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Michał Anioł (Michelangelo Buonarroti, 1475–1564)


Lublin - miasto inspiracji

Małgorzata Szczerbo-Trojanowska

Poland’s most senior interventional radiologist, and president of ECR 2010, told Interventional News how she felt when she joined a male-dominated field, why she is keeping an eye on developments in nanotechnology, and why the close link between interventional radiology and neurosurgery is sometimes cause for celebration at home!

From a time when interventional radiologists had difficulties being seen as clinicians, things have changed. Could you share your perspective on this journey for interventional radiology?

The process has taken over 40 years. In the beginning, radiologists began treating patients using percutaneous techniques developed for angiography and used X-ray imaging to guide the process. At that time radiology was recognised as a purely diagnostic specialty. It was difficult for many clinicians, particularly surgeons, to accept that radiological interventions may replace treatment options that traditionally belonged to their field.

It took some time before radiologists could prove that percutaneous radiological interventions may be better alternatives to the available therapeutic options. In some cases interventional radiology procedures were the only possible options, or the first choice treatment.

I have a very good example illustrating this evolution in my own department.

In the early Seventies, we did angiography in a haemophilic patient who after injury had a severe haematuria. Angiography disclosed an intrarenal pseudoaneurysm with blood extravasation into the urinary tract. The patient could not be immediately subjected to operation because specific antihaemophilic serum was not readily available. We decided to occlude the bleeding vessel with gelfoam. The success was twofold: we saved patient’s life and his kidney. Even though it was an evident success, many prominent surgeons criticised the method as being too revolutionary.

Despite seeing these rough beginnings, interventional radiology was developing further by introducing new methods of treatment of diseases which came under various specialties. There have now been substantial refinements in the methods of interventions and technical aids used. After many years, interventional radiology came to the point that it started to subspecialise into endovascular, oncology, musculoskeletal and other interventions. Then it became attractive for many clinical specialists and the era of turf battles started.

What are your views on the co-operation of interventional radiology with neurosurgery?

The close links between interventional radiology and neurosurgery is a very good example showing the multiple benefits cooperation between interventional radiologists and clinical specialists can bring. Historically, the first angiography was performed on brain vessels and it created one of the important turning points in the development of neurosurgery. Neurosurgery has always appreciated radiology which provides diagnosis in a highly inaccessible organ – the brain. This close interrelationship has led to the development of neuroradiology closely cooperating with neurosurgery.

So neurosurgery welcomed the effective treatment alternatives developed by interventional neuroradiologists which improved the outcomes and expanded the range of alternatives. In my case, the good links between interventional radiology and neurosurgery have a personal element as well, because my husband is the head of the neurosurgery department in my hospital. Therefore the success of either of our departments is a good reason for celebration at home.

Radiology is now seeing increasing numbers of women professionals. This is probably quite different from when you started your career…

It is clear that women are playing an increasingly important role in all aspects of life, including medicine. This applies to interventional radiology as well. When I chose interventional radiology as my field of interest, I was an exception in a male-dominated specialty. Nowadays, things are different and today there are many more women in the field. It is inevitable that the process will carry on and equilibrium will be reached in the future. I would advise a young woman considering a career in medicine that interventional radiology is an attractive, rapidly developing field with a prosperous future. She would have to develop an individual, often innovative approach to each case which is very stimulating. I would say that one can expect satisfaction that comes from well-resolved clinical problems on a daily basis.

Why did you choose medicine as a career, and how and why did you develop an interest in interventional radiology?

Choosing medicine was a continuation of the family tradition. My father was a very successful surgeon and university teacher. I was growing up in an environment where medicine and the treatment of patients was an everyday topic. This obviously developed my interest in medicine, particularly for the interventional disciplines. When I finished my medical studies, a new fascinating specialty called interventional radiology was emerging. It was in Lublin that the first interventional radiology department was created. I recognised it as a very stimulating and challenging opportunity to become involved in the development of a completely new field of therapeutic interventions. I was lucky enough to become one of the founding members of this new team.

Who have been your greatest influences?

My professional development was greatly influenced by the personality of professor Marian Klamut, one of the pioneers of interventional radiology in Europe. He created the first, and for many years only, department of interventional radiology in Poland. I was his first assistant and under his guidance and due to his innovative mind, I became involved in the development of basic and more sophisticated methods of interventional radiology. This pioneering period greatly stimulated my interest for interventional radiology and boosted my professional development.

During my training, I visited a number of renowned centres abroad. At that time, interventional radiology was well advanced in Sweden and a period of time spent with Uno Erikson was most beneficial. I also always recall philosophical chats with Doctor Sven-Ivan Seldinger – these certainly gave me new insights and ideas about my specialty. In Uppsala, I also had the opportunity to carry out some experimental research on uterine embolization. This method was at that time used to control post-partum haemorrhages. My work showed that embolization of uterine arteries in rabbits does not affect their fertility. This subject became a point of heated discussion when embolization was used utilised in uterine myoma treatment.

Unfortunately, I could not finish my studies because I had to return home due to the extremely tense political situation in Poland resulting from the first Solidarity strikes. Soon after, Marshall Law was introduced in Poland and the borders and communication channels closed.

What innovations have shaped your career?

In the early stages of my work, a variety of embolization methods constituted the core of our activity. Then, I became involved in developing new types of embolic materials to extend the area of clinical applications of embolization and to increase its safety. We have designed new radiopaque embolic materials which made it possible to follow the progress of embolization. In those days it was an important improvement, extending the range of applications of the method. Since then, our treatment has become applicable to an increasing number of patients.

Development of neurointerventional methods combined with good cooperation with neurosurgery, stimulated development of this field to a very high level in our centre.

