Cardiovascular And Interventional Radiological Society Of Europe Research Articles

CIRSE and World Interventional Radiology

AbstractOn the occasion of the 20th Indian Society of Vascular and Interventional Radiology (ISVIR) Annual Conference in Lucknow, India, in February 2018, the President of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) presented the ISVIR International Oration on the topic “CIRSE and World Interventional Radiology.” The oration addressed the current strengths but also the challenges interventional radiology (IR) is facing worldwide and emphasized the portfolio of CIRSE's activities aiming to further this innovative discipline. Four pillars for the future of IR are addressed in detail: education, certification, research and guidelines as well as communication and global collaboration. Building on these aspects, a prosperous future for IR can be expected.

The Interventional Radiology (IR) Gender Gap: A Prospective Online Survey by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)

AimA prospective online survey was conducted by the Cardiovascular Interventional Radiological Society of Europe (CIRSE) to evaluate the gender gap within interventional radiology (IR) and the barriers facing women in IR.Materials and MethodsA questionnaire (“Appendix”) was devised by the authors and the CIRSE communication and publication team and sent electronically to 750 identifiable female members of CIRSE. Responses were collected from 7 August to 24 August 2017.ResultsThe response rate was 19.9% (n = 149) with highest responses from UK (18%), Italy (11%), Germany (11%), Spain (7%), Netherlands (5%), France (5%), Sweden (4%), USA (4%). 91% of the respondents were between 31 and 46 years, 83% work full time, 62% spend > 50% of their working time in IR, and 67% practice in a university or tertiary referral institution. 85% were in the minority in their department. 52% had no leadership role in their department, but 67% expressed willingness to consider a leadership position. Their main concerns were work/family life balance, the risks of radiation exposure, the effect of pregnancy on training and practice and the male-dominated work environment.ConclusionThis survey highlights issues experienced by women in IR. Clear guidance on concerns regarding radiation exposure particularly during pregnancy is needed. Structured and supportive training is required for female IRs who may wish to train or work flexibly. The male-dominated environment is discouraging, and a scheme to promote female IRs would encourage women to take on senior leadership positions and attract more women into the specialty.

Radioembolisation in Europe: A Survey Amongst CIRSE Members

IntroductionRadioembolisation of liver tumours demands many choices from the physician regarding planning of treatment and subsequent follow-up.MethodsAn online questionnaire was distributed amongst all members of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) to investigate the current state of radioembolisation practice.ResultsThe survey was completed by 60 centres. The increasing number of radioembolisation procedures may reflect that radioembolisation is increasingly recognised as a valuable treatment option in European cancer guidelines. Imaging modalities play an important role in decision making. Furthermore, there seems to be a trend towards less coil-embolisation of non-target vessels. In addition, type of microsphere, model for dose calculation, complications and future developments are evaluated in this article.ConclusionsThis survey provides insight into the current state of radioembolisation practice across Europe.

Vertebral Fragility Fractures (VFF)—Who, when and how to operate

Vertebral Fragility Fractures (VFF) are common and lead to pain, long term disability and increased mortality. Most patients will have mild to moderate pain symptoms and can be managed conservatively. However, patients with severe pain who have minimal or no pain relief with potent analgesia, or who only achieve adequate pain relief with high doses of morphine based analgesia which results in significant adverse events, should be considered for vertebral augmentation. Ideally, for vertebral augmentation, patients should present within four months of the fracture (onset of acute pain) and have at least 3 weeks of failure of conservative treatment although early intervention may be more appropriate for hospitalised patients, who tend to be older, more frail and likely to be less tolerant to the adverse effects of conservative treatment.The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) recommends Percutaneous Vertebroplasty as the first line surgical augmentation technique for VFF in older people, which has been shown to improve pain symptoms, allow early restoration of functional mobility and may reduce the risk of further vertebral collapse. CIRSE recommends percutaneous Balloon Kyphoplasty as second line treatment in VFF, although the optimal indication is for acute traumatic vertebral fractures (less than 7–10 days) in younger people. Assessment and treatment of underlying osteoporosis is important to reduce the risk of further fractures in older people with VFF.

Highlights from the 36th European Society of Surgical Oncology Congress (ESSO 36), 14-16 September 2016, Kracow, Poland: optimising European cancer surgery.

