Cardiovascular and Interventional Radiological Society of Europe
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SocietyFellowship Grant ProgrammeCIRSE Fellowship report: Dr. Edward Johnston

CIRSE Fellowship report: Dr. Edward Johnston

It has been a privilege to complete a CIRSE Clinical Fellowship in Innsbruck under the mentorship of Professor Reto Bale. As the pioneer of stereotactic tumour ablation, Reto has created a centre that is technically innovative, academically ambitious, and grounded in the pursuit of precision. I had long admired his work, and this fellowship offered an opportunity not only to learn from him directly, but to immerse myself in a clinical culture that consistently sets the bar for high-end ablation.

I’m an Academic Consultant in Interventional Oncology at the Royal Marsden Hospital in London, where we perform over 200 ablations per year, usually with robotic guidance and often with a multi-needle approach. However, it was clear to me that what Reto and his team have built in Innsbruck goes even further — particularly in the integration of planning, execution, and philosophy.

Me next to the river Inn, in front of the Tyrolean Alps
First day at work

My objectives for the fellowship were as follows:

  • Advanced ablation planning, incorporating complex image fusion to improve tumour visualization and treatment accuracy.
  • Multineedle techniques, specifically mastering the use of more than six needles simultaneously to treat larger or irregularly shaped tumours.
  • Ablation segmentectomy, a precise approach aiming to ablate entire liver segments.
  • Gastrointestinal tract cooling, to protect adjacent structures and extend the range of safe indications.
  • Thermocouples, to develop practical familiarity with real-time temperature monitoring to guide energy delivery and improve safety.

I wanted to understand the nuances of his technique not just by observing, but by doing. I also sought to explore avenues for ongoing collaboration. The fellowship was structured across two intensive blocks in May and June 2025. This split allowed me to integrate and reflect between visits, minimizing disruption to my department and family life. From the outset, I was welcomed as a colleague rather than an observer, with increasing hands-on involvement as the weeks progressed.

Reto’s department and setting up for an early case
Plan from a trigeminal neuralgia RFA, through the cheek to access the foramen ovale

The case mix was diverse. Most involved liver tumours, both primary and secondary, but I also observed ablation of arteriovenous malformations, and notably, trigeminal neuralgia — a patient group in which the team has accrued significant experience and was pivotal to the development of their workflow, ever since Reto’s times as a student. I was also exposed to NanoKnife ablations, and these experiences broadened my understanding of how stereotaxy can be applied beyond conventional liver tumours, and how workflows can be adapted to different anatomical and technical demands.

Over the course of the fellowship, I progressed from observing to performing key aspects of needle planning and insertion. One of my proudest moments was conducting a complex stereotactic microwave ablation, a world first using this system, almost solo (although under Reto’s guidance, of course).

One particularly meaningful day involved planning and placing multiple needles for a redo giant adenoma — a difficult, privately funded case with high patient expectations. The gratitude we received afterward, combined with the technical success was a strong reminder of why we do this work.

In accordance with the objectives, I gained experience in cooling techniques, including nasogastric water instillation to safely ablate near the gastrointestinal tract. In a subset of cases, thermocouple monitoring was used for temperature feedback at critical structures, and I gained confidence in interpreting these data in real-time.

Professor Bale and myself mid case
The last case I did, practically skin-to-skin

The soft skills I picked up were equally valuable. Watching Reto mentor students, resolve complex clinical questions with clarity, and lead academic meetings taught me a great deal about academic leadership. I was also struck by the team dynamic — with particular thanks to Dr. Gregor Laimer, Dr. Moritz Kumann, and the radiographers, anaesthetists, and staff who operated with a shared commitment to excellence. Social moments — sushi, beers, and many post-case discussions — built the kind of camaraderie that underpins high-functioning teams.

A particularly inspiring part of the visit was meeting Dr. Michael Vogele, Reto’s long-time collaborator. Michael shared insights into how their stereotactic technology evolved, and I visited the lab where they continue to develop modular robotic solutions. Our discussions were productive and have opened the door to future research collaborations.

As I return to London, I’m already implementing elements of the Innsbruck philosophy. These include more structured planning documentation, subtotal needle advancement strategies, closer integration of imaging and pre-op pathways, and a more deliberate approach to mentoring. The fellowship has also strengthened my determination to progress our ablation programme, and to contribute to a more standardised, evidence-driven future for interventional oncology.

In closing, I would like to thank CIRSE for this unique opportunity and Professor Reto Bale for his generosity, mentorship, and enduring influence. I return not only with enhanced technical skills, but a broader vision for how we can evolve ablation practice in the UK.