An interview with Dr. Raffaella Niola
In this video, ETF Subcommittee member Dr. Francesco Giurazza interviews Dr. Raffaella Niola, the first ever female president of the Italian College of Interventional Radiology (ICIR) who describes her start with interventional radiology, the challenges she faced on the road to becoming an IR, and the combination of clinical practice and technology that made her fall in love with the field.
An interview with Dr. Irene Bargellini
ETF Subcommittee member Dr. Rosa Cervelli interviews Dr. Irene Bargellini, an interventional radiologist from Pisa, who specialises in the local intraarterial liver therapies. Dr. Bargellini has published more than 70 scientific papers in the field of interventional vascular radiology, interventional oncology, and liver imaging. In this interview, she describes her motivation for pursuing a career in interventional radiology, working throughout her pregnancy, and the challenges faced by women in the field.
An interview with Dr. Alex Barnacle
In this interview, former ETF Deputy Chairperson Dr. Sara Protto speaks with CIRSE Executive Committee member and Co-Chairperson of CIRSE’s Paediatric IR Task Force Dr. Alex Barnacle from the UK who explains her exciting journey in paediatric IR and practice in different countries around the world. Dr. Barnacle emphasizes the importance of paediatrics within interventional radiology, especially when it comes to technological advancements and developments of medical tools.
Watch the interview and learn more about Dr. Barnacle’s vision for women in IR!
An interview with Dr. Barbara Hamilton
ETF Subcommittee member Dr. Špela Koršič interviews Dr. Barbara Hamilton, an interventional radiologist from California who used to chair the Women in IR (WIR) section of the Society of Interventional Radiology (SIR). Dr. Hamilton describes her start in interventional radiology, her love for the field, and how she initiated the SIR statement on parental leave aimed to improve the status of female IRs. Dr. Hamilton also shares her thoughts on challenges of pursuing a career in the field while being a parent.
Watch this interview to learn how IR training can be improved to be more inclusive and supportive for women!
Meet the former and current ETF Subcommitee members!
Meet the former and current ETF Subcommittee members!
Dutch-citizen, Lidewij Spelt tells us about about her work in IR in Sweden.
Read her interview below!
Carla Gonzalez-Junyent tells us what it is like to work in as an IR in Spain and her previous fellowship in the UK.
Read her interview below!
Today, we are introducing ETF Subcommittee member Lidewij Spelt, who is Dutch but works as an IR in Sweden. Learn more about what sparked her interest in IR and what interesting research projects she has been working on.
1. Can you share with us what your first experience with IR was and why you decided to pursue a career in this field?
Upon becoming a qualified doctor, I actually first started training in general surgery. During that time, both clinical work, including multidisciplinary treatment, but also my research within oncological surgery which partly overlapped with oncological interventions got me into close contact with IR. Halfway through my surgical training I decided to make a switch and starting pursuing a career within radiology instead, with a special interest in and focus on IR from the very start.
2. What IR procedures interest you the most?
I feel greatest affinity with oncological interventions. It is a part of IR that has seen, and I expect will see, lots of development. I enjoy the versatility of the procedures, including vascular and non-vascular treatments, but what makes it even more interesting for me is the multidisciplinary aspect within oncological treatment that requires tight collaboration with other specialists, combining forces to reach the best possible results for the patients.
3. What are some things that young IRs in particular need to keep in mind throughout a procedure?
Consider your options! When unsure or in doubt, try to take a moment to really think through the consequences of your planned way ahead and consider the different options you have. Don’t hesitate to consult with a colleague when possible. Working as a team is the best way forward to learn and to develop your skills.
4. Considering your IR training pathway, is there anything you would recommend/not recommend to young IRs who are at the beginning of their career?
Since IR training pathways differ between countries it is a bit hard to recommend a certain way to go. But in Sweden it is required to become a general radiologist first. For others who are in the same situation I would recommend trying to get a taste for IR early on, partly to explore if it really is something for you, but also to start building experience.
5. You have been on the ETF Subcommittee for a few years now. Can you tell us what your motivation was in joining this community of young IRs, and what did you envision this experience would bring to you?
I really wanted to be part of a larger community of people in the beginning of their IR careers, who collaborate for educational events and who exchange ideas. It is great to participate in this international group, to contribute to the connecting of young IRs and be involved in the organisation of the congress events that are aimed at your IRs.
6. What are the benefits of being a CIRSE member? And why would you recommend young IRs to get on board?
The benefits are especially great when still in the beginning of your career. There are so many possibilities for education. The conferences obviously are very educational and also a nice way to meet other people in the field and exchanges experiences and ideas.
7. As a Dutch citizen, you have decided to live and work in Sweden. What are the benefits of working outside your home country? And on the other hand, where do you see the disadvantages, if any?
I guess a disadvantage would be you have to start over from the beginning, without contacts that you normally might have from medical school, etc. For me the transition was quite smooth though because I first came to Sweden just before qualifying as a doctor, to do research here. Also, the differences in the way of working are not very large between Sweden and the Netherlands. A benefit is that your experience generally becomes broader, you get new input and learn different points of view or slightly different approaches, increasing your own adaptability.
8. Is it difficult to balance a career in IR with personal/family commitments?
I guess it is similar to other careers in medicine that require both working normal days and on calls, so whenever adjustments are required, it is not because of IR specifically.
