DOCSLIB.ORG

Anesthesia for Interventional Radiology Mary Landrigan-Ossar & Craig D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anesthesia for Interventional Radiology Mary Landrigan-Ossar & Craig D Pediatric Anesthesia ISSN 1155-5645 REVIEW ARTICLE Anesthesia for interventional radiology Mary Landrigan-Ossar & Craig D. McClain Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA Keywords Summary radiology; interventional; arteriovenous Pediatric patients in the neurointerventional radiology setting pose the dual malformations; cerebral angiography; challenges of caring for relatively sick patients in the outfield environment. embolization; therapeutic; radiocontrast For safe and successful practice, the anesthesiologist must not only under- agents; moyamoya disease stand the nuances of pediatric anesthesia and the physiologic demands of the Correspondence cerebral lesions. They must also help maintain a team-based approach to safe, Mary Landrigan-Ossar MD, PhD, compassionate care of the child in this challenging setting. In this review arti- Department of Anesthesiology, cle, we summarize key aspects of success for several of these topics. Perioperative and Pain Medicine, Boston’s Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA Email: mary.landrigan-ossar@childrens. harvard.edu Section Editor: Sulpicio Soriano Accepted 25 March 2014 doi:10.1111/pan.12411 procedures requiring anesthesia, both diagnostic and Introduction therapeutic, which are performed on the pediatric The care of pediatric patients in interventional radiology patient in the neurointerventional radiology suite. (IR) exemplifies the credo that ‘children are not small adults’. In the adult IR suite, an anesthesiologist is a rar- Safety ity, and the vast majority of procedures are accom- plished in patients who are awake or lightly sedated. Patient and provider safety must both be considered This is not the case in the pediatric neurointerventional when working in the neurointerventional suite. Patient setting; many if not most procedures require the safety concerns in large part can be categorized under assistance of an anesthesiologist for safe and successful the greater rubric of safety for non-OR anesthesia completion. As an essential part of the pediatric neuro- (NORA). The NORA environment has long been recog- interventional radiology environment, the anesthesiolo- nized as presenting unique challenges to safe patient care gist perforce plays many roles. The physiologic and (1). These challenges notwithstanding, there are many developmental effects of anesthesia on children of all factors that can be modified to enhance patient safety in ages must be well understood. The anesthesiologist the outfield. requires as well an understanding of the physiology of It is commonly recognized that older anesthesia the cerebral lesions to be treated, the requirements for equipment is to be found in the NORA milieu (2,3). successful treatment and the potential effects of the pro- Closed-claims data have demonstrated that patients in posed treatment. In addition to these obvious responsi- the NORA environment are more likely to suffer more bilities, the anesthesiologist in this outfield environment serious harm, and inadequate monitoring is cited as a has an important role to play in developing a collabora- contributor (4,5). The neurointerventional suite, where tive approach to patient care and safety, as there is lengthy complex cases are performed on sicker patients, rarely a situation in which a ‘one-size-fits-all’ approach should have anesthesia equipment that is standardized will suffice. In this article, we will review some of the with that being used in the main operating room. This 698 © 2014 John Wiley & Sons Ltd Pediatric Anesthesia 24 (2014) 698–702 M. Landrigan-Ossar and C.D. McClain Anesthesia for interventional radiology promotes safety not only by allowing the use up-to-date technology for complex patients, but also by reducing the chance of operator unfamiliarity with infrequently used devices. The distance between the interventional suite and the main operating room cannot be changed in the absence of a dedicated IR-operating room, which is in many cases prohibitively expensive. What can be accomplished is the institution of a culture of safety in the IR suite. Communication, particularly for emergencies, between the IR suite and the ‘mother ship’ should be standard- ized (6), so that anesthesia staff can be efficiently sum- moned when needed. However, it cannot be strongly enough emphasized that the staff in the IR suite are the closest resource in case of emergency. By inculcating a Figure 1 Representative setup of room demonstrating appropriate team-based approach to patient care, which includes protection for the anesthesiologist. Note wrap-around lead apron, simulation of emergency events, a well-coordinated lead glasses, portable shield between anesthesiologist and the two group of nurses and technologists in situ can assist the X-ray sources (anteroposterior and lateral in this case). anesthesiologist in the event of a crisis (7,8). Intravenous contrast is almost invariably used in neu- compliance with local regulations. As most neurointer- rointerventional procedures, and thus the anesthesiolo- ventions are performed with biplane imaging, the dose gist must be well-versed in the recognition and to the anesthesiologist is increased, making these pre- treatment of contrast reaction. Reactions to contrast, cautions even more necessary. whose mechanism is likely anaphylactoid (9), occur in 1–3% of cases (10), and most commonly occur within Cerebral angiogram the first hour of administration. Reactions can range from rash to full-blown bronchospasm and cardiovascu- Diagnostic cerebral angiography is