1. Interventional Radiology
Croatia and
Interventional Radiology
Asst. Prof. Vinko Vidjak MD, PhD
Clinical Hospital Merkur
Zagreb, Croatia
RENAL SONOGRAPHY
Ultrasound is a very valuable modality for evaluation of the kidneys. Although CT has superceded ultrasound in renal evaluation in many instances, ultrasound is still a very useful, quick, non-invasive, relatively inexpensive, ubiquitous technique, particularly useful in children.
This Core Curriculum teaching slide series was produced by the Jefferson Ultrasound Research and Educational Institute of Thomas Jefferson University through an educational grant from the Open Society Institute , New York. The author of this Core Curriculum module is Oksana H. Baltarowich, M.D.

2. CRO = HR Croatia = Hrvatska Inhabitants: 4.3 mill
IR in Croatia, Turkey, Antalya March 2014
Inhabitants:
4.3 mill
CRO = HR
Croatia = Hrvatska

6. Nikola Tesla Tesla = Weber/m²
IR in Croatia, Turkey, Antalya March 2014
Nikola Tesla
Tesla = Weber/m²

7. Nikola Tesla Tesla = Weber/m²
IR in Croatia, Turkey, Antalya March 2014
Nikola Tesla
Tesla = Weber/m²

8. Science and Education in Croatia?
IR in Croatia, Turkey, Antalya March 2014
Science and Education in Croatia?

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

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

11. Radiology education and mentorship?
IR in Croatia, Turkey, Antalya March 2014
Radiology education and mentorship?

12. Radiology education and mentorship?
IR in Croatia, Turkey, Antalya March 2014
Radiology education and mentorship?
4 University Centers

13. Radiology education and mentorship?
IR in Croatia, Turkey, Antalya March 2014
Radiology education and mentorship?
4 University Centers
Residency programme harmonised with UEMS/ESR training curriculum

14. Radiology education and mentorship?
IR in Croatia, Turkey, Antalya March 2014
Radiology education and mentorship?
4 University Centers
Residency programme harmonised with UEMS/ESR training curriculum
Oral and practical board exams

15. Radiology education and mentorship?
IR in Croatia, Turkey, Antalya March 2014
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

16. Croatian Society of Radiology
IR in Croatia, Turkey, Antalya March 2014
Croatian Society of Radiology
316 radiologists + 64 radiology residents
4.4 mill inhabitants: 1 radiologist per inhabitants
incl residents 1: inhabitants
1200 radiographers

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

18. Section of Interventional Radiology- Croatia – sIRcro
IR in Croatia, Turkey, Antalya March 2014
Section of Interventional Radiology- Croatia – sIRcro
Officially since 2000.g.
Unofficially since 1990.g.

19. Section of Interventional Radiology- Croatia – sIRcro
IR in Croatia, Turkey, Antalya March 2014
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

20. Section of Interventional Radiology- Croatia – sIRcro
IR in Croatia, Turkey, Antalya March 2014
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
CIRSE Group Member since 2010

21. Section of Interventional Radiology – today
IR in Croatia, Turkey, Antalya March 2014
Section of Interventional Radiology – today
41 radiologists + 7 radiology residents
Most radiologists or smaller procedures (punction, drainage) under US control, diagnostic angiography,..

22. Section of Interventional Radiology – today
IR in Croatia, Turkey, Antalya March 2014
Section of Interventional Radiology – today
41 radiologists + 7 radiology residents
Most radiologists for smaller procedures (punction, drainage) under US control, diagnostic angiography,..
Significant angio therapeutic procedures
Neuroradiologic interventions
EVAR, TIPS, CAS, BTK, tm embolisation, ..

23. Section of Interventional Radiology – today
IR in Croatia, Turkey, Antalya March 2014
Section of Interventional Radiology – today
41 radiologists + 7 radiology residents
Most (41 radiologists) for smaller procedures (punction, drainage) under US control, diagnostic angiography,..
Significant angio therapeutic procedures
Neuroradiologic interventions
EVAR, TIPS, CAS, BTK, tm embolisation, ..
- 8 cath labs

24. Section of Interventional Radiology – today
IR in Croatia, Turkey, Antalya March 2014
Section of Interventional Radiology – today
41 radiologists + 7 radiology residents
Most (41 radiologists) for smaller procedures (punction, drainage) under US control, diagnostic angiography,..
Significant angio therapeutic procedures
Neuroradiologic interventions
EVAR, TIPS, CAS, BTK, tm embolisation, ..
- 8 cath labs
- 2 cath labs

