Facetime interview: Dr. Nicolette Sinclair with Dr. Nevin De Korompay

I met Dr. Nevin De Korompay (NDK) 10 years ago, when we were competing to be the Canadian Association of Radiologists (CAR) Board of Directors resident representative. I won’t say who was selected, but I think he is still bitter. We were both funded by the CAR to attend the ACR annual meeting in Washington DC, as we were both soccer players (please see my bio) and from the prairies (NDK is from Winnipeg) so we got along well. Now that we have both ended up in IR, we have stayed in contact and often share cases and pictures of our dogs. Recently, Dr. De Korompay was a part of a group in Kelowna who started performing endovascular therapy for acute ischemic stroke, building a program from the ground up. I was intrigued by this as I thought he was a “body IR’, like me. I also know that “body IRs” performing EVT is a hotly debated topic. In fact, I recall a debate at a previous CAIR (at that time CIRA) meeting on this topic. Of course, Canadians are so polite I think it ended in a draw, but I wanted to touch base with NDK to get some details. – Dr. Nicollette Sinclair

NS: Holler Nevin!  I hope all is well and you are staying safe in Kelowna. Tell me about your practice and training before EVT came into your life?

NDK: Well, I did my radiology residency in Winnipeg and IR fellowship in Vancouver.  I had done a few diagnostic cerebral angiograms during residency, none during fellowship.  I started practicing in Kelowna in 2016 and helped develop an evolving “body IR” practice, heavy on the interventional oncology, but also including aortic intervention, vascular malformations, UFEs, PAE, and dialysis work. I should also mention that diagnostic cerebral angiograms were a part of the IR practice at Kelowna General, so that did provide a foundation for EVT.

There are four IRs in our practice of 16 radiologists, we have a private clinic and cover services at Kelowna General Hospital (KGH).

NS: How did EVT become part of your practice? Can you explain your current EVT practice/setup?

NDK: Historically, all acute stroke cases were imaged with CT/CTA at KGH or surrounding hospitals, and then transferred to the lower mainland if they were EVT candidates. Transferring these patients obviously takes time, and as you may have heard once or twice, time is brain. Transfer was often prolonged in the winter with unsafe travel conditions.  Anecdotally, it was rare for a patient to get to Vancouver in time to still be considered for EVT, or have any quality outcome. KGH is a tertiary referral center for the Okanagan with 441 beds. It is a UBC teaching hospital and distributed site for the Faculty of Medicine.

About 3 years ago, we were going about our “body IR” business when neurology and administration approached us with a request to develop an EVT program, based on success in centers like Kingston and Victoria and their inability to get local patients the gold standard of care.  The stroke neurologists were putting together a multidisciplinary stroke team to improve outcomes in the KGH; a team now incorporating neurologists, patient coordinators, nurse navigators, and soon to be IRs and an endovascular neurosurgeon.

Currently we have 5 EVT operators, 4 IRs and 1 endovascular neurosurgeon, it’s a great group and I would like to mention them by name: Dr. Brooke Cairns, Dr. Paul Kurkjian, Dr. Wayne Tonogai and myself from IR and Dr. Mike Tso from neurosurgery.  All cases are reviewed in a group; even after hours whoever is available checks images and weighs in.  All cases are performed with two operators scrubbed in, the primary operator is on call, and the second operator is whoever else is available and sober. Sometimes there will be three or four of us there.  We did our first EVT case in 2019; we have done over 50 so far.  Recently we have undertaken a radial program, mostly to avoid angering Dr. Darren Klass.

We participate in weekly stroke rounds and monthly multidisciplinary conferences with the Victoria group, sharing cases, techniques and outcomes.  There are monthly quality meetings involving representatives from radiology, neurology, surgery, anesthesia, nursing, technologists, and even EMTs.  Metrics and outcomes are continuously tracked and reviewed. This has unequivocally been a team based approach and we would simply not be able to offer this service without support from a multitude of partners and an exhaustive amount of infrastructure developed behind the scenes.  It’s a lot of work but its rewarding work.