9. Based on your own experience, is there any further advice you would give to young IRs-to-be?
Try to get involved as soon as you feel the interest in IR. Even if you’re not sure about your future choices yet, it may help you to confirm what suits you best. IR is such a varied specialty and getting an understanding of different procedures and seeing how they are performed is important to be able to find out if you want to pursue a career in IR.
1. You are one of the longest serving members on the ETF! How did you connect with the ETF for the first time? What made you join the subcommittee back then?
Yes, I’ve been a member since its creation. I entered in the ETF because the president of the Spanish Society of Interventional Radiology nominated me back in 2015. It was such an honour to be nominated. I decided to join because the ETF was a great idea to try to enhance the participation of young physicians in international scientific and educational activities and start connecting with young IRs from different European countries.
2. Since the time the ETF was launched, what would you consider to be the biggest success of this network of young and passionate IRs?
I think the biggest success is mentoring; it allows young IR’s to have the possibility to contact any member to try to solve their doubts and fears in the early years of their career, which are the most uncertain and difficult ones.
3. Now, let’s get back to your professional career and the decision to become an IR. Do you remember the moment when you decided to pursue a career in this field?
The first time I entered into an IR suite I knew it was the subspecialty I wanted to pursue. When I entered and saw the type of procedures and the team working I thought this is like surgery but with more elegance.
4. Are there ample opportunities for Spanish IRs to be part of a local IR community?
In Spain we are a small group of interventional radiologists, we mainly know each other and we can connect through our Society (SERVEI) and in the biennial meeting organized by the society. You can become a part of the IR community at the very beginning as a young resident interested in IR. The SERVEI society is very inclusive.
5. What was your motivation for going abroad for an IR fellowship?
I have always been a restless person who wants to learn from different people to increase life experiences. As a student I got an Erasmus grant. During my residency I trained for three months in a hospital in Valencia in Spain, and when I finish my residency I didn’t have the opportunity to get an IR job. I decided to apply for a fellowship abroad to continue learning and improving my skills, and also to grow as a human because moving to a different country means to leave your comfort zone.
6. How long was your UK fellowship? Why did you decide to go to the UK?
At first, I did a six-month fellowship with the funding of a CIRSE grant in St. Georges’ Hospital, and after finished it I got a proper NHS fellowship in the Imperial College, which also lasted six months.
7. Would you consider moving for a job again and if yes, which country would it be and why?
I have not considered it yet, but I don’t say no to this idea. As I said before, in a previous question, I like to get out of my comfort zone and learn from the other professionals’ experiences. Maybe it will not be moving for a job, but maybe for a rotation that lets me learn a concrete technique to implement on a daily basis. Any country will be suitable, but mainly I would choose an English-speaking country.
8. What do you like the most about your job and what are the best things about IR?
The thing I like the most is the possibility to be useful to patients and other medical and surgical specialties, as we can perform a big variety of procedures in such a minimal invasive way. The best thing about being an IR is that you never stop learning.
9. Based on your own experience, is there any advice you would give to young IRs-to-be, and especially to young female physicians who are thinking of going the same direction as you did?
If IR is the career you want to pursue, go for it is totally worth it! You only have to imagine your dreams and try to achieve them; nothing can stop you and you can always rely on your mentors to guide you. Being a young female should not stop you, as you are equally as capable as a man.
10. As a woman at the beginning of her career – what is your opinion on combining a career in IR and family life?
I have never had a problem of being a woman in IR. I think it is feasible to have a career in IR and a personal life, the only thing is to enjoy the time you spend in both of your passions; your work and family.
11. What do you envision for the future of the ETF? For the future of IR?
The ETF will continuously be growing, and the older members will pass the torch to the younger generation, so the ETF will be constantly changing and expanding. Talking about the future of IR, I think we have a bright future in front of us because every year there are new procedures that can be performed to improve patients’ lives. So, in IR there are always new horizons to explore.
12. Since Spain is one of the hardest hit countries with regard to covid-19 pandemic, we would like to ask how you as an IR were involved and how the situation influenced your work?
The Spanish Society of Vascular and Interventional Radiology (SERVEI) made some recommendations for action for the management of patients within the IR Units during the pandemic with the intention to provide guidance in the management of patients, trying to preserve their safety and that of all health personnel involved in care. So, in my hospital we haven’t stop working and doing on calls, but we have worked in shifts on alternate days. We have been working during the pandemic with the same nurse and technician this past two months. All the patients that could be postponed were rescheduled and we mainly performed emergency procedures. We only scheduled patients that couldn’t be delayed because they had specific treatments planned, such as chemotherapy or dialysis.
András Bibok tells us about his work with ETF and his fellowship in the United States.
Read his interview below!
We asked Maria Tsitskari to describe her career as an IR and what it is like to be a member of the ETF.
Read her interview below!
Our next ETF member interviewee is András Bibok from Hungary. He has recently moved to Florida to start a one-year research fellowship, while at the same time trying to set up a trainee committee back home!
1. As we always ask our ETF members; what made you choose IR as your future career?
I didn’t know exactly where to go until the really last year of the university. I looked for something manual, but I didn’t like surgery or the “traditional” specialties. I’m also a computer enthusiast, so I was looking for something with “big” and “strong” computers. In the end, this turned out to radiology, especially interventional radiology. It was a hard decision, because gradual training almost did not cover IR at all. Now, I’d never choose anything else.
2. What do you like the most about your job and what are the best things about IR?
My favourite part is when I can be creative and solve not-yet-solved problems with the given tools, or when I do a procedure first time. These are the most exciting for me.
