Interventional Radiology Procedures.pptx

Interventional Radiology (IR) is a subspecialty of radiology that uses minimally invasive image-guided procedures to diagnose and treat diseases.

1. Interventional Radiology Presenter: Dheeraj Kumar MRIT, Ph.D. (Radiology and Imaging) Assistant Professor Medical Radiology and Imaging Technology School of Health Sciences, CSJM University, Kanpur

2. Interventional Radiology? Interventional Radiology (IR) is a subspecialty of radiology that uses minimally invasive image-guided procedures to diagnose and treat diseases.

3. Overview: Minimally Invasive: Procedures involve small incisions or punctures. Image-Guided: Techniques such as fluoroscopy, ultrasound, CT, and MRI guide the procedures. Example: Percutaneous Coronary Intervention (PCI): A non-surgical procedure to open narrowed coronary arteries.

4. Importance of Interventional Radiology Clinical Significance: Benefits Over Traditional Surgery: Reduced surgical trauma Decreased risk of infection Shorter recovery times Enhanced Precision and Safety: Real-time imaging allows for precise targeting. Minimizes damage to surrounding tissues. Example: Endovenous Laser Therapy (EVLT): Used for treating varicose veins with less pain and faster recovery than traditional vein stripping surgery.

5. Tools and Techniques Fluoroscopy Description: Real-time X-ray imaging that enables visualization of internal structures. Uses: Guiding catheters and wires during vascular procedures. Performing gastrointestinal procedures such as barium studies. Visualizing the placement of stents and balloons. Ultrasound Description: Imaging modality that uses high-frequency sound waves to produce images of internal organs. Uses: Guiding needle placements for biopsies. Monitoring real-time blood flow and vascular access. Visualizing abdominal and pelvic organs during interventional procedures.

6. Computed Tomography (CT) Description: Imaging technique that uses X-rays to create detailed cross-sectional images. Uses: Guiding complex procedures like tumor ablation and biopsies. Planning and monitoring of interventional procedures. Providing detailed anatomical information for accurate targeting. Magnetic Resonance Imaging (MRI) Description: Imaging modality that uses magnetic fields and radio waves to produce detailed images of soft tissues. Uses: Guiding interventions in soft tissue structures. Visualizing tumors and other lesions in the brain, spine, and joints. Planning and performing ablation procedures.

7. Instrumentation Catheters Description: Thin, flexible tubes used to access various body parts. Types and Uses: Diagnostic Catheters: For angiography and other imaging procedures. Therapeutic Catheters: For delivering treatments such as angioplasty balloons and embolic agents. Guide Wires Description: Flexible wires used to guide catheters and other instruments to the target site. Uses: Navigating through blood vessels during angioplasty. Providing support and stability for catheter-based interventions.

8. Diagnostic Catheter Therapeutic Catheter Guidewire

9. Needles Description: Hollow needles used for percutaneous access to tissues and organs. Uses: Performing biopsies of organs such as the liver and lung. Drainage of fluid collections like abscesses. Accessing vascular structures for procedures such as dialysis.

10. Specialized Equipment Balloon Catheters Description: Catheters with inflatable balloons at their tips. Uses: Dilating narrowed or blocked blood vessels during angioplasty. Opening up narrowed bile ducts or other tubular structures. Stents Description: Small, mesh-like tubes that are inserted into blood vessels or other structures to keep them open. Uses: Maintaining patency of coronary arteries after angioplasty. Supporting collapsed or narrowed airways in tracheobronchial stenting.

11. Embolic Agents Description: Substances used to block blood flow to specific areas. Types and Uses: Coils: Metal coils used to occlude blood vessels during embolization procedures. Particles: Small particles used in uterine fibroid embolization or tumor embolization. Ablation Devices Description: Tools that use various forms of energy to destroy abnormal tissues. Types and Uses: Radiofrequency Ablation (RFA): Uses high-frequency electrical currents to generate heat and destroy tumors. Cryoablation: Uses extreme cold to freeze and destroy cancerous tissues. Microwave Ablation: Uses microwave energy to generate heat and ablate tissues.

12. Thrombectomy Devices Description: Tools used to remove blood clots from blood vessels. Types and Uses: Mechanical Thrombectomy Devices: Use mechanical action to break up and remove clots in stroke treatment. Aspiration Catheters: Use suction to aspirate clots from vessels. Nephrostomy and Drainage Catheters Description: Catheters used to drain urine from the kidney or fluid from other body cavities. Uses: Relieving urinary obstruction by draining urine externally. Draining abscesses or other fluid collections in various body parts.