NS: What kind of extra training did you do?

NDK: We had proctors from all over Canada come to Kelowna for benchtop device demonstrations and mentoring, we visited other EVT sites, and we were extremely fortunate to have had mentorship from other sites in British Columbia where body IRs provide acute stroke intervention, including New Westminster and Victoria.  Then we had to start. Out of the gate we were very selective with cases and rolled out the program during specific, set hours, eventually expanding it to 24/7.

NS: Have you been criticized for being a body IR doing neuro IR?  How do you respond to that?

NDK:  Probably.  Directly to my face, not so much…although meetings have been less frequent in the pandemic. Early on there was always concern in the back of our minds we would do something silly, be deservedly lambasted, and would put patients or the future of the program at risk. That fear has not entirely vanished.  Having now participated in these cases, I respect the concerns raised by our neuro IR colleagues for maintaining quality in patient care.   I’ve also come to accept that wherever people are asymmetrically distributed, i.e. the world, there will be debate about equal access to procedures, resources, and subspecialists.  My opinion is that the right practitioner with the right team in the right environment should be capable of choosing and executing the right cases. The ESCAPE trial, for instance, featured Canadian body IR’s performing EVT and that study represents one of the definitive trials in stroke.  Currently, EVT is performed in Canada by Neuro IR, Body IR, Neurosurgery and Interventional neurology depending where you are and on what day.  All of our practices are anecdotal in some way, each a unique culmination of geography, patient population, local expertise, referring clinicians, interest, and personalities. We simply would have never have dreamed of starting an EVT program without a demonstrated need, a mandate from our clinicians and a robust multidisciplinary team.  I will admit though, I have certainly enjoyed the challenge of working with an amazing team to develop a program I’m proud of and one I wouldn’t hesitate to offer to you if a clot from your frostbitten toes should strike you down via a previously undiagnosed PFO while skiing up at Big White.

NS: Thank you, I will take you up on that offer, please tell everyone I was skiing expertly down a double black at the time. So, do you have any advice for a body IR being asked to provide acute stroke intervention/setting up a practice?

NDK: At risk of sounding like a broken record, you need a team established first before even thinking about sticking needles into anyone.  It was their motivation and mandate that got everyone to the table and ultimately resulted in this team being built and we continue to lean heavily on their infrastructure and expertise.

Locally, Getting comfortable with cerebral angios and external carotid work, i.e. crossing the neck barrier, makes it easier to psychologically approach intracranial work which is an intimidating prospect.

I would also recommend reaching out to other sites with body IRs performing acute stroke intervention to learn from their experience as well as to your partners in industry who are happy to facilitate developing expertise in using products with neuro pricing.  And speaking of equipment you will need some sort of super nurse or super tech to handle your inventory and ensure all members of the team are comfortable with flushes, triaxial systems, 014 wires, etc. that may not be part of your routine practice.

Finally be ready for lots of meetings. During the work day.

NS: Thank you so much for taking the time to talk to me, congratulations to you and your team for the fine work in Kelowna. Final question, would you attend a CAIR meeting in Saskatoon?

NDK: Little known fact about me, I was actually born in Saskatoon. #BunnyHug

NS: Oh that explains a lot about you!

NDK: But you can’t really expect the first post pandemic in person CAIR meeting to be in Saskatoon? Might I suggest Kelowna?

NS: Fair point, how about the third post pandemic in person CAIR meeting in Saskatoon?

NDK: Yeah, I’ll be there 🙂

2 year Interventional Radiology Fellowship – University of Toronto 2021-2023

Interested candidates are invited to contact Dr. John Kachura, Vascular & Interventional Radiologist and VIR Fellowship Director, at john.kachura@uhn.ca

CAIR  in Solidarity Against Anti-Asian Racism

The COVID-19 pandemic has had a significant and difficult impact on Asian communities, across the world. There is no doubt that hate crimes against Asians in Canada and in the US have been on steep rise since the beginning of the pandemic.