The best thing about IR is the patients – they’re usually surprised that we can treat them in such a minimal invasive way. It’s good to hear “That was all? I expected much worse things…” after a procedure.
3. What IR procedures interest you the most?
My main interest is interventional oncology and non-vascular interventions. TIPS is one of my favourite procedures, and I like to preform anything in a post-transplant (liver/kidney) situation, those are quite special.
4. With regard to the ETF Subcommittee membership, can you tell us how long have you been on board and what do you think are the benefits of being a member of this community of young IRs?
I didn’t plan to be part of the ETF as a committee member. I just walked to the ETF News Stand at CIRSE 2018 and asked Sara who the Hungarian representative is. She told me that I was it, and in an hour I found myself on my first committee meeting. This was a really inspiring event and I got involved even more in the following months. I like the way this pan-European community works and helps others to find their way in IR. What I enjoy the most is mentoring medical students and younger trainees at CIRSE events.
5. What do you think has been the biggest success of the ETF so far? And how would you assess the growth of the ETF activities both at the CIRSE annual meetings and beyond them?
Our biggest success is definitely the IR training report of Europe. This was an enormous job from Greg Makris´ side, and I’m really happy that this is finally out. This is the first step to improving and standardising IR training in Europe.
6. Throughout your own IR training experience, has there been anything you would have changed and/or improved?
My training isn’t over yet, but so far, I have nothing to complain about. I have/had wonderful mentors who inspire me and give lot of opportunities to learn and work. I just want to say a big thank you to all of them. So: THANK YOU!
7. Is there a community of young IRs in Hungary?
I recently established a local community for IR trainees, but we’re really at the beginning of this story. I’m in touch with our national society’s (HSIR) chair and working together to grow this community. Hopefully, one day we can turn this into an official subcommittee of HSIR.
8. You have recently moved to the US to undergo your training. What do you expect from your stay there? Can you give any advice to your peers on what to do if they would like to train abroad and what steps need to be taken in order to be successful in getting such opportunity?
This was a last minute move to the US before borders were closed due to the COVID-19 pandemic, but the situation escaladed so quickly that I was not aware of this in the middle of February. Here I’m working as a research fellow. My main task is to retrospectively analyse data of Y-90 treatment and prostate artery embolisation on a special equipment.
Doing any IR-related training/research abroad is always a good idea. There are so many different health systems with different approaches to IR that it is always good to experience how others organize/preform the IR service. IR is developing at a fast pace and it’s our role to keep up to this pace with our hospitals.
One thing to consider is how the trip abroad will affect your training. You may find opportunities that can count towards your training in your home country, while others (like mine) will push your end of the training out. It still may be worth it, just think about it.
So get out, gain some experience and take it back to your country!
9. Last but not least, we would like to know how difficult it is for you to balance a career in IR with personal/family commitments, especially now when you have moved across the pond…
That’s something I have been struggling with since the beginning of my training. Of course, I’m really into my job, but I’m also a father of two kids. 24 hours is about the half the time I’d need for a day. Moving to another continent is a big change for any family, and I’m trying to find a way to find a better balance with work, family and my personal needs. I’m really thankful to my family that they support my dedication to IR.
1. Let´s take it from the beginning – when did you decide to become an IR and why did you decide to pursue a career in this field?
As a medical student, I always dreamed of becoming a general surgeon. I was on a waiting list to get a position when I read an interesting article about interventional radiology. This was the moment I had found my calling. Until this time, I had never heard about this subspecialty.
2. What do you like the most about your job and what are the best things about IR?
There are two main aspects of interventional radiology that I like the most: the integration of imaging as a navigational tool to perform procedures and the breadth of different procedures you can perform. Performing interventions, a lot of times lifesaving, through a small incision of 2mm, patients being able to go home the following day, is totally fascinating, for me this is magic.
3. What IR procedures interest you the most?
I am mainly interested in vascular procedures, especially treating peripheral artery disease.
4. You are an EBIR (European Board of Interventional Radiology) holder – can you share with us your experience with the exam and what would you suggest for young IRs to consider before taking the exam?
Actually, getting prepared for the EBIR exam was not a really stressful period for me. I strongly believe that if you have completed a proper training during your IR fellowship and you study methodically for 3-4 months you will feel competent enough for sitting successfully for the EBIR examination. The curriculum and syllabus from CIRSE is a great guidance tool. On the top of that, the CIRSE Academy provides e-learning courses specifically tailored to the needs of physicians preparing for the EBIR exam.
5. A few years ago, you become a member of the ETF Subcommittee – what inspired you to join the community and what do you think has been the biggest success of the ETF so far?
I think what inspired me more to join this community was the idea that I could also add my bit to help young trainees follow their dreams and at the same increase the awareness of IR among medical students.
6. What do you envision for the future of the ETF? For the future of IR?
I would like to see ETF become even bigger, creating a very strong network for young IRs in the future. Finding ways to infiltrate also IR to low- and middle-income countries around the globe is also part of my vision. About the future of IR, I strongly believe that is time to become an independent specialty.
7. Not only are a member of the ETF Subcommittee, you are also a member of the CIRSE Membership Committee and the Online Education Committee that takes care of the content of the CIRSE library and academy. Can you tell us more about your role in these committees?
