The Importance of the Society of Interventional Oncology Annual Meeting

In this episode of the SIO Corner podcast, Muneeb Ahmed, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Michael Soulen, MD, University of Pennsylvania, Philadelphia, join AJ Gunn, MD, University of Alabama at Birmingham, to talk about the origin of the Society of Interventional Oncology, where it fits in along the other radiology societies, and how the SIO Annual Meeting differs from the meetings of other societies.

Transcript:

AJ Gunn, MD: Thanks everybody so much for listening to this podcast. I'm really excited today to talk to you a couple of true leaders in interventional oncology. My name is AJ Gunn. I'm an interventional radiologist at the University of Alabama at Birmingham. And I'm with Muneeb Ahmed from Beth Israel Deaconess Medical Center in Boston and Michael Soulen from the University of Pennsylvania in Philadelphia. Welcome gentlemen, thanks very much for being here.

Michael Soulen, MD: Thanks for having us.

Muneeb Ahmed, MD: Yeah, exactly. Thanks for having us.

Dr Gunn: If you wouldn't mind starting with a short introduction, including your current role within the Society [of Interventional Oncology] and what other roles that you've had inside the society over the past few years.

Dr Ahmed: Yeah, absolutely. Happy to go first. I'm the current president of the Society of Interventional Oncology (SIO). I'm actually completing my term at the upcoming 2025 meeting, so I've been doing that for a couple of years. I've been involved in the society for at least 10 or 12 years. I started out being involved in some of the research committee activities, joined the Annual Meeting Program Committee when it was the WCIO [World Congress on Interventional Oncology], or the predecessor of the SIO, as actually a local meeting representative —it was being held in Boston that year— and then stayed on the Meeting Committee, progressed through roles in developing workshops, scientific content, and then actually was the Program Committee Annual Meeting Chair in 2019. And then subsequently continued to be involved in a number of the research activities, joined the board, became the treasurer and then took on leadership, becoming the president, elected now the president. It's been quite a long road, but extremely exciting and productive.

Dr Gunn: Awesome. Michael, how about you?

Dr Soulen: I guess I'm the last remaining person involved in the leadership of the SIO who was there at the beginning. I was involved from the initial founding of WCIO and the meetings that were in 2005 in London, which was our predecessor, and then 2006 in Lake Como, which was the first thing we called WCIO. I was on the steering committee of WCIO when it was just a meeting for some years, and then sort of moved into more of a leadership role around 2010 or so, when we did the transition to WCIO being kind of a non-member–based society. It was not the SIO yet, but it had a website and functions other than an annual meeting.

I ran the annual meeting the year was in Philadelphia and then eventually we started to pull the trigger and make it a membership-based society and became the SIO and I had, like Muneeb described, progressed through the officer track somewhere around then and then I've stayed on as just a research advisor to the board and which is a term that we'll wind down in the next year or two.

Dr Gunn: It's really interesting listening to you guys describe your roles. Was there an intentionality of, “this is the next step for me inside the society,” or was it just opportunities that were presented to you, or once you did it you were like, “I have an aptitude for it”? Especially when you were a local meeting representative, and then just kind of found that maybe you did a good job and they asked you to do more? How did that unfold?

Dr Ahmed: Definitely a combination. In general, I think our community should be active in participating societies, and there's many different needs or roles. In parallel to this, I served in some SIR committees as well. You kind of find things that are interesting. I think the program committee was a really nice spot for me. I hadn't led or been involved in educational meetings that way before. I got to learn from a lot of people who'd been doing it and I just sort of grew into that.

A lot of success in volunteerism is around just showing up to be present, to be involved, taking on tasks. I think that's maybe been the hallmark of my own SIO journey. Opportunities presented themselves, often because I was doing something else and showing up and volunteering and being successful. I would continue to encourage people to become involved in societies, but I think particularly for early career individuals, sometimes it doesn't have to totally align to what you have done in the past. It's just those things that come up where there's need and they are often great learning experiences.

Dr Gunn: I got some advice really early on from a former president of the SIR who said, “If you just show up to the committee and do the assignments, you'll be in the top 10% of all committee members.” And at first I was like, “No way.” No way, right? And then now I know, yes, definitely, just showing up and even just doing the minimum work. If you do anything more than that, the opportunities will find you.