13. Radiation Protection Equipment Lead Aprons and Shields Description: Protective garments made of lead or other radiation-attenuating materials. Uses: Protecting healthcare workers and patients from radiation exposure during fluoroscopic procedures. Dosimeters Description: Devices worn by healthcare workers to monitor cumulative radiation exposure. Uses: Ensuring that radiation exposure remains within safe limits.

14. Diagnostic Procedures Biopsies: Liver Biopsy: Indication: Diagnosing liver diseases such as cirrhosis or liver cancer. Procedure: A needle is inserted through the skin to obtain a liver tissue sample under ultrasound or CT guidance. Lung Biopsy: Indication: Diagnosing pulmonary nodules or masses. Procedure: A needle is inserted through the chest wall to obtain a lung tissue sample under CT guidance.

15. Angiography: Cerebral Angiography: Indication: Diagnosing aneurysms, arteriovenous malformations (AVMs), or stroke. Procedure: A contrast agent is injected into the cerebral arteries, and X-ray images are taken to visualize blood flow. Coronary Angiography: Indication: Diagnosing coronary artery disease. Procedure: A catheter is inserted into the coronary arteries, a contrast agent is injected, and X-ray images are taken to visualize blockages.

16. Vascular Procedures Angioplasty and Stenting: Procedure Details: Angioplasty: A balloon catheter is inflated within a narrowed or blocked artery to widen it. Stenting: A stent (a small wire mesh tube) is placed in the artery to keep it open. Common Indications: Peripheral artery disease Coronary artery disease Example: Coronary Angioplasty and Stenting: Performed to open up blocked coronary arteries and restore blood flow to the heart.

17. Embolization: Uterine Fibroid Embolization (UFE): Indication: Treatment of symptomatic uterine fibroids. Procedure: Small particles are injected into the uterine arteries to block blood flow to the fibroids, causing them to shrink. Tumor Embolization: Indication: Shrinking tumors by cutting off their blood supply. Procedure: Embolic agents are injected into the blood vessels supplying the tumor.

18. Non-Vascular Procedures Drainage Procedures: Abscess Drainage: Indication: Draining infected fluid collections (abscesses). Procedure: A catheter is inserted into the abscess cavity under ultrasound or CT guidance to drain the fluid. Biliary Drainage: Indication: Relieving obstructions in the bile ducts. Procedure: A catheter is placed in the bile ducts under imaging guidance to drain bile externally or into the intestine.

19. Gastrostomy Tube Placement: Indications: Long-term enteral feeding in patients who cannot eat by mouth. Procedure: A tube is inserted through the abdominal wall into the stomach under fluoroscopic or endoscopic guidance. Example: Percutaneous Endoscopic Gastrostomy (PEG): A minimally invasive method for placing a feeding tube into the stomach.

20. Oncology Interventions Radiofrequency Ablation (RFA): Tumor Types Treated: Liver tumors Kidney tumors Lung tumors Procedure Steps: A needle electrode is inserted into the tumor under imaging guidance. High-frequency electrical currents are used to generate heat and destroy cancer cells. Example: Liver RFA: Commonly used to treat small hepatocellular carcinomas.

21. Trans arterial Chemoembolization (TACE): Use in Liver Cancer: Treats hepatocellular carcinoma (HCC) by delivering chemotherapy directly to the tumor. Procedure Details: A catheter is guided to the hepatic artery, and chemotherapy mixed with embolic particles is injected to block blood flow and trap the drug within the tumor. Example: TACE for HCC: Combines local chemotherapy delivery with embolization to maximize tumor killing and minimize systemic side effects.

22. Musculoskeletal Interventions Vertebroplasty and Kyphoplasty: Treatment of Vertebral Compression Fractures: Indicated for fractures due to osteoporosis or metastasis. Procedure Explanation: Vertebroplasty: Bone cement is injected into the fractured vertebra to stabilize it. Kyphoplasty: A balloon is first inserted and inflated to create space before injecting bone cement, helping to restore vertebral height. Example: Kyphoplasty: Often used for treating painful vertebral compression fractures with the goal of pain relief and spinal stability.