My role as a member of the Online Education Committee is to support the development (as an author and as a reviewer) and delivery of online e-learning courses for the CIRSE Academy. Currently, there are 41 courses available on oncology, embolisation, neurointerventions, aortic, arterial, venous, and non-vascular interventions. To ensure updated, high quality courses, there is a need of continuous reviewing and updating each online course. As a member of the Membership Committee, I am in charge, together with the rest of the members, of reviewing and approving applications for individual CIRSE membership and fellowship, as outlined in CIRSE’s articles of association.
8. Is it difficult to balance a career in IR with personal/family commitments?
Finding a balance between work and personal/family commitments is not so difficult. This is an issue that affects anyone with a high-pressure job and requires good personal help and understanding from all sides of the family.
9. Based on your own experience, is there any advice you would give to young IRs-to-be?
Yes. I would like to advise them that if they have a dream, whether it’s to become a surgeon, a pilot, or an astronaut, they can’t just turn it off or “forget about it.” Becoming an IR is a long training pathway with moments of glory and failure along way. But if you have the desire and drive to do it you just know it.
We spoke with Dr. Jonathan Nadjiri from Munich about him becoming an IR and his membership with the ETF.
Read his interview below!
We talked with Dr. Sara Protto, an Italian IR and a mom of a 2-year old boy, living and practicing IR in Finland.
Read her interview below!
We spoke with Dr. Jonathan Nadjiri from Munich, our newest ETF Subcommittee member representing Germany.
1. Let´s take it from the beginning – when did you decide to become an IR and why did you decide to pursue a career in this field?
Since I always liked working with my hands, I intended to become a surgeon just like my father. During my medical education I really became aware of IR for the first time when I did an internship in a radiology department at the university hospital here in Munich during my last study year. Supported by the interventional radiologist in my internship, I did my first small steps in IR. That was when I realized that this work could fulfil me, that IR has an enormous clinical potential and also a great potential for further development. I really got fascinated by IR, understanding that IR could solve several clinical problems that have required surgical treatment in the past in a very elegant way. So that was when I decided to become an interventional radiologist.
2. Throughout your IR training, has there been anything you would have changed and/or improved?
That is a very important question, since it probably concerns many young IRs in Europe, as in many countries IR is a subspecialty of radiology. That’s also the way it is in Germany. That means you will have to go through probably four years of diagnostic radiology training. Of course, this is a very important training for skills required in IR, such as planning interventions based on CT or MRI scans and evaluating indications of IR procedures and so on. However, this might be a little bit discouraging for young students looking for a career in IR. Moreover, the IR training usually takes place in the last years of medical education to become a board-certified radiologist. Also, IR training commonly becomes an educational bottle neck in many departments, with IR being a part of the medical education to become a radiologist. This means that colleagues who intend to become a diagnostic radiologist still need to complete IR training. This limits the opportunities for aspiring IRs to work in IR for longer than the minimal required IR training to become board certified as a radiologist.
In retrospect, I think it was beneficial to communicate my interest in IR to my supervisors and head of department early. I should have done this even at an earlier time point. This would have allowed for even more training with more rotations in IR. However, the regular pathway is to do IR at the end of the education, and with the high demand for IR training in many departments, for above mentioned reasons, it is hard to constantly ask your supervisors for more. That especially is true when you are new to the department.
3. What do you like the most about your job and what are the best things about IR?
I really like the manual challenge of IR, and to succeed with complicated techniques is quite enjoyable. But of course, the purpose of IR is not to make me happy. The best thing about IR, in my eyes, is that the patients really benefit from the procedures. In this context I am thinking about abscess drainages, transcatheter vessel occlusions in bleeding patients and many more. These are cases where you often can directly see clinical improvement when the procedure is finished.
Besides the procedures themselves, I really enjoy the interdisciplinary aspect of IR. Proper indications for procedures require good and efficient communication with many other disciplines. Being a part of a larger concept of a patient’s optimal oncologic treatment and seeing patients improve after therapy is also a very likable aspect of the job.
4. What are some things that young IRs in particular need to keep in mind throughout a procedure?
That is an interesting question. I think that it is important to have the intervention planned carefully in advance and you must have your plan A, B, C, D….and so on prepared in your mind. If something unexpected happens, take a few seconds to revaluate the situation before you act. Know when you need to ask someone for help and when you can fix everything yourself.
If you have a series of failures, analyse them carefully with your supervisor; if everything was technically sound, don’t change anything the next time you do the procedure and trust yourself. Don’t be discouraged. Accumulation of undesired outcomes can be a coincidence and may not be connected to you. However, all cases of undesired outcome need to be investigated carefully afterwards.
5. What IR procedures interest you the most?
I have a liking for interventions requiring supra-selective catheterisation, but also for TIPSS or PTCDs. For me the most interesting interventions are those which are part of a multidisciplinary therapy approach. A good example for that is a portal vein occlusion to induce hypertrophy of one liver lobe to allow for a surgical resection of the other. Seeing these patients years later in the clinic for check-ups again after our curative treatment of an initially palliative/inoperative situation is a great gratification. In my eyes, these interdisciplinary approaches have great potential and their developments in the future are of great interest to me.
6. You have been part of a research group focusing on improving of existing cross-sectional imaging techniques and establishing new imaging approaches in cardiovascular diseases. Can you tell us more about this project?
