SIR is pleased to announce the launch of the Giveback Project, a program designed to support IRs participating in educational visits to developing countries or lower-middle income regions. The purpose of these educational trips is for U.S.-based SIR members to engage, teach, interact with and learn from interventional radiologists outside of the United States.
Recently, two SIR members, Sreekumar Madassery, MD (fall 2018), and Jon C. Davidson, MD, FSIR (winter 2019), volunteered to travel to China as part of this program. In this article, Drs. Madassery and Davidson describe their experiences overseas.
Sreekumar Madassery, MD
Rush University Medical Center, Chicago
After hearing about the Giveback Project at an SIR meeting, I was intrigued by the opportunity: my understanding was that practice patterns and patient populations in China are so different from those in a city like Chicago (where I practice)—and I could only imagine what I would experience in the middle of another continent.
Ultimately I traveled to Zhengzou, China, in September 2018. I met my host, Prof. Guangshao Cao, at the airport, and his incredible kindness, hospitality and generosity set the stage for the rest of my week. When I first arrived at the Henan Peoples Hospital in Zhengzou, I was surprised with a welcome notice on the scrolling LED board in front of their large hospital campus.
I then received a guided tour of the inpatient wards, some of which the interventional section manages on its own. As we navigated through the halls, I realized what a massive number of patients are treated there, as there could be hundreds of people in line just for the elevators.
Every staff member, from physician to nurse, from fellow to student, greeted me with the warmest of introductions and respect.
We stopped in a workroom where they were holding patient case rounds. Even with some initial translation difficulties, I found that the workup, treatment plans and ideas being discussed were thorough and unchanged from what I would hope to see anywhere.
Over the next few days, I continued touring the different wards and meeting varying section/department chiefs, including vascular surgery, interventional oncology and neuroInterventional. I was deeply inspired by the immense effort taken to treat so vast a number of patients every day (into the night), while maintaining advanced interventions. It was an honor to be able to provide my thoughts and potential interventions for cases presented to me.
Particularly interesting was the complex aortic and peripheral vascular revascularization cases, as well as advanced oncologic patients in need of curative or palliative treatments. Scrubbing in a complex critical limb ischemia revascularization case was humbling, as I soon realized how thinking outside the box is important when you do not have a vast equipment array to choose from—yet you still need to accomplish the same outcome as anywhere else.
From what I could gather, the biggest challenges to IR in China may be access to costly therapeutics. For example, radioembolization is widely used in the United States for transplant bridging/downstaging or for palliation. However, it is not available in China (except for a few mainland areas), with cost being a major factor. In lieu of this approach, they can take on 10–20 bland or chemoembolizations a day, and still offer treatments. In the vascular space, most atherectomy and thrombectomy devices are not available, either. Therefore, the intervention options are significantly different from what we would likely choose. That doesn’t necessarily mean their outcomes are different, so this difference may be a lesson for us as well.
The practice environment was remarkable. I have to say that I have yet to experience an environment with such respect for one another and elders. The respect demonstrated by a phenomenal, established vascular surgeon for his more senior colleague was incredible. While there were too many fellow-level trainees for me to count, they seemed to be taught this mindset as well.
While I was in China, I felt a strong desire by our friends there to have visiting rotations developed at many of our institutions for trainees and young physicians to come and learn/adapt interventions that are carried out in the United States—especially in the oncology, venous and practice-building areas. That isn’t to say that approaches are better here or there. I simply believe that such an exchange would increase collaboration and uniformity and would certainly be a two-way street, just as in my short time there I picked up quite a few pearls that I can utilize in my practice.
In conclusion, I strongly recommend SIR’s Giveback Project to anyone interested in expanding our interventional mission on the around the world. It is an excellent way to realize how many different learning opportunities exist in every global demographic—and how many of their approaches can improve your own practice.
Jon C. Davidson, MD, FSIR
University Hospitals of Cleveland
I first learned of the SIR Giveback Project through the SIR website and SIR International Division Councilor Brian F. Stainken, MD, FSIR. I had already traveled to China twice in the previous three years, and international collaboration interests me very much—so I thought the program would be a very good fit.
