New CIRSE group member – the Tunisian Interventional Radiology Association (TIRA)

July 21, 2025 – The Tunisian Interventional Radiology Association (TIRA) recently became a CIRSE group member. We spoke with TIRA President Prof. Nadia Hammami about the history of interventional radiology in Tunisia, TIRA’s work, and how CIRSE and TIRA can work together to support the growth and recognition of IR in Tunisia.

CIRSE Insider: Can you tell us about the history of IR in Tunisia?

Hammami: The evolution of interventional radiology in Tunisia has experienced remarkable growth over the past five decades. From the first vascular radiological procedures in the late 1960s to advanced image-guided therapies, Tunisia has seen pioneering efforts that positioned the country as a leader in IR within the region. In 1968, Dr. Haddouk and Dr. Dité performed some of the earliest vascular radiology procedures in the country at the Hôpital Charles Nicolle in Tunis. Their work was followed by Dr. M. Sellami, whofurther solidifying this foundation of this specialty also at Hôpital Charles Nicolle. In 1980, Professor S. Touibi expanded the scope of IR by introducing ENT embolization techniques at the National Institute of Neurology, Tunis, marking a significant step toward more diversified therapeutic radiology practices.

A significant leap occurred in 1986, led by Dr. Khalil Hamza whose contributions established several national firsts, such as the first iliac artery angioplasty, the first biliary drainage, the first esophageal varices embolization, and more. Another IR pioneer in Tunisia was Professor Lotfi Hendaoui, who made pioneering contributions in abdominal IR. His efforts emphasized precision-guided interventions, especially in oncologic care. Thanks to these pioneers, Tunisia has become a reference point in North Africa for interventional radiology, offering cutting-edge treatments that continue to save lives and improve patient outcomes.

CIRSE Insider: How was your path of becoming an IR? 

Hammami: Initially, I intended to specialize in diagnostic neuroradiology. I went to France and joined the University Hospital of Montpellier for a one-year training to deepen my expertise in neuroradiology. It was there that I discovered interventional neuroradiology, a field that did not yet exist in Tunisia at the time (2000–2001). And that’s when a deep and lasting passion for this field began. I decided to pursue this discipline further, which led me to complete a second internship at Henri Mondor Hospital, followed by two years at the Rothschild Foundation with the team of Professor Jacques Moret who became my mentor. After four and a half years of intensive training, I felt confident and autonomous, and in 2005, I decided to return to Tunisia, where I was able to establish and develop this specialty within my institution and the country.

CIRSE Insider: What is the path for students or physicians to become an IR in Tunisia today?

Hammami: We currently do not have a formal fellowship program in interventional radiology; each individual receives training through their own initiative. However, we have been actively working on this topic within TIRA and have developed a structured program that we hope will be adopted by the College of Radiology. It is worth noting that within our institution, I have established and implemented a two-year training curriculum that residents interested in interventional neuroradiology are required to follow.

CIRSE Insider: How does your society inform patients about IR treatments? How aware of interventional radiology is the public in Tunisia? 

Hammami: Our society is deeply committed to improving patient awareness of interventional radiology and its benefits. We utilize multiple channels to educate the public, promoting awareness of interventional radiology through media campaigns, physician education, and digital outreach, highlighting IR’s minimally invasive treatment options. We collaborate with healthcare providers and patient groups to distribute educational materials and organize informational events. However, public understanding remains limited – many patients still don’t recognize IR as a distinct specialty offering alternatives to surgery for conditions like cancer or vascular disease. This awareness gap demonstrates the need for continued efforts to communicate IR’s benefits of reduced risk and faster recovery times to both patients and referring physicians.

CIRSE Insider: What are your local challenges? Conversely, what is something you feel that Interventional radiologists do exceptionally well in Tunisia and others could learn from?

Hammami: In Tunisia, we face significant challenges including limited numbers of interventional radiologists and constrained healthcare funding, which restrict our capacity and access to cutting-edge equipment. Despite these obstacles, our IR community demonstrates remarkable resilience and commitment to excellence. We strictly adhere to international guidelines and continuously strive to implement the latest techniques and technologies available within our means. What sets us apart is our ability to deliver high-quality, patient-centered care with limited resources – maximizing outcomes through innovation, careful technique selection, and strong collaboration with other specialties. This resourceful approach, combining evidence-based practice with adaptability, could serve as a valuable model for other resource-limited healthcare systems.

Also, we successfully established INR within the public healthcare sector, and despite numerous challenges, we have managed to turn our centre into an internationally recognized reference. A testament to this achievement is our participation, two years ago, in the largest global congress on interventional neuroradiology—LINNC—where we broadcasted two live cases (an aneurysm treatment and an intracranial AVM procedure) from our centre to the Carrousel du Louvre.

CIRSE Insider: What are your local challenges? Conversely, what is something you feel that Interventional radiologists do exceptionally well in Tunisia  and others could learn from?

Hammami: In Tunisia, we face significant challenges including limited numbers of interventional radiologists and constrained healthcare funding, which restrict our capacity and access to cutting-edge equipment. Despite these obstacles, our IR community demonstrates remarkable resilience and commitment to excellence. We strictly adhere to international guidelines and continuously strive to implement the latest techniques and technologies available within our means. What sets us apart is our ability to deliver high-quality, patient-centered care with limited resources – maximizing outcomes through innovation, careful technique selection, and strong collaboration with other specialties. This resourceful approach, combining evidence-based practice with adaptability, could serve as a valuable model for other resource-limited healthcare systems.

Also, we successfully established our centre, the Institut National de Neurologie, within the public healthcare sector, and despite numerous challenges, we have managed to turn our centre into an internationally recognized reference. A testament to this achievement is our participation, two years ago, in the largest global congress on interventional neuroradiology—LINNC—where we broadcasted two live cases (an aneurysm treatment and an intracranial AVM procedure) from our centre to the Carrousel du Louvre.

CIRSE Insider: What CIRSE initiatives are you and other TIRA members involved in or hope to become involved in in the future? 

Hammami: TIRA and CIRSE have been strengthening their partnership through several key initiatives. Currently, CIRSE provides TIRA members with valuable access to educational platforms and resources, fostering knowledge exchange and professional development. We are also in active discussions to expand this collaboration further—particularly in establishing fellowship programs to enhance training opportunities for Tunisian interventional radiologists. Additionally, we are exploring ways for CIRSE to support our local and regional activities, such as workshops, conferences, and mentorship programs. This growing alliance reflects our shared commitment to advancing IR in Tunisia and across the region while aligning with global standards of practice.

CIRSE Insider: What are your hopes for the future of IR in Tunisia?

Hammami: For the future of interventional radiology in Tunisia, we have three fundamental aspirations. First, we seek to develop IR as a fully recognized specialty with dedicated training programs and clear career pathways. Second, we aim to achieve broader recognition of IR’s vital role in modern healthcare, among both medical professionals and the public. Most importantly, we are committed to making these advanced minimally invasive treatments accessible and affordable for all Tunisian citizens, ensuring equitable access to these life-changing procedures regardless of socioeconomic status.

CIRSE Insider: Anything else you’d like to add?  

Hammami: I would like to emphasize the tremendous value of our growing collaboration with CIRSE, which we believe will be transformative for TIRA’s activities. Through CIRSE’s support in training, knowledge exchange, and international standardization, we are building capacity to better serve our patients while positioning Tunisian IR specialists as active contributors to global advancements in our field. This strategic alliance represents a crucial step forward in realizing our vision for IR in Tunisia.