The ESSO Congress is the event for all surgeons with an interest in surgical oncology. The congress is a gathering for the surgical oncology community from all around the world to meet and gain an insight into state-of-the-art technology, latest healthcare services, and solutions within their field.The ESSO 36 congress gathered over 750 participants from 58 countries. With over 100 speakers, the scientific programme featured 18 scientific symposia including a joint symposium with the American Society of Surgical Oncology (SSO), 6 multidisciplinary sessions including joint sessions with CIRSE (Cardiovascular and Interventional Radiological Society of Europe) and JCOG (Japanese Clinical Oncology Group), 8 meet-the-expert sessions, 5 debates, 13 proffered paper sessions, and 2 video sessions.

Executive Summary of the Joint Position Paper on Renal Denervation of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the European Society of Hypertension (ESH).

Executive Summary of the Joint Position Paper on Renal Denervation of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the European Society of Hypertension (ESH).

Readability of Online Patient Education Materials Related to IR

PurposeTo assess the readability of online patient education materials (OPEM) related to common diseases treated by and procedures performed by interventional radiology (IR). Materials and MethodsThe following websites were chosen based on their average Google search return for each IR OPEM content area examined in this study: Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), National Library of Medicine, RadiologyInfo, Mayo Clinic, WebMD, and Wikipedia. IR OPEM content area was assessed for the following: peripheral arterial disease, central venous catheter, varicocele, uterine artery embolization, vertebroplasty, transjugular intrahepatic portosystemic shunt, and deep vein thrombosis. The following algorithms were used to estimate and compare readability levels: Flesch-Kincaid Grade Formula, Flesch Reading Ease Score, Gunning Frequency of Gobbledygook, Simple Measure of Gobbledygook, and Coleman-Liau Index. Data were analyzed using general mixed modeling. ResultsOn average, online sources that required beyond high school grade–level readability were Wikipedia (15.0), SIR (14.2), and RadiologyInfo (12.4); sources that required high school grade–level readability were CIRSE (11.3), Mayo Clinic (11.0), WebMD (10.6), and National Library of Medicine (9.0). On average, OPEM on uterine artery embolization, vertebroplasty, varicocele, and peripheral arterial disease required the highest level of readability (12.5, 12.3, 12.3, and 12.2, respectively). ConclusionsThe IR OPEM assessed in this study were written above the recommended sixth-grade reading level and the health literacy level of the average American adult. Many patients in the general public may not have the ability to read and understand health information in IR OPEM.

Specialty status for interventional radiology: the time is now.

The rapid growth of interventional radiology (IR) during the past 20 years has led to the formation of IR societies in most European countries. However, in many European countries, IR is hampered by a lack of specialty status, which would allow it to determine its own future in terms of clinical practice, governance, training, and certification. In 2009, the Union of European Medical Specialists (UEMS) recognized IR as a distinct specialty of radiology. This landmark vote by the UEMS to recognize IR as a specialty has resulted in a number of European countries pursuing the same objective. Now is the time to seek specialty status for IR throughout Europe, within the house of radiology. Internationally, specialty status for IR was achieved in the United States some years ago and, more recently, specialty status has been granted to IR in Canada. Specialty recognition for IR is now a truly global phenomenon, giving IR the opportunity to shape and control its own destiny. Appropriate training in IR, certification of training, and clinical practice are now a reality for IR. Specialty status also helps to highlight the need for more IRs to allow safe and effective delivery of service, especially out of hours. This need must be met by increasing the quotas of dedicated IR trainees, which is difficult whilst IR is not recognized as a distinct specialty. The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) together with the Interventional Radiology Division of Radiology at UEMS are working closely to pave the way for IR specialty recognition in all EU countries. Applications for specialty status must demonstrate that curriculum-based training and certification of training are in place. CIRSE has already introduced an IR curriculum (www.cirse.org/curriculum_syllabus), which has been adopted by many European countries as the training standard for IR. Training in IR, as in any other training program, should be certified to ensure that the trainee has reached a certain standard and is safe to practice IR. The European Board of Interventional Radiology (EBIR), which was developed by CIRSE in 2010 and endorsed by the ESR and the IR Division of the UEMS, is rapidly becoming adopted as the certification standard for European IRs (www.cirse.org/ebir). Application for specialty status in IR occurs through the Medical Chamber or Council in each European country. CIRSE has published some general guidelines and directions on how to proceed with the application process on its website (www.cirse.org/specialtystatus). CIRSE, together with the IR Division of Radiology at UEMS, encourages all National IR Societies to apply for IR specialty status, within the house of Radiology. Specialty status for IR throughout Europe will eventually allow harmonization of training and certification throughout Europe, which will enhance patient care and safety.

Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Position Statement on Renal Denervation for Resistant Hypertension

Hypertension is a major global healthcare challenge now recognised as the leading cause of mortality across the developed and developing world (1). Resistant hyperten- sion (systolic BP (140 mmHg on three or more medica- tions) makes up a significant minority of this group (5-15 %) and is associated with a considerably increased risk of cardiovascular events. Renal denervation (RDN) is emerging as a significant step forward in the treatment of patients with resistant hypertension. The publication of the Symplicity I and II trials has firmly established the pro- cedure with both proof of principle and short-term efficacy using randomised controlled trial methodology (2-4). Who is Eligible for RDN? At present the evidence only supports its use in resistant hypertension. This was defined in the trials as a clinic systolic blood pressure C160 mmHg (C150 mmHg in type 2 diabetes) on three or more antihypertensive medica- tions. Ideally, this should be supported with ambulatory blood pressure measurements to exclude the ''white coat phenomenon.'' In the trials, patients were excluded if the estimated GFR \45 ml/min/1.73 m 2 and local protocols should be in place if patients with an eGFR \45 ml/min/1.73 m 2 are to be treated.

Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression From the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, With Endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE)

J INTRODUCTION Tube feeding has been practiced for more than 400 years (1). In addition to feeding, gastrointestinal (GI) access can be used for decompression in cases of enteral obstruction. Temporary access can be achieved with a nasogastric (NG), oral gastric (OG), nasojejunal (NJ), or oral jejunal (OJ) feeding tube. These tubes can be placed “blindly” at the bedside, with the use of image guidance (eg, fluoroscopy, ultrasound), or with the use of endoscopic guidance. Unfortunately, natural orifice tubes often fail because of clogging as a result of their relatively small diameter or inadvertent dislodgement (2). More permanent enteral access can be obtained

Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010: 25 Years of Success: Innovation—Education—Intervention, October 2–6, 2010, Valencia, Spain

Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010: 25 Years of Success: Innovation—Education—Intervention, October 2–6, 2010, Valencia, Spain

Conference Scene: CIRSE 2010 – helping minimally invasive therapy reach its maximum potential

The annual Cardiovascular and Interventional Radiological Society of Europe (CIRSE) congress is Europe’s most influential interventional radiology platform, and 2010 was no exception. With over 5600 attendees traveling to the host city of Valencia, it once again set records. The high attendance is representative of the meeting’s scientific importance – CIRSE 2010 also featured a broader scientific program than ever, with record numbers of scientific submissions and educational workshops.

Cardiovascular and Interventional Radiological Society of Europe Commentary on the Treatment of Chronic Cerebrospinal Venous Insufficiency

Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS) [1]. The core foundation of this theory is that there is abnormal venous drainage from the brain due to outflow obstruction in the draining jugular vein and/or azygos veins. This abnormal venous drainage, which is characterised by special ultrasound criteria, called the “venous hemodynamic insufficiency severity score” (VHISS), is said to cause intracerebral flow disturbance or outflow problems that lead to periventricular deposits [2]. In the CCSVI theory, these deposits have a great similarity to the iron deposits seen around the veins in the legs in patients with chronic deep vein thrombosis. Zamboni, who first described this new theory, has promoted balloon dilatation to treat the outflow problems, thereby curing CCSVI and by the same token alleviating MS complaints. However, this theory does not fit into the existing bulk of scientific data concerning the pathophysiology of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the associated balloon dilatation treatment, even though there is no supporting scientific evidence. Furthermore, most of the information we have comes from one source only. The treatment is called “liberation treatment,” and the results of the treatment can be watched on YouTube. There are well-documented testimonies by MS patients who have gained improvement in their personal quality of life (QOL) after treatment. However, there are no data available from patients who underwent unsuccessful treatments with which to obtain a more balanced view. The current forum for the reporting of success in treating CCSVI and thus MS seems to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we receive approximately 10 to 20 inquiries a month about this treatment. In addition, many interventional radiologists, who are directly approached by MS patients, contact the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) for advice. Worldwide, several centres are actively promoting and performing balloon dilatation, with or without stenting, for CCSVI. Thus far, no trial data are available, and there is currently no randomized controlled trial (RCT) in progress Therefore, the basis for this new treatment rests on anecdotal evidence and successful testimonies by patients on the Internet. CIRSE believes that this is not a sound basis on which to offer a new treatment, which could have possible procedure-related complications, to an often desperate patient population.

