| Bhavna Sahu |
Recently, one of my siblings happened to be diagnosed with increased heartbeat, ‘tachycardia’, as we say in medical terms. Apprehension in the family rose when the episodes of tachycardia became more frequent. So, the family landed up in a multi-speciality hospital and consulted a cardiologist. Post all routine investigations, the heart was subjected to an electro physiology (EP) study, wherein it was mentioned to the family that in case there is an extra outlet of electrical activity outside or near the heart, it will be taken care of by burning the outlet. To the patient as well as his family, who were completely unaware about the procedure, it was like a minor psychological shock leading to an assumption that some burning near heart is going to be a great deal of surgery. But, thanks to the innovations in technology most of the surgeries have been reduced to just a few minor cuts and few days of hospital stay. The effect of the same also reflects in terms of reduced hospital expenses. And, the bottom line is that walk-in individuals can walk out individually, post their surgeries.
Actually, interventional radiology (IR) is a medical sub-speciality of radiology which makes use of
minimally-invasive image-guided procedures for diagnosis and treatment of diseases. Premise of IR relies on the diagnosis and treatment of patients by minimal incisions, minimal risk and improved health outcomes. Utilising the radiological imaging modalities like X-ray, CT scan, ultra-sonography, MRI, etc., the preoperative or intra-operative images are then employed by surgeons as the guide to the procedure. Vast number of surgical interventions like cancer surgeries, percutaneous biopsies, gastrointestinal interventions, spinal interventions, angiographies, angioplasties, tumour ablations, peripheral vascular interventions, etc., which required major surgical procedures are nowadays being treated by interventional radiologists and surgeons in a day or two using non-surgically/minimally invasive procedures. By minimising the physical trauma to the patient, peripheral interventions can also reduce infection rates and recovery time, as well as shorten hospital stays.
| DVT thromobosis | Endovenous laser ablation |
Great innovations from the past
Charles Dotter, MD is known as “Father of Interventional Radiology” for pioneering techniques in interventional radiology. And it was Alexander Margulis who coined the term “interventional” for the new, minimally invasive techniques. He laid emphasis on the point that innovation should be achieved through training, technical skill development, clinical knowledge acquisition, and superior patient care in close coordination with surgical and medical doctors and their teams.
Percutaneous uroradiologic interventions like percutaneous kidney/ gall bladder stone extraction, nephrostomy drainage, and urethral stenting were brought in by the innovations of interventionalists Kurt Amplatz, Willi Castaneda and Dave Hunter. 1990s were the time when interventional oncology was pioneered with the introduction of radiofrequency ablation (RFA) technique for liver tumours, soft tissue tumours (bone, breast, kidney, lung and liver cancer) and embolisation for treatment of bone and kidney tumours. Embolisation techniques for pulmonary AVMs were pioneered by Bob White. Treatment for bone and kidney tumours by embolisation and treatment of disseminated liver metastases was done by Sid Wallace. In 1991, abdominal aortic stent grafts were introduced which was then followed by balloon expandable coronary stent, intra-arterial delivery of tumour-killing viruses and gene therapy vectors to the liver, percutaneous delivery of pancreatic islet cells to the liver for transplantation to treat diabetes and development of the endovenous laser ablation procedure for treatment of varicose veins and venous disease.
The present
In present times, image-guided IR has its utility in all minimally invasive surgeries as well as major surgeries. The vast range of which could be listed as laparoscopy, angiography (CT guided – CTA/ MR assisted – MRA), angioplasty, drainage procedures, per cutaneous tumour ablations, radiotherapy, embolisation, CT guided biopsies, peripheral vascular interventions, intramuscular psychotherapy, balloon angioplasty, angioplasty, and implantation of drug eluted stets, spinal interventions – vertebrate, treatment of thrombi-embolism by using retrievable inferior vane cave (IVC) filters, treatment of vascular disorders by ablations, and many more.
These procedures have become substitutes to the conventional procedures, diagnostics and major surgeries. Though all procedures involve risk, the minimally invasive ones are found to have minimal risks and rapid recovery time. Image-guided IR techniques and procedures are the best alternatives when surgeries of certain type involve high risks when operated using conventional methods. Unlike catheter hagiography, noninvasive CTA and MRA are less risky to patients and facilitate rapid diagnosis.
Innovations for future
What the future holds for the fields of surgery can be foreseen. With the rapid advancements in technology and interventions, it can be ascertained that image-guided interventions will drive the medical and surgical fields.
Radiology is capital and labour-intensive. In this era of healthcare reforms and budget restrictions, long-term planning becomes a need of the hour. IR’s cost-effectiveness has allowed its widespread deployment. The process of diagnosis and treatment is also expedited with the usage of picture archival and communication systems (PACS) by the healthcare service delivery institutions.
Innovations in technology, interventional devices and procedures will surely add to the benefits in the fields of minimally invasive surgery. Multifarious approaches involving usage of more than one imaging modality can aid in the diagnosis of diseases. However, development of appropriate technology, as per the current requirements, which can cover the pit falls in the existing procedures/ techniques/ intervention and standardisation of such interventions can be a challenge. Also, enabling radiologists and surgeons towards adaptability of the newer methods of technology and interventions can be an upfront challenge, as adequate training is of utmost importance in such cases.
As Steve Jobs said, “Everyone here has the sense that right now is one of those moments when we are influencing the future.”
Hence, it can be said that today’s IR certainly shows us a bigger picture of what the future beholds.
I really like the information which is shared in this blog about the interventional radiologist (IR) is a medical sub-speciality of radiology which makes use ofminimally-invasive image-guided procedures for diagnosis and treatment of diseases. Premise of IR relies on the diagnosis and treatment of patients by minimal incisions, minimal risk and improved health outcomes. Radiology is capital and labour-intensive. In this era of healthcare reforms and budget restrictions, long-term planning becomes a need of the hour. IR’s cost-effectiveness has allowed its widespread deployment. The process of diagnosis and treatment is also expedited with the usage of picture archival and communication systems (PACS) by the healthcare service delivery institutions.