Dr Soulen: That's for sure. I mean, all potential societies run on their volunteers. And for every committee of 10, there's 8 people who just sit in the room and 2 people who do the work. But societies are very quick to recognize those 2 people, and they just sink your claws into you and they never let go.

Dr Gunn: Or just allow you to grow, if we put in a positive spin on it? How about that?

Dr Soulen: Right, but I mean, it's to your point, that if you show up and do the work, you're in the minority and that gets recognition. With recognition comes opportunity to do the next thing, and the next thing, and the next thing, should you choose to do that.

In my case, I already been through the leadership of the SIR. Between SIR itself and the Foundation board, I was doing board-level service for like 13 years. I had that experience under my belt as a much younger faculty member. And then SIO came along and was really run primarily by Michael Brunner in the early years, after he finished being president of SIR, and when it came time for him to pass the baton, right around the time we were forming really a professional organization and not just a meeting, it was one of those things where you just looked around the room and everyone except me looked away and then all of a sudden…

It is somewhat opportunistic, and some of it's being in the right place at the right time but you do have to you know, show your merit along the way. And if you, but if you do that, there'll be lots of opportunities for you.

Dr Gunn: I agree with that for sure. Michael, you mentioned you've been around since the WCIO and the building of the SIO. At the time, what did you feel like the need was, for a separate society? And could you explain some of the differences between the SIR and the SIO, for people who might not know the advantages of being an SIO-specific member?

Dr Soulen: In the beginning, the WCIO came into being because of the surging interest in applications of interventional radiology in the oncology space, at a time when SIR and CIRSE, which are outstanding organizations that represent all practitioners, they had to cover all the bases. There’s a lot of breadth, but not as much depth. There was such a demand and interest in international oncology, that a group of people from around the world just said, "We need to have our own meeting,” Industry was on board, so industry was supporting that. And it's kind of amazing, you throw a meeting on a lake in Northern Italy, and a thousand people showed up.

That gives you a sense of the magnitude of interest, because there was nothing else. None of the other IO meetings existed back then. For the first few years, the WCIO was incredibly successful as a standalone meeting because you could hold that meeting anywhere and get a thousand people to show up.

But of course the momentum in the field was such that, the WCIO, the original idea was it would be a world meeting. The steering committee was pan-Europe, US, Asia. The first 2 meetings were really in Europe. And the idea was that would rotate around the world. Well, very quickly, the rest of the world realized that they couldn't be without a meeting for 2 years while the WCIO wander off to North America or Asia, or whatever. Of course, CIRSE then started ECIO and the Asia Pacific Societies started the Asia Pacific CIO. You had sort of more academic research-based meetings being developed by professional associations really around the globe. That sort of limited the scope of WCIO because you didn't need 2 meetings in the same place.

And then of course, even with the continued growth of interest, then you spun off the more CME-based meetings like Synergy, CIO, etc. Every little town had its own interventional oncology meeting just to meet the educational needs in the field because there was such growth. So that's what drove the concept of having meetings in this space.

Then the question became, what does WCIO do in the long run? Because ECIO is part of CIRSE and the Asia-Pacific meeting was run by the mother Asia-Pacific organization. And WCIO was an orphan. It wasn't part of a society. That’s a risk. Because if you have a meeting that loses money, who's going to pay for it? It really was one of those evolve or die things.

First, we evolved into a non-member–based virtual society with the website and offering a broader range of services and educational offerings than just the meeting. We also hired professional association management at that time. Before we just had a meeting manager, because we were just a meeting. We made the switch to a major professional society membership organization, that runs lots and lots of societies, and with their backing, we were able to grow and have more of a backbone of resources. And then there was a lot of debate about if and when to become a professional membership society. Eventually it came to pass that the consensus was we should do that.

The question of how do you distinguish, especially organizations like SIO, from SIR, I think it's like everything else in interventional radiology: SIR is our professional organization that represents our profession. For all 8,000 IRs in the country, they do coding reimbursement, regulatory stuff, economics. All the things that are important to anyone practicing interventional radiology, most of the vast majority of whom were in private practice. Then you have subspecialty meetings. SIO is not a standalone. There are dialysis organizations, arterial organizations, venous disease organizations. Now you have a bunch of subsocieties and submeetings that are really disease state-focused. And they're not professional service organizations, they're research and educational organizations.

