Reporter’s Notebook: News From SIR 2025
Radiology Today
Vol. 26 No. 5 P. 8
Editor’s Note: This article is based on materials distributed for press conferences at the Society of Interventional Radiology 2025 Annual Scientific Meeting in Nashville.
Improving Care With Process-Based Quality Indicators
A new study seeks to develop process-based quality indicators (QIs) for patients undergoing IR procedures, filling a need for a standardized, evidence-based approach to assessing the quality of care of patients undergoing IR procedures.
“As modern health care systems become increasingly reliant on IR procedures, ensuring appropriate quality of care is of utmost importance,” says Victor Lee, lead author of Developing Process-Based Quality Indicators for Interventional Radiology: A Feasible Standardized Evidence- Based Approach to Assessing the Quality of Care of Patients Undergoing Interventional Radiology Procedures, one of the SIR 2025 Featured Abstracts. Lee believes that assessing the quality of care requires three metrics: structure, process, and outcome.
“Though outcome measures of quality of care have been longstanding elements of surgery and procedural subspecialities, over the past decade, increasing emphasis has been placed on process-based measures as an effective means of assessing quality of care,” he says.
To fill this gap, researchers developed process-based QIs using a modified Delphi technique based on the RAND/UCLA Appropriateness Methodology. They performed a structured review of published literature, including clinical guidelines and semistructured interviews with nationally recognized leaders in IR, to identify candidate process-based QIs and determine the level of evidence supporting the validity of their use.
“A national expert panel comprising 12 members, including interventional radiologists and multidisciplinary members of the health care team, was convened, which rated candidate process-based QIs on their validity and feasibility during two rounds of independent ratings,” Lee says. Process-based QIs were selected by the expert panel’s median ratings of validity and feasibility and the level of agreement among the expert panel as measured by a disagreement index during the final round of independent ratings.
This study employed validated methodology to identify a comprehensive set of 47 process-based QIs for patients undergoing IR procedures. “Ultimately, 47 process-based QIs were developed, encompassing four domains: departmental processes, preprocedural, periprocedural, and postprocedural patient care,” Lee says. These developed processbased QIs facilitate the assessment of quality of care in IR and identify a priori of actionable steps for subsequent quality improvement initiatives.
Lee and his team intend to deploy these developed process-based QIs in a retrospective observational cohort study at their large, university-affiliated institution, where they will assess the quality of care for IR patients by measuring adherence to the quality indicators and evaluating the association between quality of care and postprocedural complications.
“We hope that employing a validated methodology to identify a comprehensive set of process-based quality indicators will advance quality improvement initiatives in IR and encourage collaboration with other investigators to build upon this meaningful work,” Lee says.
Ablation Technique for Prostate Cancer Shows Success
Transperineal focal laser ablation (TPLA) may be a safe, durable, and cost-effective option for patients with organ-confined prostate cancer (PCa), according to a new international study. Prostate cancer is a slow-growing cancer, but it is highly prevalent, says Eric M. Walser, MD, lead author of MRI-Directed Ultrasound-Guided Transperineal Focal Laser Ablation (TPLA) for Prostate Cancer: One-Year Follow-up of 158 Patients, one of the SIR 2025 Featured Abstracts. Walser has been focally treating PCa since 2011—but the treatment is still relatively new, and the long-term follow-up is limited.
Because of this, it can be a struggle to establish patient populations large enough to validate the long-term safety and efficacy. However, three clinics in the United States and Europe chose to combine their expertise and findings.
“It was incredibly important to collect our data together, because while there have been many papers on focal therapy, there has been no consensus yet,” says François Cornud, MD, of the Clinique de l’Alma.
Together, the three sites were able to collect a one-year follow-up for 158 PCa patients who were treated between 2018 and 2023.
“There are a lot of tiny studies out there, but they really don’t have any power to tell us the importance of this treatment,” Walser says. “When you start to get up to the numbers that we’re reporting on, we’re able to make some actual, substantial additions to the literature and research.”
The data focused on patients with clinically significant prostate cancer who were treated with TPLA and received follow-up prostate-specific antigen (PSA) tests, MRI scans at six or 12 months, and biopsies as indicated. Researchers found that at six-month follow-up, PSA levels decreased from 7.5 ng/mL to 3.3 ng/mL. The MRI scans of 134 patients found that 30% still showed positive lesions in the treated area, and of the 82 patients who had biopsies, 51% had in-field recurrence. As a result, researchers determined that the TPLA treatment was successful in about 74% of the patients.