On my trip, which took place in January 2019, I visited three hospitals, in different cities: Nanjing, Lishiu and Shanghai.
My first stop was Zhongda Hospital, Southeast University, in Nanjing. Zhongda Hospital has one of the busiest and most productive IR departments in all of China. The IR department is led by 2016 SIR Gold Medal recipient Gao-Jun Teng, MD, FSIR, who is one of the pioneers and most influential IR physicians in Asia. Dr. Teng also is the dean of the Southeast University School of Medicine in Nanjing. I also had the pleasure of meeting Dr. Jin-He Guo, who is the vice director of IR at Zhongda Hospital. Dr. Guo has extensive experience with brachytherapy, specifically with the use of I-125 impregnated stents for use in malignant biliary obstruction, portal venous thrombosis and malignant esophageal strictures. I gave two lectures that evening, after a very gracious introduction from Dr. Teng. I spoke about the value of SIR membership and provided a general overview of intra-arterial locoregional liver-directed therapies in the United States.
My second stop was to Lishiu City Central Hospital, which also had a busy IR practice. I met IR Director Dr. Jiansong Ji, who gave me a tour of the hospital. I gave two lectures there, as well, on SIR membership and Y-90 radioembolization. The audience, including several of the IR attendings, seemed very interested in Y-90, as most of their IO practice consisted of TACE.
My third and final stop was at Changzheng Hospital in Shanghai, led by Weihua Dong, MD. This very large hospital (3,000 beds) had an extremely busy IR practice. Here I gave formal lecture on my experience with locoregional liver therapies, highlighting many of the past and ongoing studies that demonstrated the value of Y-90. Many key opinion leaders (KOLs) attended, including Dr. Yongde Chang, editor-in-chief of the Chinese Journal of Interventional Radiology. Much of the ensuing discussion after my talk consisted of cost and regulation.
In summary, this was an extremely valuable and productive trip that afforded me the privilege of meeting many IR KOLs in China. One of the many highlights of my trip was meeting Dr. Teng, who also gave an incredibly eye-opening lecture on the current status of IR in China. According to Dr. Teng, the approximately 6,000–8,000 practicing IRs throughout China are performing 2–3 million procedures a year! What was even more interesting is that more than half of the IR groups in China have separated from diagnostic radiology and have their own department. Also, most IR practices have dedicated IR patient wards. At Zhongda Hospital, they have an entire hospital floor dedicated to IR with 106 inpatient beds.
Most of what I witnessed during my trip surprised me with how advanced and innovative IR has become throughout the country. Dr. Teng, coordinator of the largest IR annual meeting in China (CCI; April 18–21, Nanjing), said that he was expecting approximately 10,000 attendees.
I would highly recommend volunteering for the SIR Giveback Project. This was one of the most valuable professional endeavors that I have ever participated in, and there are many upcoming opportunities in South America and the Middle East.
A trainee's story
Sreekumar Madassery, MD
One of the trainees I met in China, Ali, has a truly moving story that I think is precisely the type of individual that SIR can help. He was a general physician in Tanzania, Africa. Over time, thanks to the internet, he had heard of interventional procedures. He realized that these procedures, some life-saving, others life prolonging, is not available in his country.
He decided to devote nearly a decade to undergoing radiology training followed by interventional radiology training at Zhengzou, so that he can then go back and start saving the many patients that are generally seen as helpless, with no options. He is therefore learning as much general, neuro, vascular and oncology interventions as he can as there is no one to endovascularly treat strokes, limb preservation and cancer.
He hopes to be able to train others and set up clinics performing complex IR in his country, and his government is behind him. He gets to see his wife and children one month per year. This tears at him, but the prospect of bringing so much good to so many in his country keeps him going.
Connecting him to our society was one of the most rewarding parts of my experience and I hope we can all help him accomplish his goals of spreading IR even further.
