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 Although CT has superceded ultrasound in renal evaluation in many instances, ultrasound is still a very useful, quick, non-invasive, relatively inexpensive, ubiquitous technique,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.

CRO = HR Croatia = Hrvatska Inhabitants: 4.3 mill IR in Croatia, Turkey, Antalya 19-22 March 2014 Inhabitants: 4.3 mill CRO = HR Croatia = Hrvatska

Nikola Tesla Tesla = Weber/m² IR in Croatia, Turkey, Antalya 19-22 March 2014 Nikola Tesla Tesla = Weber/m²

Nikola Tesla Tesla = Weber/m² IR in Croatia, Turkey, Antalya 19-22 March 2014 Nikola Tesla Tesla = Weber/m²

Science and Education in Croatia? IR in Croatia, Turkey, Antalya 19-22 March 2014 Science and Education in Croatia?

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

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

Radiology education and mentorship? IR in Croatia, Turkey, Antalya 19-22 March 2014 Radiology education and mentorship?

Radiology education and mentorship? IR in Croatia, Turkey, Antalya 19-22 March 2014 Radiology education and mentorship? 4 University Centers

Radiology education and mentorship? IR in Croatia, Turkey, Antalya 19-22 March 2014 Radiology education and mentorship? 4 University Centers Residency programme harmonised with UEMS/ESR training curriculum

Radiology education and mentorship? IR in Croatia, Turkey, Antalya 19-22 March 2014 Radiology education and mentorship? 4 University Centers Residency programme harmonised with UEMS/ESR training curriculum Oral and practical board exams

Radiology education and mentorship? IR in Croatia, Turkey, Antalya 19-22 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

Croatian Society of Radiology IR in Croatia, Turkey, Antalya 19-22 March 2014 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

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

Section of Interventional Radiology- Croatia – sIRcro IR in Croatia, Turkey, Antalya 19-22 March 2014 Section of Interventional Radiology- Croatia – sIRcro Officially since 2000.g. Unofficially since 1990.g.

Section of Interventional Radiology- Croatia – sIRcro IR in Croatia, Turkey, Antalya 19-22 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

Section of Interventional Radiology- Croatia – sIRcro IR in Croatia, Turkey, Antalya 19-22 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

Section of Interventional Radiology – today IR in Croatia, Turkey, Antalya 19-22 March 2014 Section of Interventional Radiology – today 41 radiologists + 7 radiology residents Most radiologists or smaller procedures (punction, drainage) under US control, diagnostic angiography,..

Section of Interventional Radiology – today IR in Croatia, Turkey, Antalya 19-22 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, ..

Section of Interventional Radiology – today IR in Croatia, Turkey, Antalya 19-22 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

Section of Interventional Radiology – today IR in Croatia, Turkey, Antalya 19-22 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

Section of Interventional Radiology – today IR in Croatia, Turkey, Antalya 19-22 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

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

Interventional Radiology – training IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology – training

Interventional Radiology – training IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology – training Subspecialisation of radiology (general radiology+2 years)

Interventional Radiology – training IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology – training Subspecialisation of radiology (general radiology+2 years) Subspecialty exam since 2000 (IR, NR, UZV)

Interventional Radiology – training IR in Croatia, Turkey, Antalya 19-22 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

Interventional Radiology – training IR in Croatia, Turkey, Antalya 19-22 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

Interventional Radiology - training IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology - training

Interventional Radiology - training IR in Croatia, Turkey, Antalya 19-22 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)…

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

IR experience ……………. (… two institutions) 2009.g : 1550 hospital beds IR in Croatia, Turkey, Antalya 19-22 March 2014 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 experience Procedures graph (… two institutions) 2009.g.: IR in Croatia, Turkey, Antalya 19-22 March 2014 IR experience Procedures graph (… two institutions) 2009.g.: vascular interventions pts EVAR / TEVAR 32 CAS 43 PTA / stenting SFA 206 PTA / iliac artery stenting 140 BTK 84 Mechanical thrombectomy 15 Embolisation 90

IR experience Procedures graph (… two institutions) 2009.g.: IR in Croatia, Turkey, Antalya 19-22 March 2014 IR experience Procedures graph (… two institutions) 2009.g.: non vascular interventions pts Billiary 80 Urogenital 30 Esophageal 20 CT / US drainage 150

Clinical Hospital Merkur – Zagreb IR in Croatia, Turkey, Antalya 19-22 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,....

Clinical Hospital Merkur – Zagreb IR in Croatia, Turkey, Antalya 19-22 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,....

Clinical Hospital Merkur – Zagreb IR in Croatia, Turkey, Antalya 19-22 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,....

Experience in organization of IR meetings? IR in Croatia, Turkey, Antalya 19-22 March 2014 Experience in organization of IR meetings?

sIRcro 2009 VII. Meeting of Croatian Interventional Radiologists IR in Croatia, Turkey, Antalya 19-22 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 .........

Moto: bringing IR closer to clinitians IR in Croatia, Turkey, Antalya 19-22 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 .........

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

Moto: bringing IR closer to young radiologists IR in Croatia, Turkey, Antalya 19-22 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

sIRcro 2013 IX. Meeting of Interventional Radiologists IR in Croatia, Turkey, Antalya 19-22 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

Moto: hot topics in IR sIRcro 2013 IR in Croatia, Turkey, Antalya 19-22 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

AVS 2010

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

Modul education: I Carotid artery, II Femoral and SFA III BTK IR in Croatia, Turkey, Antalya 19-22 March 2014 Modul education: I Carotid artery, II Femoral and SFA III BTK from 2010 part of Crossroads "Centers of exellence"

Interventional Radiology -Why interest??? IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology -Why interest???

Interventional Radiology -Why interest??? IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology -Why interest??? Creative

Interventional Radiology -Why interest??? IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology -Why interest??? Creative Attractive

Interventional Radiology -Why interest??? IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology -Why interest??? Creative Attractive Innovative

Interventional Radiology -Why interest??? IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology -Why interest??? Creative Attractive Innovative Multipotent

BUT !!! Interventional Radiology -Why interest??? Creative Attractive IR in Croatia, Turkey, Antalya 19-22 March 2014 Interventional Radiology -Why interest??? Creative Attractive Innovative Multipotent BUT !!!

Interventional Radiology - problems IR in Croatia, Turkey, Antalya 19-22 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

Interventional Radiology - consequence IR in Croatia, Turkey, Antalya 19-22 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

vs Interventional Radiology IR in Croatia, Turkey, Antalya 19-22 March 2014 State healtcare vs Interventional Radiology

Interventional Radiology – solutions IR in Croatia, Turkey, Antalya 19-22 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

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

Thank you for your attention IR in Croatia, Turkey, Antalya 19-22 March 2014 Welcome sIRcro 2015 …….Trust us, we work also …..