Interventional Radiology in Greece

1. Interventional Radiology in Greece Elias N Brountzos, EBIR Head IR Division Attikon University Hospital 2ndDept of Radiology, School of Medicine National and Kapodistrian University of Athens.

2. Subspecialisation of Interventional Radiology in Europe2009

3. Interventional Radiology in Greece2012 Republic’s Gazette 3 April 2012: • Interventional Radiology is established as having subspecialty status within Diagnostic Radiology. • The content of IR are image-guided procedures both diagnostic and therapeutic which are minimally invasive. • Such treatments involve peripheral PTA, percutaneous aneurysm management, tumor ablation, etc.

4. IR in Greece • Subspecialty of Radiology • Area of expertise: Image-guided minimal invasive diagnostic or therapeutic medical procedures • With the exception of coronary and neuro-interventional procedures.

5. IR training in Greece during DR residency Current Radiology curriculum New Radiology Curriculum Harmonization with ESR. 3-years of core knowledge. 2-years of specialization. 2-years of IR subspecialization within Radiology training. • 5 year training. • Interventional Radiology: mandatory 6-months rotation. • In some University Hospitals: 3-years IR training.

6. Subspeciality IR training in Greece • Board certified Radiologists can apply for Subspecialty. • Time of training: 2 years. • 16 months theoretical and clinical training in the field of vascular IR. • 8 months theoretical and clinical training in non vascular IR.

7. SubspecialityIR training in Greece Training centres: • Tertiary Hospitals with ≥200 beds covering all the clinical specialties (internal medicine, surgery, oncology, vascular surgery, Intensive Care Unit, etc.) • With angiography unit, CT, MRI, U/S

8. SubspecialityIR training in Greece Selection of applicants: • Radiology title • CV • Personal interview at the selected cites

9. SubspecialityIR accreditation in Greece Title of IR subspecialty • Acquired after written and oral examinations • IR logbook (150 diagnostic and100 therapeutic vascular and non vascular procedures as first of second operator. At least 50 diagnostic and 30 therapeutic procedures as a first operator) • IR Publications

10. IR Certificate Issued by the Greek Ministry of Health

11. is important to develop an IR curriculum to ensure that every trainee is trained to a set standard and assessed before they are accredited as specialists. This is particularly important when interventional radiologists cross European borders, and a set curriculum offers a means of ensuring quality control and competency,”

13. IR procedures in Greece Late 70s: first steps Today: all kinds of vascular, non vascular and emergency IR procedures

14. INTERVENTIONAL RADIOLOGY IN GREECE (by Prof D Kelekis) • 1993 : Foundation of Society of Interventional Radiology • 1970: Intraarterial Angiography • 1971: Selective angiography of renal and splachnic vessels • 1979: Selective embolization of juvenile fibroadenoma • 1979: PTA of renal artery • 1980: PTA of iliac arteries • 1982: Chemoembolization of tumors • 1984: Embolization of internal iliac arteries for hemorrhage • 1986: Intraarterialthrombolysis • 1996: Radiofrequency Ablation • 1997: Endovascular Treatment of Abdominal Aneurysms • 2004:Chemoembolization with DEB • 2009: Microwave Ablation

15. IR procedures in GreeceEmergency IR • Trauma centres in the majority of the major Greek hospitals performing endovascular embolization/stenting procedures • TIPS • Emergency EVAR- TEVAR network under development

16. Vascular IR • PAD (IC, CLI, ALI) • EVAR-TEVAR • Dialysis access maintenance • Venous disease (DVT, Varicose veins)

17. Non Vascular IR • Musculoskeletal • Obstructive uropathy • Biliary disease • Image-guided biopsies/drainages

18. Interventional Oncology • RFA • TACE • GI/biliary stenting • Supportive care: Port/PICC,painmanagement • SIRT currently available in Athens In all major hospitals

19. Research

20. Experimental protocols • Animal labs investigating new IR devices and techniques. • Development of various animal models for PAD, cancer, angiogenesis, uropathy, ect. • Multi-disciplinary experimental protocols (vascular surgeons, urologists, interventional cardiologists, etc.) Academia of Athens

21. Clinical Investigation • Multiple high-impact IR publications in major peer-review journals • Pioneer work in HCC (TACE) , PAD (infrapopliteal drug-eluting stents), musculoskeletal disease (vertebroplasty) and dialysis access (drug-coated balloons) treatment • Continuously growing participation in multi-centre trials.

22. International recognition • Society of Interventional Radiology (USA) Gold Medal. In 2012.

25. IR division 2ndDept of RadiologyAttikon University Hospital

26. IR in GreeceCIRSE Group member • Greek Society of Interventional Radiology www.epemvatiki.gr • Post-graduate course (MSc) in IR at the University of Athens CIRSE Group member

28. Thinks to do… • Establish a truly clinically oriented IR specialty –within Radiology. • Create an IR department in every hospital. • Change the Radiology residency curriculum towards an IR module after a core diagnostic knowledge. • Attract enthusiastic young physicians who want to be Irs!!