The Canadian Association for Interventional Radiology (CAIR) condemns the escalating violence and ongoing harassment directed at Asians and Asian Canadians and stands in solidarity and compassion with the diverse Asian community.

We are deeply saddened by the news of the horrific shootings in Atlanta and we express our sincere condolences to the families, friends, and coworkers of those injured and killed in this senseless act.

CAIR Board of Directors

You have the wisdom, expertise, and experiences to share. We provide you with the platform and voice to spread it.

Why submit content for our newsletter and website?

1. Share your expertise
2. Exposure to the IR community
3. Awareness about IR

What we look for?

Are you passionate about IR and would like to influence positive change? Do you have a solid base of expertise and experience? Do you have fresh ideas and new perspectives?

Ideas and articles submitted for consideration should be of interest to IR readers and have a tone that is appropriate for the CAIR community. We like articles that introduce new ideas and advance conversations around topics and trends that engage the IR community.

No pitches, abstracts, outlines, press releases, or offers.

What to expect if your submission is accepted

Submissions are reviewed frequently, and the process is selective, however, please note that we may be unable to respond to all submissions. If you don’t receive a response within two weeks of submitting, it’s safe to assume that your piece was not selected for publication.

For the submissions we do choose to publish:

• All articles are subject to editing.
• Content may be edited for style, tone, or substance.
• Art will be added at the discretion of the organization.
• No compensation is offered.

How to submit

Article guidelines

• Articles should be provided as Microsoft Word files (.doc or .docx). Do not send articles in PDF format.
• Do not send drafts. Send the final article that has been signed off by all applicable persons or departments in your organization.
• At least 600 words and no longer than 800 words.

Graphics guidelines

• You must either own or have permission  for each graphic submitted.
• TIF, BMP, PNG, or JPEG format. Do not send images that have been embedded in a Microsoft Office product (Word, Excel, PowerPoint)

Woman. Interventional radiologist. You rarely heard those terms together in Manitoba until Dr. Alessandra Cassano-Bailey entered the field of interventional radiology in 2012.

Before Dr. Cassano-Bailey was a doctor, she was Miss Cassano, physics and chemistry teacher at St. John’s High School where she attended as a student not too long before. This position is where she first made room for herself in what was traditionally a male-dominated field. “I took over from my old physics teacher who was retiring and was happy to have a female in that role,” says Dr. Cassano-Bailey.

While Dr. Cassano-Bailey knew from a young age that she wanted to be a doctor, she awakened a passion for teaching when she tutored her fellow University of Manitoba basketball teammates. Dr. Cassano-Bailey pursued teaching before following her childhood dream of becoming a doctor. Even though Dr. Cassano-Bailey has retired from the basketball court and the high school classroom, she has found a field where she can weave in teaching. In her current role as an interventional radiologist at HSC Winnipeg, Dr. Cassano-Bailey mentors resident doctors and teaches her patients about their liver health. “I was able to build one career on top of the other,” notes Dr. Cassano-Bailey.

Full article via HSC Foundation.

Type of Remuneration: Fee for Service

About the Opportunity

The Department of Radiology at Victoria, British Columbia seeks to recruit a full time Radiologist with Interventional Radiology sub-speciality.

The successful applicant will join a group of 26 Radiologists, including 5 other Interventional Radiologists, who cover the Royal Jubilee Hospital, Victoria General Hospital, Saanich Peninsula Hospital, Lady Minto Hospital, the BC Cancer Agency and a variety of clinics in Victoria, BC.

Through our two Siemens Artis Q equipped interventional suites, we provide Interventional Radiology services to the whole Vancouver Island with a population of approximately 870 000.  We offer essentially the gamut of body interventional radiology (including interventional oncology), diagnostic neuroangiography and endovascular treatment for ischemic stroke.