In my earlier career, my research focus was lying on cardiac imaging in CT and MRI. Mainly in CT, we evaluated coronary plaque parameters which can be used to predict adverse events and found a way to detect high risk patients better than other previous techniques. But we also developed a technique in CT which allows for use of Gadolinium as contrast agent without losing diagnostic confidence of the CT. In MRI, we evaluated quantitative instead of qualitative techniques to characterize myocardial pathology. We found that these methods were better than the other available techniques at that time point, and further that they can predict outcomes, e.g. after TAVR. These methods are part of the current guidelines of cardiac imaging now. Although, these subjects are part of cardiovascular disease, I decided to refocus my research to interventional radiology. The reason being that I believe that my research is more efficient if the research subject is also the main content of my daily clinical work. Nevertheless, I think that I can transfer some of the results and knowledge from my earlier research into research and clinical practice in IR, such as utilization of alternative contrast agents in CT, advanced plaque characterization using conventional and spectral CT as well as MRI angiography without contrast agent.
Also, the clinical partners from other disciplines at our hospital who worked with me on cardiac imaging before are also the main contact persons for clinical questions and research in interventional radiology. Actually, this a good opportunity to thank my earlier supervisors, my clinical partners and my mentor, Prof. Paprottka, for the good collaboration, for supporting me and patiently tolerating my learning curves.
7. You have recently joined the CIRSE´s ETF community – we are curious what convinced you to take this step?
My fascination for IR started with the procedures themselves and later augmented to multidisciplinary approaches. These approaches rely heavily on the relations between the different disciplines. These relations can be supported by a framework of guidelines and knowledge of national and international societies such as CIRSE. Especially, CIRSE highlights several topics that will improve the framework for interdisciplinary work, but also other important topics such as the promotion of the IR service to other clinicians. Further, CIRSE has shown interest in the educational situation in Europe. Especially, the role of IR being a rather small part of the clinical education of radiologists in general in many European countries. This has been discussed by the ETF community at several occasions when I first visited a CIRSE meeting. In my eyes, IR is not just performing the procedures and caring for the patients, but it is also a quickly evolving field that requires constant organized communication between the different disciplines on a larger scale.
Also, there is an increasing demand for IRs, highlighting the importance of recruitment of young people interested in IR. I wanted to contribute to these important questions of IR. I wanted to contribute to IR and promote this specialty beyond my own hospital. Since I am responsible for education of medical students in radiology at our university, I am especially interested in the topics promoted by the ETF community and always looking for ways to increase the awareness and interest for IR in young people. The ETF community, therefore, is a great opportunity for me to get connected and exchange with other members about ideas and get inspirations. I would like to thank the CIRSE committee and the ETF subcommittee for nominating me to become a member of the ETF community and for the warm welcome. I am looking forward to collaboration.
8. What expectations do you have from the ETF and what benefits do you think it might bring to you and to the community of young IRs from all over the world?
I am really looking forward to my work for the ETF. I hope to get inspiration for IR education for students, but also for the physicians in education at our facility. I hope that inspirations and experiences from the ETF might help to improve the educational situation in Germany. Our group has an accepted a paper about structural availability of certain IR techniques in Germany, which will be published in the coming months. We found that for young IRs, the educational situation is very good regarding the distribution of high-volume centres offering IR training. However, the organisation of IR being a part of the education in radiology might discourage young people from pursue a career in IR. The ETF and CIRSE can help to motivate these young colleagues and provide them with a training perspective and a career perspective and maybe someday even be of help to reorganize IR training in Germany. Beyond that, CIRSE and the ETF provide a great chance for homogeneous educational standards in IR and promotion of IR in students in Europe allowing for a better exchange of knowledge.
9. Do you already have in mind any IR-trainee-related projects which you would like to bring to the table?
Actually, we use a simulator for training of young interventional radiologists at our facility, but we also use the simulator for the education of students. There are seminars where several students get to try different simple vascular interventions after lectures. But we are also working on an even more dedicated intensive IR training for students with several lectures and several IR sessions at the simulators. I would be happy to share our experiences and am also really looking forward to getting inspired by the other members of the subcommittee. There are already several great offers for hands-on sessions at the CIRSE meetings where simulators are in use. Therefore, I am very interested in the opinions of the ETF community on IR training on simulators. Further, I would like to ask whether the use of simulators should be intensified with dedicated sessions for students with additional short lectures from experts and courses for young IRs perusing EBIR.
10. Is it difficult to balance a career in IR with personal/family commitments?
That is a very interesting question. Actually, in January my first child, Malia Aurelia, was born, so I do not have much experience with balancing my career with my family commitments. However, since I was a teenager I was very much into music. I spent countless hours on practicing at home, for rehearsals and concerts. This has changed a lot over the years until today, because these hours are going into my job now and I only play a few hours on the weekends. However, this was a choice which I happily made and it developed slowly over time. Sometimes it is just time for a reorientation. Additionally, my wife always supported me and always has known me spending many hours for my dedication. I feel that my job in IR is quiet fulfilling. This satisfaction in my eyes improves the quality time with my family and I very much appreciate their commitment. Sometimes there is even some extra time left to pick up one of my many guitars.
11. Based on your own experience, is there any advice you would give to young IRs-to-be?
This question relates a bit to a self-critical analysis of my own career. Some things worked out others did not. Some things I did unintentionally were very helpful; some things I did intentionally did not work out. From what I know now, my advice for a career in IR would be the followings:
- Decide early what goal you want to achieve. Apply at places that offer what you are looking for.
- Look for a mentor.
- Clearly, adequately communicate what you want. If you want to do more IR rotations or more IR procedures just politely ask for it as early as you can and do that repeatedly. The only thing that can happen is that your requests get denied.
