Afshin Gangi

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Professor Afshin Gangi is a well-respected interventional radiologist from the University Hospital of Strasbourg, France. He recently spoke to Interventional News about his career and passion for medicine, and his love of fast cars.

 

Did you always want a career in medicine?
Yes, even as a child I knew I wanted to be a doctor. I think it was because of my uncle – he was a physician. When I was about five or six I decided that I wanted to follow in his footsteps. So basically ever since I can remember, I wanted a career in medicine.

When did you decide to specialise and become an interventional radiologist?
When you become a physician in France you have to choose a speciality. In the beginning, I did not want to be a radiologist because there was no patient contact and I’ve always wanted to be able to physically examine and treat patients. I did one semester in internal medicine and then I did pneumology. A friend of mine told me to do radiology as it was really interesting and exciting and so I thought I would give it a try. After six months in radiology I thought I had found my calling. At that time, radiology was the new kid on the block, on the verge of the technology revolution with many new techniques and computers – a man’s dream. But there was a problem – no patient contact. It’s like looking at the fish in an aquarium; I don’t just want to look at the fish I want to touch them as well!
So I spoke to my boss, Professor Jean-Louis Dietemann, and explained to him that I found radiology very exciting but missed the doctor-patient relationship. He advised me – “why not try interventional radiology?”
After three of four terms in diagnostic radiology, he sent me to Luxemburg to Dr R F Dondelinger – the big man of IR. I worked there for a year and then returned to Strasbourg. I soon discovered that everyone was doing vascular interventional radiology, but no one was doing non-vascular intervention. After consultation with Professor Dietemann, I started with non-vascular interventions and from that point on became interested in bone and spine IR.

Who have been the greatest influences in your career?
I think one of the greatest influences would have to be my boss at Strasbourg, Professor Jean-Louis Dietemann. He was the first person who pushed me to do interventional radiology and supported me when I started my career.
Andy Adam has also been a great influence. I have worked a lot with him and he has the one of the sharpest minds I know in interventional radiology. He is a very good clinical radiologist and has excellent decision-making skills. And finally, Peter Muller, from Boston.

You have obviously had many great moments in your career, what have been the proudest moments?
I would think receiving my PhD in Laser Physics. It did involve a lot of sacrifice from my family. I also cherish receiving my first award at RSNA.
What brings me the greatest joy today, is when a patient comes to me the day after treatment and tells me that the pain they have been suffering from has disappeared and that life is normal again. There is nothing compared to that.

You have taught many workshops and seminars, do you think that young surgeons and medical students should gain experience in interventional procedures and techniques as well as surgery?
I think the future will involve mixing radiology and surgery. I don’t think there will be any choice. Today I am working with surgeons who accept us as part of their team with a two-way flow of ideas so that patients receive the best possible care that modern medicine can provide.
I did surgery while I was a medical student and this training has stood me in good stead as an interventional radiologist. Today’s interventional radiology training should include some semesters in surgery, some in interventional radiology, with a very strong base in diagnostic radiology. If you cannot diagnose, you cannot treat and come up with appropriate interventional ideas and solutions.
In Strasbourg, we perform both diagnostic and interventional radiology so when we report scans we also offer any further radiological management if possible. However, now 90% of our activity is interventional.
Kyphoplasty has been described as a ‘first cousin’ to vertebroplasty. Would you say that kyphoplasty is an essential successor to vertebroplasty or is it a more expensive and time-consuming procedure that doesn’t have any significant advantages over vertebroplasty?
This is a very delicate subject because there is a lot of power and money involved. The truth is vertebroplasty is an established technique which is easy to perform under local anaesthesia after appropriate training.

Kyphoplasty on the other hand is a more complex and expensive procedure, but has some specific indications. In Strasbourg, we use kyphoplasty especially for stable, traumatic fractures in young patients within the first week of the traumatic injury. For tumour cases I would never use kyphoplasty.
One of the objectives of kyphoplasty is the reduction of complications, mainly cement leakage. Experts trained in vertebroplasty know that the number of cement leakages is low and 95% of leakages are asymptomatic with no clinical consequences. You cannot replace vertebroplasty with kyphoplasty. It does not make economic sense to replace the relatively inexpensive vertebroplasty by kyphoplasty which costs 2000 Euros per level.