SIO does a deep dive in applications of interventional radiology in cancer, just like the other societies do it for vascular diseases or whatever else. That's really the big difference between the two. You go to SIR because they take care of your profession. And you come to SIO because you want to do a deep dive into interventional oncology research and education.

Dr Gunn: That's a great explanation. I hadn’t really thought about SIR being the overarching societal organization for interventional radiology, in that sense. I always think about RSNA [Radiological Society of North America] and ACR [American College of Radiology], and then SIR being a subset of that. But really, for interventional radiology, so much is different now from diagnostic radiology. I think that makes a lot of sense.

Dr Soulen: I think Muneeb can probably address that we're very thoughtful about what we do and what we don't do, in terms of— We view certain areas as SIR’s territory. We’re not going to duplicate that, they already do it. Maybe Muneeb can comment on that.

Dr Ahmed: Yeah, absolutely. I think Michael's explanation was really quite good. Just to build on that, there are opportunities from a subspecialty organization like the SIO, there are things that can be done with a smaller organization or focused on a disease topic type area, that can't be done from the large organization. And there's some real advantages to that. To the original question, I think people should be members of both. I'm a member of the SIR, I do IO. There's clear advantages and I'll talk about some of those to being a member of the SIO as well.

The SIO, I think one of the reasons it really grew into a society beyond just a standalone meeting is that there has been a growing and continued need for an organization to take on several things beyond just having kind of a meeting place for people to come to. One of those has been research, as Michael alluded to. You need to really help define the research trajectory that's required by the community. You have to help develop areas to fund it, to teach research that's specific to interventional oncology in a way that meets the bar that is set by other specialties.

As IO has grown over the last 20 or 30 years one of the key elements that we've understood is that we have to be doing high caliber research that meets both the gaps in data, but also the standards that other societies are doing that research. To be able to make things available to patients and in clinical practice. There’s a lot of advantages for a subspecialty society to be able to do that and really kind of focus on the gaps in what kind of basic or clinical research studies need to be done, and then help trying to really develop methods to fund them and to teach people how to do that kind of research.

And the SIR does that, or other larger organizations do that, but their efforts are more broad. They're focused on multiple disease states. In any given year, people who apply for funding are competing against a very wide spectrum of individuals and many of those other non-cancer areas are also hot areas and need research. It just doesn't allow people necessarily the space to be able to really focus on oncology. I think that's what one of the SIO’s missions is.

The other element is around education. Again, you go to a larger meeting and there's like 10 parallel sessions, they're all great, they cover a host of topics, which just doesn't allow people to really focus in a way where they're really gaining some information in oncology or interventional oncology specifically. One of the things the SIO has done nicely is really building educational programs that understand the needs of the learner and teach to that versus just sort of teaching at people. With masterclass courses, hands-on courses, and other things. That’s what you can do in a smaller space, you can be a little more creative in how meetings are run or what types of things you teach. That's another really important function of the society.

And the last is that it does build a community of people who are doing interventional oncology. Not everybody is. In interventional radiology, we know across the spectrum of even within the US, that there's a lot of different types of interventional radiologists. Not all of them are doing cancer care. Many of them are doing peripheral arterial disease or venous disease. And so sometimes there's a need to show up to a place where other people are really doing and focusing on some of the stuff you're doing. We really try to build a big tent for the interventional oncology community, even if you're doing only 20% or if you're doing a lot more than that, you have a place to come to.

And one of the other secondary aspects is that we are an international organization. SIR or CIRSE, there are other specific, maybe large organizations that are focused on specific regions as their primary function. Following the history of the WCIO, we have tried to really make the SIO available to practitioners from around the globe, not only interventional radiologists. In reality, the WCIO and interventional oncology had origins with surgeons and other people and those technologies are going to continue to evolve and develop and sometimes those people need a home too and the SIO should be able to be inclusive of them.