- Start research, preferably in the field of your clinical work, as early as possible.
- Give 100% for your goal; no excuses.
- Put in hours for yourself: Research, clinical work on weekends, free days and after hours, read!
- Steel with your eyes:Try to observe as many procedures as you can at as many different places as you can.
- Always be friendly and believe the best of others unless the opposite is clearly proven. Still stay friendly.
- Value your co-workers. They will guard your back!
- If something went wrong start looking for errors at yourself.
- If something goes wrong analyse logically and try to learn.
And most importantly: Trust yourself! Don’t let anybody discourage you.
We talked with Dr. Sara Protto, an Italian IR and a mom of a 2-year old boy, living and practising IR in Finland. Sara became deputy chairperson of the ETF Subcommittee last year and has been a very active and important role model for female IRs!
1. How long have you been a member of the ETF Subcommittee and what inspired you to join?
I became involved with ETF almost from the beginning, I think it was 2016. The ETF was born from the need of a better and more efficient network between young IRs. I decided to become involved because I really believed in it and I wanted to contribute in the creation and development of a network between young IR colleagues who could help each other and learn from each other. Moreover, I think it is important to promote IR between young residents and medical students, and ETF gives me this possibility.
2. Since you have joined, what would you consider as the biggest success of the subcommittee?
We have accomplished a lot since 2015, when ETF was created. One of the things I am personally really proud of is the amazing student programme we have developed with the help of CIRSE. This programme gives students around Europe the possibility to take part in congresses, get to know our speciality and even present personal research. As a further matter, we are working with CIRSE to establish a grant system allowing IRs to visit other hospital and complete training periods in other countries (stay tuned for more news about this!)
3. Let´s take it from the beginning – when did you decide to become an IR and why did you decide to pursue a career in this field?
I think we could say that it was love at first sight. I was a 4th year medical student and, by chance, during my Erasmus in Finland, I was assigned to the department of interventional radiology for one week. At that time, I did not even know about its existence! Anyway, I felt straight away that there was nothing more interesting and appealing in any other medical field. It was so elegant and at the same time so effective. I decided I wanted to become an IR and once a I went back home I followed the everyday work of the IR department in my hometown for two years.
4. What do you like the most about your job and what are the best things about IR?
The work is really heterogeneous, every patient is different, as is every procedure. Moreover, I feel like I am really affecting the life of my patients, helping them having a better quality of life. Daily, we treat patients with life-threatening conditions and helping them is rewarding. For me, feeling that I am making a difference is really important
5. What are some things that young IRs in particular need to keep in mind throughout a procedure?
It is always of central importance to plan your procedure in advance, studying the old scans and imaging and asking more experienced colleagues for help when in doubt about what to do. Try to think about possible complications so you can be ready if something unexpected happens. Of course, is not possible to be ready for everything, but it is advisable to prepare yourself as much as possible.
6. What IR procedures interest you the most?
I like mostly intravascular procedures and particularly BTK interventions, even if those can be really time consuming and demanding. It is gratifying to see an open vessel where before there was a diseased artery, knowing that this is could change the patient’s future. Those patients normally suffer from wounds and could need an amputation if the vascularisation is not restored. Another field I am really interested in is interventional oncology, which is the future of tumour treatment. IO is growing really fast and has given hope to many patients suffering from cancer.
7. Based on your own experience, is there any advice you would give to young IRs-to-be?
Never give up! There will be days when you feel you are not able to do even the simplest procedures, and days when something goes wrong or you make a mistake or you cannot save your patient. If you really love what you do, you will always find the strength to continue learning and growing as a professional.
8. Is it difficult to combine a career in IR and family?
The situation is probably different in every country; thus, I am just referring to what happens in Finland. I do not think that being an IR here is more challenging than working in any other medical field. In almost all fields there are nightshifts and week-ends and sometimes long days. I think that organizing my day in advance helps, knowing where I have to be and when makes it easier to juggle between work, family and hobbies. I am lucky that I get to spend a lot of time with my son, as here our workday normally ends in the early afternoon and I get to spend my evenings with my family.
9. What do you envision for the future of the ETF? For the future of IR?
I think ETF has just started to show what we can achieve as a committee. In just a few years, we have been able to grow and organize amazing events for trainees and students. I believe it will continue to grow and help young IRs to become the best professionals they can be.
Regarding the future of IR, I think IR is the future. More and more, every procedure will become less invasive, and with the help of newer devices we will be able to do so much more than now. That´s why we have to inform our medical students and young doctors about this field of medicine. Moreover, in my opinion, we should try to establish a speciality in IR to standardise the path to become an IR and be sure that the level of expertise is similar in different hospital and countries.
Meet our expert IRs!
In addition to our ETF Subcommittee member interviews, we have also reached out to senior female IRs and asked them to tell us more about their career path and what it takes to pursue a career in the field of interventional radiology.
CIRSE Past President Prof. Anna-Maria Belli tells us about striving for a career in IR as a woman.
Read her interview below!
Dr. Georgia Tsoumakidou tells us about her time working in France and balancing a career in IR with family commitments.
Read her interview below!
CIRSE Past President Prof. Anna-Maria Belli is a role model for many women who are striving for a career in IR.
1. When did you first become familiar with IR and when did you realize that you would like to pursue a career in this field?
