“The spine is an area where interventional radiologists play a crucial role in both diagnosis and therapeutic management of a variety of pathologies”.
Dimitrios Filippiadis is associate professor of diagnostic and interventional radiology (IR) at the National and Kapodistrian University of Athens (Athens, Greece) whose practice centres around musculoskeletal (MSK) interventions and diagnostics, and interventional oncology (IO) and cancer pain management. Beyond this, he is passionate about IR education, which has seen him, this year, take up the position of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Online Education Committee chair. From his research on discomanometry, to personal experience at the forefront of adopting ablation procedures within Greece, Filippiadis speaks to Interventional News about the “intrinsic rewards” and “lifelong memories” that being an interventional radiologist has given him in his decorated career thus far.
What attracted you to a career in IR?
When I started my residency in diagnostic radiology, I had a lot of second thoughts about sitting in front of a computer monitor dictating reports. Then, a fellow resident came to me and suggested I register for a postgraduate course in IR, which was organised by Professor Dimitrios Kelekis in Greece. From the introductory courses onwards, I knew that this was the clinical career path I wanted to follow. Some years later, a visit to Strasbourg on a CIRSE grant made me realise that interventional oncology (IO) and pain management would be my specialist practice.
Who are, or were, your mentors?
I was fortunate enough to have had wonderful mentors early on in, and throughout, my career. During my residency, Alexis Kelekis introduced me to spinal and MSK procedures and influenced me greatly. Elias Brountzos taught me that providing patient care is one aspect of our work, with the other being to bolster the IR community by volunteering our time and expertise to help our specialty to flourish further. Nikolaos Kelekis gave me the opportunity to work almost exclusively in the field of ablation and I will always be grateful to him for this chance. Last but not least, even though I have never worked with him, Loukas Thanos, a Greek pioneer in the field of ablation, has had a great influence on my career.
Could you describe a particularly memorable case of yours?
I will never forget the first time I treated a paediatric cancer patient. He was 16 years old with a history of right paraganglioma and right nephrectomy due to renal cell carcinoma (RCC) and presented with an endophytic RCC lesion in the lower pole of his left kidney. The stress obtaining the parents’ consent and preparing for the ablation was unbearable, at least for me. The night before the ablation, I was not able to sleep, imagining only the worst-case scenario. However, after the procedure, when I informed the parents that everything had run smoothly, that we had totally ablated the tumour without any adverse events, they started crying. It is a moment I will never forget.
What led you to pursue your PhD in quantitative discomanometry? How is it complementary/relevant to your role as an interventional radiologist?
The spine is an area where interventional radiologists play a crucial role in both diagnosis and therapeutic management of a variety of pathologies. Specifically for intervertebral disc herniation, what I have always found fascinating is the fact that the success rate of percutaneous decompression techniques is around 80% no matter which technique you use. Discomanometry could serve as a diagnostic tool to escalate patients, leading to an improved patient-specific, or even better, hernia-specific, approach.
Your paper on pain management in cancer patients, recently published in Current Oncology Reports, is one of many you have authored on the subject—what innovations do you see on the horizon in this area?
Management of cancer pain is one of the most interesting topics in my everyday clinical practice. We have published numerous papers on the topic, but myself and the rest of the co-authors are actually particularly proud of this publication, which has been included in the National Comprehensive Cancer Network 2021 guidelines for adult cancer pain. As far as innovations in the field of pain management are concerned, I am convinced that cryoneurolysis is the ideal technique for pain palliation, as it offers more confined and more organised nerve regeneration alongside pain reduction. Although, at present, there is no standardised ablation protocol, given the wide range of variables that affect intraprocedural temperature at the ablation site, a more palatable solution will be a new device with information-gathering capabilities, to form and perform individual cryoneurolysis protocols.
You were appointed to the position of associate professor of diagnostic and interventional radiology at the National University of Athens Medical School—what has changed the most about your practice since your early senior consultant days over a decade ago?
Being an educator offers intrinsic rewards and brings with it lifelong memories. Providing real-life clinical experiences and context to medical students is an essential part of today’s medical education—whereas I had only very minimal obligations towards medical students and teaching when I started as a senior consultant. Integrating the role of medical students into the healthcare system provides added value, both to clinical care and medical education. You need to change your workflow in order to allow students to contribute before, during, and after visits, and to engage them holistically in patient care. Last but not least, you need to strike a balance between apprenticeship and an academic model, and choose which approach works best for whom.
You were at the forefront, at your centre, when it came to integrating microwave and navigation-guided ablation into IR services, yours being the first in Greece to adopt both procedures—why do you think it is important to lead the charge in adopting new techniques and procedures?
New techniques and procedures go hand in hand with IR, which is a discipline born of innovation; adopting new technologies is essential for the growth and flourishing of our specialty. Early adoption results in improved efficacy, ability to offer what no one is offering at the moment, and empowering practice with new and improved systems that make for better services. From our first experience with microwaves in 2008 to today, it has been evident for us that this technology offers unique advantages and has a role in today’s ablation practice. Ideally, when it comes to locoregional therapies, we want to have all the ablation techniques available in our armoury and to be able to take a lesion-tailored approach. Application of navigation tools as well as simulation and verification software significantly contribute to standardisation of ablation; I strongly believe that in the near future, these tools and software will be part of all interventional radiologists’ everyday practice. The tools will prove their value by allowing for better comparison of percutaneous ablation to surgical and radiation oncology.
In (also) becoming the first Greek hospital to enrol in the International Accreditation System for Interventional Oncology Services (IASIOS), what has the impact on your practice and patients been?
Even though the second department of radiology is in the process of acquiring the IASIOS accreditation, the benefits for patients and in terms of practice performance are more than evident. The whole process of patient care and treatment is improved. During the IASIOS accreditation process, we have analysed our service, improved its coordination and monitoring, and the end result is improved delivery of high-quality IO care, with the patient receiving the best possible treatment for an optimal, individual clinical outcome. This improvement has been throughout the department, affecting not only IO but all IR services.
You recently became the CIRSE Online Education Committee chairperson—what do you hope to do in this role that has not been done before?
Education extends beyond practical knowledge. Educated physicians develop thinking and skills, which help them make good decisions for the benefit of the patients. The Online Education Committee deals with the CIRSE Library, Academy and Webinars as well as with everything included in these three main pillars of virtual and online education provided by our scientific society. To leave your own footprint on this position I must admit is a very difficult task, since my predecessor Stefan Müller-Hülsbeck has done a superb job in organising almost everything from scratch. I am positive though, that along with my deputy chairperson Julien Garnon and all the members of the Committee, we will rise to the challenge and structure education in order to foster a love of learning among our IR community.
What are your hobbies and interests outside of medicine?
Before and during my medical studies, I worked as a DJ. What I have left from these days and nights are thousands of vinyl records and CDs of all kinds of music, which I love listening to in my free time. Apart from listening to music, I love reading books, especially historical novels (Bernard Cornwell, Wilbur Smith and Ken Follett are my favourite authors). My other main hobbies are playing basketball and swimming, especially on my beloved island of Lefkada where we have a beach house.