Interventional Radiology 
 
 
 
 
An interventional radiologist performs minimally invasive procedures with imaging guidance. He/she is trained in the use of fluoroscopy, CT, and ultrasound to guide passage through the skin by needle puncture for performing procedures such as biopsies, draining fluid collections or abscesses, inserting drainage catheters, or dilating or stenting narrowed ducts or vessels.

 

Angiography

 
Angiography is a minimally invasive medical test that helps physicians examine blood vessels and diagnose and treat medical conditions in key areas of the body, including the brain, heart, lungs, kidneys, gastrointestinal tract, aorta, neck, chest and limbs. It may involve the use of

X-rays, computed tomography (CT) and/or magnetic resonance imaging (MRI).

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Angioplasty and Venous Interventions

Angioplasty with or without vascular stenting is a minimally invasive procedure performed to improve blood flow in the body's arteries and veins. It is commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body, including:

        narrowing of large arteries (aorta and its branches) due to atherosclerosis, or hardening of the arteries.

        peripheral artery disease (PAD), a narrowing of the arteries in the legs or arms.

        renal vascular hypertension, high blood pressure caused by a narrowing of the kidney arteries.

        carotid artery stenosis, a narrowing of the neck arteries supplying blood to the brain.

        coronary artery disease, a narrowing of the coronary arteries that carry blood and oxygen to the heart muscle.

        venous narrowings involving the central veins (in the chest, abdomen or pelvis).

        narrowing in dialysis fistula or grafts.

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Biliary Interventions

Biliary interventions are minimally invasive procedures performed to treat blockages or narrowing in bile ducts. In addition, minimally invasive techniques can be used to treat an inflamed or infected gallbladder.

There are several conditions that can cause a blockage or narrowing in bile duct, including:

             Inflammation of the pancreas (pancreatitis), inflammation of the bile ducts (sclerosing cholangitis)

             Tumors - cancer of the pancreas, gallbladder, bile duct, liver, or enlarged lymph nodes

             Gallstones, either in the gallbladder or in the bile ducts

             Injury to the bile ducts during surgery

             Infection

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Biopsies

A biopsy is the removal of tissue from the body in order to examine it for disease. Some biopsies involve removing a small amount of tissue with a needle while others involve surgically removing an entire lump, or nodule, that is suspicious.

Often, the tissue is removed by placing a needle through the skin (percutaneously) to the area of abnormality. Biopsies can be safely performed with imaging guidance such as ultrasound, X-ray, computed tomography (CT), or magnetic resonance imaging (MRI). These types of imaging are used to determine exactly where to place the needle and perform the biopsy.

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Chest Interventions

Chest interventions are minimally invasive procedures used to diagnose and treat excess fluid in the space between the outside of the lungs and the inside of the chest wall, known as pleural space. This condition is caused by several conditions, including infection, inflammation, heart failure or cancer. Excess fluid in the pleural space can make it difficult to breathe.

Chest interventions are performed to:

            Relieve pressure on the lungs

            Treat symptoms such as shortness of breath and pain

            Determine the cause of excess fluid in the pleural space.

 

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Dialysis and Fistula/Graft Declotting Interventions

Dialysis fistula/graft declotting interventions are minimally invasive procedures performed to improve blood flow in the fistula and grafts placed in the blood vessels of kidney dialysis patients. When fistulas and grafts become clogged or narrowed, which can prevent a patient from undergoing dialysis, interventional radiologists use image-guided interventions to fix the problem.

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Embolization

Embolization is a minimally invasive treatment that closes off one or more blood vessels or vascular abnormalities to:

        Control or prevent abnormal bleeding.

        Close off vessels that are supplying blood to a tumor.

        Eliminate a vascular malformation or abnormal connection between arteries and veins.

        Treat aneurysms (a bulge or sac formed in a weak artery wall)

        Treat varicoceles (enlarged veins) in the scrotum that may be a cause of infertility.

In embolization procedures, physicians use image guidance to place medications or synthetic materials called embolic agents through a catheter into a blood vessel to prevent blood flow to the area of abnormality.