Guidelines for Peripheral and Visceral Vascular Embolization Training: Joint Writing Groups of the Standards of Practice Committees for the Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Canadian Interventional Radiology Association (CIRA)

Guidelines for Peripheral and Visceral Vascular Embolization Training: Joint Writing Groups of the Standards of Practice Committees for the Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Canadian Interventional Radiology Association (CIRA)

Simulation Devices in Interventional Radiology: Validation Pending

MEDICALsimulationoffersatantaliz-ing breadth and depth of potential fortraining and assessment in interven-tional radiology. It promises to providesolutions to many of the shortcom-ings of our traditional “apprentice-ship” training. Mandatory restric-tions on in-hospital work hours ofresident trainees limit the time avail-able for training and the breadth ofcase material to which the individualtrainee is exposed. At the same time,advances in noninvasive imaginghave reduced trainee exposure to in-vasive procedures. Thus today’s res-ident/trainee has limited opportu-nity to acquire the basic gatewayskills (eg, selective diagnostic cathe-ter angiography), upon which moreadvanced interventional skills arebased (1–3). Medical simulators en-gineered for interventional radiologytraining have the potential to ad-dress these gaps.Simulators introduce a novel capa-bility not only to train but also to es-tablish objective evidence of technicalcompetence during and after training(4–6). Although there is growing evi-dence for their effectiveness, few med-ical procedural simulations have dem-onstrated predictive validity. In otherwords, in very few instances has pro-ficiency with a medical proceduralsimulator been proved to transfer tothe clinical situation. This transfer oftrained skills to patients has now beenshown for simulations of laparoscopicsurgery, colonoscopy, and anesthesia(7–9), but at the time of writing, simi-lar evidence is still being sought forendovascular simulators.In the future, it is likely that simu-lations will be incorporated into certi-fication examinations for interven-tional radiology (6). Although it maybe intuitive that skills learned on sim-ulators should effectively transfer tothe clinical interventional radiologyenvironment, intuition is not evidence.A great deal of work on the develop-ment and validation of interventionalradiology procedural simulations mustbe completed before the inclusion ofsimulations on board, and other statu-tory, certification examinations can beendorsed. Ideally, the development andvalidation of the critical measures ofperformance (metrics) and test items tobe used in simulators should be ac-complished through a joint effort ofprofessional societies and the certify-ing bodies. Only in this way will weensure that the test instrument is com-patible with the educational curricu-lum and that the desired competenciesare being assessed. Input will be re-quired from psychologists and expertsin the subject matter, who will analyzeknowledgeandtaskperformance,break-ing them down into their key compo-nents (10,11). Metrics must be identifiedand used specifically for assessment ofthe learner. By design, this can be madeto occur automatically (by a simulator)within the context of a simulation. Thesubject experts involved in test develop-ment must be appointed with completetransparency by the certifying authori-ties. They must faithfully represent a ro-bust interventional radiology curricu-lum, with all facets of content, skill, andeven geographic diversity.Ideally a single, comprehensive setof procedures, skill sets, and metricsshould be defined and provided asopen source for incorporation into ac-ademic and commercial simulatormodels. Each set of metrics based onthe test items must in turn be vali-dated for its stated purpose. The di-versity of training environments rep-resented within and across radiologysocieties provides an excellent oppor-tunity for careful test validation. Theuse of trainees in transfer-of-trainingstudies will show whether skills ac-quired through simulation indeedtranslate into performance in patients.Subsequent review would demon-strate whether that performance ismaintained. Funding and support forthis work should derive jointly fromindustry, the various specialty societ-ies, and government agencies in theform of public-private partnerships.