25. Section of Interventional Radiology – today
IR in Croatia, Turkey, Antalya March 2014
Section of Interventional Radiology – today
41 radiologists + 7 radiology residents
Most (41 radiologists) for smaller procedures (punction, drainage) under US control, diagnostic angiography,..
Significant angio therapeutic procedures
Neuroradiologic interventions
EVAR, TIPS, CAS, BTK, tm embolisation, ..
- 8 cath labs
- 2 cath labs
- 4 cath labs

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

27. Interventional Radiology – training
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology – training

28. Interventional Radiology – training
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology – training
Subspecialisation of radiology (general radiology+2 years)

29. Interventional Radiology – training
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology – training
Subspecialisation of radiology (general radiology+2 years)
Subspecialty exam since 2000 (IR, NR, UZV)

30. Interventional Radiology – training
IR in Croatia, Turkey, Antalya March 2014
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

31. Interventional Radiology – training
IR in Croatia, Turkey, Antalya March 2014
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
Oral and practical board exams

32. Interventional Radiology - training
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology - training

33. Interventional Radiology - training
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology - training
PROGRAM
Nr of procedure and…..
vascular IR…
PTA (30), stents (20), EVAR (ass),….
TIPSS (10 ass, 2 alone),……
non vascular IR
US guided drenaige (40), US guided biopsy (30)…

34. IR in Croatia, Turkey, Antalya 19-22 March 2014
IR experience
…………….

35. IR experience ……………. (… two institutions) 2009.g : 1550 hospital beds
IR in Croatia, Turkey, Antalya March 2014
IR experience
…………….
(… two institutions) 2009.g :
1550 hospital beds
Annualy more than 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,....

36. IR experience Procedures graph (… two institutions) 2009.g.:
IR in Croatia, Turkey, Antalya March 2014
IR experience
Procedures graph (… two institutions) 2009.g.:
vascular interventions pts
EVAR / TEVAR
CAS
PTA / stenting SFA
PTA / iliac artery stenting
BTK
Mechanical thrombectomy 15
Embolisation

37. IR experience Procedures graph (… two institutions) 2009.g.:
IR in Croatia, Turkey, Antalya March 2014
IR experience
Procedures graph (… two institutions) 2009.g.:
non vascular interventions pts
Billiary
Urogenital
Esophageal
CT / US drainage

38. Clinical Hospital Merkur – Zagreb
IR in Croatia, Turkey, Antalya March 2014
Clinical Hospital Merkur – Zagreb
Associate Professor Vinko Vidjak, MD, PhD
IR experience
More 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,....

39. Clinical Hospital Merkur – Zagreb
IR in Croatia, Turkey, Antalya March 2014
Clinical Hospital Merkur – Zagreb
Associate Professor Vinko Vidjak, MD, PhD
- IR subspecialization mentorship
- Ambulatory IR consultations
IR experience
More 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,....

40. Clinical Hospital Merkur – Zagreb
IR in Croatia, Turkey, Antalya March 2014
Clinical Hospital Merkur – Zagreb
Associate Professor Vinko Vidjak, MD, PhD
- IR subspecialization mentorship
- Ambulatory IR consultations
IR experience
More 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,....

41. Experience in organization of IR meetings?
IR in Croatia, Turkey, Antalya March 2014
Experience in organization of IR meetings?

42. sIRcro 2009 VII. Meeting of Croatian Interventional Radiologists
IR in Croatia, Turkey, Antalya March 2014
VII. Meeting of Croatian Interventional Radiologists
with International Participation
sIRcro 2009
Lectures: 80
Lecturers: 57
Participants: 240
Clinical Faculty
Okan Akhan
Firas Al-Ali
Massimiliano Fusaro
Antonin Krajina
Robert Morgan
Zoran Milošević
Andrej Schmidt
Luc Stockx
István Szikora
Renan Uflacker
Christof Zollickoffer

43. Moto: bringing IR closer to clinitians
IR in Croatia, Turkey, Antalya March 2014
VII. Meeting of Croatian Interventional Radiologists
with International Participation
sIRcro 2009
Moto: bringing IR closer to clinitians
Lectures: 80
Lecturers: 57
Participants: 240
Clinical Faculty
Okan Akhan
Firas Al-Ali
Massimiliano Fusaro
Antonin Krajina
Robert Morgan
Zoran Milošević
Andrej Schmidt
Luc Stockx
István Szikora
Renan Uflacker
Christof Zollickoffer

