Croatia and Interventional Radiology Asst. Prof. Vinko Vidjak MD, PhD Clinical Hospital Merkur Zagreb, Croatia

Croatia and Interventional Radiology

Asst. Prof. Vinko Vidjak MD, PhD

Clinical Hospital Merkur

Zagreb, Croatia

Inhabitants:4.3 mill

CRO = HR Croatia = Hrvatska

IR in Croatia, Turkey, Antalya 19-22 March 2014

Nikola Tesla

•Tesla = Weber/m²


Nikola Tesla

•Tesla = Weber/m²


Science and Education in Croatia?




Radiology education and mentorship?



• 4 University Centers




• Residency programme harmonised with UEMS/ESR training curriculum





• Oral and practical board exams






• Committee consisting of three examiners


Croatian Society of Radiology

316 radiologists + 64 radiology residents

4.4 mill inhabitants: 1 radiologist per 14.000 inhabitants incl residents 1: 11.600 inhabitants

1200 radiographers


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Radiologists/million inhabitants

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Section of Interventional Radiology- Croatia – sIRcro

• Officially since 2000.g.

• Unofficially since 1990.g.






• Regular Meetings with International Parcitipation every 2 years since 1986.

• Cooperation with Slovenia, Austria, Hungary





• Regular Meetings with International Parcitipation every 2 years since 1986.

• Cooperation with Slovenia, Austria, Hungary

• CIRSE Group Member since 2010

Section of Interventional Radiology – today

• 41 radiologists + 7 radiology residents

• Most radiologists or smaller procedures (punction, drainage) under US control, diagnostic angiography,..




• Most radiologists for smaller procedures (punction, drainage) under US control, diagnostic angiography,..

• Significant angio therapeutic procedures

• Neuroradiologic interventions

• EVAR, TIPS, CAS, BTK, tm embolisation, ..




• Most (41 radiologists) for smaller procedures (punction, drainage) under US control, diagnostic angiography,..





- 8 cath labs








- 8 cath labs

- 2 cath labs








- 8 cath labs

- 2 cath labs

- 4 cath labs

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Catheter Labs per million inhabitants

Average


Interventional Radiology – training


Interventional Radiology – training• Subspecialisation of radiology (general radiology+2 years)


Interventional Radiology – training• Subspecialisation of radiology (general radiology+2 years)

• Subspecialty exam since 2000 (IR, NR, UZV)



PROGRAM•5 months on nonradiology clinical departments (vasc.,abd.,thorac.,urorad./surgery and oncol) •9 months on vascular IR procedures•8 months non vascular IR procedures

• Subspecialisation of radiology (general radiology+2 years)




PROGRAM•5 months on nonradiology clinical departments (vasc.,abd.,thorac.,urorad./surgery and oncol) •9 months on vascular IR procedures•8 months non vascular IR procedures

• Subspecialisation of radiology (general radiology+2 years)




Interventional Radiology - training


Interventional Radiology - training

PROGRAMNr of procedure and…..

•vascular IR…PTA (30), stents (20), EVAR (ass),….TIPSS (10 ass, 2 alone),……

•non vascular IRUS guided drenaige (40), US guided biopsy (30)

…


IR experience…………….


IR experience…………….


(… two institutions) 2009.g :

• 1550 hospital beds• Annualy more than 1.100 angio therapeutic procedures

• Type of procedures:

PAD (pta/stenting), PTA/stenting on other arteries, CAS, EVAR, embolisations, reocclusive technics (mechanical, aspiration thrombectomy, thrombolysis),interventional oncology (TACE, RFA...) billiary, urogenital, digestive interventions, CT controlled interventions,....

IR experienceProcedures graph (… two institutions) 2009.g.:

vascular interventions pts1. EVAR / TEVAR 322. CAS 433. PTA / stenting SFA 2064. PTA / iliac artery stenting 1405. BTK 846. Mechanical thrombectomy 157. Embolisation 90


IR experienceProcedures graph (… two institutions) 2009.g.:

non vascular interventions pts1. Billiary 802. Urogenital 303. Esophageal 204. CT / US drainage 150


Clinical Hospital Merkur – ZagrebAssociate Professor Vinko Vidjak, MD, PhD

IR experienceMore than 800 (angio therapeutic + diagnostic) procedures anually• Treatment types: PAD (pta/stent), PTA/stent on other arteries, subintim rec., CAS, EVAR, BTK, embolisation, reocclusive techniques (mechanical, aspiration thrombectomy, TIPSS, (thrombolysis), billiary, urogenital, digestive interventions, CTguided drainage,....



IR experienceMore than 800 (angio therapeutic + diagnostic) procedures anually• Treatment types: PAD (pta/stent), PTA/stent on other arteries, subintim rec., CAS, EVAR, BTK, embolisation, reocclusive techniques (mechanical, aspiration thrombectomy, TIPSS, (thrombolysis), billiary, urogenital, digestive interventions, CTguided drainage,....