SIR/RSNA/CIRSE Joint Medical Simulation Task Force Strategic Plan Executive Summary

Strategic MissionThe Executive Councils of the Society of InterventionalRadiology (SIR), Radiological Society of North America(RSNA), and Cardiovascular and Interventional Radiolog-ical Society of Europe (CIRSE) have charged their MedicalSimulation Task Forces and Work Groups to cooperate toachieve excellence and safety in interventional radiologypatient care by jointly recommending and guiding imple-mentation of a robust infrastructure and process to supportInterventional Radiology (IR) simulation development,assessment, validation, application, and dissemination.The goal of medical training is to create practitionerswho demonstrate mastery of the professionalism (skills,knowledge, attitudes, and behavior) required for the suc-cessful delivery of medical therapy [1]. A well-designedand fully integrated curriculum is the essential mechanism

CIRSE 1985 to 2005: 20 Years of Growing Success

To commemorate the history of CIRSE, we need to take ashort look at the developments in European interventionalradiology before CIRSE was created in the spring of 1985.Until then, two ‘‘interventional societies’’ existed in Europe:the European College of Angiography (ECA) and theEuropean Society of Cardiovascular and InterventionalRadiology (ESCVIR), which were both founded in 1976.The idea of gathering European cardiovascular and inter-ventionalradiologistsintoascientificsocietywasconceivedin the early 1970s. By 1975 numerous prominent Europeancardiovascular and interventional radiologists had startedseriousdiscussions, whichresultedinthecreation ofthetwoEuropean bodies.Whereas the ECA was more academically oriented, witha limited membership of 75 and defined credentials in car-diovascular radiology to be eligible for membership, theESCVIR was founded as an open society for all doctorsinterested in cardiovascular and interventional radiology. Inthe years between 1982 and 1984 the ESCVIR and ECAcombined their annual meetings, and the American sistersociety SCVIR was invited for joint meetings. Since mostleading European angiographers and interventionists weremembers of both societies, the idea of a unified, singleEuropean society was aired as early as 1981 by severalleading figures such as FranAois Pinet, Ivo Obrez, RobertoPassariello, Plinio Rossi, Eberhard Zeitler, Gian-CarloFeltrin, Ulf Tylen, Rolf Gnther, and Friedrich Olbert.In a water-taxi from the airport in Venice to the HotelExcelsior on the Lido of Venice, FranAois Pinet askedFriedrich Olbert whether he would be willing to carrythrough the merging of the two societies at the forthcomingjoint meeting in Vienna in 1985. Friedrich Olbert happilyagreed to do so, and certainly Vienna as an internationalmelting-pot was the ideal place for such an undertaking.Moreover, Friedrich Olbert as a renowned leader in inter-ventional radiology and a person of great diplomatic skillspromised to be the right choice for such a delicate task.However, it was first necessary for leading figures such asFranAois Pinet, Ulf Tylen, Eberhard Zeitler and others, whofortunately were members of both societies, to do somelobbying for a single European society. Under their influ-ence, working groups started to draw up regulations andarticles to be ready for presenting to the two societies attheir joint meeting in Vienna in 1985.At 1p.m. on April 24th, during the joint general assem-bly, the Cardiovascular and Interventional RadiologicalSociety of Europe (CIRSE) came into existence. The newarticles drawn up by Ulf Tylen were accepted and FriedrichOlbert—president of the joint meeting of the ECA and theESCVIR—was immediately appointed as the new presidentof CIRSE. FranAois Pinet and Christoph Zollikofer werevoted in as secretary-general and treasurer of the newsociety. Members of the ECA automatically became fellowsof CIRSE. The new society now had a combined member-ship of about 300 which triggered the beginning of a veryfruitful era. A total of 556 scientists from all over Europehad been present at the Vienna meeting and the congressmade a substantial profit, which served as the basis forfinancing future congresses.The first CIRSE congress and joint meeting with theAmericanSCVIRwasheldinMay1986inJerusalem,underthepresidencyofAlexRosenberger.Furtheryearlymeetingsfollowed in Porto Cervo, Berlin, Paris, Brussels, and Oslounder the presidencies of Plinio Rossi, Reingard Sorensen,Jean-Michel Bigot, Julien Struyven, and Ivar Enge in theyears 1987 to 1991, with growing attendances of up to 800.With an expanding membership, and with the increasingimportance of interventional radiology in radiology andmedicine as a whole, it was felt that the existing structure ofthe society—with a distinct lack of continuity in the exec-utive body due to the yearly changing presidency, and nopermanentsecretarialoffice—wasnolongergoodenoughtocope with its future tasks. The need for training, education,and research on the one hand, and on the other the deter-mination to become a recognized and powerful subspecialty

