Interventional News recently spoke to Professor Jim Reekers, President of CIRSE, about what he hopes to achieve as President and how he plans to develop a 'Green Society' by introducing a CO2 Neutral Flying Programme. He also talks about who his greatest influences were and current areas of research.
What made you decide you wanted a career in medicine?
I did not intend to be a doctor in the beginning. I wanted to be an airline pilot until I realised that airline pilots do not fly aeroplanes, the only thing they do is manage data and look at computers all the time. So I thought, 'well what can I do with my life', and then I decided to get into medicine - not because my father is a doctor, but because I thought this is a way I can work with my hands. Working with my hands was always a very important thing for me. I wanted to become what all young boys do, and that is a surgeon. I realised this when I was about 19 or 20, and believed that becoming a surgeon was a way I could help people. So I first wanted to go into medicine to become a surgeon.
Why did you want to specialise in Interventional Radiology?
We had a very famous professor in vascular surgery in our hospital, his name was van Dongen, who was world famous, and I followed him for some time, and then I came into the works of Charles Dotter. When I was in my third year of medical school, I realised that there was not going to be a future in vascular surgery and I thought that interventional radiology, especially minimal invasive endovascular therapy was going to be very important. At this time, everybody laughed and thought I was crazy. It was a time when stents were not around and things like that, but I really thought that this was going to be great.
I studied at the Medical School at the University of Amsterdam and I also did my doctoral thesis at this University and now I am a professor in Interventional Radiology at the same university. So I have never been a great cosmopolitan. I feel very European.
Who have been your greatest influences?
When I started interventional radiology, there were only a few people around who you could really learn from. As I did not go to the US, I tried to find those people in Europe. So I travelled around and I visited Professor Allison in Hammersmith Hospital, and also Dr Stark in Kassel, Germany, where I spent some time. I then went to Paris and learnt about vascular malformations from Professor Merland. So through travelling around I tried to pick up all sorts things from people who in those days were famous and innovative in their own way. I studied interventional radiology by spending time with these people, listening and learning and then moving on and doing the same with somebody else. That's how I learnt interventional radiology. Fellowships in interventional radiology where not around at that time in Europe.
What have been your proudest moments?
I have proud moments every week. When I do something that benefits the patient - that is a proud moment. On the other hand, sometimes these proud moments are followed by deep frustration. And that is the way it is sometimes. I mean, interventional radiology is a profession that has been growing due to frustration. The fact that you cannot touch things and everything that you do is remote, everything is done through a catheter or a wire. A surgeon, for example, can just cut open the belly and find the blood vessel - we can't do this. The frustration is that you really can't do things that surgeons can do, so you have to find new solutions. And the moment you find a solution, like finding a thrombectomy catheter, or a stent, you solve another problem. We have great moments and proud moments where you do something good but frustration is where you say, 'well, we have to find a new way to treat it.' An other frustration is that you are able to do almost everything, but not everything that vascular surgeons can do, and the proud moment is when you succeed and help a patient without putting the patient through theatre for operation. Helping a patient avoid going through the operation theatre is for me a proud moment.
What do you hope to achieve as being President of CIRSE?
There are a lot of things I want to achieve. As you may well know, we have what is called ESIR programmes, where CIRSE goes to Eastern European countries, such as Poland, Hungary and we are planning to go to Moscow and Ukraine, to educate and teach young interventionalists. One of my plans is to continue this programme, which is very important for CIRSE. The other thing that I think is very important is that we work on a European curriculum that will have standards of teaching, so everybody who practices interventional radiology, whether they are a surgeon or a radiologist, they all have the same teaching background and have the same level of expertise. This is something I want to work on with CIRSE and come to a mutual standard with mutual guidelines and also a mutual curriculum for interventional radiology and that is a very important goal for the near future.
I also have a few small goals, one of which is to turn CIRSE into the first 'green' medical society in Europe. I'm planning to install a programme for CO2 neutral flying, so everyone who comes to the annual meeting can plant trees through CIRSE and achieve a good environmental balance - that is a small plan but it is something I want to incorporate. We will do this by calculating the number of CO2 emissions you have used to travel to CIRSE, then plant a certain amount of trees that will replace the CO2 emissions that have been omitted, and the idea is that you travel CO2 neutral. The trees are planted all over the world and we will offer all our members to be involved in this project. So then you have a good conscience, you do pollute but you do something good for the environment by planting a certain number of trees.
