Alternatives to surgery within radiology

“I have an aneurysm in my brain. My mother died of bleeding from an aneurysm. I do not want the same thing happening to me, but I am also scared of open surgery, how can you treat it without opening my skull?”

“I have a fibroid in my uterus, they are going to take out my uterus but I want to preserve my fertility”.

“I am 85 year-old my enlarged prostate keeps me up all night, I am not eligible to surgery, is there another treatment option?”

“The vessels in my left leg are blocked, I cannot even walk a block, now I also start to have wounds in my toes. I do not want to lose my toes or foot. Can you do something for me?”

“I have had a minor stroke in the past year and my carotid artery was found to be significantly narrowed. I do not want any surgeries because the doc told me that it would be risky due to previous heart surgeries. What am I going to do?”

“I had metastatic breast cancer. I have received several rounds of chemo, almost all but the liver tumors shrunk. Can you do something for my liver?”

These are some of the typical questions that an interventional radiologist might encounter in the clinics while seeing patients. As “interventional” radiologists, we are now offering so called “minimally invasive” treatment opportunities in almost every organ system and in almost every disease state.

filling material
Illustration of filling material (called coils) inside an aneurysm (“endovascular coiling” of a brain aneurysm is one of the most common procedures done in neurointerventional field).

The discovery of X-rays in 1895 by Wilhem Conrad Röntgen had revolutionized our capabilities of diagnosing disease by direct imaging. It could be counted as one of the most important steps in modern medicine other than the discovery of antibiotics and the antiseptic methods during surgeries. Especially after 1950s the imaging methods have greatly improved our understanding of the disease and pinpointing abnormalities. We now have MRs, CTs, ultrasounds and several other advanced imaging techniques in our armamentarium. The physicians who are dealing with these imaging methods have to have a comprehensive understanding of the technology besides in depth knowledge about human anatomy and diseases.

 

How can interventional radiology help to you

Interventional radiology is a subspecialty of radiology where the doctors perform procedures on patients. This is something different than what other radiologists usually do such as interpreting the images or planning the studies without seeing the patient face to face.

Interventional radiology has 3 main fields:

One is interventional neuroradiology where mostly problems related to brain vessels are treated including acute stroke, aneurysm bleeding, arteriovenous malformations (presence of shortcut channels between arteries and veins).

The second one is vascular interventional radiology which mainly tackles diseased vessels outside the brain and heart, as well as embolization procedures for the body. Embolization means cutting off the blood supply to a vascular problem, unstoppable bleeding or tumour.

Figure2
Reconstitution of blood flow to an occluded leg artery after atherectomy (removing of plaques using a tiny catheter with rotating blades) and stenting (placing a metal device to keep the vessel open).

Nonvascular interventional radiology mainly is a problem solving field. In nonvascular interventional radiology doctors usually deal with evacuating fluid or pus within the body, obtaining tissue biopsies and also take care of obstructions in the urinary system or bile ducts. Treatment of tumours by disposing energy via small needles is also one of the common tasks in nonvascular interventional radiology.

Most of the time the patient is referred to the interventional radiologist by the primary doctor. But nowadays owing to wide availability of online resources and presence of social media channels, patients themselves can seek alternatives.

Figure3
Chemoembolization (injected submilimeter sized beads loaded with chemo drugs to treat tumours and cut the blood supply).

Today interventional radiology has become a clinical specialty and the patients need to be seen by the interventional radiologists at the clinics, evaluated thoroughly, discuss about the potential risks and benefits and then decide on what to do.

 

References for further reading:

  1. http://www.sirweb.org/patients/
  2. http://en.wikipedia.org/wiki/Interventional_radiology
  3. http://www.hopkinsmedicine.org/vascular/what_is_IR.html
  4. http://www.bsir.org/patients/what-is-interventional-radiology/

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