23. Joint Injections: Indications for Pain Management: Osteoarthritis Rheumatoid arthritis Bursitis Procedure Overview: A corticosteroid and/or anesthetic is injected into the affected joint to reduce inflammation and pain. Example: Hip Joint Injection: Used for pain relief in patients with hip osteoarthritis.

24. Neurological Interventions Thrombectomy: Acute Stroke Treatment: Indicated for patients with large vessel occlusions causing ischemic stroke. Procedure Steps: A catheter is navigated to the site of the clot under fluoroscopic guidance. Mechanical devices or aspiration techniques are used to remove the clot and restore blood flow. Example: Mechanical Thrombectomy: Performed within a specific time window to significantly improve outcomes in stroke patients.

25. Spinal Procedures: Spinal Nerve Blocks: Indication: Managing chronic pain conditions such as sciatica. Procedure: An anesthetic or corticosteroid is injected around the spinal nerves to relieve pain. Epidural Steroid Injections: Indication: Treating radicular pain from herniated discs or spinal stenosis. Procedure: An injection is given into the epidural space around the spinal cord to reduce inflammation and pain. Example: Epidural Steroid Injection: Commonly used for lumbar radiculopathy (sciatica) to alleviate pain and improve function.

26. Renal and Genitourinary Interventions Nephrostomy: Indications: Obstructive uropathy (e.g., due to kidney stones, tumors) Hydronephrosis Procedure: A catheter is inserted percutaneously into the renal pelvis under ultrasound or fluoroscopic guidance to drain urine externally. Example: Percutaneous Nephrostomy: Used to relieve obstruction in patients with severe hydronephrosis due to ureteral stones.

27. Ureteral Stenting: Indications: Ureteral obstruction (e.g., due to stones, tumors, strictures) Post-surgical or post-traumatic ureteral injury Procedure: A stent (a thin tube) is placed inside the ureter to maintain patency and allow urine to flow from the kidney to the bladder. Example: Double-J Stent Placement: Commonly used to manage ureteral obstruction and ensure urine drainage.

28. Patient Care and Safety Pre-Procedure Preparation: Patient Assessment: Thorough medical history and physical examination Laboratory tests (e.g., coagulation profile, renal function) Consent and Education: Informing the patient about the procedure, risks, benefits, and alternatives Obtaining written informed consent Example: Pre-Procedure Checklist: Ensuring all necessary evaluations and preparations are completed before the procedure.

29. Post-Procedure Care: Monitoring and Follow-Up: Regular monitoring of vital signs and puncture sites Post-procedure imaging to confirm successful intervention Managing Complications: Early detection and management of complications (e.g., bleeding, infection) Example: Post-Angioplasty Care: Monitoring for signs of re-occlusion or complications like hematoma at the puncture site.

30. Future Trends in Interventional Radiology Technological Advancements: Robotics: Enhanced precision and control in complex procedures Example: Robotic-Assisted Endovascular Procedures: Allowing for greater accuracy and stability in catheter-based interventions. Artificial Intelligence (AI): Improved image analysis and decision support Example: AI-Guided Imaging: AI algorithms assisting in real-time interpretation of imaging data to optimize procedural outcomes.

31. Emerging Procedures: New Applications and Innovations: Expansion of interventional radiology into new therapeutic areas Example: Cryoablation for Prostate Cancer: Using extreme cold to destroy cancerous tissues, offering a minimally invasive alternative to traditional surgery. Personalized Medicine: Tailoring interventions based on individual patient characteristics Example: Genomic-Guided Interventions: Using genetic information to guide the choice of interventional therapies for optimal efficacy.

32. References Interventional Radiology: A Comprehensive Textbook Author: Anthony F. Watkinson, Andy Adam Publisher: Springer Year: 2009 IR Playbook: Interventional Radiology Procedure and Technique Author: Karim Valji Publisher: Elsevier Year: 2018 Handbook of Interventional Radiologic Procedures Author: Krishna Kandarpa, Lindsay Machan Publisher: Lippincott Williams & Wilkins Year: 2016 Vascular and Interventional Radiology: The Requisites Author: John A. Kaufman, Michael J. Lee Publisher: Elsevier Year: 2013 The Practice of Interventional Radiology, with Online Cases and Video: Expert Consult Premium Edition Author: Karim Valji Publisher: Elsevier Year: 2011