I came across IR in my first year as a doctor when a young boy with a nasal angiofibroma was embolised to reduce blood loss at surgery. I was impressed by its elegance, but didn’t think of it as a career until a few years later when I was choosing my career options. I was attracted to surgery and practical procedures, and realised that IR would give me that professional satisfaction. So, I entered radiology with a view to going into IR. Like many others I lost sight of that for a while as I was immersed in diagnostics. There wasn’t a great deal of IR being practised where I trained, but I remembered my first love and got a scholarship to attend other institutions. That rekindled my enthusiasm, which I realised had never really gone away.
2. What do you like the most about your job and what are the best things about IR?
The fact that what we make a difference. We can fix things and the range and scope of what we can do is only limited by technology and our imagination. My job has never been boring. I was performing procedures that were new to me or applying familiar procedures in new situations right up until the day I retired. I was learning new things to the bitter end.
3. Would you say that there are any major differences with regard to what it took to become an IR at the time you completed your training in comparison to what is required from young IRs-to-be now?
I think things have changed for the better. There was no IR programme when I started, which meant my training was dependent on where I practised, which is why I practised vascular IR rather than non-vascular IR. IR time was not protected and we had no separate IR emergency cover, so we could be called at any time. There was no appreciation of our clinical role either. On the other hand, IR was not so developed and wide ranging as it is now, which is why we needed to develop a separate curriculum and training programme. This now means that young IRs should get a more thorough grounding in the range of IR procedures and their role as clinician.
4. You have achieved a lot in your career as an IR – just to list a few achievements – you were president of British Society of Interventional Radiology, president of CIRSE, received several honours from different radiological and IR societies and have served on many important committees and working groups. Can you tell us more about these achievements and pick a few of them which have had a big impact on you?
I was incredibly proud to serve as president of CIRSE and my national society BSIR, but am sad that I am still the only woman to have done so. Although I have no doubt that will soon change. To receive the gold medal from both those societies was amazing enough, but then to be awarded the ESR gold medal was the cherry on the cake as it was an honour from the whole specialty of radiology. All of these honours have had a big impact on me, as it inferred that my role in IR had been recognised and by reflection all those who helped me and supported me both personally and professionally.
5. What was the latest IR-related project/study you worked on? Can you please briefly describe what the project/study was about?
We have just completed the FEMME trial, an RCT between myomectomy and UAE, which will be published in the NEJM. This trial shows how the two main uterine preserving treatments for fibroids compare and confirms that both treatments are valid options for women and should be offered. I hope the results will dispel the myth that UAE has a more negative impact on fertility and menopause compared with the surgical options. However, I think this will remain a contentious issue.
6. In 2008, you became the first British female professor of interventional radiology. As a role model and inspiration for many, is there any advice you would give young female IRs in particular on how to approach their IR career and be successful?
Simply work hard, ask questions of your treatment methods and publish as much as possible. Everything you do in IR has the potential to educate others and be publishable. Criticism is part of the game and it is difficult not to take this to heart, but if you have a good team around you, you will get the support you need and the stimulus of having your ideas challenged and new ideas developed. And if at first you don’t succeed, keep trying! That advice goes for men and women but for young female IRs in particular I would say don’t believe you haven’t got it in you, because you really have. Don’t be shy of putting yourself forward for leading roles.
7. The European Trainee Forum was created during your CIRSE presidency. What were your expectations back then for this group of young and aspiring IRs?
Young IRs are our future and life blood, and we wanted to create a feeling of excitement for IR at a time when IR seemed under threat from all sides by other specialties and there was a lot of negativity in the air. We also needed trainees’ input into developing the curriculum and training requirements of IR in Europe, which they helped us achieve.
8. What do you envision for the future of the ETF? For the future of IR?
I believe IR will always have a place, as it needs imagination and knowledge of a wide range of other specialties, which radiology inevitably has and those with a single specialist interest do not. The ETF has been fantastic in this respect. I feel they have created a groundswell of excitement amongst aspiring IRs and their participation in the work of CIRSE and its congresses has enriched us all. They have the enthusiasm and ambition of youth, and that keeps us all rejuvenated.
9. Is it difficult to balance a career in IR with personal/family commitments?
IR is a demanding specialty, and is less predictable than diagnostic radiology, but as the number of IRs increases it should become a little easier to merge professional and family life. We need to see acceptance of part time training and working, not just for women but also men, as both demand a reasonable work/life balance. Family support is necessary, but if IR numbers increase, then it would be possible to regulate the hours and on call commitment so that planning social and family life becomes a bit easier. However, like any job, if you love it, you will find a way without too many sacrifices with support from your team and family.
10. Based on your own experience, is there any advice you would give to young IRs-to-be?
I would tell them to follow their passion and not be put off by others who usually have a vested interest in trying to persuade young radiologists not to follow a career in IR. I have loved every minute of my career. There have been low as well as high points, but that is life, and looking back I feel very lucky and privileged to have had such an interesting and varied professional life. I would do it all again.
We talked to Dr. Georgia Tsoumakidou, a Greek interventional radiologist who spent some years working in France before moving to Switzerland to continue her IR career at the University Hospital in Lausanne. Learn more about Dr. Tsoumakidou’s international career and how she was able to combine it with family life!
1. What made you curious to learn more about the field of IR? When did you hear about interventional radiology for the first time?
I first came in contact with IR as a medical student in Greece. I thought it was very exciting to be able to treat patients using a non-surgical and still very efficient treatment. At that time, I was hesitating between interventional cardiology and IR, but I soon realised that IR has a vaster field of action, with many different treatments and possibilities for research and innovation.
