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Interventional radiology | Wikipedia audio article


Interventional radiology (IR), is a radiology
specialty which provides minimally invasive image-guided diagnosis and treatment of disease. Although the range of procedures performed
by interventional radiologists is broad, the unifying concept behind these procedures is
the application of image guidance and minimally invasive techniques in order to minimize risk
to the patient.==Training=====
United States===Training for interventional radiology occurs
in the residency portion of medical education, and has gone through developments. In 2000, the Society of Interventional Radiology
(SIR) created a program named “Clinical Pathway in IR”, which modified the “Holman Pathway”
that was already accepted by the American Board of Radiology to including training in
IR; this was accepted by ABR but was not widely adopted. In 2005 SIR proposed and ABR accepted another
pathway called “DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training) Pathway”
to help trainees coming from other specialities learn IR; this too was not widely adopted. In 2006 SIR proposed a pathway resulting in
certification in IR as a speciality; this was eventually accepted by the ABR in 2007
and was presented to the American Board of Medical Specialities (ABMS) in 2009, which
rejected it because it did not include enough diagnostic radiology (DR) training. The proposal was reworked, at the same time
that overall DR training was being revamped, and a new proposal that would lead to a dual
DR/IR specialization was presented to the ABMS and was accepted in 2012 and eventually
was implemented in 2014. By 2016 the field had determined that the
old IR fellowships would be terminated by 2020.A handful of programs have offered interventional
radiology fellowships that focus on training in the treatment of children.===Europe===
In Europe the field followed its own pathway; for example in Germany the parallel interventional
society began to break free of the DR society in 2008. In the UK, interventional radiology was approved
as a sub-specialty of clinical radiology in 2010. While many countries have an interventional
radiology society, there is also the European-wide Cardiovascular and Interventional Radiological
Society of Europe, whose aim is to support teaching, science, research and clinical practice
in the field by hosting meetings, educational workshops and promoting patient safety initiatives. Furthermore, the Society provides an examination,
the European Board of Interventional Radiology (EBIR), which is a highly valuable qualification
in interventional radiology based on the European Curriculum and Syllabus for IR.==Procedures==
Interventional radiologists commonly perform both diagnostic and therapeutic procedures,
although diagnostic angiography is becoming less common as the quality and reliability
of CT and MRI angiography has allowed for alternative forms of non invasive evaluation.===Diagnostic===
Angiography: Imaging the blood vessels to look for abnormalities with the use of various
contrast media, including iodinated contrast, gadolinium based agents, and CO2 gas. Cholangiography: Imaging the bile ducts within
the liver to look for areas of blockage. Biopsy: Taking of a tissue sample from the
area of interest for pathological examination from a percutaneous or transvenous approach.===Therapeutic===
Vascular Balloon angioplasty/stent: Opening of narrow
or blocked blood vessels using a balloon, with or without placement of metallic stents
to aid in keep vessel patent. Endovascular aneurysm repair: Placement of
endovascular stent-graft across an aneurysm, in order to prevent expansion or progression
of the defective vessel. Embolization: Placement of a metallic coil
or embolic substance (gel-foam, poly-vinyl alcohol) to block blood through to a blood
vessel, either to stop bleeding or decrease blood flow to a target organ or tissue.Uterine
artery embolization (UAE) or uterine fibroid embolization (UFE)
Prostate artery embolization (PAE) Thrombolysis: Catheter-directed technique
for dissolving blood clots, such as pulmonary embolism, deep venous thrombosis) with either
pharmaceutical (TPA) or mechanical means. IVC filters: Metallic filters placed in the
vena cava to prevent propagation of deep venous thrombus. Dialysis related interventions: Placement
of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis
of poorly functioning surgically placed AV fistulas and grafts. TIPS: Placement of a Transjugular Intrahepatic
Porto-systemic Shunt (TIPS) for select indications in patients with critical end-stage liver
disease and portal hypertension. Endovenous laser treatment of varicose veins:
Placement of thin laser fiber in varicose veins for non-surgical treatment of venous
insufficiency.Biliary intervention Placement of catheters in the biliary system
to bypass biliary obstructions and decompress the biliary system. Placement of permanent indwelling biliary
stents. Cholecystostomy: Placement of a tube into
the gallbladder to remove infected bile in patients with cholecystitis, an inflammation
of the gallbladder, who are too frail or too sick to undergo surgery.Catheter placement Central venous catheter placement: Vascular
access and management of intravenous devices (IVs), including both tunneled and non-tunneled
catheters (e.g. PIC, Hickman, port catheters, hemodialysis catheters, translumbar and transhepatic
venous lines). Drainage catheter placement: Placement of
tubes to drain pathologic fluid collections (e.g., abscess, pleural effusion). This may be achieved by percutaneous, trans-rectal,
or trans-vaginal approach. Exchange or repositioning of indwelling catheters
is achieved over a guidewire under image guidance. Radiologically inserted gastrostomy or jejunostomy
: Placement of a feeding tube percutaneously into the stomach and/or jejunum.Ablative
Chemoembolization: combined injection of chemotherapy and embolic agents into the arterial blood
supply of a tumor, with the goal of both local administration of chemotherapy, slowing “washout”
of the chemotherapy drug, and also decreasing tumor arterial supply. Radioembolization: combined injection of radioactive
glass or plastic beads and embolic agents into the arterial blood supply of a tumor,
with the goal of both local administration of radiotherapy, slowing “washout” of the
radioactive substance, and also decreasing tumor arterial supply. Radiofrequency ablation (RF/RFA): local treatment
which uses a special catheter to destroy tissue by using heat generated by medium frequency
alternating currents. Cryoablation: local treatment which uses a
special catheter to destroy tissue by using cold temperature generated by rapid expansion
of compressed argon gas. This technique is mostly used for the treatment
of small renal cancers and for the palliation of painful bone lesions. Microwave ablation: local treatment which
uses a special catheter to destroy tissue by using heat generated by microwaves.Genitourinary
Percutaneous nephrostomy or nephroureteral stent placement: Placement of a catheter through
the skin, directly into the kidney in order to drain from the collecting system. This is typically done to treat a downstream
obstruction of urine. Ureteral stent exchange: indwelling double-J
type ureteral stents, typically placed by urologist using cystoscopy, may be exchanged
in retrograde fashion through the female urethra. The IR uses a thin wire snare under fluoroscopy
to capture the distal portion of the stent. After partially extracting the distalmost
stent, exchange for a new stent can be accomplished over a guidewire.Pain management Vertebroplasty: Percutaneous injection of
biocompatible bone cement inside a fractured spinal vertebrae in order to restore vertebral
body height and relieve pain

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