Interventional Radiology

Overview

Interventional radiology (IR) is a subspecialty of radiology. Doctors in interventional radiology not only evaluate medical pictures but also execute minimally invasive surgical operations through small incisions in the body.

What is Interventional Radiology?

Interventional radiologists (IR) employ medical imaging to guide minimally invasive surgical treatments to diagnose, treat, and cure a wide range of illnesses. Fluoroscopy, MRI, CT, and ultrasound are among the imaging modalities employed.

Interventional radiology began in the 1960s with the development of angioplasty techniques to treat artery blockages as an alternative to open surgical bypass. Since then, interventional radiology techniques have grown in their capacity to treat a growing number of ailments.

If you were to go into a normal IR surgery, you would observe the patient lying on an operating table with a specialized X-ray camera—a fluoroscope—above them. The radiologist would be dressed in protective clothing, such as a blue robe and a mask. They would be directing needles and other wire-like medical equipment into the patient's body while watching medical images presented on the screen. It's incredible how they can utilize medical pictures to pinpoint the exact location of their equipment and how to operate within the body without creating any big incisions.

The number of disorders that can be addressed with IR is large and growing all the time. Some of the following names may be familiar to you: It is critical to understand that interventional therapy is typically one of several treatment choices available, ranging from nothing through pharmacological treatment and surgery. Each case must be judged on its own merits.

Reduced risks, shorter hospital stays, cheaper expenses, more comfort, faster convalescence and return to work are all well-known benefits of these minimally invasive treatments. Treatment efficacy is frequently higher than with standard therapies. It should be mentioned that IR benefits creatures other than humans. Veterinary surgeons are also shifting to interventional procedures, so you and your animals may receive comparable therapy.

Who is Interventional Radiologist?

Interventional radiologists use imaging techniques such as: 

• X-rays,
• MRIs (magnetic resonance imaging) scans,
• Fluoroscopy (an X-ray procedure that makes it possible to see internal organs in motion), 
• CT (computed tomography) scans and
• Ultrasounds.

Interventional radiologists treat malignancies, take organ samples, and place stents by introducing tiny tools and thin plastic tubes (catheters) into the body through an artery or vein. The pictures are utilized to direct catheters and devices to the precise location of the surgery or therapy. This eliminates the need for traditional (open) or keyhole (laparoscopic) surgery since therapy may be administered through a little plastic tube the size of a straw.

Benefits of IR Treatments

While no therapy is without danger, IR techniques are less risky than open surgery and provide patients with sophisticated care. Other advantages include:

• Most procedures are performed as an outpatient or with a short hospital stay.
• General anesthesia is usually not needed.
• Pain and recovery times are often significantly reduced.
• Procedures may be less costly than traditional surgery.

Interventional Radiology Procedures

The variety of illnesses that may be addressed with interventional radiology techniques is expanding. Because IR therapy is often one of several possibilities, it is critical that you consult with your SSM Health clinician to determine the best approach for you. Interventional radiologists carry out a variety of treatments, including:

• Oncology Interventional Radiology

Minimally-invasive procedures performed for the treatment of various cancers include:

• Radiofrequency ablation – An outpatient procedure used to treat tumors by heating and destroying cancer cells locally.
• Cryoablation – An outpatient procedure that kills and destroys cancer cells by freezing them.
• NanoKnife® – An outpatient procedure used to treat inoperable tumors using localized electric currents.
• Y-90 Radioembolization – Treatment of various cancers within the liver using internal radiation, delivered through the arterial supply to the liver.
• Chemoembolization – Chemotherapy directed to liver tumors via the arterial supply.
• Heart and Vascular

Interventional radiologists repair aneurysms, unblock blocked arteries and veins, and plug arteries to halt bleeding using a number of procedures.

Imaging methods are utilized in an angioplasty operation to guide a balloon-tipped catheter, a long, thin plastic tube, into an artery or vein and advance it to where the channel is narrowed or stopped. The balloon is then deflated and removed after being inflated to open the vessel. A thin wire mesh tube called a stent may be permanently inserted in the newly opened artery or vein to help it remain open if necessary.

• Arteries

Narrowing of arteries, resulting in limited blood flow (peripheral vascular disease): Interventional radiologists treat this by stretching the artery using balloons (balloon angioplasty, PTA) and occasionally employing metal springs called stents to keep it open. Sometimes arteries or bypass grafts unexpectedly block, resulting in a loss of blood circulation to a limb. Amputation may be required if the blood supply is not restored. Interventional radiologists can aid by directly infusing clot-busting medications into the artery through tiny catheters, perhaps saving several limbs.

