CIRSE Fellowship report: Dr. Nguyen Tan Tai

My name is Nguyen Tan Tai, and I am currently an interventional radiologist at Nhan dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam. I have been working as an IR for the past six years since I completed my residency, and I am truly passionate about interventional radiology and interventional oncology.

Located in the northeastern area of Ho Chi Minh City, Nhan dan Gia Dinh Hospital is one of the biggest multidisciplinary hospitals in the city. We receive more than 3000 patients at our outpatient centre and more than 400 emergency cases per day. We also have a team of interventional radiologists that are able to perform multiple types of procedures, ranging from neurointerventions, such as mechanical thrombectomy and aneurysm coiling; to visceral and peripheral interventions, such as plug-assisted transvenous obliteration (PARTO), transjugular intrahepatic portosystemic shunt (TIPS), percutaneous biliary drainage and stenting, arteriovenous fistula angioplasty, and percutaneous transluminal angioplasty for treating peripheral artery disease (PAD). However, interventional oncology is a new area not only in our hospital but also in our country. We have little experience with it as of yet and perform only radiofrequency/microwave ablation for hepatocellular carcinoma (HCC). Because of this, my fellowship goal was to focus on learning novel interventional oncology procedures. The Nouvel Hôpital Civil at the University of Strasbourg, led by Prof. Afshin Gangi, proved to be the perfect fit for my learning goals. It was a true honour to be able to learn from their IR team every day during my one-month stay.

With Prof. Gangi

View of Nouvel Hôpital Civil

Prof. Gangi is a world-renowned expert in the field of interventional oncology, especially ablation for a wide variety of benign and malignant tumours. His centre is also International Accreditation System for Interventional Oncology Services (IASIOS) accredited, providing an extremely high standard of quality and more patient-centred care. The department is equipped with one uniplanar angiosuite, one angio-CT and one interventional MRI. This fellowship has allowed me to learn the following from the team:

• Setup and workflow of patient care, which I find most interesting and impressing. This is the basis for me to make improvements to the setup at our centre.
• Setup for Angio-CT and interventional MR, and how they can be most approriately tailored to different IR procedures.
• How IASIOS assists in delivering a highly effective clinical IO service.

A typical day in the ward is carefully organized to manage a high volume of patients. The ablation cases usually start with the anaesthetist preparing the patients at around 08:00. In the afternoon and until late evening, the list is full of image-guided biopsy and infiltration cases. There is also a review meeting every Tuesday afternoon, where all cases for the next week will be reviewed and discussed. Prof. Gangi, Prof. Garnon, Dr. Cazzato, Dr. Caudrelier, Dr. Koch, Dr. Pierre-Alexis, Dr. Bertucci, and Dr. Weiss, as well as all the technicians, are very enthusiastic in sharing their experience and were willing to answer all of my questions regarding the procedures.

Me at the Immagerie Interventionnel

With Prof. Garnon

Speaking of technical aspects, I am impressed by the use of cryoablation in treating malignant diseases, such as renal cell carcinoma, metastatic diseases. This is the first time I have had an opportunity to view such procedures. I was also excited to observe the use of hydrodissection to protect critical structures during ablation. I would call it “the art of hydrodissection”. By using small 22G needles, a continuous saline infusion is achieved and the target is isolated from all the surrounding critical organs, giving a protective effect to them and ensuring a complete tumour ablation. I was also able to watch irreversible electroporation (IRE) for treating a centrally located HCC – which is a difficult location due to treat due the risk of thermal biliary damage. The case was performed by Prof. Garnon, and with his expertise, all the probes were correctly inserted into the tumour as planned and combined with microwave ablation to ensure the safety margin of the ablation zone.

Angio-CT is also a great tool to improve the efficiency of interventional procedures. For liver tumour ablation, a celiac angiography is performed under flouroscopy, and CT angiography is established to locate the tumour on the arterial phase, leading to precise ablation. It is interesting to see that angio-CT can greatly enhance the efficiency and accuracy of tumour ablation.  Moreover, it was also my very first time to witness MRI-guided intervention. Never did I ever imagine how MRI could be able to provide a real-time and accurate probe insertion, with the advancement of tissue resolution compared to CT. I was fortunate to see some cases of prostatic intervention under MRI guidance, which I found truly incredible.

A case is done with the help of Angio-CT

Electrochemo therapy – a new technique that I find interesting!

A cryoablation case done by utilizing Angio-CT

I was able to observe how quality patient care and safety are strong foci. The Nouvel Hôpital Civil was the second centre worldwide to be accredited by the International Accreditation System for Interventional Oncology Service (IASIOS), and is the first-ever IASIOS Centre of Excellence. This means the clinical care is even more standardised, bringing more quality assurance to the patients.

My fellowship at Nouvel Hôpital Civil has been a transformative experience that will enlighten my professional career in countless ways. Being exposed to so many types of advanced procedures in interventional oncology has enriched me with knowledge and skills that I will try to bring back and develop at my home centre, since interventional oncology is a new area to us all. I also look forward to sharing the insights and knowledge gained during my fellowship with my colleagues and contributing to the advancement of interventional oncology at my hospital. I am strongly confident that such innovations will significantly benefit our patients and result in higher quality, more patient-oriented care. I would like to send my gratitude to Prof. Gangi for this precious opportunity of being at his centre. He is a great mentor, also is very warm and kind. Even though he is so busy, he still finds time to look after his fellows and patients. I also would like to say thanks to the team. They are full of energy, friendly, and they really helped me a lot through my times there. Finally, I would highly recommend any doctor having an interest in developing their career in interventional oncology to visit Prof. Gangi and his team to experience interventional oncology at its highest level.