Dr Gunn: I was in a shuttle with somebody at some other meeting and they asked me what I like about SIO, and I said, it's like going to SIR, but only having stuff that I really care about being the topics. Every session was something that I felt like I cared about. I think the organizers do a really great job of, instead of it being device- and procedure-specific, it's disease state-specific. When we have a session about endocrine tumors, it's on the latest data on bland or Y90 embolization, but we also have a medical oncologist, we also have a surgeon. When we are talking about HCC [hepatocellular carcinoma] or renal cell carcinoma, whatever else it is, we invite radiation oncologists and medical oncologists. I think that discussion around the disease state is so much more representative of what I experienced during tumor boards that I really like that approach, as a disease state rather than just saying, “Hey, it should be Y90 or ablation all the time, and if anybody does anything else, then you're crazy.” No, this is a multidisciplinary team of how we treat these patients in that disease state.

Dr Ahmed: Yeah, and I think that's a great. That is actually just a very SIO-specific trait that's really been present within the WCIO and SIO, all of these years. We see that now in other meetings, but it's really a core philosophy around how we teach and, compared to meetings you go to where it's just going to be technical talks on how to do or treat a certain thing with what sort of catheter or what technique. And, yeah, those are interesting and valuable for us, we need to know that, but I think this core focus on how to function in the disease space remains a differentiator. We do it really well and, to your point, that's actually what people need to know. They need to know how to do an ablation, but they also need to know how to pick that patient, how to care for them, how to offer them the best treatment options, whether that's an interventional option or not. And we continue to have to really embrace that.

Dr Gunn: Yeah. Speaking to the annual meeting, Michael, you've got the very well-deserved honor of delivering the Wallace Lecture. You don’t need to tell us exactly what you're going to say, but can you talk a little bit about what that is, and maybe give us a bit of a preview?

Dr Soulen: Sure. The Wallace lecture was founded 4 or 5 years ago. It was our version of the Dotter lecture [at SIR], if you will. It’s named in honor of Sidney and Michael J. Wallace, who were consecutive chairs of interventional radiology at MD Anderson Cancer Center, and both luminaries in our field, especially Sidney, for many decades. The lectureship is named after the two of them, who unfortunately are both deceased. I knew them both personally and, in fact, Sid Wallace did his residency with my mother, at Jefferson in Philadelphia. So, in addition to our typical tributes to the Wallaces with which we lead off the session, I hope to be able to add some spicy anecdotes from my mom about what Sid was like as a resident, because he was quite the character.  

I will definitely acknowledge the Wallaces, I will probably spend a minute or two paying homage to last year's speaker, Thierry de Baere, who is one of my personal gurus in our field. When we get into the actual meat of the lecture, that's still very much in the formative stage, but I’ll probably touch on a little bit of origin history since I was there, and I'm probably the last person ever to give this lecture who was there. Some people like a little bit of that, but not too much. And then kind of how we got to where we are now. And I think probably the emphasis will more be on where I think we should go from like the 10,000 foot view.

Muneeb alluded to the big challenges that the SIO tries to address, which is, how do we build a core of people who can sit at the table with medical oncologists, speak their language, have their quality data, and get into the guidelines and take care of care patients? There are some things that are aspirational, that I'm hoping that we will get to eventually, like we need to build a core of clinical researchers that do clinical trials in cancer the same way all the other specialties do. We have a few people who do that, but not many, and we need to build the base. And there's a big demand for that now, especially as more and more systemic therapies are moving into the interventional space. The drug companies are used to running these big trials and they need a lot of centers and they need centers with interventional oncologists who know how to be trialists. Also, we would like to see the science being stimulated by our people, and not just what industry chooses to hand us.

People need to learn how to do trials as you have, AJ. RSNA has an excellent training course in teaching people clinical trials methodology, which you have taken. But the problem is, it’s a course that's for interventional radiologists and diagnostic radiologists and radiation oncologists and all people. We really need training that's specific to IR. I think that's aspirational for us as well, in terms of building that core.

And then I think one of the things that in my opinion, and maybe this is a little bit old-fashioned, but you're not really on the map as a society until you have your own journal, whatever that would look like in this day and age. But the SIO has done the background research using various expert consultants to determine that in fact there is an unmet need, there's space for yet another journal focusing on interventional oncology. And there is an economic model, it would probably be completely online, and there are different ways of doing it, but there is an acceptable economic model to actually have a new journal. I feel good about that. Then the real challenge is finding an editor and a solid editorial board and writers who are going to populate that journal. We have a model, but we need the people. We need the skill and the will to actually make that happen. I don't know when that's gonna happen, but I still think it has to happen.

