We spoke to Prof. Garnon to learn more about his presentation at CIRSE 2022.
Building the best IR team
Strasbourg, December 2004, beginning of my residency: Some ultrasound-guided biopsies are done in different ultrasound rooms across the hospital. There is an Angio suite for vascular emergencies and diagnostic angiograms. Percutaneous CT-guided interventions (biopsies, cementoplasty, ablations) are performed twice a week on two CT machines usually dedicated for diagnostic radiology. None of the consultant radiologists are dedicated 100% to IR. There is a long waiting list, no outpatient clinics, and a lot of last-minute cancellations.
Strasbourg, September 2021, beginning of my professorship: There are 13 consultants, including four with an academic position, who are working in six rooms dedicated to all kinds of IR procedures five days a week (excluding neuro). Last-minute cancellations are now exceptional (Covid excepted) and the waiting time relative to image-guidance availability has dropped down to ten days maximum for a biopsy.
This sounds like a success story of the creation of an IR team. But what exactly happened during those 15 years?
The first step toward creating the best possible IR team was the establishment of a department dedicated to IR. Medical equipment was not shared anymore with diagnostic radiology, thereby streamlining the access to percutaneous interventions even when CT-guidance was needed. Parallel to that new IR organisation, the radiologists involved in interventions reduced their diagnostic workload to increase their full-time availability not only for scheduled and emergent procedures, but also for outpatient clinics and in-hospital patient management. This did not mean giving up on diagnostic and disowning the roots of IR, but simply creating a new organisation within the hospital. The new repartition also included technicians who also became part of a dedicated IR service, thus allowing them to increase their knowledge in patient positioning, material selection and delivery, and manipulation of image-guidance modality. Same as for doctors, the mastery of diagnostic modalities remained (and still remains) in the technician’s veins and served as the basis for their evolution.
But this change is not sufficient. The dedication to IR should also include all other healthcare professionals, from the cleaners to secretaries to nurses. This is the only way to optimise the workflow and create a real team. Growing as a department is not without issues; conflicts and divergence of opinions have and will continue to arise, like in any company. Therefore, this is where team spirit takes place, and it should not be just like a word or a vague theory. Optimal management of a patient before, during and after the intervention should be the primary goal of an IR service. It requires the full commitment of the people involved in the process. The IR is the leading person in this task and should lead the others by being a great example to the team. The task can be challenging and mentally consuming, but this is how to create the best IR team possible. Strasbourg is proudly the second department accredited by the IASIOS process in Europe, a recognition that took more than 20 years of work.
Finally, setting up a complete IR service is the only way to attract the young generations of physicians, technicians and all other people involved in the field. The financial temptation of diagnostic in private practice may be a threat, but it cannot compete against the fantastic potential of attraction of IR. Nowadays, it is possible to have a large and general formation as well as opportunities to develop new services (prostate embolisation or paediatric IR, for example). By having a general formation, the new IR generation will integrate the care permanency (team spirit) smoothly. And the EBIR certification may serve as a basis for that. Moreover, by continuously learning via online and on-site congresses and journals, there is great potential for sub-specialisation, which is crucial for professional achievement.
To summarise, interventional radiology is probably one of the fastest, if not the fastest, growing specialties in medicine. The available applications of various percutaneous treatments have changed from biopsies, drainages and peripheral arterial interventions to a great variety of diagnostic, symptomatic, palliative and curative treatments in almost all locations in the body. This has progressively increased the role of IR in treating patients. It is nowadays inconceivable to have a hospital without a minimum service of IR treatment, not only for emergency purposes but also for the regularly scheduled practice. Many radiological departments are now seeking to develop IR as an independent specialty, in terms of interventional equipment (including dedicated Angio and CT suites) and the management of healthcare professionals. Building the best possible IR team is an exciting challenge which unfortunately, will not happen with the snap of a finger. It is crucial to create an IR unit with the rationale of “patient first”! Here, the Strasbourg experience has been highlighted, but there are certainly different paths to achieving the same goal.
University Hospital of Strasbourg, Strasbourg/FR
Prof. Julien Garnon is currently practicing at the University Hospital of Strasbourg in the Department of Interventional Radiology. In 2009, he completed his fellowship at the University of Strasbourg; the subject of his thesis focused on: “Cryotherapy of musculoskeletal metastases.” Prof. Garnon has presented numerous times at CIRSE congresses and is the ECIO advisor for the CIRSE social media subcommittee. He is the associate editor for CVIR's musculoskeletal section.