CIRSE Fellowship report: Dr. Maciej Szmygin

By Dr. Maciej Szmygin

I am an interventional radiologist (IR) at the Department of Interventional Radiology and Neuroradiology at the Medical University of Lublin in Poland. In operation for over 50 years, our department treats patients with all sorts of vascular diseases (both intracranial and peripheral) and serves a relatively large region of eastern Poland, with a population of 2 million people. Our hospital is also a stroke centre, with over 200 mechanical thrombectomies performed every year. While the endovascular part of our everyday clinical practice is already well-established, we are now trying to expand our role in the multidisciplinary treatment of oncological patients by offering them various minimally invasive therapies, including  chemoembolization and percutaneous ablation. Although we are already quite experienced with the former, the latter is just being introduced in our department. I did not doubt that a fellowship in one of Europe’s most experienced centres in stereotactic thermal ablation and percutaneous tumour and pain treatment would be a great opportunity to learn from the very best. Additionally, the fellowship gave me a chance to revisit Innsbruck, a vibrant city located in the heart of Austrian Alpes, where I spent one year as an Erasmus student during the 4^th year of my medical studies.

The Department of Interventional Oncology in Innsbruck. 

The typical setup for an ablation.

The Department of Interventional Oncology and Minimally Invasive Therapies is a part of the Department of Radiology at the Medical University of Innsbruck. Prof. Reto Bale is the head of this department, and together with his dedicated team, they treat a wide variety of benign and malignant tumours using various ablation techniques. My main learning objectives for this month were the following:

• To observe the clinical (indications, patient’s preparation and follow up) and technical (procedural details, workflow) setup of various ablation techniques
• To learn the clinical use of different imaging modalities with special regard to their fusion in the context of minimally invasive therapies
• To witness the organizational aspects of a well-run interventional radiology department
• To participate in a multidisciplinary (MDT) approach applied to manage complex oncological patients and understand the role of IR specialists in the tumour board

Prof. Bale’s Department manages a high volume of patients every day. It is equipped with two independent CT rooms adapted to perform percutaneous procedures. Usually, tumour ablations are carried out under general anaesthesia in one room, while pain management and biopsy procedures which do not require the presence of an anaesthesiologist take place in the second.

Days started early (patients arrived at the operating room at 7:30 am) with morning evaluations of the cases. I was amazed by the attention to the technical aspects of the procedures paid by Prof. Bale and his team. Ablations were planned after an initial CT with the patient properly positioned, this was the crucial moment of the procedure. During this part, the operator carefully evaluated the targeted lesion and its relation to the surrounding structures, checked for the presence of any blood vessel that might lead to haemorrhagic complications, and decided about the number, placement and trajectory of the needles required for complete ablation of the tumour. It was a demanding process, especially considering the number of antennas used for the treatment. It is worth mentioning that, due to the massive amount of the experience and the esteem of the IRs in Innsbruck, a majority of the procedures performed in this department are unusually challenging procedures.

Planning the procedure and needle placement using Prof. Bale’s navigation system.

Prof. Bale developed an advanced but user-friendly navigation system equipped with robotic arms that enable the precise positioning of the needles. Thanks to that, his team is treating complicated cases with excellent results and low complication rates. Their main focuses are liver lesions (both primary and metastatic), but during my stay, I also saw renal tumour ablation, trigeminal radiofrequency ablation, and multiple spinal interventions. I was also very fortunate to try the navigation system on my own – at first it was quite difficult, but after some time and insightful tips from Prof. Bale, I was able to position the navigation in a satisfactory manner.

Without a doubt, the main key to the success of Prof. Bale’s Department is its great medical team, who are dedicated and devoted to their patients, but at the same time really open, friendly, and easy-going. I have never witnessed any signs of impatience or rush, even during long working hours (we rarely made it out of the hospital earlier than 4 pm). They were very welcoming and patiently listened to and answered my questions in German even when I was far from perfect. I was happy to see that they are really well integrated (we ate lunch and had coffee together) regardless of their medical profession and position (everyone says “du” – informal you, rather than “Sie” – formal you). I would also like to thank Dr. Moritz Kummann and Dr. Gregor Laimer (fellow CIRSE and ETF member) for taking special care of me.

Me trying to impress Prof. Bale.

The Austrian Alps in the summer.

Although my work schedule was quite busy, I managed to find some time to enjoy my life in Innsbruck. Together with Prof. Bale, we attended an inspirational lecture held by Prof. Christopher Huber, a co-founder of BioNTech Company (most famous for their COVID vaccine) who studied medicine in Innsbruck. We also went to a political stand-up comedy performance held by two of the most famous comedians in Austria – Dirk Stermann and Christoph Grissemann. In addition to this, I had a chance to experience a 2024 UEFA European Football Championship in a public viewing zone. Poland played against Austria in a group stage! (unfortunately, we lost 1:3). And of course, I don’t have to explain that the breathtaking view of the Alps on my way to work left me in awe every day.

In summary, I am very happy that I had a chance to participate in the CIRSE Fellowship Grant Programme. I can wholeheartedly recommend it to all CIRSE members, as it was a great and inspiring experience during which I met a number of motivated people and had an opportunity to be a part of a world-class medical team. I am sure that this eye- and mind-opening month will be a huge boost in my everyday clinical practice and scientific career. Thank you to Prof. Reto Bale for being an incredible host and a real mentor!