Dr Gunn: Sounds like you're volunteering to lead.

Dr Soulen: Absolutely not. That is one of the problems, this project will live or die on the editor. It's got to be someone who as the skill and the will and the time and is really committed, is going to do a great job. Who is just going to drive this to success. And that's got to be someone who's at least 10 years younger than I am, because I'm not starting projects that I can't finish. So it's tough. Look at the history of the internship of JVIR, it's been not stellar. It's hard. It's a hard, hard job that takes a lot of time and effort. So, you really need someone passionate about it. We need to find that passionate person. If anyone in the audience out there is feeling passionate about this, contact the SIO.

Dr Gunn: I love it. Well, speaking of leadership, Muneeb, to do one last question, because I know you're coming up the end of your term as the president of society. Can you reflect back on an accomplishment that you're most proud of, or just anything that you want to reflect back on as president of the society?

Dr Ahmed: Absolutely. It's been a really great period of time and before I dive into some of the details, to build on our conversation earlier, one of the best things about getting involved in societies and in leadership of societies, is that you get to meet other volunteers who are exceptional leaders in their space, in their field, and learn from them. You don't really have that opportunity if you're not involved in professional societies. You might meet people who are at your institution or at your university, but this ability to get to know other really great people, I think is such an unsung benefit of really getting involved.

I say that because I'll be finishing a 2-year period of presidency of the SIO in January, and probably the thing personally that stands out for me most is just the ability to have spent time with Michael, Matt Callstrom, Bill Rilling, all these people who are just exceptional people. I view myself as— There's a generational shift here. I'm of a generation, I wasn't present at the formation of the WCIO, and I really had an opportunity as part of being an SIO leader to learn from those who were there and to share from some of their experience, I think it's been fantastic.

At a societal level, I'm proud of a number of things. The SIO continues to mature as an organization. I would look back in the last couple of years and it's been just a steady, pretty fast pace of progress. We're a rather young society. I think it was formed in, I want to say 2017. It’s less than a decade old and we are just moving at a really fast pace. I've described my own last 2 years as that.

It's been a lot of commitment, but we got a trial off the ground. ACCLAIM, which is focused on colorectal ablation and incorporating margin confirmation as an outcome. We started that as a society, got it funded before my time, but it's kicked off in the last year and a half, and we're already more than halfway to recruitment, so moving on schedule. That's a really big move for the society to be able to do that. Our experience there is going to allow us to build on that and continue to develop trials that we think are needed in this space.

We continue to fund basic science research. We have some commitments for more funding that'll be announced in the coming months, but well over 2.5 million dollars in funding that we've committed to early pilot grants consistently over the last several years and we're starting to see, at the annual meeting, those presentations of grants that have been funded and the research work that's coming out of that, what the society has done on those fronts, has been fantastic.

And we're continuing to build novel models of education. I was involved in the original MSK/IO master class creation concept. AThe SIO has just really done that well, and continues to do that well, in terms of how we teach the next kind of generation of IO practitioners.

There's a lot of stuff there, and this is a team sport, so I by no means am taking any credit for any of it. Again, to your original point, I show up and I'm committed and involved and I get the pleasure of seeing many of the other volunteers really commit time and effort to this and its shared success. And it's just been a real honor to be part of the society.

Dr Gunn: I love hearing you reflect on that because sometimes it can feel very hectic and like putting out fires or whatever else, but if you take a minute to reflect and look back at your team and things that other individuals have accomplished and look back and think, “hey, we got this over the finish line, we got that over the finish line,” and really map out all the different things that you've been involved in and helped, it's really a cool process.

So, congratulations and thanks so much for your leadership. And Michael, thank you as well for your leadership in the society and getting us to where we are today.

Guys, thank you for taking time. Hopefully this was informative for people listening and might inspire some people to either number one, come to the annual meeting to hear more about where we are in interventional oncology or number two, even better, to get involved, to reach out to any one of us, to get involved inside the society. Like we said, just showing up is a huge part of the battle. There are lots of things that people are doing and a huge need for volunteer efforts to continue pushing patient care forward.

With that, thanks very much and you guys enjoy the rest of your day.