CIRSE Fellowship report: Dr. Andrzej Lejawka

My name is Andrzej Lejawka. I am originally from Poland, but I did my residency training in diagnostic and interventional radiology in Sheffield in the United Kingdom. Currently, I am working as an interventional radiology consultant at the Nottingham University Hospitals, a large and busy NHS Trust and a major trauma centre serving a catchment area of more than 4 million people.

So far in my interventional radiology career, I have gained considerable experience in various vascular and non-vascular procedures. However, my exposure to interventional oncology, especially thermal ablations, has been somewhat limited. To gain more experience in this exciting and promising field, I chose to apply for a CIRSE Fellowship grant at the European Institute of Oncology (Istituto Europeo di Oncologia, IEO) in Milan, Italy. I first learned about this institute during ECIO 2022 in Vienna, where I was captivated by the advanced ablation techniques and cutting-edge equipment showcased by Dr. Franco Orsi, the head of the interventional radiology department, and his colleagues.

The Interventional Radiology team at the European Institute of Oncology.

Selfie with Dr. Franco Orsi – Chief of the Interventional Radiology Department at the European Institute of Oncology.

The Istituto Europeo di Oncologia (IEO) is a leading cancer research and treatment centre which has scored a spot among the top 10 best oncology hospitals in the world, according to the latest edition of the prestigious Newsweek ranking. This recognition highlights its commitment to exceptional cancer care, research, and innovative treatments.

Interventional radiology plays a significant role in this achievement. The IR department is proud to hold the IASIOS accreditation awarded by CIRSE which confirms that the interventional oncology treatments offered adhere to high quality standards. The IRs at the IEO conduct over 550 ablation procedures annually, primarily targeting the kidneys and liver, but also including lung, bone, thyroid, adrenal and breast ablations. They use all ablation techniques and modalities available on the market including microwave, radiofrequency, cryoablation, electroporation, and occasionally chemical ablation. They also perform embolization procedures for oncology patients, such as TARE and TACE for metastases, as well as TAE for hepatocellular carcinoma. Additionally, they carry out a wide range of other procedures including but not limited to biopsies, drain and stent insertions, vertebroplasties, and IV access.

Dr. Giovanna Pitoni performing microwave ablation of a renal tumour.

Dr. Gianluca Varano and Dr. Franco Orsi performing electrochemotherapy of a centrally located hepatic tumour.

The main interventional room is the state-of-the-art angio-CT room. It is here where most of the ablations take place. Most of the procedures are performed under general anaesthetic, often with the useful technique of single lung ventilation to eliminate breathing-related motion of the organs. It is not only CT, DSA, and excellent ultrasound machines which are available here but also advanced navigation and fusion technologies. The navigation equipment allows precise positioning of needles and probes, and the fusion software allows for the simultaneous display of an ultrasound image and a perfectly matched MPR view of the pre-acquired CT. This allows targeting lesions in the most difficult locations (hepatic dome, diaphragm etc.) and accessing them from unconventional approaches and through limited ultrasound windows. Basically, no lesion can feel safe in the IEO IR department.

Additionally, there is another CT room equipped with C-arm fluoroscopy and ultrasound machine, where less complex procedures are conducted, i.e. biopsies, drainages, and stent insertions. They also have an ambulatory room fitted with ultrasound and portable fluoroscopy machines which is primarily used for ultrasound-guided biopsies and IV access procedures, mainly portacath insertions.

Dr. Paolo Della Vigna and Dr. Franco Orsi performing cryoablation of a metastasis in the lesser trochanter of the femur followed by percutaneous placement of a screw for reinforcement. 

Dr. Paolo Della Vigna and Dr. Guido Bonomo performing balloon dilatation of a strictured choledochojejunostomy.

Dr. Daniele Maiettini performing radiofrequency ablation of a hepatic tumour during one of the workshops.

The IEO team is deeply committed to providing holistic patient care, going beyond the role of mere technicians performing procedures ordered by other specialties. They hold regular outpatient clinics and operate a 24/7 radiology ward with dedicated beds, ensuring more independence from other specialties, efficient workflow, and comprehensive support for patients.

The IR team at the IEO is highly committed to education. During my brief time there, I had an opportunity to take part in three courses that they organized. The standout experience was a fantastic two-day ESIR course on thyroid ablation techniques.

It is impossible to list everything I have learned or seen during my one month stay at the IEO, but some of the interesting things are:

• Exposure to all ablation modalities, particularly the ones which I had no prior real-life experience with such as cryoablation, chemo-electroporation and ethanol ablation.
• Treatment of very complex cases, including particularly large tumours, multiple lesions, and lesions located in challenging areas like the dome of the liver, diaphragm, or centrally located in the kidney or liver hilum.
• Ablation of bone lesions often followed by percutaneous screw placement.
• Breast, adrenal, and thyroid ablation.
• Experience with ablation devices from different manufacturers and observing their performance in real life over a short time span, which allows for easy comparison and helped me draw conclusions about the strengths and weaknesses of particular devices.

Some of the treats of Milan: Galleria Vittorio Emanuele II, ballet at the Teatro alla Scala, Inter Milan match at the San Siro stadium, Tiramisu.

“Un caffe normale” (one of many a day) with IR friends.

Believe it or not, Milan actually has a little bit more to offer than just IEO. It was lovely to see the beautiful monuments such as Duomo di Milano, Galleria Vittorio Emanuele II, and Castello Sforzesco. I was lucky to see a ballet “La dame aux camélias” at the famous Teatro alla Scala and a match of the Inter Milan team at the San Siro stadium. It was also great to see the paintings of great artists at the Pinacoteca di Brera and more modern art exhibitions at the Fondazione Prada. The other upsides of being in Milan were obviously related to fantastic Italian food and delicious desserts.

To summarise, doing a CIRSE fellowship at the European Institute of Oncology in Milan was an amazing experience which has greatly benefited me in my further professional development. I learned a lot from the interventional radiology team. They have made me feel very welcome and were always happy to answer any questions and give advice. I was extremely lucky to be able to learn from the best in the field of interventional oncology. I thoroughly recommend CIRSE Fellowship Programme and the European Institute of Oncology as a potential hosting centre.

I extend a massive thank you to Dr. Franco Orsi and his IR team and to CIRSE for giving me this great learning opportunity.