- IR subspecialization mentorship

- Ambulatory IR consultations



IR experienceMore than 800 angio therapeutic + diagnostic procedures anually• Treatment types: PAD (pta/stent), PTA/stent on other arteries, subintim rec., CAS, EVAR, BTK, embolisation, reocclusive techniques (mechanical, aspiration thrombectomy, TIPSS, (thrombolysis), billiary, urogenital, digestive interventions, CTguided drainage,....

- IR subspecialization mentorship

- Ambulatory IR consultations


Experience in organization of IR meetings?


Clinical FacultyOkan AkhanFiras Al-AliMassimiliano FusaroAntonin KrajinaRobert MorganZoran Milošević Andrej Schmidt Luc StockxIstván SzikoraRenan UflackerChristof Zollickoffer.........

Lectures: 80Lecturers: 57Participants: 240

VII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2009


Clinical FacultyOkan AkhanFiras Al-AliMassimiliano FusaroAntonin KrajinaRobert MorganZoran Milošević Andrej Schmidt Luc StockxIstván SzikoraRenan UflackerChristof Zollickoffer.........


VII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2009

Moto: bringing IR closer to clinitians


International Clinical Faculty

Jan RaupachIstvan BattyanyPavel BerdenTomaž KljučevšekKarl-Ludwig SchulteMarkus GrafMaria SchoderDimitrij KuheljAndrej SchmidtZoran Milošević……………

VIII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2011




Jan RaupachIstvan BattyanyPavel BerdenTomaž KljučevšekKarl-Ludwig SchulteMarkus GrafMaria SchoderDimitrij KuheljAndrej SchmidtZoran Milošević……………

VIII. Meeting of Croatian Interventional Radiologists with International Participation

sIRcro 2011


Moto: bringing IR closer to young radiologists



Andrej Schmidt , Leipzig Hart Zentrum, GermanyJan Raupach, Hradec Králové, The Czech Republic Okan Akhan, Ankara, Turkey Marco Manzi , Abano Terme, Padua, ItalyFiras Al Ali , Kalamazoo, USAZoran Milošević , KBC Ljubljana, SloveniaAntonin Krajina , Hredec Kralove, Czech RepublicRaman Uberoi , Oxford, Great BritainIstvan Battany , KB Pesch, Hungary

IX. Meeting of Interventional Radiologists of Croatiawith international participation

sIRcro 2013




Andrej Schmidt , Leipzig Hart Zentrum, GermanyJan Raupach, Hradec Králové, The Czech Republic Okan Akhan, Ankara, Turkey Marco Manzi , Abano Terme, Padua, ItalyFiras Al Ali , Kalamazoo, USAZoran Milošević , KBC Ljubljana, SloveniaAntonin Krajina , Hredec Kralove, Czech RepublicRaman Uberoi , Oxford, Great BritainIstvan Battany , KB Pesch, Hungary

IX. Meeting of Interventional Radiologists of Croatiawith international participation

sIRcro 2013


Moto: hot topics in IR


AVS 2010


Modul education: I Carotid artery, II Femoral and SFAIII BTK

from 2010 part of Crossroads "Centers of exellence"


Interventional Radiology -Why

interest???



interest???

Creative



interest???

Creative

Attractive



interest???

Creative

Attractive

Innovative



interest???

Multipotent

Creative

Attractive

Innovative



interest???

BUT !!! Multipotent

Creative

Attractive

Innovative


Interventional Radiology - problems

• Low monthly IR limits… for depart.

• More than 40% IR procedures are not recognized by state healtcare (CAS, DEB, PMTh,…..

• State directed material reimbursment

• No working benefits for IR doctors


Interventional Radiology - consequence

• Less and less radiologists on IR

• IR lose interest in profesion mainly due to financial rectrictions

• Few centers left

• Low procedure numbers (education?)

• Inflow of other clinitians ( vascular surgeons, interventional cardiologists …) into IR


State healtcare vs Interventional

Radiology


Interventional Radiology – solutions• EU/CIRSE recomendations for IR

• Education standardisation

• Implementation of EBIR as national board exam

• Centers of IR exellence (2-3 in Croatia) without financial restrictions

• Independent funding for high price procedures

• Less goverment control

• More involment of private healtcare companies


IR in Croatia, Turkey, Antalya 19-22 March 2014 Thank you for your attention

IR in Croatia, Turkey, Antalya 19-22 March 2014 Thank you for your attention

Welcome sIRcro 2015 …….Trust us, we work also …..

Documents

Croatia and Interventional Radiology Asst. Prof. Vinko Vidjak MD, PhD Clinical Hospital Merkur Zagreb, Croatia