What are your current areas of research?
There are many research areas which I am excited about.
I am really interested in pain management. I am looking at tumour decompression, not ablation. Tumour decompression helps reduce pressure in the tumour, which is especially important in the spine where you can have cord compression.
We are also working with robotics. We have engineers from the Physics School of Strasbourg working with us. We are working on utilising robotic technology in the performance of image-guided interventions. This is a big subject as the technology has to be extremely precise. This is the future; I don’t think it will be available tomorrow but perhaps in a few years.
We have obtained with Professor Michel de Mathelin, a professor of robotics, a dedicated interventional MR system which will be available in our department at the end of this year.
We are also working on new cements for vertebroplasty. Another very exciting clinical research concern cryoabaltion. For 15 months we have been working on tumour ablation with cryoablation. The technique is very promising in many organs particularly bone and soft tissue and renal tumours.
Soon on the market there will be focused ultrasound machines which we hope to use for bone tumours and in pain management.
So there are plenty of interests!

What do you think are the current challenges facing interventional radiology, with particular reference to the spine?
Spine and bone intervention is becoming minimally invasive and being performed under image guidance. We are the creative guys innovating the new techniques. We should be more involved with patient care. Today the greatest risk to interventional radiology is the absence of clinical accountability. I think that not only should we be doing the procedure but also be involved in the clinics, the after care and follow-up of patients.
Furthermore, I think we should have our own ward like everyone else, with our own beds. In Strasbourg the university hospital is building us a new interventional department with three interventional theatres including all modalities CT, MR, US and fluoroscopy.

Do you prefer to teach interactively?
I like human contact and to me the most rewarding aspect of a university job is teaching. When you are teaching in a workshop, you are communicating directly with the individual. You can see their enthusiasm and know they are learning and understanding the procedure you are demonstrating. The hands-on experience gives the individual a sense of accomplishment. At the end of the workshop you can see the excitement in their eyes and this is very satisfying and rewarding. Workshop teaching is a lot more time consuming, but the outcomes are more productive.
I think that, when you are teaching you should not be too serious. It’s good to minimise stress by having fun and sharing jokes and being more relaxed. Learning is laughing and having fun.

Where do you think the future of spinal treatment lies?
The future is multi-modality imaging guided treatment. In our interventional suite we utilise CT, ultrasound, fluoroscopy and 3D imaging, and at the end of this year, we will have interventional MRI and robotics.

Outside of medicine, what other interests do you have?
I like anything that moves fast. My big, big problem is fast cars! But I am getting over that now as the love of fast cars has been replaced by my Persian greyhound. So recently I have changed my sports car to something that the dog can fit in.
I love reading. My favourite hobby is to read and collect antique books on Persian, Greek and Roman history. I also appreciate impressionist art such as Monet, and when I’m travelling I always make it a point to visit the museums.

Fact File

Born  
7 December 1962, Teheran, Iran

Present position  
Professor of Radiology, University Hospital of Strasbourg, France

University and hospital titles
1987         Residency at the Medical school of the University Hospital of Strasbourg (France)
1990–91    Residency in Interventional Radiology (Prof R.F. Dondelinger), Luxembourg
1991         Medical degree of the Medical school of Strasbourg (France)
1991         Board of diagnostic radiology
1991–97    Fellowship in radiology at the University Hospital of Strasbourg (France)
1994         Master of science in medical biology, option medical imaging at the University Claude-Bernard of Lyon (France)
1997         PhD in laser physics – CNRS Strasbourg (France)
1997         Associate professor in diagnostic and interventional radiology at the University Hospital of Strasbourg (France)
2000         Full professor of radiology
2003         Associate Professor – King’s College of London

Society membership (selected)

  • RSNA (Radiological Society of North America)
  • CIRSE (Cardiovascular and Interventional Radiological Society of Europe)
  • Goupe de Travail Pluridisciplinaire sur le Rachis (Rachis 50)
  • Subcommittee Member ECR 2004

Editorial boards (selected)

  • Assistant Editorial Board of Investigative Radiology
  • Member of the Editorial Board of Radiologie Journal du CEPUR
  • Member of the Editorial Board of the Journal de Radiologie (Société Française de Radiologie)

Awards (selected)
1993         Certificate of Merit RSNA 93 Scientific exhibit
1999         Prize of CEPUR (Collège d’Enseignement post-Universitaire de Radiologie)
1999         Magna Cum Laude RSNA
1999         CUM Laude RSNA
2000         CUM Laude RSNA
2002         Certificate of Merit, European Congress of Radiology, Vienna
2002         Magna Cum Laude, European Congress of Radiology, Vienna
2003         Medal of the Royal College of Radiologists, London