One of the other challenges I have is to integrate vascular surgery and interventional radiology but maintaining the current level of quality. I want to keep the option open for a radiologist to become an endovascular specialist. What I want to do is present an integration of interventional radiology. Interventional radiology is more than only endovascular, we also do a lot of non-vascular treatments, such as GI bleeders, uterine fibroids, trauma - which is all a part of the things we do and the surgeons tend to forget this. They are only interested in endovascular work. But the rest of the patient care that we do is also very important. So, for instance, if a trauma patient comes and has to go for embolisation and if there is nobody around that can do this, it is going to be a huge step back in medicine. And if interventional specialists are only on-call every now and then, this will completely disappear. What I also want is if the surgeons come into the business, which I think is very good, then they also have to pick up some of the work that we do after hours, like trauma, GI bleeders and that sort of thing. They should not only go for elective work which they do during the day, they should also be involved in the other work that we do, in the night time and the evening. They can not just do a stent during the day and have nobody around during the evening for a post-traumatic pelvic haemorrhage. This is a big challenge for me also. When the integration comes, and it will come, this part of interventional radiology won't be lost, but must be a part of interventional training and also for vascular surgeons who want to get into this business. This is a huge challenge to convince them that it is more than putting a stent in or an endograft and that really the profession is a whole lot more than that and they should get involved otherwise this will be lost for the next generation.
The last challenge of course is interventional oncology. This area is growing very rapidly and there are a lot of new techniques, such as catheter techniques, radiofrequency ablation which are really taking off for cancer patients. We have the European Congress of Interventional Oncology (ECIO) meeting in April 2008, held in Florence, Italy, in which we will try to promote catheter skills for oncology treatment.
There are a lot things going on that we want to establish in the following years. I think that the future is going to be a hybrid person who can do both, not just deploy a stent and EVAR but who can manage trauma patients, GI bleeders etc. That has to be part of the whole thing. Integration is the future.
Do you think that it is important to learn about techniques and technologies used in other countries ie. encouraging more sessions such as CIRSE meets India at meetings?
It is very important. Asia and China for example are really fast developing countries concerning interventional radiology. They have huge populations and are now facing such diseases as atherosclerosis, and there are huge opportunities for interventional radiologists. Cardiologists have already recognised this and they have invested heavily in training and training programmes in China and Asia.
What are your current areas of research?
I have a number of research lines going on, one is critical limb ischaemia in relation to diabetics and the diabetic foot. This is a huge problem, as the population gets older we are seeing more cases. There is a lot of good evidence now that shows that radiology can have a good solution here, as good as surgery. Much cheaper and much more less invasive and more friendly to the patient.
I am also working on uterine fibroid embolisation and we also have a good research line on treatment of acute ruptured aneurysms. These are the three lines we have currently running in my department.
Aside from medicine, what are your other interests?
Well when I have some spare time, (I'm quite busy!), I am a passionate collector of contemporary art. I love going to galleries and buying art, especially drawings and photos. I also like to play music, I play the drums. And I like to travel a lot; I am very found of Asia.
Fact File: Jim Reekers
Born 1953, Amsterdam
Selected education and qualifications
1986 Board Certification in Radiology
1986 Staff Radiologist, Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
1999 Professor of Interventional Radiology, University of Amsterdam
Memberships
• Fellow Cardiovascular and Interventional Radiological Society of Europe
• Member European Society of Vascular and Endovascular Surgery
• Fellow Society of Interventional Radiology
• Current chairman Dutch Society of Interventional Radiology (NGIR) :
• Sept 2007, President CIRSE
• Honorary fellow BSIR
Editorial work
• Editorial board Cardiovascular and Interventional Radiology Editorial board since
• Editorial board European Journal of Vascular and Endovascular surgery
• Editorial board Journal of Endovascular Therapy
Awards
1993 European Congress of Radiology: Medal for best presentation
1996- Stauffer Award. Door Society of Academic Radiology for Best clinical paper
• Honorary member Greek society of Interventional Radiology
• Honorary member Korean Society of Interventional Radiology
Research topics
• Treatment of critical ischaemia
• Vascular malformations
• Uterine artery embolisation.
Publicities
• 85 peer reviewed papers on interventional radiology
• Lectures: More than 250 invited lectures.
• Editor several books on interventional radiology
• More than 30 book chapters
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