This new column spotlights the growth of interventional radiology around the world. We thank Wael Darwish, MD, Mohamed Eid, MD, and Jeanne M. LaBerge, MD, FSIR, for their assistance with this article.
Geography
Egypt is a transcontinental, Mediterranean country spanning the northeast corner of Africa and southwest corner of Asia by a land bridge formed by the Sinai Peninsula. It is bordered by the Gaza Strip and Israel to the northeast, the Gulf of Aqaba to the east, the Red Sea to the east and south, Sudan to the south, and Libya to the west. Across the Gulf of Aqaba lies Jordan, and across from the Sinai Peninsula lies Saudi Arabia, though Jordan and Saudi Arabia do not share a land border with Egypt.
Interventional radiology practice
IRs in Egypt mainly perform procedures related to interventional oncology (TACE, TARE and ablations), hepatobiliary and urological interventions, venous access, IVC filters, bleeding embolization and neurointerventional procedures. Peripheral arterial diseases and aortic interventions are performed by vascular surgeons, though some cases are performed jointly with IRs.
Interventional radiologists are seeing a rise in irreversible electroporation, PAE, UAE, radial access procedures, breast embolization/chemoinfusion for locally advanced breast cancer, Y-90, thyroid ablation and varicose veins ablations.
The biggest challenges that IRs face are the time it takes to obtain new products and their high cost to the centers and patients. Furthermore, Egypt lacks the facilities and resources that would enable IR to catch up to the fast world of medical innovations. Highly skilled IRs are not spread evenly throughout the country. According to Mohamed Eid, MD, 2016 SIR International Scholar, Aswan University Hospital, Aswan City, there are a few centers in the north and middle regions of Egypt. His facility, located deep in southern Egypt, was launched two years ago. The center provides tertiary care to about 10 million people and the nearest skilled IR center is 700 miles away, making it a challenge for emergency services.
IR meetings and societies
Radiology departments in universities and the big Ministry of Health hospitals have their own small IR meetings, approximately six per year. The Egyptian Society of Radiology and Nuclear Medicine (ESRNM) has an annual meeting, though the Egyptian Society of Interventional Radiology (ESIR) and the Scientific Society of Radiology (SSR) don’t have meetings.
For the past two years, the Middle East Endovascular Therapy (MEET) Symposia has brought together invited speakers from the United States and the Middle East. Organized by Wael E. Saad, MD, FSIR, these symposia have been held jointly with SIR, Global Embolization Symposium and Technologies (GEST), Egyptian Societies of Interventional Radiology and Radiology, Interventional Master Aortic Course (I-MAC), Turkish Society of Interventional Radiology (TGRD) and African Society for Interventional Radiology and Endovascular Therapy (SAFIRE).
IR certification process
For the last few years, SIR’s International Division been assisting developing countries to enhance IR training and certification. SIR 2018 Gold Medalist Karim Valji, MD, FSIR, University of Washington, has been working with interventionalists in Egypt to design and implement a certifying exam similar in content and rigor to the IR exam in the United States.
Dr. Ikram Hamed, director of the EBIR, has taken a leadership role in promoting high-quality, state-of-the-art IR in Egypt. He has been assisted in administering this year’s examination by Dr. Wael Darwish, an IR at the National Cancer Institute (NCI) at Cairo University and associate director of the EBIR.
Every 6 months, two SIR members visit Egypt to teach, train and examine the IR fellows. In early 2018, Jeanne M. Laberge, MD, FSIR, was invited to join Dr. Valji to participate in the annual EBIR IR board exam—the third board examination administered by EBIR. According to Dr. LaBerge, “Our visit to Cairo was an unforgettable experience that I will always treasure. I discovered that the future for IR in Egypt and the middle east is very bright and that the SIR and Interventionalists in the U.S. can play a key role in advancing the specialty in Egypt and the region.”
The future of IR in Egypt
By Wael Darwish, MD
Over the last 5 years, I’ve seen IR rising rapidly and gaining more popularity among the patients and doctors from other specialties. Egyptian IRs perform around 60–80 percent of what’s performed in the United States; from the volume standpoint, though, it is less than 20 percent of the need.
We may have a good number of angio suites in university hospitals and educational facilities, as well as MOH hospitals, but we need more IR doctors, and more tools (catheters, balloons, stents, etc.) I think that, with the help of organizations like SAFIRE, Egypt can serve an important role in IR education for the rest of Africa.