Expanded arteries (aneurysms) at risk of rupture and bleeding:  IRs treat these by relining the vessel with a tube called a stent graft

Bleeding (hemorrhage).  The most frequent vascular emergency addressed by IR is this. Hemorrhage may occur practically anywhere, including the intestines, as a result of a significant injury, or shortly after delivery. Bleeding may frequently be stopped permanently by blocking the vessel (embolization), relining the vessel with a stent graft, or inflating a balloon in the vessel to stop the bleeding until emergency surgery can be performed. Interventional radiology is also used to reduce bleeding during some types of surgery, such as caesarean section in individuals who are at high risk of bleeding due to an abnormal placenta (postpartum hemorrhage).

• Veins

Blood clots in the lung (pulmonary embolism, PE):  Interventional radiologists provide two types of treatment: device installation (inferior vena cava filters) to trap blood clots before they reach the lung and prevent future PE. An interventional radiologist may use tiny catheter tubes to break up the blood clot and restore blood flow when there is a large PE causing collapse.

Dilated veins (varicose veins):  These are most usually found in the legs, however they can also be found in the pelvis or scrotum. These can be treated by obstructing the vein with heat (laser or microwave), irritating medicines, or embolization procedures.

Blocked veins:  This can happen in the context of a blood clot in the veins (venous thrombosis, DVT), which is occasionally treated by injecting blood clot dissolving drugs (thrombolysis) into the vein using a tiny catheter. When a clot is broken down with balloons and stents, some individuals suffer blood clots as a result of a constriction in a vein. Tumors in the chest can sometimes compress a vein, causing face swelling, headaches, and other symptoms that can typically be resolved with a stent.

• Non vascular intervention

The procedures are commonly referred as interventional oncology but they are also useful in benign conditions. IR treatments are used to treat the following conditions:

• To relieve the effects of the cancer on other systems e.g. blockage of the gullet (oesophagus), bowel, kidney (nephrostomy) or liver (biliary drainage)
• To drain collections of fluid or pus in the chest or abdomen
• To place feeding tubes (gastrostomy, jejunostomy)
• To treat collapsed spinal bones (vertebroplasty)

Liver, kidney and other tumors (e.g. bone, lung):  These can be treated with destructive treatments (ablation), which often include heat (radiofrequency, laser, microwave, and ultrasound) or cold damage (cryotherapy). Imaging is used to execute and monitor the therapy (ultrasound, computed tomography or magnetic resonance imaging).

Uterine fibroids: Fibroids, which are benign tumors, can cause excessive menstrual flow and discomfort. These can be treated by obstructing blood arteries and causing shrinking (uterine fibroid embolization, UFE). Embolization is occasionally used in conjunction with chemical therapy (chemoembolization) or radiation (radioembolization), which directs the effect to the tumor and reduces some of the negative effects of cancer therapy.

• Stone Disease

Renal stones are frequent and can cause discomfort, infection, and kidney obstruction. Kidney obstruction in the presence of infection will result in irreparable kidney damage. Interventional procedures include inserting a tube into the kidney (nephrostomy) to drain urine and removing stones with a variety of devices inserted through the skin into the kidney. Large kidney stones are best treated by making a small skin incision into the kidney and then inserting an endoscope straight into the kidney, shattering the stone with special equipment, and taking the fragments out (percutaneous nephrolithotomy).

One of the most frequent upper abdominal illnesses is gallstones. Laparoscopic surgery is used to treat the majority of them. When stones or tumors prevent bile from draining from the liver, it causes jaundice. This is usually treated with a telescope passed down the throat (endoscopy), but it is occasionally necessary for an interventional radiologist to perform drainage by inserting catheter tubes through the liver to either remove the stones or place stents to allow drainage.

