional radiologist. Initially, I imagined these frequent interactions might be distracting, but I soon realized they make the interventional radiologist more visible and accessible — something I came to appreciate.

After the paperwork was reviewed, the consultant would inform the patient about the procedure and possible complications. In my setting back home, this is usually handled by the referring clinician. I found this practice valuable; after all, it’s important that the patient knows their physician. While one procedure had been completed in one theatre, another was already being prepared in the other, which made it possible to complete a considerable number of cases each day.

One of the aspects I found most inspiring was the widespread use of conscious sedation. This is something I’ll certainly aim to incorporate into our practice. Midazolam and fentanyl were administered by the physician, and a dedicated nurse monitored vital parameters and documented them in the patient’s chart. This approach makes procedures far less painful and, in many cases, allows sedation to replace general anaesthesia, which is not always readily available. I also appreciated the post-procedural monitoring, for which there were two places, where patients were attended by nursing staff until they were ready to return to their ward.

I received a gift from Dr. Cormac after my presentation on thermal ablation

The indispensable part of the interventional team is its nurses

I was surprised by the broad scope of procedures performed in Galway. Many catheter insertions, routines that have long since been delegated to anaesthesiologists in our hospital, were done by the IR team. It was interesting to observe these procedures, should I ever be asked to assist in the future.

But what truly drew me to Galway were the venous interventions and urogenital embolizations. I felt lucky to observe a prostate embolization, a procedure we are working to implement at our hospital, as well as several fibroid embolizations with Prof. O’Sullivan at Galway Clinic. It’s never just about the procedure itself. What we discussed multiple times, and what was most impactful to me, was the workflow and patient selection.

Of course, technical knowledge is essential, but the real difference lies in how patients are selected and prepared. I learned which types of fibroids are suitable for embolization, and that contrast-enhanced MRI is a key tool in the selection process. I also received a very practical list of criteria for deciding when prostate embolization should be offered.

I saw how hypogastric nerve blocks could be performed before fibroid embolization to reduce post-procedural pain. I closely followed a pelvic congestion syndrome case, which was preceded by a deep discussion on how these patients typically present and what symptoms they report. One particularly clever and practical technique I witnessed involved partially inflating a balloon in the left common iliac vein and gently dragging it to assess whether there was significant resistance from the vein narrowing.

As much as I appreciated being present for key procedures, the most valuable part of the fellowship was the in-depth conversations with Prof. O’Sullivan and Dr. O’Brien about patient workup and case selection. These discussions will serve me for years to come. I felt privileged to be welcomed into the Galway team and to work side by side with such generous and skilled physicians as Gerry and Cormac.