Croatia and Interventional Radiology

Croatia and Interventional Radiology

Asst. Prof. Vinko Vidjak MD, PhD

Clinical Hospital Merkur

Zagreb, Croatia

Inhabitants:4.3 mill

CRO = HR Croatia = Hrvatska

IR in Croatia, Turkey, Antalya 19-22 March 2014

Nikola Tesla

•Tesla = Weber/m²


Nikola Tesla

•Tesla = Weber/m²


Science and Education in Croatia?




Radiology education and mentorship?



• 4 University Centers




• Residency programme harmonised with UEMS/ESR training curriculum





• Oral and practical board exams






• Committee consisting of three examiners


Croatian Society of Radiology

316 radiologists + 64 radiology residents

4.4 mill inhabitants: 1 radiologist per 14.000 inhabitants incl residents 1: 11.600 inhabitants

1200 radiographers


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Radiologists/million inhabitants

Average


Section of Interventional Radiology- Croatia – sIRcro

• Officially since 2000.g.

• Unofficially since 1990.g.






• Regular Meetings with International Parcitipation every 2 years since 1986.

• Cooperation with Slovenia, Austria, Hungary





• Regular Meetings with International Parcitipation every 2 years since 1986.

• Cooperation with Slovenia, Austria, Hungary

• CIRSE Group Member since 2010

Section of Interventional Radiology – today

• 41 radiologists + 7 radiology residents

• Most radiologists or smaller procedures (punction, drainage) under US control, diagnostic angiography,..




• Most radiologists for smaller procedures (punction, drainage) under US control, diagnostic angiography,..

• Significant angio therapeutic procedures

• Neuroradiologic interventions

• EVAR, TIPS, CAS, BTK, tm embolisation, ..




• Most (41 radiologists) for smaller procedures (punction, drainage) under US control, diagnostic angiography,..





- 8 cath labs








- 8 cath labs

- 2 cath labs








- 8 cath labs

- 2 cath labs

- 4 cath labs

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35

Countries

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Catheter Labs per million inhabitants

Average


Interventional Radiology – training


Interventional Radiology – training• Subspecialisation of radiology (general radiology+2 years)


Interventional Radiology – training• Subspecialisation of radiology (general radiology+2 years)

• Subspecialty exam since 2000 (IR, NR, UZV)



PROGRAM•5 months on nonradiology clinical departments (vasc.,abd.,thorac.,urorad./surgery and oncol) •9 months on vascular IR procedures•8 months non vascular IR procedures

• Subspecialisation of radiology (general radiology+2 years)




PROGRAM•5 months on nonradiology clinical departments (vasc.,abd.,thorac.,urorad./surgery and oncol) •9 months on vascular IR procedures•8 months non vascular IR procedures

• Subspecialisation of radiology (general radiology+2 years)




Interventional Radiology - training


Interventional Radiology - training

PROGRAMNr of procedure and…..

•vascular IR…PTA (30), stents (20), EVAR (ass),….TIPSS (10 ass, 2 alone),……

•non vascular IRUS guided drenaige (40), US guided biopsy (30)

…


IR experience…………….


IR experience…………….


(… two institutions) 2009.g :

• 1550 hospital beds• Annualy more than 1.100 angio therapeutic procedures

• Type of procedures:

PAD (pta/stenting), PTA/stenting on other arteries, CAS, EVAR, embolisations, reocclusive technics (mechanical, aspiration thrombectomy, thrombolysis),interventional oncology (TACE, RFA...) billiary, urogenital, digestive interventions, CT controlled interventions,....

IR experienceProcedures graph (… two institutions) 2009.g.:

vascular interventions pts1. EVAR / TEVAR 322. CAS 433. PTA / stenting SFA 2064. PTA / iliac artery stenting 1405. BTK 846. Mechanical thrombectomy 157. Embolisation 90


IR experienceProcedures graph (… two institutions) 2009.g.:

non vascular interventions pts1. Billiary 802. Urogenital 303. Esophageal 204. CT / US drainage 150


Clinical Hospital Merkur – ZagrebAssociate Professor Vinko Vidjak, MD, PhD

IR experienceMore than 800 (angio therapeutic + diagnostic) procedures anually• Treatment types: PAD (pta/stent), PTA/stent on other arteries, subintim rec., CAS, EVAR, BTK, embolisation, reocclusive techniques (mechanical, aspiration thrombectomy, TIPSS, (thrombolysis), billiary, urogenital, digestive interventions, CTguided drainage,....