Introduction of stentgrafts for treatment of aortic aneurysms was recognised by us as a great chance for patients with this severe condition. My department was the first in the country to introduce and offer this treatment. We have treated a large number of patients which gave us experience and enhanced the reputation of the centre which was seen as capable of managing the most complex and difficult cases.

Can you share some of the proudest moments in your career?

There have been many moments in my career which give me a feeling of satisfaction. I was a co-founder and elected president of the Polish Section of Interventional Radiology for two terms. I felt highly rewarded by the election to the board of CIRSE. The summit of my work for the Polish Medical Radiological Society was being elected as the President of the Society. One clear highlight in my career is being President of the European Congress of Radiology in 2010.

It is worth mentioning that the work of an interventional radiologist still gives me a feeling of fulfilment after each successful intervention on a patient with a severe or life-threatening disease.

What do you hope to achieve as ECR 2010 president?

My aim is to make the ECR congress in 2010 to be the best ever with a multiplicit¬y of educational and research exchange opportunities so that the participants are satisfied.

One charming feature of the ECR congress is that each year, you can discover some innovations in the programme.

In 2010, a new type of organ-oriented course will be launched, starting with “Liver from A to Z”. A second innovation will be the introduction of multidisciplinary symposia, which will start with “Managing patients with cancer”. During this symposium, four topics – prostate, ovary, colon and lung cancer – will be discussed by surgeons, oncologists, radiologists and interventional radiologists, reflecting the well-recognised fact that a multidisciplinary approach to radiology is essential for the future success of our specialty.

Which developing technologies or techniques are you watching closely in the future?

am fascinated with the possibilities which nanotechnology can bring for interventional radiology, especially in the field of gene therapy and targeted drug delivery. I am also watching how new nanocomposites can improve devices used by interventional radiologists.

What are your current areas of research?

We are now focused on catheter-guided cancer therapy. Along with oncologists, we have a programme dedicated to intra-arterial treatment of hepatic lesions with the use of chemotherapeutic agents loaded in embolic materials. Another project we are working on is with angiologists, with whom we closely cooperate. This is devoted to stimulation of angiogenesis in patients with critical limb ischaemia. I have always had a strong interest in device development. We are also working on improving the technique of aortic stentgraft implantation in patients with difficult vascular anatomy.

What are the contributions of IR societies to the field? What have they achieved?

Societies bring together radiologists interested in and practicing interventional radiology, and consolidate and coordinate their efforts to develop and promote the discipline. Practicing in Europe and being involved in CIRSE, I will obviously refer to the European Society.

It organises courses, congresses and scientific exchanges and issues a scientific journal. The European Society runs a yearly, international scientific congress which is growing from year to year and is becoming the most important event, very attractive not only to interventional radiologists but as well to many other specialists involved in minimal invasive therapy. CIRSE established a very successful School of Interventional Radiology (ESIR) a few years ago. Many young interventionalists benefit a lot from this high level training opportunity.

Preparation of standards of practice documents also plays a very important role. The latest highlight reflecting CIRSE activity is recognition of interventional radiology by UEMS as a subspecialty of radiology.

Without involvement of CIRSE and its efforts undertaken on different levels, this would not have been possible. It is a great success of CIRSE and will have a tremendous influence on the status and future development of interventional radiology all over Europe.

Outside of medicine, what interests do you have?

I like good music very much, and my husband and I are both great opera fans. I also enjoy travelling and sports, particularly skiing and sailing. I am a very family-oriented person and the time I can devote, now to my granddaughters, is the most enjoyable time for me.

Career history

1970 Qualified with distinction as a physician (MD), University Medical School in Lublin, Poland
1976 Board certified specialist in Diagnostic Radiology
1976 PhD, University Medical School in Lublin
1977 Assistant professor at the Department of Interventional Radiology, University Hospital Lublin
1985 Associate professor at the Department of Interventional Radiology, University Hospital Lublin
1993 Professor at the Department of Interventional Radiology, University Hospital Lublin
1995 Head of the Department of Interventional Radiology, University Hospital Lublin
1999 Chairman of the Department of Radiology, Head of the Department of Interventional Radiology, University Medical School in Lublin

Research and training fellowships abroad

1970 Dept of Surgery, Princess Margaret Hospital in Swindon, UK
1979 Dept of Radiology, Uppsala University, Sweden
1980 Dept of Radiology, Karolinska Institute, Stockholm, Sweden
1985 Dept of Radiology, University in Giessen, Germany
1990 Dept of Radiology, Southampton University, UK

Functions in the scientific societies

1980–1990 Founder and chairman of the Section of the Interventional Radiology of the Polish Medical Society of Radiology
1990–2001 Chairman of the Training and Education Committee of the Polish Medical Society of Radiology
1989–1999 Founder and member of the Board of the Polish Society of Magnetic Resonance
1990 Member of the Board of the Polish Medical Society of Radiology
2001 President of the Polish Congress of Radiology
2001–2004 President of the Polish Medical Society of Radiology
2004–2007 Member of the Executive Committee of the European Congress of Radiology (ECR)
2005–2007 Member of the Executive Committee of the (CIRSE), chairman of the Rules Committee
2007–present Chairman of the Radiology Committee of the Polish Academy of Sciences
2007–present Member of Executive Committee of the European Society of Radiology (ESR)
2009 President of ECR 2010

Membership

• Polish Medical Society of Radiology
• Polish Society of Magnetic Resonance
• Polish Society of Ultrasound
• Polish-German Radiological Society
• American Association for Women Radiologists
• European Society of Radiology
• Cardiovascular and Interventional Radiological Society of Europe
• Radiological Society of North America
• Societas Scientarum Lublinensis
• Neuroscience Committee of the Polish Academy of Sciences

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