44. IR in Croatia, Turkey, Antalya 19-22 March 2014
VIII. Meeting of Croatian Interventional Radiologists with International Participation
sIRcro 2011
International Clinical Faculty
Jan Raupach
Istvan Battyany
Pavel Berden
Tomaž Ključevšek
Karl-Ludwig Schulte
Markus Graf
Maria Schoder
Dimitrij Kuhelj
Andrej Schmidt
Zoran Milošević
……………
Lectures: 85
Lecturers: 60
Participants: 230

45. Moto: bringing IR closer to young radiologists
IR in Croatia, Turkey, Antalya March 2014
VIII. Meeting of Croatian Interventional Radiologists with International Participation
sIRcro 2011
Moto: bringing IR closer to young radiologists
International Clinical Faculty
Jan Raupach
Istvan Battyany
Pavel Berden
Tomaž Ključevšek
Karl-Ludwig Schulte
Markus Graf
Maria Schoder
Dimitrij Kuhelj
Andrej Schmidt
Zoran Milošević
……………
Lectures: 85
Lecturers: 60
Participants: 230

46. sIRcro 2013 IX. Meeting of Interventional Radiologists
IR in Croatia, Turkey, Antalya March 2014
IX. Meeting of Interventional Radiologists
of Croatiawith international participation
sIRcro 2013
International Clinical Faculty
Andrej Schmidt , Leipzig Hart Zentrum, Germany
Jan Raupach, Hradec Králové, The Czech Republic
Okan Akhan, Ankara, Turkey
Marco Manzi , Abano Terme, Padua, Italy
Firas Al Ali , Kalamazoo, USA
Zoran Milošević , KBC Ljubljana, Slovenia
Antonin Krajina , Hredec Kralove, Czech Republic
Raman Uberoi , Oxford, Great Britain
Istvan Battany , KB Pesch, Hungary
Lectures: 90
Lecturers: 70
Participants: 270

47. Moto: hot topics in IR sIRcro 2013
IR in Croatia, Turkey, Antalya March 2014
IX. Meeting of Interventional Radiologists
of Croatiawith international participation
sIRcro 2013
Moto: hot topics in IR
International Clinical Faculty
Andrej Schmidt , Leipzig Hart Zentrum, Germany
Jan Raupach, Hradec Králové, The Czech Republic
Okan Akhan, Ankara, Turkey
Marco Manzi , Abano Terme, Padua, Italy
Firas Al Ali , Kalamazoo, USA
Zoran Milošević , KBC Ljubljana, Slovenia
Antonin Krajina , Hredec Kralove, Czech Republic
Raman Uberoi , Oxford, Great Britain
Istvan Battany , KB Pesch, Hungary
Lectures: 90
Lecturers: 70
Participants: 270

48. AVS 2010

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

50. Modul education: I Carotid artery, II Femoral and SFA III BTK
IR in Croatia, Turkey, Antalya March 2014
Modul education:
I Carotid artery,
II Femoral and SFA
III BTK
from 2010 part of Crossroads "Centers of exellence"

51. Interventional Radiology -Why interest???
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology
-Why interest???

52. Interventional Radiology -Why interest???
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology
-Why interest???
Creative

53. Interventional Radiology -Why interest???
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology
-Why interest???
Creative
Attractive

54. Interventional Radiology -Why interest???
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology
-Why interest???
Creative
Attractive
Innovative

55. Interventional Radiology -Why interest???
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology
-Why interest???
Creative
Attractive
Innovative
Multipotent

56. BUT !!! Interventional Radiology -Why interest??? Creative Attractive
IR in Croatia, Turkey, Antalya March 2014
Interventional Radiology
-Why interest???
Creative
Attractive
Innovative
Multipotent
BUT !!!

57. Interventional Radiology - problems
IR in Croatia, Turkey, Antalya March 2014
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

58. Interventional Radiology - consequence
IR in Croatia, Turkey, Antalya March 2014
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

59. vs Interventional Radiology
IR in Croatia, Turkey, Antalya March 2014
State healtcare
vs Interventional Radiology

60. Interventional Radiology – solutions
IR in Croatia, Turkey, Antalya March 2014
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

61. Thank you for your attention
IR in Croatia, Turkey, Antalya March 2014

62. Thank you for your attention
IR in Croatia, Turkey, Antalya March 2014
Welcome sIRcro 2015
…….Trust us, we work also …..