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Neuro Interventional Radiology

This subspecialty of radiology is dedicated to the diagnostic imaging and diagnosis of the brain and nerves, head, neck and spine. This includes X-rays, computed tomography (CT or CAT) scans, ultrasound and MRI.

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Carotid stenting

Carotid stenting is a minimally invasive procedure in which the same techniques used to open blocked arteries near the heart are used to improve the flow of blood to the brain from the carotid arteries located on each side of the neck, and help prevent stroke. A small metal coil called a stent is placed in the clogged artery to prop it open and decrease the chance of it narrowing again.

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Percutaneous Abscess Drainage

 
An abscess is an infected collection of fluid in the body. In general, people who have an abscess will experience fever, chills and pain in the approximate location of the area that is involved. If a patient has these symptoms, it is not uncommon that they will undergo an X-ray test (usually a CT scan) or an ultrasound exam, to assist in making the correct diagnosis. Once the diagnosis of an abscess has been made, an assessment is made by your physician and an interventional radiologist to decide which therapy is appropriate. As long as it is deemed safe, percutaneous (through the skin) abscess drainage, a minimally invasive therapy, can be used to help abscess treatment.

During the procedure, an interventional radiologist uses imaging guidance such as computed tomography (CT) scanning to place a thin needle to remove or drain infected fluid (abscess) from an area of the body such as the chest, abdomen or pelvis.

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Peritoneal Port

A peritoneal port is a small reservoir or chamber that is surgically implanted under the skin to provide a painless way to withdraw excess fluid from or to deliver anti-cancer drugs into the abdominal or peritoneal cavity over a period of weeks, months or even years. The port has a silicone rubber top that can be penetrated by a needle. The peritoneal port is implanted by an interventional radiologist during an image-guided minimally invasive procedure.

Physicians use peritoneal ports to help treat:

        Ascites, a condition in which excess fluid continually builds up in the abdominal, or peritoneal cavity. Ascites may be caused by cirrhosis (chronic liver disease), cancer, heart failure, kidney failure, tuberculosis or pancreatic disease.

        Ovarian cancer.

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Radiofrequency ablation

Radiofrequency ablation, sometimes referred to as RFA, is a minimally invasive treatment for cancer. It is an image-guided technique that heats and destroys cancer cells.

In radiofrequency ablation, imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide a needle electrode into a cancerous tumor. High-frequency electrical currents are then passed through the electrode, creating heat that destroys the abnormal cells.

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Spinal Interventions

Spinal interventions include the following minimally invasive, image-guided procedures. 

        Epidural injection is delivered into the epidural space of the spine to provide temporary or prolonged relief from pain or inflammation.

        A nerve block is an anesthetic or anti-inflammatory injection targeted toward a certain nerve or group of nerves to treat pain. 

        A lumbar puncture (also called a spinal tap) involves the removal of a small amount of cerebrospinal fluid—the fluid that surrounds the brain and spinal cord—or an injection of medication or other substance into the lumbar (or lower) region of the spinal column.

        Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column. In vertebroplasty, physicians use image guidance to inject a cement mixture into the fractured bone through a hollow needle. In kyphoplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.

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Urinary Interventions

Ureteral Stenting and Nephrostomy

Urine is normally carried from the kidneys to the bladder through long, narrow tubes called ureters. The ureter can become obstructed due to conditions such as kidney stones, tumors, infection or blood clots. When this happens, physicians can use image guidance to place stents or tubes in the ureter to restore the flow of urine to the bladder. A ureteral stent is a thin, flexible tube threaded into the ureter.

When it is not possible to insert a ureteral stent, nephrostomy is performed. During this image-guided procedure, a tube is placed through the skin on the patient's back into the kidney. The tube is connected to an external drainage bag or from the kidney to the bladder.

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Uterine Fibroid Embolization

Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors of the uterus. The procedure is a specialized form of Uterine Artery Embolization (UAE) which has been used for decades to stop severe pelvic bleeding caused by trauma, malignant gynecological tumors and hemorrhage after childbirth.

Fibroid tumors, also known as myomas, are benign tumors that arise from the muscular wall of the uterus. It is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, and pressure on the bladder or bowel.

 In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms.

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Hahnemann University Hospital | 230 N Broad St, Philadelphia, PA 19102