CIRSE Fellowship report: Dr. Duccio Rossi

By Dr. Duccio Rossi

My name is Duccio Rossi, MD and I am an interventional radiology consultant at the Department of Radiology, Ospedale Luigi Sacco in Milan, Italy. I completed my residency in diagnostic and interventional radiology at the University of Milan in 2022 with a strong motivation to pursue a career in interventional radiology and a special commitment to interventional oncology. However, I have always been interested in developing my skills as much as possible and wanted to visit a centre of excellence outside my home country where the entire spectrum of interventional radiology was covered. Therefore, I decided to apply for and received a CIRSE Fellowship Grant that I used to get the extraordinary opportunity to spend a month at the interventional radiology department of St George’s Hospital in London, England.

Embarking on this fellowship was a significant milestone in my professional journey as an interventional radiologist. The anticipation of learning from some of the leading experts in the field, coupled with the opportunity to experience a different healthcare system filled me with excitement and eagerness. Over the course of my stay, I immersed myself in a wealth of learning opportunities, ranging from advanced procedural techniques to efficient clinical practices.

This report aims to showcase my experiences, the skills I developed, and the professionalism I witnessed throughout my fellowship.

St George’s Hospital, Tooting, London.

Me with some IR team members (doctors, fellows, physician assistants and nurses) after a long, stressful but successful day.

Learning from Experts

One of the most rewarding aspects of my fellowship was the opportunity to learn from some of the foremost interventional radiologists in the field, such as Prof. Robert Morgan and Dr. Joo-Young Chun, who was also my mentor for this experience.

As I have a good amount of experience in endovascular procedures, especially in low extremities revascularizations, Dr. Chun’s deep expertise in all vascular interventions and her methodical approach and emphasis on patient safety provided valuable insights into these procedures for me.

From Dr. Mike Gonsalves and Dr. Seyed Renani, renowned experts in interventional oncology, I could get a deeper understanding of kidney cryoablations and transarterial chemoembolization (TACE).

Dr. Raj Das introduced me to his favourite field of urological IR, teaching me his tips and tricks for percutaneous nephrostomies and urological stenting both in the angiosuite and in the operating theatre.

I had the chance to attend Dr. Lakshmi Ratnam’s clinics and observe her performing state-of-the-art bleomycin sclerotherapies for venous malformations and paediatric interventions. She was a really enthusiastic mentor throughout my stay, offering invaluable insights and guidance into a niche and particular field of interventional radiology.

I was deeply impressed by the professionalism and dedication of the entire IR team. Every aspect, from the meticulous board rounds and team meetings to the execution of complex procedures, was managed with the utmost care and precision. The exemplary attitude and high standards of the department are qualities I aspire to bring back to my home institution in Italy.

A good new day cannot start without a board round!

Me with some IR colleagues following CIRSE webinar on Clinical Practice in IR….

…of course the webinar has Dr. Joo-Young Chun in it!

Observing different setups

Another fascinating aspect of my fellowship was the opportunity to observe the different setups and workflows at St George’s Hospital. The interventional radiology department was equipped with two state-of-the-art DSA suites and a recently opened day case and recovery unit with six beds.

Together, with a great team of highly skilled healthcare professionals, everything was carefully organized and standardized to ensure smooth and efficient operations.

The workflow at St George’s was highly efficient, with well-defined protocols and a collaborative approach between all health professionals that ensured optimal patient care. The multidisciplinary team included interventional radiologists, nurses, and technicians who worked together seamlessly to deliver high-quality care. This collaborative environment not only improved patient outcomes but also created a positive and supportive work atmosphere.

The morning routine began early, with all the IR fellows and international fellows like myself gathering patients’ information for the upcoming board round, ensuring that all necessary details were prepared.

The IR department

By 08:45, all IR staff working that day gathered for the board round. This meeting played a pivotal part in the day, involving a thorough assessment of the day’s cases and strategic planning to ensure a smooth workflow. The board round is not only essential for setting the tone for the day’s operations but also for fostering a cohesive approach to patient care.

Once the board round concluded, the team moved into action, beginning interventions across various settings. These included the two angiography suites, the CT lab, the six-bed day case and recovery unit, and other operating theatres where IR specialists were needed. The team was engaged in handling interventional cases continuously from the morning until approximately 6-7 pm, always in a dedicated and efficient way.

During the afternoon, apart from their procedural duties, some senior IR consultants held clinic hours, during which they attended to patients with specific needs. This aspect of their role was crucial in providing comprehensive care as any other surgical or internal medicine colleague would do. Furthermore, several multidisciplinary team (MDT) meetings were held weekly, involving fellows and consultants working alongside other specialties. These meetings focused on a variety of cases, including vascular, aortic, paediatric, and malformation cases, highlighting the collaborative nature of the department.