The average week consists of 2 – 3 days of Interventional Radiology with 2 – 3 days of General Radiology (including MR, CT, US, X-ray, biopsies, drainages and fluoroscopy procedures).  Attendance at interdisciplinary rounds and after hours/on call services (with a frequency of approximately 1 in 6) are required.

Qualifications

Candidates must hold Royal College of Physicians and Surgeons of Canada certification in Radiology (FRCPC) and be eligible for full licensure with the College of Physicians and Surgeons of BC.  An Interventional Radiology fellowship and willingness to learn endovascular treatment for ischemic stroke (or experience in EVT) are required.  Please refer to the BC Medical Quality Initiative for training/experience requirements (http://bcmqi.ca/credentialing-privileging/dictionaries/view-dictionaries).

Locuming with the group is encouraged if possible.

To Apply

Please submit a letter of intent and CV to melina.warren@viha.ca and jacobus.kritzinger@viha.ca​

Deadline is April 15 2021.

Maternity leave locum opportunity in Kamloops, BC

Type of remuneration: Daily Locum Rate
Incentive: Travel and Accommodation expenses

Kamloops Medical Imaging is seeking a locum Interventional Radiologist to join our group March 29, 2021 to cover a 5 month maternity leave. Shorter locum coverage will be considered.

The Medical Imaging department at the Royal Inland Hospital is a collaborative team of 8 radiologists. Currently 2 are fellowship trained in Interventional Radiology. Royal Inland Hospital is a Tertiary Care and Trauma Centre providing services in x-ray, fluoroscopy, ultrasound (Phillips IU22), CT (Siemens Dual Source Flash x2), MRI (1.5T GE), digital mammography, nuclear medicine, bone densitometry and vascular/non vascular interventional.

Responsibilities include Diagnostic and Interventional Radiology coverage. There is currently no Interventional call and minimal Diagnostic call expectation past 6 pm (US and MRI). Candidates must hold certification from the Royal College of Physicians and Surgeons of Canada and be eligible for full licensure by the College of Physicians and Surgeons of BC. Fellowship training in Interventional Radiology is a requirement.

Kamloops is a city of approximately 100,000 residents located in the Interior of British Columbia. Sun Peaks Resort is located a short 45 minute drive away and is the second largest ski area in Canada. Kamloops boasts some of the hottest summers (33 days > 30 degrees) and is ranked second for the driest climate and warmest spring.

Interested candidates should submit a CV and cover letter:  Dellano Fernandes, MD, FRCPC, Department of Medical Imaging, Royal Inland Hospital, 311 Columbia Street, Kamloops BC V2C 2T1 or by email to:  dr.dellano.fernandes@interiorhealth.ca

With a growing demand for minimally invasive procedures and a large underserved population worldwide, global outreach in IR is growing at a rapid pace. Tanzania is at the center of these advances with road2IR, the first IR training program in Subsaharan Africa.  In Tanzania, a country of over 60 million people, there is only 1 diagnostic radiologist per 1 million people and no prior IR service.

Established in 2018 under the leadership of Yale University’s Dr. Frank Minja, neuroradiologist, and Dr. Fabian Laage Gaupp, IR fellow then resident, road2IR has created an IR master of science (MSc) degree at the Muhimbili National Hospital (MNH) in Dar es Salaam.  The curriculum is based on hands-on case-by-case learning as well as online teaching and journal clubs. The first three IR fellows in the program are Dr. Ivan Rukundo, Dr. Azza A. Naif, and Dr. Erick M. Mbuguje. They have previously completed their diagnostic radiology residency at the same institution.  Three radiology residents have already been selected to start their IR training in the next academic year.

Road2IR has attracted the participation of many IR departments including Emory, Yale, and Michigan. From Canada, there has been participation from health professionals from McGill University and Lakeridge Health in Oshawa. All visiting IR teams are welcomed at MNH as part of two-week rotations. Teams are composed of an interventional radiologist, IR nurse, IR technologist, and may include fellows, residents, and medical students.  Flights for IR nurses and technologists are paid for in full by the organization. The aim of road2IR is not only to train the physicians but to train an entire team, as the techs and nurses are also new to IR in Tanzania.