Additional Procedures

• Venous access – Placement of PICC lines, central lines, and central venous ports.
• Enteric access – For patients who are unable to eat, tubes can be placed within the bowel for feeding. These procedures include gastrostomy tubes, gastrojejunostomy tubes, and jejunostomy tubes.
• Image-guided tissue biopsy – A needle biopsy or tissue sample collected from a mass or other abnormal condition in the body in order to make a diagnosis.
• Drainage procedures – Drainage catheters are used to remove fluid from body cavities such as the abdomen (paracentesis) or the area around your lungs (thoracentesis), as well as other abscesses.
• Urologic procedures – Nephrostomy tubes and ureteral stents are placed for obstructed kidneys.
• Biliary procedures – Biliary drainage tubes and stents are placed for biliary obstruction.
• Uterine fibroid embolization: A tiny catheter is placed into a groin or wrist artery and directed to the arteries that give blood to the uterine fibroids. Small particles are injected into the vessels to restrict blood flow to the fibroids, causing them to shrink and alleviating discomfort and bleeding during or between menstrual cycles.
• Varicocele embolization: A tiny catheter is directed to the larger vein in the scrotum by being put into a vein in the neck or groin. Small particles are injected into the vein to impede blood flow, reducing discomfort and increasing fertility.
• Inferior vena cava (IVC) filter placements and retrievals: Filters are placed in the IVC — the vein that transports blood from the lower body to the heart — to prevent blood clots in the legs from reaching the heart or lungs When the filter is no longer needed, it is removed using another catheter-based process.
• Vertebroplasty and kyphoplasty: A hollow needle inserts a specific bone cement into the broken vertebrae of individuals suffering from osteoporosis. Balloons are used in kyphoplasty to generate space for the cement to be inserted. Both surgeries relieve pain associated with the fracture and give spine stability.
• Transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO): These medications are for portal hypertension, a condition caused by liver disease. TIPS employs a shunt to establish an artificial channel between the liver's main veins. A balloon is used to restrict dilated veins in the stomach that are at danger of rupturing.
• Palliative care: Long-term drainage catheters can be safely implanted and used at home or during hospice care to ease symptoms caused by end-stage cancer fluid buildup. Nerve-blocking techniques aid in pain alleviation.
• Pulmonary angiography and thrombectomy: Blood clots in the lungs are potentially fatal. Thrombectomies or thrombolysis remove blood clots from the arteries of the lung, improving blood flow and reducing heart strain.
• Trauma and acute care procedures: After a major accident, catheter-based techniques can be used to unblock clogged arteries in the legs or arms and plug damaged blood vessels.

Differences Between Interventional Radiology and Diagnostic Radiology

An interventional radiologist's objective is to employ an imaging modality that reduces risk and pain while promoting speedy recovery and favorable patient outcomes. Although interventional radiologists and diagnostic radiologists are both members of the same medical profession, their training and areas of competence differ.

• Interventional radiology uses imaging technologies to guide and perform medical procedures that are performed to diagnose and treat a wide range of health concerns.
• Diagnostic radiology uses imaging technologies to determine, evaluate, and diagnose illnesses and injuries inside the body.

Specialties that Use Interventional Radiology

Interventional radiologists work with many other medical specialties. These include:

• Hospice and Palliative Medicine: Interventional radiologists who work in hospice and palliative medicine help manage patients with life-limiting illnesses.
• Neuroradiology: interventional radiologists who work in neuroradiology diagnose and treat conditions of the brain, sinuses, spine, spinal cord, neck, and central nervous system, such as aging and degenerative diseases, seizure disorders, cancer, stroke, cerebrovascular diseases, and trauma.

Angiography, myelography, interventional methods, and magnetic resonance imaging (MRI) are among the imaging modalities employed. This sub-specialty necessitates two years of further training, one year of fellowship and one year of practice or additional authorized training.

• Nuclear Radiology: A nuclear radiography interventionist uses trace doses of radiopharmaceuticals to collect diagnostic pictures and create physiological data for the diagnosis and treatment of benign and malignant disorders. Gamma cameras, single photon emission computed tomography (SPECT)/computed tomography (CT), and positron emission tomography (PET)/computed tomography (CT) may be used by a nuclear radiologist (CT).
• Pain Medicine: An interventionist who specializes in pain medicine treats patients with acute, chronic, and/or cancer pain in both inpatient and outpatient settings, coordinating care with other experts. Before a doctor can be labeled a pain medicine specialist, he or she must complete an additional year of fellowship study.
• Pediatric Radiology: An interventionist who specializes in pediatric radiology employs imaging and interventional treatments to diagnose, treat, and manage congenital abnormalities and disorders that affect newborns and children. A pediatric radiologist must complete two years of further training, including a year of fellowship and a year of practice or additional training.
• Interventional Radiology: According to the American Board of Radiology, the specialty of vascular and interventional radiology has been superseded by interventional radiology/diagnostic radiology (IR/DR), which was given for the first time in 2017.

Conclusion

Interventional radiology (IR) is a branch of medicine that uses cutting-edge technology to perform image-guided operations to treat a wide range of disorders throughout the body. Interventional radiology procedures reduce risk, necessitate fewer incisions, and are often performed under sedation rather than general anesthesia. Many diseases that used to necessitate traditional open surgery can now be addressed using tiny catheters or other devices guided by radiologic imaging; this is frequently a less expensive technique that allows for a quicker recovery.