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

Subspecialisation of Interventional Radiology in Europe 2009

Interventional Radiology in Greece 2012 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.

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.

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

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.

Subspeciality IR 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

Subspeciality IR training in Greece Selection of applicants: Radiology title CV Personal interview at the selected cites

Subspeciality IR accreditation in Greece Title of IR subspecialty Acquired after written and oral examinations IR logbook (150 diagnostic and 100 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

IR Certificate Issued by the Greek Ministry of Health

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,”

IR procedures in Greece Late 70s: first steps Today: a ll kinds of vascular, non vascular and emergency IR procedures

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: Intraarterial thrombolysis  1996: Radiofrequency Ablation  1997: Endovascular Treatment of Abdominal Aneurysms  2004:Chemoembolization with DEB  2009: Microwave Ablation

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

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

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

Interventional Oncology RFA TACE GI/biliary stenting Supportive care: Port/PICC,pain management SIRT currently available in Athens In all major hospitals

Research

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

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.

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

IR division 2 nd Dept of Radiology Attikon University Hospital

IR in Greece CIRSE Group member Greek Society of Interventional Radiology Post-graduate course (MSc) in IR at the University of Athens CIRSE Group member

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!!