the most common lar collapse. Treatment is supportive and can include and least physiologically deranging neurointerventional antihistamines, steroids, and hemodynamic and/or air- procedure performed on pediatric patients. While nonin- way support when indicated (11). Patients at high risk of vasive imaging modalities such as computed tomogra- contrast reaction, such as those with a prior history of a phy (CT) and magnetic resonance imaging (MRI) have reaction or a history of asthma or atopy, should be pre- become increasingly useful in the elucidation of intracra- treated with steroid and antihistamine. nial pathology, cerebral angiography is still considered Patient safety is obviously at the forefront of the the ‘gold standard’ for the diagnosis of neurovascular anesthesiologist’s mind, but this should not be at the pathology (16). Some of the more common indications expense of personal safety. It is incumbent on every for cerebral angiography include hemorrhage, stroke anesthesiologist to appropriately protect themselves (including that from vasculopathies such as Moyamoya from radiation. Radiation is particularly insidious, as disease) and postoperative evaluation of cerebrovascular there are no external indicators such as heat or light interventions (17). that potentially harmful exposure is occurring. There is The requirements for a successful procedure are few: no minimum acceptable dose of radiation, and the an immobile patient and the ability in most cases to pro- effects of exposure–increased incidence of cancer or cat- vide intermittent moments of apnea. General endotra- aracts–do not manifest themselves for decades (12,13). cheal anesthesia is most commonly used in children to In the procedure room, anesthesiologists’ exposure to provide these conditions (17). While a more mature radiation is threefold greater than that of radiologists’ patient may be able to cooperate with this procedure on the opposite side of the procedure table due to scat- with no adjunct or with light sedation to relieve anxiety, ter radiation (14). To reduce exposure, anesthesiologists any deeper levels of sedation increase the risk that the should wear lead aprons, preferably wrap-around, and patient will be unable to comply with breath holding. In protective eyewear. Portable lead shields should be situations where sedation is deemed to be the appropri- placed between the radiation source and the anesthesi- ate choice from an anesthetic perspective, it is essential ologist (Figure 1). If feasible, the anesthesiologist to communicate with the neurointerventionalist and should leave the room during angiography ‘runs’ (15). confirm that the image quality without apnea will be Portable dosimeters should be worn and monitored in acceptable. © 2014 John Wiley & Sons Ltd 699 Pediatric Anesthesia 24 (2014) 698–702 Anesthesia for interventional radiology M. Landrigan-Ossar and C.D. McClain Considerations for anesthetic management of patients are nephrologic consequences of contrast administra- for this relatively quick procedure (generally less than tion. 1 h) include blood pressure, fluid management, and postprocedure care. Care must be taken, particularly Therapeutic neurointerventions with induction of anesthesia, to avoid hypotension which can put patients with a vasculopathy such as Indications for neurointerventional procedures include Moyamoya at risk of cerebral hypoperfusion (18). On embolization of intracranial vascular anomalies, such as the other hand, acute hypertension, which could precipi- arteriovenous malformations (AVM) (Figure 2), arte- tate catastrophic bleeding in an unstable aneurysm or riovenous fistulae and aneurysms, targeted injection of arteriovenous malformation (AVM), must also be intra-arterial chemotherapy for tumors, and presurgical avoided. An arterial line for this short procedure is gen- embolization of both AVMs and tumors of the head erally unnecessary.
Load more

Recommended publications
  • THE FUTURE of INTERVENTIONAL RADIOLOGY Introduction
    Volume 13 No 3 / Jun 2017 Quarterly publication of The Royal Australian and New Zealand College of Radiologists THE FUTURE OF INTERVENTIONAL RADIOLOGY Introduction A Day in the Life of a Modern Interventional Radiology Unit Interventional radiology (IR) has been It’s 7:30am on Wednesday morning and many of them with treatment histories a dynamic field since its inception the HCC meeting is about to start. The stretching back years. We have come over 50 years ago through the work room is filled with gastroenterologists, a a long way from an average life of early pioneers in the field. In hepatic surgeon, oncologists, diagnostic expectancy of seven months. 1964, Charles Dotter described and and interventional radiologists, IR By 8:30am, it’s time to get going on the performed the first angioplasty and and HCC nursing staff and keen first case of the day. He is a 54-year- in the years that followed, he and radiographers. It’s a relatively new old hypertensive vasculopath with other innovators brought about a meeting borne out of the UGI meeting calcified vessels and critical stenoses revolution in procedural medicine with that was at risk of stretching to several of his renal arteries. He was seen in the development of catheter directed hours by the prospect of an ever- the interventional clinic several weeks therapies and other minimally invasive increasing tide of chronic liver disease before for a pre-procedural assessment image guided techniques. (viral and NASH) predisposing to HCC. where he was fully worked up and Today, modern IR and the healthcare The first patient is a 65-year-old female paperwork completed so there are no system in which it operates is with cirrhosis, Child-Pugh A and ECOG hold ups getting him on the table.
