Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology

Abstract

Background

Interventional oncology (IO) employs various techniques to enable minimally invasive, image-guided treatment of tumor diseases with both curative and palliative goals. Additionally, it significantly contributes to managing tumor-related and perioperative complications, offering diverse supportive procedures for patients at all stages of their diseases. The execution of IO procedures places unique demands on the equipment, personnel, and structural organization of radiological clinics, necessitating specific expertise from interventional radiologists.

Methods

This position paper aims to comprehensively outline the multifaceted aspects of IO and discuss the requisite criteria for hospitals, radiological clinics, and interventional radiologists (IRs). Furthermore, it underscores overarching considerations of quality assurance that clinics and professional societies should prioritize.

Conclusion

The requirements for hospitals, radiological clinics, and IRs are varied and demand not only a high level of proficiency in performing IO procedures but also in-depth knowledge of the differential therapy for various tumor diseases. This expertise is essential for effectively serving as clinical partners in the interdisciplinary treatment of oncologic patients. Additionally, a thorough understanding and safe handling of ionizing radiation technologies, along with proficiency in radiation protection methods, which are fundamental aspects of radiological specialist training, is crucial for ensuring the safety of IO procedures for both patients and staff. The Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have long-established dedicated quality management programs, accrediting radiology clinics and certifying IRs. These initiatives aim to uphold the highest standards of care and meet the quality expectations set by politics in healthcare system, particularly in the realm of interventional radiology.

Key Points

• The various procedures in the field of interventional oncology (IO) are complex medical interventions that require not only the most advanced technical equipment but also adequate human resources, particularly specialized expertise in interventional radiology, diagnostic imaging, oncology, and radiation protection.

• This expertise is an integral part of the specialized medical training in radiology and is certified by professional societies such as the German Society for Interventional Radiology (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

• Professional societies like DeGIR, CIRSE, and the American Society of Interventional Radiology (SIR) establish the necessary quality assurance framework for comprehensive, high-quality IO therapy through quality assurance (QA) registries, standard operating procedure (SOP) documents, and participation in guideline development.

• Currently, radiology is the only discipline that provides physicians with the theoretical and practical knowledge, skills, and competencies required to perform the demanding procedures in the field of IO through specialized training programs and tailored certification processes.

Citation Format

• Isfort P, Sommer CM, Bruners P et al. Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology. Rofo 2025; 197: 546–556

• References

• 1 Kim HS, Chapiro J, Geschwind JH. From the Guest Editor: Interventional Oncology: The Fourth Pillar of Oncology. Cancer J 2016; 22: 363-364
• 2 Nadjiri J, Schachtner B, Bucker A. et al. Nationwide Provision of Radiologically-guided Interventional Measures for the Supportive Treatment of Tumor Diseases in Germany: An Analysis of the DeGIR Registry Data. Fortschr Röntgenstr 2022; 194: 993-1002
• 3 Lewandowski RJ, Salem R. Implementation of radiation segmentectomy for early-stage hepatocellular carcinoma. Lancet Gastroenterol Hepatol 2022; 7: 783-784
• 4 Liu B, Zhang Y, Chen H. et al. The combination of transcatheter arterial chemoembolisation (TACE) and thermal ablation versus TACE alone for hepatocellular carcinoma. Cochrane Database Syst Rev 2022; 1: CD013345
• 5 Bendix MB, Houston A, Forde PF. et al. Electrochemotherapy and immune interactions; A boost to the system?. Eur J Surg Oncol 2022; 48: 1895-1900
• 6 Matrood S, Gress TM, Rinke A. et al. Radiofrequency and microwave ablation controls hepatic oligoprogression of advanced gastroenteropancreatic neuroendocrine tumors. J Neuroendocrinol 2023; 35: e13289
• 7 Reig M, Forner A, Rimola J. et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol 2022; 76: 681-693
• 8 Toyoda H, Kumada T, Sone Y. Impact of a unified CT angiography system on outcome of patients with hepatocellular carcinoma. AJR Am J Roentgenol 2009; 192: 766-774
• 9 Tsetis D, Uberoi R, Fanelli F. et al. The Provision of Interventional Radiology Services in Europe: CIRSE Recommendations. Cardiovasc Intervent Radiol 2016; 39: 500-506
• 10 Miller DL, Vano E, Bartal G. et al. Occupational radiation protection in interventional radiology: A joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. J Vasc Interv Radiol 2010; 21: 607-615
• 11 Lennartz S, Diederich S, Doehn C. et al. Radiological Monitoring of Modern Immunotherapy: A Novel Challenge for Interdisciplinary Patient Care. Rofo 2020; 192: 235-245
• 12 Mahnken AH, Boullosa Seoane E, Cannavale A. et al. CIRSE Clinical Practice Manual. Cardiovasc Intervent Radiol 2021; 44: 1323-1353
• 13 Bryant T, Ahmad R, Diamantopoulos A. et al. Access to beds for interventional radiology patients: Improving patient care. Clin Radiol 2023; 78: 288-294
• 14 Sommer C, Kätzlmeier S, Do TD. et al. IROS 2020 Abstracts – P-7: The Clinic of Radiology (CoR) with own patient ward and coding/billing responsibility: Key Economic Performance Indicators (KEPIs) on the example of a German hospital offering the full spectrum of interventional radiology (IR). Cardiovasc Intervent Radiol 2020; 43 (Suppl. 01) 1-20
• 15 European Curriculum and Syllabus for Interventional Oncology. First edition. 2019 Zugriff am 31. Januar 2024 unter: https://www.cirse.org/wp-content/uploads/2019/03/cirse_IOcurriculum_syllabus_2019_web.pdf
• 16 Radosa CG, Nadjiri J, Mahnken AH. et al. Availability of Interventional Oncology in Germany in the Years 2018 and 2019 – Results from a Nationwide Database (DeGIR Registry Data). Fortschr Röntgenstr 2022; 194: 755-761
• 17 Uberoi R, Spooner M, Weren M. et al. EBIR Evolution: Meeting the Challenge for Twenty-First-Century IR. Cardiovasc Intervent Radiol 2019; 42: 485-486
• 18 Nadjiri J, Geith T, Waggershauser T. et al. Comparison of radiation exposure in common hepatic interventions: A retrospective analysis of DeGIR registry data. Radiologe 2021; 61: 80-86
• 19 Crocetti L, de Baere T, Pereira PL. et al. CIRSE Standards of Practice on Thermal Ablation of Liver Tumours. Cardiovasc Intervent Radiol 2020; 43: 951-962