Together with the International Accreditation System for Interventional Oncology Services (IASIOS), the European School of Interventional Radiology will be offering a two-day course on how to manoeuvre the modern multidisciplinary tumour board this fall. We talked to local hosts Profs. Laura Crocetti and Marco Calandri as well as leadership transformation specialist Sarah Perugia about challenges in the MDT and how they can be overcome.
CIRSE Insider: Why is it so important for IOs to participate in MDTs?
Calandri: Interventional radiology has always been a technology-driven discipline, focused on delivering minimally invasive care to patients. However, for too long in the past, we’ve overlooked the clinical side of our role—limiting ourselves to being mere proceduralists. Today, this approach is no longer sustainable. The clinical expertise of interventional oncologists must continue to evolve, allowing us to engage meaningfully with other specialists and contribute to selecting the most appropriate treatment pathway for each patient.
Crocetti: I totally agree with Marco. Participating in tumor boards is now essential for three main reasons: proper patient selection, ongoing clinical growth, greater visibility within the hospital ecosystem. Simply put, to quote CIRSE President Prof. Pereira, we must have a seat at the table—not being in the menu.
CIRSE Insider: Do you think interventional radiologists’ perspective is sufficiently seen at MDTs? If not, how can IRs change that?
Crocetti: Unfortunately, interventional radiology is still underrepresented in many multidisciplinary tumor boards—even in some official guidelines. There are significant differences depending on the specific type of cancer. For instance, in hepatocellular carcinoma, IR has long held a central role within the MDT. But this level of integration is still lacking in many other oncological settings.
Calandri: To change this, IRs must come prepared—not only with technical expertise, but with a strong clinical background that allows us to engage on an equal footing with other specialists. Being part of an MDT means being able to discuss treatment strategies, not just procedures. This is where interventional radiologists still have work to do. We must continue to strengthen our clinical knowledge and communication skills. The path forward is clear, and our collective efforts should be focused precisely on this transformation.
CIRSE Insider: What are other common communication hurdles IRs face in these multidisciplinary meetings?
Calandri: One common challenge is that interventional radiologists are often the “newcomers” at the tumor board. Many of the other specialists may have been working together for years, with well-established relationships and dynamics. Joining that conversation—and being recognized as an equal partner—can take time and persistence.
Crocetti: Another hurdle lies in the interpretation of scientific evidence. While the data may not differ dramatically across specialties, differing perspectives and clinical backgrounds can lead to friction or disagreement over treatment strategies. Navigating these dynamics requires not only clinical competence, but also confidence, clarity, and a willingness to engage in open, respectful dialogue. Building trust with the team is key—and that starts with showing up consistently, being prepared, and speaking the same clinical language.
CIRSE Insider: Ms. Perugia, are there strategies IRs could apply when being the “new kid on the block”? How can the establishment of trust in IRs’ skills be enhanced?
Perugia: So when we are brand new into a situation, my advice is also always to walk in with curiosity. Ask yourself:
It is okay to start with listening. Listening with presence and confidence can establish connection. Establishing strong credibility can come both verbally and non-verbally. Don’t just think about what you want to say but also how you say it. If possible, I find that clients benefit from building one to one connections with as many stakeholders as possible when in a new role. When in a brand-new situation, it’s much easier to establish trust, connection and credibility one to one before stepping into a group situation such as a tumour board. You might even make an agreement with a key contact that they ask you a question or invite you to speak in a multi-disciplinary meeting. So my advice would be to think about how many trusting connections, supporters and allies you can create in order to have connection and support in a group situation.
It might also be worth thinking about mindset. When we’re new to a situation that can lead us to doubt ourselves, to feel like an imposter and to hold back from sharing our knowledge and insight. Before stepping into a new situation, it’s worth taking some time to think about past successes, learning, skills, abilities, and of course, the unique value that you bring with you into that room. The more confident and calm we feel, and the more clear about our own value, the easier it is to speak up and share our perspective.
CIRSE Insider: When did you start attending MDT meetings? What’s your personal approach and has it changed over time?