A unique lR learning environment and new cultural experiences were driving factors in my decision to join the February 2020 University of Michigan team as a second-year radiology resident. Having discovered the program a year earlier online, I was initially hesitant to embark on my first international radiology project, especially with an IR team from another institution whom I did not know. However, I am so glad to have taken this leap of faith, as my participation in the new IR program in Tanzania has been one of the most rewarding experiences.

What happens when you sign up as a volunteer? Pre-departure preparations and logistics are organized by the road2IR team, making the experience simple and seamless. You receive an email containing information to facilitate your trip and have a series of calls to go over details and answer questions. Once in Dar Es Salaam, you are greeted at the airport and taken to your team’s apartment, a 20 min walk from the hospital. For the two-week period, your team has a dedicated driver.  You typically work from 8 am to 4 pm Monday to Friday.  A teaching session given by the visiting attending, first thing in the morning, is always welcome. Residents and fellows work up and present referred patients to the visiting attending to plan appropriateness, type, and timing of intervention.  On weekends, visiting teams are encouraged to explore the beaches of Zanzibar or go on a safari adventure in the Serengeti National Park.

During my two week rotation, we did ultrasound and CT guided core biopsies, nephrostomy and biliary drainage tube insertions and exchanges, biliary stent insertions, uterine artery embolizations, a splenic artery embolization, and a permacath insertion. Limited resources fostered creativity and innovation in the IR procedure room. The positive impact of these minimally invasive procedures was undeniable. Inserting percutaneous nephrostomy tubes allowed patients with obstructive uropathy, due to advanced cervical cancer, to have symptom relief. Offering image-guided core biopsies increased the probability of pathological diagnosis, in comparison to the local practice of blind fine-needle aspirations.

The highlight of my experience was working with and learning from the motivated local team of IR fellows, residents, nurses, and techs.  I have reached out to the current IR fellows to get their perspective on their road2IR initiative.

Dr. Rukundo, how did you get introduced to IR, and what made you develop a passion for this specialty?

My introduction to image-guided interventions was during my exchange clinical rotation in Interventional Cardiology at a hospital in Germany. The procedures were life-saving, less invasive, and looked fancy like nothing I had ever seen back home. When I finished medical school, I had already decided on doing radiology and not cardiology but still wanted to pursue the dream of doing the fancy, image-guided and life-saving procedures. My passion grew because of my love for the ever-evolving imaging technology, the chance to interact with patients and the innovation in IR.

Dr. Naif,  what benefits have you seen with offering IR services in Tanzania?

The benefits have been immense. We have heard so many positive feedback from the referring services and patients themselves. We have been able to somehow extend life expectancy to some of our patients, for example, those with advanced cervical cancer who were not able to undergo chemotherapy due to renal failure. Without percutaneous nephrostomies, their cancer treatment was not an option for them.

Dr. Mbuguje, what were the logistics and difficulties involved in introducing road2IR in your institution? 

I would comment that there were no difficulties, rather opportunities. The IR service in Tanzania is a new field of medicine. We were required to introduce the field even to our fellow doctors and community in general through clinical meetings and going on live television for public awareness. Our institutes welcomed it with great passion and gave us the support we wanted. Current challenges are the availability of  IR attendings, nurses, and technologists, and the issue of equipment which is still a problem in Tanzania and Africa in general.

Dr. Naif, what has been the highlight of your IR experience thus far?

To see those patients that would have died but otherwise got saved by IR procedures. To be able to learn from the incoming teams has also been the best experience. Everyone comes in so enthusiastic to teach which has been really great.

Dr. Rukundo, what do you think could be done to improve the process and outreach of road2IR even more?