“This paper is different from other studies because you can see huge interinstitutional variability in treating with focal laser ablation,” says Katelijne de Bie, MD, one of the coauthors and a physician in the department of urology at Vrije Universiteit in Amsterdam. “But despite these variabilities, if you look at those three clinics, you see almost no Clavien- Dindo III or higher complications.”
de Bie says this is important because, despite the variations, it establishes a baseline safety level. In addition, the data showed that TPLA does not impact quality of life.
“Urinary symptoms and erectile function did not change after therapy, so it does not implicate any significant effect on sexual or urinary function in our group,” she says. “There was a small number who experienced retrograde ejaculation after the treatment, and some patients with transient urgency. But there are no patients with incontinence, so that is a huge difference compared to radical prostatectomy.”
The quality-of-life differential is important, Walser says, because in his experience, this patient population is often unwilling to acknowledge the side effects of treatment.
“I’ve seen so many men who have gone through radical surgery and radiation and have life changing complications and side effects, but they suffer in silence. It can lead to depression and true quality-of-life issues,” he says. “We found that focal laser has really almost eliminated those side effects.” According to Walser, an increasing number of patients are pursuing TPLA as a safe and durable treatment—but few IRs in the United States are performing this procedure.
For de Bie, it’s important that other physicians understand TPLA is an outpatient clinic procedure that takes less than an hour. “The laser treatment itself takes 10-15 minutes, and the patients can go home within two hours,” she says. “And 90% of them or more don’t need a catheter after a few days.”
Cornud and de Bie add that, at least at their clinics, TPLA can be done using only local, rather than general, anesthesia.
However, Walser notes that most IR departments in the United States may not have the correct ultrasound equipment or experience doing MRI intervention in this space. If IRs want to go into the focal treatment of prostate cancer, they must be well-versed in working with these new technologies, he says. But there is a future in this area, he believes.
“MRI intervention is still in its infancy. It’s growing,” Walser says. “It’s catching on in the neuro space for motion disorders and refractory epilepsy, but in other parts of the body, it’s still young. But I think it will develop in time.”
Researchers are still gathering data and looking into longer term follow-up, as well as ways to standardize their techniques.
Magnetic Nanoparticles Offers Promise in Pancreatic Cancer Model
Applying iron oxide nanoparticles (IONPs) during treatment for pancreatic cancer may increase drug efficacy and create antitumor effects, according to a new study. In Enhanced Local Drug Accumulation via Intra-arterial Administration of Magnetic Nanoparticles and Hyperthermia Induced Antitumor Effects in a Rat Pancreatic Cancer Model, one of the SIR 2025 Featured Abstracts, researchers utilized a rat pancreatic cancer model to determine whether selective intraarterial (IA) administration of cobalt-doped IONPs would enhance drug accumulation, compared with systemic IV administration.
“Pancreatic cancer has a poor prognosis and a high mortality rate, despite recent advancements in molecular targeting agents,” says Kentaro Yamada, MD, PhD, lead author of the study. “The dense interstitial tissue of the pancreas, consisting of fibroblasts and extracellular matrix, can prevent anticancer drugs from permeating the tissue, hindering effective pharmacotherapies.”
Working under Khashayar Farsad, MD, PhD, FSIR, and in collaboration with bioengineers, Yamada and his team hypothesized that IONP-induced hyperthermia could loosen this interstitial tissue, facilitating drug delivery and inducing apoptosis.
“In combination with an externally applied alternating magnetic field, the nanoparticles can induce hyperthermia to facilitate apoptosis,” Yamada says. “We investigated utilizing IONPs for locoregional therapy for deep-seated cancers, such as pancreatic or liver cancer, to maximize treatment effects while minimizing systemic side effects.”
First, researchers needed to establish a rat pancreatic cancer model for IR research, as none currently existed for transarterial therapy. They then worked to determine whether selective IA delivery of IONPs was possible without shunting or washout. Finally, they sought to discover whether IONP-induced hyperthermia could provoke an anticancer effect compared with controlled treatment.
Researchers found that organ-totumor near-infrared signal rations in the brain, lungs, heart, liver, and kidneys were much lower in the IA group compared with the IV group. In addition, rats that had induced hyperthermia via alternating magnetic fields showed tumor shrinkage at rates comparable to tumor growth in the control group.
“Our findings suggest that nanoparticle-based therapies can be effectively integrated with IR treatments, offering significant potential for future research,” Yamada says. “Additionally, our research demonstrates that hyperthermia-induced antitumor effects are effective, even for deep-seated cancers.”
The next step, Yamada says, is to investigate tissue permeability changes in pancreatic cancer tissue, as well as tumor immune environment changes, after hyperthermia therapy.