Presidential Address: Like a Bridge Over Troubled Waters: Presented at the 29th Annual Meeting of the Society of Interventional Radiology

KNOWLEDGEABLE patients prefer interventional radiology, even though few outside of medicine recognize those two words. Patients seek information on minimally invasive treatments over the Internet, from friends, or through a second opinion—and specialists are adapting our techniques into their own field to attract these patients. How can we blame them for wanting to provide the best treatments to their patients? Competition is not foreign to our history, and as the leaders, we should expect it. With this, the 40th anniversary of angioplasty, it is hard for others to ignore the impact we have had on 21st century medicine and the advances we offer in patient care. A recent forbes.com article stated, “[t]he fastgrowing discipline, known as endovascular therapy, could replace up to 70% of conventional surgeries by the end of the decade.” Interventional radiology is a clear target for others to imitate because one thing is agreed upon: that it is the future of medicine. The only question is how strong a role we will play in that future. Interventional radiologists will remain leaders if we focus on moving interventional radiology into the mainstream of patient care, toward the first choice slot of referrals, and if we ensure the highest quality of research to replenish our innovations. We cannot do this alone: all of us in the radiology community need to work together. We need to create strong alliances based on common goals and expertise. This past year, I have worked with the Society of Interventional Radiology (SIR) to reconnect with long-time allies and reach out to international colleagues. I believe that all those connected to interventional radiology need to join together for our mutual benefit . . . and that SIR is the conduit for this process. During the past year, our collaborative projects included: •Working with the American College of Radiology to release a White Paper supporting interventional radiologic and neurointerventional radiologic clinical practice, to create the Interventional Radiology Learning File CD-ROM, and petition the Center for Medicare and Medicaid Services to expand magnetic resonance (MR) angiography coverage; •Working with the Radiological Society of North America for a media briefing in New York, in addition to Certificate of Added Qualifications preparation, promotion of interventional radiology to residents, and creation of the self-assessment for the American Board of Radiology; •Working with the American Society of Interventional and Therapeutic Neuroradiology on the Cardiovascular and Interventional Radiology Research and Education Foundation (CIRREF; now called SIR Foundation) IR Stroke meeting, the Stroke Consensus Conference, the Journal of Vascular and Interventional Radiology Stroke Supplement, a Joint Carotid Stent and Stroke Prevention Task Force; and collaboration on carotid training for our members; •Collaborating with the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) to develop the first joint CIRSE/SIR clinical practice guideline, which provides for the same standard of patient care on both sides of the Atlantic Ocean; we also collaborated on emerging therapies and research. In addition to CIRSE, SIR is working with a variety of international interventional radiology groups to broaden our experience and educational efforts and prevent each other from “reinventing the wheel.” The world now requires that we think and act globally. I am pleased to personally announce the collaborative partnership SIR has just established regarding oncology. There is a new SIR interventional oncology task force, and we have invited into our society the Tumor Ablation Workgroup, which represents interventional radiologists who largely comprise cross-sectional imagers. The wealth of research and expertise these individuals bring compleFrom the Department of Radiology, Swedish Covenant Hospital, 5145 North California Avenue, Chicago, Illinois 60625. Received April 23, 2004; revision requested April 26; revision received April 29; accepted April 30. Address correspondence to M.C.B.; E-mail: mbrunner@schosp.org

Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata

THE joint Standards of Practice Committee of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the Society of Interventional Radiology (SIR) is comprised of experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such they represent a valid broad expert constituency of the subject matter under consideration for standards production.