I would say increasing the time that visiting teams spend in Tanzania from two week blocks to let’s say one month or more depending on availability. This would help trainees to steadily develop under the available attending and would give more time for attendings to train targeted skills and better monitor the progress of trainees. Another idea is increasing global visibility via a road2IR website where all information can be accessed.

Dr. Mbuguje, how could Canadian IR teams contribute to road2IR?

The most important is to develop mutual agreements on how we can arrange human resources in capacity building. For example, sending IR attendings, nurses and technologists, getting the chance to attend professional meetings and workshops conducted by Canadian IR societies as well as benefit from professional mentorships.

In the short two years since its creation, road2IR has flourished into a multi-university collaborative effort and has become the new model for IR global outreach missions. The future is bright for this program which has been recently awarded the Derek Harwood-Nash International Education Scholar Grant by the RSNA Research and Educational Board of Trustees. There are now plans of expansion to create the first IR program in Rwanda, as Dr. Rukundo intends to bring his training back to his home country. Road2IR is also working with the Society of African Interventional Radiology and Endovascular Therapy (SAFIRE) towards advancing vascular and interventional radiology throughout the African continent.

Road2IR is always looking for IR teams to participate in their initiative, may it be in-person or virtually. If you are interested and would like to get more information, please contact me at aline.d.khatchikian@mail.mcgill.ca, follow road2IR on Twitter, Instagram, or Facebook, and visit Yale University’s global IR outreach website.

Article submitted by Aline D. Khatchikian, MD, PGY-3 Radiology Resident at McGill University

Over the last 50-55 years, since the first description of peripheral angioplasty, interventional radiologists (IRs) are at the forefront in advancing minimally invasive treatments of various diseases from the head (endovascular treatment of stroke) to the toe (limb salvage peripheral vascular treatments with angioplasty).

Interventional radiologists participate in different multidisciplinary care teams in the treatment of various diseases including (but not limited to):

• Peripheral vascular disease with endovascular therapies like balloon angioplasty, stenting, clot retrieval among others for patients with acute stroke and vascular disease involving the neck, aorta and branches, pelvis and legs for both occlusive and aneurysm disease
• Cancer with different procedures like biopsies, venous access for chemotherapy and different image-guided therapies for various cancers including tumour ablation, chemoembolization and radioembolization
• Dialysis interventions with different procedures for dialysis dependent patients including placement of hemodialysis catheters and maintenance of AV fistulas and grafts
• Trauma and emergency interventions with different embolization procedures in patients with acute life-threatening bleeding
• Inpatient interventions including many of the procedures listed, along with venous access procedures, enteral feeding procedures, abscess drain insertions, nephrostomy and biliary drain insertions among others

In addition, many Canadian IRs have followed the lead from their counterparts in other countries, by establishing clinical services. This includes outpatient IR clinics to allow for preprocedural clinical assessment, discussion of the intervention and development of a patient care plan, both in discussion with the patient and referring physician.  As part of this service, many Canadian IRs have inpatient privileges to admit and manage patients after their IR procedures.  As with any specialty, IRs should consult with any appropriate specialists to ensure good patient management, at their discretion.

This departure from “technician” and from the traditional role of diagnostic radiologist led to IR receiving subspecialty status from the Royal College of Physicians and Surgeons of Canada, and to the development of the IR residency.  Although the technical skills of an IR are paramount, clinical training is emphasized in the standards of training documents.

In summary, CAIR supports interventional radiologists in taking an active role in patient care, including outpatient clinics and inpatient admissions in the care of patients undergoing IR procedures.

CAIR Board of Directors

Les imprévus vont de pair avec la médecine, un domaine dans lequel la certitude n’existe pas. Ce sont la capacité d’adaptation des médecins et leur acharnement à prévoir l’imprévisible qui leur permettent de garder leur calme et leur sang-froid.

Dr. Veronique Caty – Tele-Quebec – ‘De garde 24/7 Imprévus’