2. Can you tell us more about your IR training and the challenges you faced while undergoing it?
As a radiology resident in Athens I had the possibility to dedicate an important part of my training to IR. While on the last year of my residency I received a CIRSE grant which gave me the opportunity to visit and practice months in Strasbourg for six months in the department of Prof. Gangi. This was my first close contact with non-vascular and different pain management procedures. So, after the first challenge (having to leave my country) I had to face a second one; choosing between vascular and non-vascular IR. Prof. Gangi and the whole team made me really love the percutaneous procedures and I soon realised how lucky I was to be able to receive a two-year fellowship in Strasbourg. I learned the majority of percutaneous procedures (from simple biopsy and drainage procedures to more complex spinal thermal ablation etc), using different image guidance modalities (US, fluoroscopy, CT, MRI, and PET/CT).
3. How would you describe your experience working in different countries? What would you consider to be the best learning experience and why?
Having the possibility to change countries and working environments is a blessing and a bit of curse also. It’s a blessing because you can really get the most out of every team and every country, see different health care systems, and establish relationships with colleagues from all over the world. On the other hand, it is a bit of curse because I had to abandon my country (including family, friends and first mentors), to get familiar to different medical systems, and to be accepted by new colleagues, though establishing relationships with other specialists is a nice challenge.
Being able to collaborate with different teams is, for me, one of the best learning experiences as it allows me to get the most out of every team and to exchange ideas and progress.
4. Who and what would you say has motivated you the most during your IR career pathway? Why?
My Prof. in Strasbourg. Prof Gangi is so passionate with his work, open-minded, ready to share his knowledge, and at the same time is warm and funny. He inspired me to dedicate the first steps of my career in pain management procedures and taught me that working hard and loving our work and our patients is the key to success. He taught us to work in a team, to appreciate and to help one another. Being interventional radiologists, we are all part of a team, and we need to work well inside the team in order to better treat our patients.
5. What field interests you the most? What is your current research focused on?
My main field of interest is thermal ablation procedures. We are currently working on a protocol of segmentation on liver thermal ablation for primary and secondary liver tumours. It would be so helpful if we can manage to predict where our ablation margins are sufficient and where we should expect a recurrence during the procedure.
6. What would your advice be for young IRs regarding research activities? What steps would you suggest for them to take in order to begin their research work?
Research is a part of our work as IRs. It is very important to find the research filed that most excites us and work on it. Certainly, very often it is hard to combine research and clinical work (as workload is often intense), but only through research we can go further. The first step is to concentrate on the field of research they like the most. CIRSE and other IR congresses are the best place to exchange ideas with colleagues on research programs, establish relationships and attract the industry if help is needed from their side.
7. Since 2015, you have been giving lectures at CIRSE events. Can you share with us what your very first experience with CIRSE was? What would you recommend to young female IRs in order to get the chance to be involved with CIRSE?
I started attending the CIRSE congress while still a radiology resident. I was impressed by the high level of expertise of the participants and I was hoping one day to be able to participate more actively. My first steps were with EPOS presentations and then, step by step, I managed to give my first free papers and invited lectures.
Young female IRs, should not hesitate to get involved in CIRSE. Both the CIRSE congress and the rest of the committee’s activities (grants, training courses, journals etc) are a great opportunity to learn, exchange and to further present their work.
8. What do you consider to be the highest achievement in your career thus far? Can you tell us about any future goals you may have related to your career and IR-related scientific work?
This is a hard question. Probably the greatest achievement in my career so far is to be invited as a speaker at international congresses.
My main future goal is to manage to establish and begin to perform MR-guided procedures in Lausanne. I used to be so fond of MR-IR and there so many advantages over the other image-guidance modalities. However, it is not always easy to persuade hospital directors to invest in our projects. I hope that soon we will manage to finally have our MR-IR theatre. Regarding research projects, with Prof. Denys we are about to begin a new prospective study regarding the efficacy and safety of prostate artery embolisation in patients with Parkinson’s disease and benign prostate hypertrophy.
9. Apart from the role of IR you are also a mother. Is it difficult to balance a career in IR with family commitments?
I would so much like to say it is easy, but balancing family life and a high-pressure career is not always easy. The working hours are long, the demands are huge and the on calls-duties as an IR in a university hospital are quite demanding. I often have to run to the hospital in the middle of the night, leaving my family behind. Especially for a Greek mother that wants to be present in her children’s life all the way, combing career and family isn’t always easy. But I never regret my choice. With our work we help patients: we can treat their cancer, relieve their pain, elevate their quality of life. We can save lives.
10. What do you think the barriers for women to become IRs are?
There are no real barriers for women to become IRs. Women IRs are as talented as men IRs. I was working fully during both my pregnancies. Certainly, I had to adjust my procedures so as not to get exposed to radiation, but I was still very active treating my patients. In the last years, we see more and more women IRs. This is the proof that there are no real barriers and it is very encouraging for the future. In general, a person’s career opportunities should not be limited by their gender, race or sexual orientation.
11. CIRSE strives to help increase participation of women in IR. Why do you think it’s important to have more women represented in the field of IR?
Women and men often approach things differently. Women have a very different perspective and mentality than men. In recent decades, increasing numbers of women surgeons have broken into what was once regarded as an exclusive ‘men’s club’. So, why not in IR also? I strongly believe that the presence and collaboration of men and women can only be for the benefit of the patients, our specialty and medicine in general.