After work

To foster team cohesion and provide a well-deserved break, the team often engaged in social activities after work hours, usually on Fridays. Even if a month is not long enough to explore London at its best, we could enjoy some quality time together at one of the nearby bars, which helped with team building, especially during the toughest European football championship matches! Moreover, there was a pub conveniently located within the hospital grounds, given its university status, offering a good spot for some relaxation even during the busiest days of the week.

Me with some young fellows and IR consultants (Dr. Chun, Dr. Ratnam and Dr. Gonsalves) reaching the end of another stressful day at the end of the week.

Saying goodbye to a young and talented IR fellow is never easy, but Dr. Patel will be a great consultant!

Clinical practice insights

In addition to enhancing my procedural skills, I was able to gain some valuable insights into various aspects of clinical practice, which was one of my fellowship goals. This included patient assessment, pre-procedure planning, post-procedure care, and follow-up protocols. The holistic approach to patient care at St George’s emphasized the importance of patient communication, informed consent, and individualized care plans, all of which are crucial for successful outcomes, especially in a relatively young specialty such as interventional radiology. I could observe that at St George’s, patient communication was given high priority. Patients were thoroughly informed about their procedures, including potential risks and benefits, and were actively involved in the decision-making process. This approach not only improved patient satisfaction but also ensured that patients were well-prepared for their procedures and could provide informed consent.

Pre-procedure planning at St George’s was meticulous, with detailed discussions about each patient’s case starting during the routine multidisciplinary team meetings. This collaborative approach ensured that all aspects of the patient’s health were considered, leading to more comprehensive and effective treatment plans. In contrast, pre-procedure planning at my home institution is often less detailed, with fewer opportunities for multidisciplinary input which often lacks of support and involvement. Implementing a more thorough and collaborative planning process will certainly improve patient care and treatment outcomes.

Post-procedure care and follow-up at St George’s were also well-coordinated, with clear protocols in place to monitor patients and address any complications that may arise. This comprehensive approach ensured that patients received the necessary care and support throughout their treatment journey with follow-up appointments at the IR clinic already organized at patients’ discharge. In comparison, post-procedure care at my home institution is less structured, with inconsistencies in follow-up protocols and no direct involvement of IR as referring physicians for patients’ follow-ups. I believe that improving post-procedure care and follow-up processes will enhance patient outcomes and satisfaction as well as increase our visibility as a clinical specialty.

Meeting expectations

My expectations for my CIRSE fellowship were high, and I am delighted to say that they were not only met but exceeded. The combination of hands-on experience, expert mentorship, and exposure to cutting-edge technology created an unparalleled learning environment. The collaborative atmosphere throughout all the department and staff members, and the emphasis on continuous learning made this experience truly exceptional.

I had hoped to gain practical skills, especially in purely endovascular procedures such as BTK revascularizations, and get a deeper knowledge of how to run a proper IR clinical practice, and the fellowship provided ample opportunities for this. The mentorship from Dr. Joo-Young Chun was invaluable, offering guidance and support that enhanced my understanding of both the technical and clinical aspects of all interventions performed at St George’s. Additionally, the exposure to different clinical setups and workflows broadened my perspective and highlighted the importance of innovation and efficiency in delivering high-quality care.

Conclusion

My CIRSE fellowship at St. George’s Hospital was a transformative experience that enriched my professional development in countless ways. The exposure to advanced procedures, efficient workflows, and multidisciplinary collaboration has equipped me with the knowledge and skills that I’ll try to bring back and significantly enhance my practice. I am eager to implement the new techniques and strategies learned during my fellowship, and I am confident that these innovations will lead to better patient care and optimized operations at my home institution. I look forward to sharing the insights and knowledge gained during my fellowship with my colleagues and contributing to the advancement of interventional radiology at my hospital.

Finally, I am deeply grateful to Dr. Joo-Young Chun, my mentor, for her invaluable guidance and support throughout my fellowship. I also want to thank the entire team, including all IR consultants, the physician assistants, nurses, and staff, for their helpfulness and courtesy. A well-deserved thank you goes to the wonderful fellows and physician assistants including Matt, Arjan, Shy, Lola, Helen and Lottie who helped me feeling at home from the very beginning and who were always available for me when needed. Their goodwill and willingness to help out made my time at St George’s both educational and incredibly gratifying.

I was really lucky to spend such a fruitful month at St George’s Hospital and I thank the CIRSE Fellowship Programme for making this opportunity possible!