Why IR innovation need not cost the world: A global solution

The keynote lecture on day one of the Pan Arab Interventional Radiology Society annual meeting (PAIRS; 11–14 February, Dubai, UAE) advocated a simultaneously global and local approach when it comes to conducting research in interventional radiology (IR), and when innovating. Jafar Golzarian (University of Minnesota, Minneapolis, USA) talked delegates through the rationale for basing ideas for research and new medical devices or products on what is already familiar— or ‘local’—while bearing in mind that international collaboration with societies and individuals from other geographical regions can lead to more cost-effective innovations.

CITING THE USA AS AN EXAMPLE OF A country that invests a relatively large proportion of

According to the speaker, “it takes somewhere between US$5 and 10 million to get a US Food and Drug Administration [FDA] 510(k) class II approval” for a new medical device, hence the need, he believes, for a new way of innovating and researching in healthcare, and more specifically the IR field.

Golzarian conveyed his optimism despite this high financial burden on innovators—“innovation does not have to come with a cost”. Illustrating this, he cited the Fairembo concept—the use of suture fragments as an embolic—which is “feasible, safe” and “inexpensive”. With this in mind, Golzarian dogs having seizures,” the presenter went on to say, which “opened the door” to using Y90 for GBM. Compared to humans, dogs’ cerebral anatomy does not allow for “selective injections” when delivering the Y90, yet, Salem shared, “the dogs were able to tolerate these hemispheric treatments”. urged budding innovators among the delegates to ask themselves “how can [their idea] help other people across the globe while being affordable?” Posing questions, he continued, is “important for the younger generation”, as is getting “frustrated” and “out of your comfort zone”, as this can often lead to finding a solution to the clinical problem that has elicited the questions and frustration in the first place. The solution, Golzarian supplemented, as exemplified by Fairembo, is to “always consider cost” and “material availability locally”. This being said, it is key not to sacrifice quality, were the presenter’s final words on innovation, before transitioning to speak on the similar issue faced by those wishing to pursue research—the high cost of doing so.

Regarding the FRONTIER trial, Salem confirmed that “in humans, of course, we want to get much more selective, and this is something we will be able to share once data start coming out”. In the Hopkins study, “all canines demonstrated initial reduction in tumour volume” and therefore, it is proof of concept, the speaker summed up.

“The FRONTIER trial is open and recruiting,” Salem told the audience, conceding that he was unable to divulge much more about the trial’s progress. Summarising the use of Y90 for GBM, the presenter relayed that “imaging is much more critical than in hepatic space and there is a level of cerebral vascular complexity that does not exist in the liver”. There are challenges to applying this product in the brain, such as the need to “re-engineer the microspheres” so as to use fewer than in the liver, however, “there is a lot of excitement [including] at the prospect of treating meningiomas [in the future]”.

“Usually what people think,” the presenter averred, is that research is not worth their while—because of a “lack of ideas”, but also sometimes because they consider it to be too time-consuming and expensive. However, Golzarian assured, “research is not as complex as we think […] we need to demystify [it].” Conceding that multicentre, randomised trials are valuable, the speaker opined that, in IR, what is “probably most significant is real-world research”, but that knowing the outcomes of one’s procedure is vital. “Reflecting on complications is a very good start,” Golzarian shared.

Addressing the younger interventional radiologists in attendance once again, the speaker advocated for beginning a research endeavour with the procedures “you perform the most”, as well as doing a “thorough literature search”. Then, “you can start to fill the gap” if there seems to be one in the existing evidence. Golzarian then returned to a previous point—that “cost should always be a consideration”. This may prompt research into cheaper materials that could substitute those used currently, and, even better, those which could be “useful globally”.

A personal anecdote led Golzarian to emphasise how crucial cost and collaboration considerations are when it comes to research—over the last 10 years, he has sought to conduct a trial with 110 patients