Interventional Radiology is a subspecialty of Radiology using radiological imaging methods in order to diagnose and treat diseases without surgery.
What is an interventional radiologist?
They are doctors trained in ‘minimally invasive’ targeted therapies, which they perform guided by radiographic images of the body. They capitalize on their experience in studying x-rays, ultrasounds, CAT and MRI scans in order to guide microscopic instruments, such as catheters ( flexible tubes of small diameter), in the vessels or go straight through the skin into various organs to treat medical conditions and disease without open surgery. Interventional radiologists work closely together with the clinical physician of any given patient to ensure optimum treatment.
How are interventional radiology operations performed?
Interventional radiologists use ‘images’, such as x-rays or MRI imaging, to ‘peek into’ the patient’s body, locate exactly where the problem is and plan on how they can get access to that part without operating on the patient. Next, they drive catheters into the vascular system, through other routes or straight through the skin. In this way, they treat diseases or tumors exactly where they are located by means of tiny incisions which are 1-2 mm long (as long as the nib of a pencil) and through the guidance they get from scanning the body during the procedure.
What are the advantages?
- The dangers of interventional radiology are significantly fewer compared to those of open surgery.
- Normally, there is no need for general anesthesia.
- Risks, pain, the period of recovery before returning to daily activities – are all substantially reduced.
- Procedures cost much less compared to standard surgery or other types of treatment.
Ultimately, what does interventional radiology treat?
By combining their experience in diagnostic radiology and their advanced training in non-surgical techniques, and through using the body’s images for extra guidance, interventional radiologists may treat various serious diseases by going straight to the heart of the problem, without making any surgical incisions.
Cancerous tumors can be treated with chemoembolization, a treatment during which high dosages of chemical agents are sent straight into the tumor while, at the same time, blood flow to the tumor is blocked, or alternatively there can be thermocatheterisation where radiofrequencies are used to warm up and destroy the tumor.
Atheromatosis of lower limb arteries, or peripheral artery disease, which obstructs blood flow and often causes pain while walking, may be treated with balloon angioplasty in the narrowed or obstructed vessels, resulting in the restoration of blood flow to the tissues that require it.
Varicose veins (painful and flawed veins in our legs) are treated by means of cauterization and by ‘sealing-off’ the major saphenous vein of the leg, thus improving circulation and shrinking the bloated veins in the femur and calves, a technique called ‘vein ablation’.
In the case of uterine fibromyomas, embolism is performed through a thin tube (microcatheter) that carries tiny particles to that artery, which nourishes those benign tumors and cuts off blood flow to them. As a result, fibromyomas shrink and symptoms subside.
When spondyloplasty is performed on osteoporotic patients who have fractured vertebra, a fine needle is placed in the center of the vertebra to fill in the injured vertebra with special ‘cement’ which stops the pain and stabilizes the fracture.
Stenosis in the arteries of the neck (the carotids) may lead to stroke. Instead, arteries can be distended and kept open by placing a metal grid (stent) in the carotid.
Varicocele, where enlarged veins in the man’s scrotum cause pain or sterility, may be treated by diverting blood flow away from the problematic vein by placing tiny coils through a technique called ‘varicocele embolisation’. This is also the way to treat distended veins around the uterus or the ovaries of a woman; which cause pain when pelvic congestion syndrome first manifests (something which is unknown to many but still quite frequent in women suffering from chronic pelvis pain).
Patients suffering from infections and abscesses can be treated once a small incision, 1-2 mm long, is made and a fine catheter is placed into the abscess to remove the pus without surgery. This is a non-invasive method called abscess or fluid drainage.
In biliary drainage, stenotic or obstructed biliary ducts (the fine tubes that carry bile from the liver to the colon) are opened up by placing metal stents, thus restoring bile circulation and smooth liver function.
In fine needle biopsy, using ultrasounds or CAT scanning, the radiologist places a needle into the tumor and, while staying clear of organs or vessels which could have otherwise caused bleeding, takes cells or a very small section of the tumor (just a few millimeters), in order for the pathoanatomist to microscopically check it as the latter will give the definite diagnosis whether the tumor is benign or malignant.
Abdominal aorta aneurysm under the guidance of radioscopy is now treated intravascularly by placing covered stents which block the circulation in the problematic ‘bloated’ aortic wall and minimize the risk of rupture or bleeding.
To preserve arteriovenous communication (in the case of fistula) or hemodialysis grafts for the sake of nephropathy patients, balloon angioplasty (opening up using a balloon) or thrombolysis (injection of clot – dissolving substances) may extend the time duration of the artificial dialysis route..
And since interventional radiologists are always dealing with «perforating» vessels and their anatomy, they are experts in venous catheter placement, i.e. catheters placed in the major veins of the neck or the arm, and which are used to inject chemotherapeutic or nourishing substances. The most frequently used catheters are the so-called ports which are implanted under the skin where they are not visible, and which can remain in the body for a very long time. The simultaneous monitoring of the procedure on the radiology and ultrasound monitors makes this procedure one of the safest in the field of interventional radiology.
How safe is the radiation during the therapy?
During medical procedures performed, the highest safety standards – in terms of the radiation patients are exposed to – are strictly complied with. The training radiologists undergo highlights issues such as safe dosage of radiation, x-rays physics and the biological impact of radiation. The dosages the patients (and the attending radiologist) are exposed to are constantly recorded and checked; they never exceed safety limits.