What is interventional radiology?
Interventional radiologists are involved in the treatment of the patient, as well as the diagnosis of disease. They treat an ever-widening range of conditions inside the body from outside the body by inserting various small instruments or tools, such as catheters or wires, with the use of various x-ray and imaging techniques (i.e., CT scanners, MRI scanners, ultrasound scanners). Interventional radiology offers an alternative to the surgical treatment of many conditions and can eliminate the need for hospitalization, in some cases.
Who is the interventional radiologist?
The interventional radiologist is a medical doctor who has completed four years of study in radiology. The interventional radiologist is then eligible to take the board examination given by the American Board of Radiology. Following board certification, the interventional radiologist completes an interventional radiology fellowship training program. Interventional radiologists work closely with other physicians and play an important role on the treatment team.
What procedures do interventional radiologists perform?
Interventional radiologists perform a vast variety of procedures, including the following:
- angiography - an x-ray of the arteries and veins to detect blockage or narrowing of the vessels. In many cases, the interventional radiologist can treat the blockages, such as those occurring in the arteries in the legs or kidneys, by inserting a small stent, which inflates and opens the vessel. This procedure is called a balloon angioplasty.
- embolization - the insertion of a substance through a catheter into a blood vessel to stop hemorrhaging, or excessive bleeding.
- gastrostomy tubes - a gastrostomy tube (feeding tube) is inserted into the stomach if the patient is unable to take food by mouth.
- intravascular ultrasound - the use of ultrasound inside a blood vessel to better visualize the interior of the vessel in order to detect problems inside the blood vessel.
- stent placement - a tiny, expandable coil, called a stent, is placed inside a blood vessel at the site of a blockage. The stent is expanded to open up the blockage.
- foreign body extraction - the use of a catheter inserted into a blood vessel to retrieve a foreign body in the vessel.
- needle biopsy - a small needle is inserted into the abnormal area in almost any part of the body, guided by imaging techniques, to obtain a tissue biopsy. This type of biopsy can provide a diagnosis without surgical intervention. An example of this procedure is called the needle breast biopsy.
- blood clot filters - a small filter is inserted into a blood clot to catch and break up blood clots.
- injection of clot-lysing agents - clot-lysing agents, such as tissue plasminogen activator (TPA), are injected into the body to dissolve blood clots, thereby increasing blood flow to the heart or brain.
- catheters insertions - a catheter is inserted into large veins for giving chemotherapy drugs, nutritional support, and hemodialysis. A catheter may also be inserted prior to bone-marrow transplantation.
- cancer treatment - administering cancer medications directly to the tumor site.
- vein ablation - procedure that treats varicose veins and their underlying cause, venous reflux, with little or no pain.
- uterine fibroid embolization (UFE) - treatment for benign tumors (fibroids) that grow in or on the uterus. UFE works by blocking the blood supply to the fibroid, causing it to shrink and become inactive.
Patient Profile -- Interventional radiology: Walking without pain
Balloon angioplasty provides fast relief from peripheral vascular disease Bertha Henshaw could not walk 20 steps without sitting down to rest. The pain that had gradually developed in her left leg over the years became too much. For years, she had loved walking along Revere Beach near her home - sometimes three miles - but the pain forced her to rest on the sea wall and contemplate the distant ocean.
"I loved walking barefoot on the sand along the water's edge," said the 85-year-old mother of two. "But the pain was horrible. My left leg felt like someone with an air pump was filling it and it was ready to burst," she said. "I couldn't put any weight on that foot. I'd rest and then try to walk it out. But you can't walk out pain like that. You just can't."
MRI finds clogged leg artery, preventing potential limb loss
After monitoring the situation over time, Henshaw's doctor referred her to Wayne Wivell, MD, associate chief of radiology at Melrose-Wakefield Hospital. Dr. Wivell reviewed a magnetic resonance imaging (MRI) test to diagnose an 85-percent artery blockage in her leg. The blockage indicated peripheral vascular disease (PVD), a disease of the body's circulatory system that commonly leads to clogged leg arteries.
"Ms. Henshaw was experiencing excruciating pain, but we saw a clear solution with the MRI images," Dr. Wivell said. "If left untreated, PVD can lead to amputation."
Interventional radiology makes life-changing procedures less invasive
To unclog the artery in Henshaw's leg, Dr. Wivell performed a balloon angioplasty procedure. For the procedure, Dr. Wivell used fluoroscopy (x-ray imaging) to guide and inflate a balloon-like device to force open the blockage, restoring blood flow. Then, using the same catheter, Dr. Wivell inserted a wire-mesh stent (similar to those used to hold open clogged arteries in the heart) to keep the diseased artery permanently open. Although Henshaw had been suffering from her condition for a long time, she went home the morning after the minimally invasive procedure. She was able to walk without pain that same day.
"It's amazing how, one day, you can be in such terrible pain, and the next…it's gone," Henshaw said. Many interventional radiology procedures can be performed on an outpatient basis. In the Radiology Department's Special Procedures Suite at Melrose-Wakefield Hospital, angiographic x-rays allow interventional radiologists to guide catheters through a patient's arteries to attack tumors, strengthen broken vertebrae and unclog arteries - while watching their progress on a computer screen.
Interventional radiology procedures also require less anesthesia than traditional surgery - which helps patients recover faster.
The joy of walking on the beach
Soon after her successful procedure, Henshaw accompanied her daughter on a trip to Aruba. It had been a long time since she had walked barefoot down a beach.
"It was like I never had any problem," she said. "I walked a mile or two. I picked up a few shells, but mostly I just walked. It was wonderful."
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