Crocetti: I started attending tumor board meetings during my residency, initially by joining a more senior colleague. At that time, interventional radiology in our center was involved mainly in the hepatocellular carcinoma board. Today, we’re making a strong effort to ensure broader representation across multiple tumor boards—doing our best, within the limits of our resources, to bring our expertise to more specialists and more clinical discussions.
Calandri: When I first began attending new tumor boards, I remember preparing by looking up the most relevant studies and articles to support our interventional treatments. I wanted to make sure I could clearly and confidently explain the rationale behind our therapeutic approach. That experience inspired one of the sessions we now offer in our course: “5 Papers You Must Know.” It’s designed to give all participants a practical, ready-to-use reference—something they can rely on when presenting or defending treatment strategies in multidisciplinary settings.
CIRSE Insider: Are there specific tips and tricks that will be discussed at the course?
Calandri: Absolutely. As mentioned earlier, knowing the evidence that supports our treatments is essential. Too often, interventional radiologists are highly skilled in performing procedures but less familiar with the scientific literature that underpins our role in patient care. Bridging that gap is a core focus of the course. The first day will be focused on more clinical skills, even in specific setting such as in case of geriatric patients.
Crocetti: But we won’t stop there—because being clinically well-prepared is only the starting point. To truly make an impact in MDTs, we also need to engage with other specialists effectively and elevate the level of discussion. That’s why we’ll also explore how to strengthen our interpersonal and communication skills. We’re fortunate to have Sara Perugia, an expert in medical communication, joining us to help participants develop the tools they need to communicate clearly, confidently, and persuasively within multidisciplinary teams.
CIRSE Insider: Ms. Perugia, what tips and tricks will participants learn from you?
Perugia: We will think carefully about how we can build credibility and confidence using our nonverbal communication. So of course, my expertise is not to do with medical knowledge or specialist experience. My expertise centres around communication, exploring influencing skills and styles. In the session, we will explore how we might think positively and confidently when in a high-pressure situation. We will think about how we can use our bodies to come across as assertive and confident, but also how physicality can help us feel more confident too.
We will also think about how we might manage our physiology. Heart rate, cortisol and adrenaline levels rise when we feel under pressure or challenged, so simple techniques to active our parasympathetic nervous system can be powerful. Taking care of our mindset, our physicality and our breathing can help manage any nerves, so that we can have good cognitive function. This means we can access that unique skillset that each IR brings with them into the room. The session will be interactive and practical!
CIRSE Insider: What are some of the things interventional radiologists should be particularly aware of when participating in MDTs?
Calandri: To quote a memorable presentation by John Kaufman at CIRSE a few years ago, the key is: “Collaborate when you can, compete when you must.” However, Personally, we believe that collaboration—not competition—is the real driver of success for interventional radiology within the multidisciplinary setting.
Crocetti: Interventional radiologists should be particularly aware that their clinical presence in MDTs goes beyond procedures—it’s about building relationships, fostering dialogue, and becoming a trusted voice in shared therapeutic decisions. Imaging -guided minimally invasive treatments can provide cure or tumor control, ultimately improving overall survival with minimal or no impact on quality of life.
CIRSE Insider: In your daily practice, how do you present a case to ensure that the IR standpoint will be heard? Could you share a specific instance where a treatment’s success particularly depended on the close collaboration between interventional radiology and other multidisciplinary colleagues?
Crocetti: To make our voice heard, we need to be fully involved in the decision-making process—and genuinely focused on what’s best for the patient. It’s not about promoting one treatment over another. It’s about selecting the right treatment for the right patient. I truly believe that multidisciplinary care only works when we all act with humility, including knowing when to step back if a different approach is more appropriate. That’s the spirit of real collaboration—and ultimately, of better patient outcomes.
Calandri: I remember one case of a patient with metastatic renal cancer involving the lungs. Through close coordination between interventional oncology and radiation oncology, we combined cryoablation with radiotherapy. This approach allowed the patient to avoid losing lung function and continue his normal life. To this day, after two years from the last treatment, he still sends us photos of himself riding his bike. That, to us, is the most rewarding part of our work—and it always comes from a multidisciplinary effort.
