CIRSE Fellowship report: Dr. Albert Leka

“Muito obrigado meus amegos e colegas!
A medical practice journey in the beautiful city of Lisbon.”

By Dr. Albert Leka.

My name is Albert Leka, MD. I am a diagnostic radiologist working for Klinika San Luka in Lezhe, Albania.

I completed my residency training in diagnostic radiology at the University Hospital Mother Teresa in Tirana, Albania in 2009. Since I finished my residency programme in diagnostic radiology I have been motivated to train in interventional radiology. I could not achieve this in Albania, as we do not have an official medical curricula for IR and practical training for IR is not offered at all.

My first step towards IR was a one-week training in Greece in 2010 at The Center of Panagia Philanthropini in Ormylia, Greece. It mostly focused in FNA-s and biopsies for breast and thyroid nodules.  At that time I was working as a diagnostic radiologist in the district hospital of Mirdita, my home town in Albania.

In October 2013, I attended a one-month training in IR at the Hadassah Medical University Center in Jerusalem, Israel, with Prof. Jocob Sosna, Dr. Liat Applebaum, and Dr. Naum Goldberg, and focused on IR procedures for chest and abdominal disease, biopsies under CT and ultrasound, drainages, thoracocentesis, and paracentesis. During this period (2012-2015) I was working as a chest radiologist for the Thoracic  Diseases’ University Hospital in Tirana ( Albanian capital) where I started to perform FNAB and biopsies under US and CT guidance and drainage procedures ( non-vascular).

Prof. Tiago Bilhim, me, and other junior and senior doctors at Curry Cabral.

Prof. Bilhim performing a vascular procedure at Hospital Curry Cabral.

Since 2015 I have been working at the Klinika San Luka which is a private medical centre in Lezhe, North Albania, where I now live.

I wanted to further develop my IR skills and needed to refresh both my knowledge and my hands, as I am planning to set up an ablation service in my country. I then decided to contact Prof. Thiago Bilhim of the Curry Cabral hospital in Lisbon, as I knew he is doing great things there. He replied immediately to me and was keen to accept me at his hospital.

I then applied to CIRSE for a fellowship grant to help me with this initiative. I had attended ECIO 2023 and ET 2023 and knew about the great opportunities CIRSE offers  to physicians to deepen their knowledge in IR outside their home countries. CIRSE awarded me this grant, and Prof. Bilhim and I decided together that the best time for me to arrive for training at the IR unite of Curry Cabral University hospital in Lisbon would be would be in September and October.

My focus and area of interested before going to Curry Cabral and during the training was non-vascular procedures, especially thermal ablations. I observed every one of these procedures I could, and besides that I also participated and observed many vascular procedures that doctors and other supporting staff performed at the IR centre.

In the first half of my fellowship, I had the opportunity to attend CIRSE 2024, which was held in Lisbon this year. I had the opportunity to meet many colleagues, attend many educational activities, and attend some of the hands-on training workshops organized during this big event.

I also attended some satellite symposia, lectures, and workshops presented by world experts in the field of interventional radiology.

A workshop of great importance for me was the IASIOS workshop, which I found very useful for my endeavours and attempts to work with one of the most prominent private hospitals in Albania with the aim to be the first future IASIOS accredited centre in Albania.

The experience and training at Curry Cabral Hospital was great, very intense, with lots of new practical information and tips and tricks you need to know for every patient and every specific procedure.

Curry Cabral Hospital has an IR department which has a state-of-the-art hybrid angio-suite with CT,  and a fluoroscopic room where different procedures are performed. There is also a dedicated ultrasound room for US guided procedures. The department has a very structured system of workflow and patient referrals. The team has an outpatient clinic as well.

Work begins in the morning at 08:30 with all the IR doctors and residents looking at the patients’ information and ensuring that necessary preparations have been completed before the procedures starts.

The procedures start simultaneously with the main angiosuite and ultrasound room running in parallel. The procedural reports are immediately completed on the hospital information system. The team is supported by a dedicated team of experienced nurses and radiographic technicians.

Dr. Alfonso and me in the morning before the start of a procedure.

My view arriving at Hospital Curry Cabral.

The Curry Cabral IR team performing a vascular procedure.

The procedures start simultaneously, with the main angiosuite and ultrasound room running in parallel. The procedural reports are immediately completed on the hospital information system.

The team is supported by a dedicated team of experienced nurses and radiographic technicians.

IR procedures I observed during my fellowship:

• Biopsies under CT and US guidance for parotid gland, liver, lung, kidney, soft tissues, retroperitoneal masses, and metastases
• Drainage for soft tissue collections and other deep collections
• Paracentesis and thoracocentesis drainages
• Microwave ablation (MWA) for kidney and liver tumours.
• Cryoablation (CrA) for renal masses
• TIPS, chemoembolizations, and TACE
• Portal embolizations, TIPS revision, arterial angioplasty
• Embolization for varicocele, bronchial artery embolizations, and prostatic artery embolizations.

Senior and junior doctors working at IR unit at Curry Cabral who mentored me during my fellowship:

• Tiago Bilhim
• Elia Coimbra
• Daniel Torres
• Antonio Caetano
• Teresa Resende Neves
• Rafaela Pereira
• Afonso Fonseca, IR resident
• Martim, a 4^th year radiology resident

The team is exceptionally talented and performed ablations and biopsies of deep-seated, difficult-to-target liver, lung, renal, and adrenal lesions in a precise manner.

SAMS Hospital in Lisbon.

Me at CIRSE 2024 in Lisbon!

A view of the Lisbon city centre.

Dr. Tiago Bilhim was very supportive during all my stay, and was generous in writing a letter of support for me.

I was deeply impressed by the professionalism and dedication of the entire IR team. Every aspect, from pre-procedural consultations, to team meetings, to the execution of complex vascular and non-vascular procedures, was managed with the most care, professionalism, and precision. The high standard of the consultations and procedures at the IR department at Curry Cabral are something I hope to be able to bring back and practice at my home institution in Albania.

Another interesting aspect of my fellowship was the opportunity to observe the different setups and workflows at the Curry Cabral Hospital IR unit.

Together, with a great team of highly skilled healthcare professionals, everything was carefully organized and standardized to ensure smooth and efficient operations.

The workflow at the Curry Cabral IR unit was highly efficient, with well-defined protocols and a collaborative approach between all health professionals that ensures optimal patient care. The multidisciplinary team includes interventional radiologists, nurses, and technicians who work together seamlessly to deliver high-quality care. This collaborative environment not only improves patient outcomes but also created a positive and supportive work atmosphere for me during my observership at their department.

The team was engaged in handling interventional cases continuously from the morning until approximately 16:00, always in a dedicated and efficient way.

Dr. Afonso, Dr. Martim and Dr. Rafaela were always present and keen to help me, guide me and answer questions I had during the daily practice.

I especially want to thank Dr. Afonso who was a very dedicated guide for me, staying with me all day and even having lunch with me every day.

On the last day of my training, I went with Prof. Tiago to observe vascular procedures at SAMS hospital, which is a private hospital where Prof. Tiago gained a lot of experience performing prostate embolizations many years ago. I was able to observe for the first time a prostate embolization and varicocele embolization at this hospital and had a good time with the supporting staff there.

The communication was in English, and everybody helped me a lot. I tried to learn some Portuguese words during my stay there and I would say to all of them:

Muito obrigado meus amigos e colegas!