IR experienceMore than 800 (angio therapeutic + diagnostic) procedures anually• Treatment types: PAD (pta/stent), PTA/stent on other arteries, subintim rec., CAS, EVAR, BTK, embolisation, reocclusive techniques (mechanical, aspiration thrombectomy, TIPSS, (thrombolysis), billiary, urogenital, digestive interventions, CTguided drainage,....

- IR subspecialization mentorship

- Ambulatory IR consultations



IR experienceMore than 800 angio therapeutic + diagnostic procedures anually• Treatment types: PAD (pta/stent), PTA/stent on other arteries, subintim rec., CAS, EVAR, BTK, embolisation, reocclusive techniques (mechanical, aspiration thrombectomy, TIPSS, (thrombolysis), billiary, urogenital, digestive interventions, CTguided drainage,....

- IR subspecialization mentorship

- Ambulatory IR consultations


Experience in organization of IR meetings?


Clinical FacultyOkan AkhanFiras Al-AliMassimiliano FusaroAntonin KrajinaRobert MorganZoran Milošević Andrej Schmidt Luc StockxIstván SzikoraRenan UflackerChristof Zollickoffer.........

Lectures: 80Lecturers: 57Participants: 240

VII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2009


Clinical FacultyOkan AkhanFiras Al-AliMassimiliano FusaroAntonin KrajinaRobert MorganZoran Milošević Andrej Schmidt Luc StockxIstván SzikoraRenan UflackerChristof Zollickoffer.........


VII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2009

Moto: bringing IR closer to clinitians


International Clinical Faculty

Jan RaupachIstvan BattyanyPavel BerdenTomaž KljučevšekKarl-Ludwig SchulteMarkus GrafMaria SchoderDimitrij KuheljAndrej SchmidtZoran Milošević……………

VIII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2011




Jan RaupachIstvan BattyanyPavel BerdenTomaž KljučevšekKarl-Ludwig SchulteMarkus GrafMaria SchoderDimitrij KuheljAndrej SchmidtZoran Milošević……………

VIII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2011


Moto: bringing IR closer to young radiologists



Andrej Schmidt , Leipzig Hart Zentrum, GermanyJan Raupach, Hradec Králové, The Czech Republic Okan Akhan, Ankara, Turkey Marco Manzi , Abano Terme, Padua, ItalyFiras Al Ali , Kalamazoo, USAZoran Milošević , KBC Ljubljana, SloveniaAntonin Krajina , Hredec Kralove, Czech RepublicRaman Uberoi , Oxford, Great BritainIstvan Battany , KB Pesch, Hungary

IX. Meeting of Interventional Radiologists of Croatiawith international participation

sIRcro 2013




Andrej Schmidt , Leipzig Hart Zentrum, GermanyJan Raupach, Hradec Králové, The Czech Republic Okan Akhan, Ankara, Turkey Marco Manzi , Abano Terme, Padua, ItalyFiras Al Ali , Kalamazoo, USAZoran Milošević , KBC Ljubljana, SloveniaAntonin Krajina , Hredec Kralove, Czech RepublicRaman Uberoi , Oxford, Great BritainIstvan Battany , KB Pesch, Hungary

IX. Meeting of Interventional Radiologists of Croatiawith international participation

sIRcro 2013


Moto: hot topics in IR


AVS 2010


Modul education: I Carotid artery, II Femoral and SFAIII BTK

from 2010 part of Crossroads "Centers of exellence"


Interventional Radiology -Why

interest???



interest???

Creative



interest???

Creative

Attractive



interest???

Creative

Attractive

Innovative



interest???

Multipotent

Creative

Attractive

Innovative



interest???

BUT !!! Multipotent

Creative

Attractive

Innovative


Interventional Radiology - problems

• Low monthly IR limits… for depart.

• More than 40% IR procedures are not recognized by state healtcare (CAS, DEB, PMTh,…..

• State directed material reimbursment

• No working benefits for IR doctors


Interventional Radiology - consequence

• Less and less radiologists on IR

• IR lose interest in profesion mainly due to financial rectrictions

• Few centers left

• Low procedure numbers (education?)

• Inflow of other clinitians ( vascular surgeons, interventional cardiologists …) into IR


State healtcare vs Interventional

Radiology


Interventional Radiology – solutions• EU/CIRSE recomendations for IR

• Education standardisation

• Implementation of EBIR as national board exam

• Centers of IR exellence (2-3 in Croatia) without financial restrictions

• Independent funding for high price procedures

• Less goverment control

• More involment of private healtcare companies


IR in Croatia, Turkey, Antalya 19-22 March 2014 Thank you for your attention

IR in Croatia, Turkey, Antalya 19-22 March 2014 Thank you for your attention

Welcome sIRcro 2015 …….Trust us, we work also …..

Documents

Croatia and Interventional Radiology