CIRSE: Given that this is its first year, in what ways do you envision ET 2019 benefitting CIRSE and the field of IR as a whole?
Inoue: Embolotherapy covers a wide range within the field of IR. As the target of embolotherapy includes wide variety of diseases, it is often very hard to grasp the full picture. Accordingly, ET 2019 will have an important role in developing a more clear, holistic point of view of the specialty.
Müller-Hülsbeck: The ET congress closes a gap and is the connecting link between the ECIO, CIRSE and IDEAS conferences. Having a congress on embolotherapy is unique and outstanding. It’s more than just an additional meeting; it’s a chance to inform and discuss the latest developments in embolotherapy with already proven and developed concepts. The organisers are well known and established, and the sessions are presented in a wide range of formats, making the event worthwhile for interested IRs worldwide.
CIRSE: What are you personally most excited for in ET 2019?
Prevoo: I’m excited to meet experts in the field of ET, find new ways of treatment, and get updates on how to apply new materials and imaging methods.
Müller-Hülsbeck: I am excited to attend to a conference dedicated to embolotherapy, as it will enable me to learn about the latest advances and expanding indications in the field of embolisation as well as to have the opportunity to discuss and exchange information with many IR experts. I am very proud to have been involved in the development of this congress from the beginning.
CIRSE: Dr. Prevoo, do you think that expertise in lymphography diminished as a result of the introduction of cross-sectional imaging techniques? If so, what do you think patients miss out on as a result?
Prevoo: Cross-sectional imaging really took over the role of lymphography evaluating lymph nodes and lymphatic diseases. Apart from the thoracic duct, the lymphatic system is not as simple and straightforward as the main vascular systems. It is possible to distinguish the thoracic duct on CT (if you know where to look) and with MR lymphography. However, imaging the widespread lymphatic vessel system in the limbs, pelvis and abdomen is difficult. In fact, only a lymphogram can show this chaotic lymphatic anatomy. So, we may miss out on rare diseases like Noonan’s, Gorham's, Behcet's or lymphangioleiomyomatosis. Lymphography still has its value evaluating the whole lymphatic system in cases treating chyle leakage. Although leakage is a relatively rare complication, it is still important to know the basic techniques of how to perform lymphography and how to embolise.
CIRSE: Prof. Müller-Hülsbeck, how do you think the role of interventional radiology in trauma, particularly for haemodynamically unstable patients, has evolved in recent years?
Müller-Hülsbeck: During the last years, the role of IR for treatment of haemodynamically unstable patients was well established in large trauma centres. However, again and again, radiology and IR need to sharpen awareness of IR services in this patient population with life-threatening diseases. This starts with the routine evaluation of the CT trauma scan by a radiologist. She or he needs to make an immediate decision about whether it’s an option to control and stop bleeding through endovascular means, and if she or he is uncertain, the IR on duty needs to get involved immediately, without any delay. Offering these services 24/7 is quite challenging; however referring the patient to the IR unit and blocking arterial flow within minutes may save a patient’s life. It is therefore desirable that these IR services are provided readily and are made available at both large trauma centres and referring centres.
CIRSE: Dr. Inoue, what are some of the main challenges of conducting retrograde thoracic duct catheterisation and how do you combat them?
Inoue: Identifying the thoracic duct entry is usually difficult. Lymphangiography can visualise its entry; however, the precise location of the entry is hard to recognise in many cases. Another important issue is that the thoracic duct cannot be visualised on venography, because there is a valve at the entry. Therefore, we must cannulate the thoracic duct based on lymphangiography information and advance a guidewire to the invisible thoracic duct. Recently, MR thoracic ductography has been able to clearly visualise the thoracic duct, which can give us useful information before the procedure.
CIRSE: Since IR is ever-evolving and innovating, how do you ensure that you and your team keep abreast of the latest developments within your area of specialisation?
Müller-Hülsbeck: Keeping up to date on the latest developments in IR is rather challenging, because the field of IR is growing at a rapid pace. Personally, I focus primarily on reading (articles, serving as journal reviewer or even journal editor and using e-learning platforms like the CIRSE Academy); listening (attending conferences, including live and on-demand options offered in the CIRSE Library, serving as lecturer); and practicing (daily work in the cath lab, training and establishing new skills).
Inoue: Of course, it is very important to read papers; however, the things which are written in papers are not always accurate. Therefore, it is very useful to attend congresses like ET 2019 to hear presentations and then have the opportunity to ask the doctors follow-up questions.
CIRSE: What is the most rewarding part of your work? What sustains you, both personally and professionally?
Müller-Hülsbeck: There is only one short answer: the patient’s smile and her or his thankfulness after completing an IR procedure. Receiving this immediate feedback sustains me during exhausting periods of time, which nowadays appear more often due to economic challenges and restrictions.
Inoue: I work not only for a living, but also for fulfillment. I feel especially happy when patients thank me.
Prevoo: Most of all, happy patients and happy co-workers. Furthermore, successful treatments; low complication rates; good teamwork with motivated colleagues, techs and nurses; full access to innovation; and applying new procedures. Personally, travelling with my son and sailing to far and exotic destinations keeps me running.