CIRSE Fellowship report: Dr. Hans-Jonas Meyer

By Dr. Hans-Jonas Meyer

My name is Hans-Jonas Meyer and I am currently working as an attending radiologist at the University Hospital of Leipzig in Saxony, eastern Germany. I completed my residency two years ago with strong ambitions to continue my career in interventional radiology, specializing in interventional oncology. The clinical focus of our hospital is the full spectrum of hepato-biliary interventions, including percutaneous and endovascular procedures up to chemosaturation. However, we are in the early stages of establishing a cryoablation and electrochemotherapy programme. This was the reason for my motivation to complete my CIRSE fellowship in Strasbourg, so I could have the opportunity to learn these procedures from world-renowned experts in the field. Additionally, I was excited to witness how a large interventional radiology centre functions in another European country. The Nouvel Hôpital Civil at the University of Strasbourg, directed by Prof. Afshin Gangi, is a leading hospital for interventional oncology, which proved to be the perfect fit for my learning goals.

This essay aims to showcase my experiences, the skills I was able to learn, and the professionalism I witnessed throughout my fellowship.

Me before entering the Nouvel Hôpital Civil of the University of Strasbourg for the first time.

The last farewell in Professor Gangi’s office. A very well decorated one!

Professor Gangi proudly presents his argon storage. I wish every department could have such an organization.

Prof. Gangi is a world-renowned expert in the field of interventional oncology, particularly in percutaneous ablation of a wide variety of benign and malignant tumours. This high level of expertise is also demonstrated by the fact that the Nouvel Hôpital Civil is the first International Accreditation System for Interventional Oncology Services (IASIOS) Centre of Excellence in the world.

The department is equipped with an uniplanar angio-suite, an angio-CT, and an interventional MRI. A strength of the department is also that it focuses completely on interventional radiology and has a large and highly trained staff

A typical day in the unit is carefully organized to manage a high volume of patients. Ablation cases usually begin with the anaesthetist preparing the patients at around 08:00. In the afternoon and into the late evening, the list is filled with image-guided biopsy and infiltration cases. Remarkably, the anaesthesia capacity is available every day of the week except Tuesdays. However, Prof. Gangi proudly told us that soon there will be anaesthesiologists on Tuesdays as well.

Every Tuesday afternoon we met for a meeting where all the cases for the next week are reviewed and discussed.

The map at the entrance of the department showing the visitors of the department. Simply put – there were a lot of people from all over the world in Strasbourg.

The latest treasure of the department. The new interventional MRI scanner from Siemens (FreeMax with 0.55T), which was proudly shown by Professor Gangi.

I was very impressed with how much fluid you can use for a hydro-dissection.

One of the most impressive aspects of the University Hospital of Strasbourg is the clear organization and structured patient care from admission to procedure. The whole team is dedicated and experienced in treating patients. Prof. Gangi is an enthusiastic mentor. Once he enters the department, a crowd gathers next to him and he empathically mentors about radiology and/or life. He is so passionate about interventional radiology and teaching every day. During his procedures, you can feel the symbiosis of his lifelong experience in interventional radiology and his enthusiasm for teaching.

Personally, the most interesting procedures were the cryoablations, which were numerous, one is performed nearly every day. Other cases that stood out to me were very large renal tumours that seemed to be easily treatable under MR guidance, and there was a large subcutaneous desmoid tumour that I did not expect to be treatable percutaneously. Another very important aspect for me was witnessing the highly efficient way the team performed hydro-dissection in each case. I was impressed by the amount of fluid applied to the subcutaneous space to allow ablation of the desmoid tumour. The staff at the University of Strasbourg has some tricks and techniques to improve the quality of many procedures.

Professor Gangi performing a cryobablation of an endometriosis of the abdominal wall using sonography to place the needle and the MRI-guidance to visualize the formation of the ice ball.

The big Christmas tree at the Christmas market.

The great cathedral of Strasbourg.

In addition to caring for patients, Prof. Gangi and his team are renowned researchers and pioneers in innovative therapies. During my stay, the new interventional MRI scanner was installed. The large bore, lower field strength of 0.55T resulting in better sequences, and of course lower cost, could improve the field of MRI-guided therapies immensely.

Despite his busy schedule as a physician and department head, Prof. Gangi still manages to find time to take care of the fellows and his patients.

I was fortunate to have two other fellows during my stay, one from the University of Pennsylvania and one from the Hospital of Winterthur, Switzerland. We had great discussions about cases, the department, and interventional radiology.

One of the highlights besides interventional radiology was the Christmas market in Strasbourg (“Marché de Noël”) for which Strasbourg is very famous. I had the wonderful opportunity to visit it with my fiancée. Strasbourg is also called the capital of Christmas because the entire city centre is lit up and festively decorated. Other famous attractions of Strasbourg are the world-famous cathedral (for a long time, the largest building in the world) and the European Parliament.

I would highly recommend any IR interested in developing interventional oncology services to visit Prof. Gangi and his team to experience clinical IO at its best!

I am very grateful for the opportunity of the CIRSE Fellowship.