    [Show full text]
  • Interventional Radiology Curriculum for Medical Students
    Interventional Radiology Curriculum for Medical Students Second Edition A brief overview of the most common clinical R conditions C SE handled by IRs May 2019 Editorial Board Editor in Chief Christoph Binkert Editors Roberto Cazzato Jan Jaap Janssen Gregory Makris Arash Najafi Fatemeh Sakhinia CIRSE Central Office Neutorgasse 9/6 1010 Vienna Austria Phone: +43 1 904 2003 Fax: +43 1 904 2003 30 E-mail: [email protected] www.cirse.org © All rights reserved by the Cardiovascular and Interventional Radiological Society of Europe / 2019 Table of Contents Introduction 2 1 Vascular IR 3 1.1 Peripheral Vascular Disease 3 1.2 Aneurysms 4 1.3 Venous Disease 5 1.3.1 Venous Thromboembolic Disease 5 1.3.2 Chronic Venous Obstruction 5 1.4 Embolisation for Benign Conditions 6 1.4.1 Uterine Fibroid Embolisation 6 1.4.2 Prostate Artery Embolisation 6 1.4.3 Gastrointestinal Bleeding 7 1.4.4 Gonadal Vein Embolisation 7 1.5 Access 8 1.5.1 Central Venous Access 8 1.5.2 Dialysis Shunt 8 2 Non-Vascular IR 9 2.1 Biopsies and Drainages 9 2.2 Biliary Procedures 9 2.3 Genitourinary Interventions 10 3 Interventional Oncology 11 3.1 Ablative Therapies 11 3.1.1 Liver Tumour Ablation 11 3.1.2 Renal Tumour Ablation 11 3.1.3 Lung Tumour Ablation 12 3.2 Liver Malignancy Embolisation 13 4 Musculoskeletal Interventions 14 4.1 Vertebral Compression Fractures and Vertebral Augmentation 14 4.2 Lower Back Pain 15 References 16 CIRSE and Interventional Radiology 18 Supporting IR’s Next Generation 19 Introduction In order to make medical students aware of the ever-increasing role of IR in hospital medicine and to provide guidance on the learning outcomes required to prepare medical students for their role during residency years, CIRSE published the first edition of the Interventional Radiology Curriculum for Medical Students in 2012.
    [Show full text]
  • Interventional Radiology in the Diagnosis and Treatment of Solid Tumors
    THE ROLE OF INTERVENTIONAL RADIOLOGY IN THE DIAGNOSIS AND TREATMENT OF SOLID TUMORS Victoria L. Anderson, MSN, CRNP, FAANP OBJECTIVES •Using Case Studies and Imaging examples: 1) Discuss the role interventional (IR) procedures to aid in diagnosing malignancy 2) Current and emerging techniques employed in IR to cure and palliate solid tumor malignancies will be explored Within 1 and 2 will be a discussion of research in the field of IR Q+A NIH Center for Interventional Oncology WHAT IS INTERVENTIONAL RADIOLOGY? • Considered once a subspecialty of Diagnostic Radiology • Now its own discipline, it serves to offer minimally invasive procedures using state-of- the-art modern medical advances that often replace open surgery (Society of Interventional Radiology) NIH Center for Interventional Oncology CHARLES T. DOTTER M.D. (1920-1985) • Father of Interventional Radiologist • Pioneer in the Field of Minimally Invasive Procedures (Catheterization) • Developed Continuous X-Ray Angio- Cardiography • Performed First If a plumber can do it to pipes, we can do it to blood vessels.” Angioplasty (PTCA) Charles T. Dotter M.D. Procedure in 1964. • Treated the first THE ROOTS OF patient with catheter assisted vascular INTERVENTIONAL dilation RADIOLOGY NIH Center for Interventional Oncology THE “DO NOT FIX” CONSULT THE DO NOT FIX PATIENT SCALES MOUNT HOOD WITH DR. DOTTER 1965 NIH Center for Interventional Oncology •FIRST EMBOLIZATION FOR GI BLEEDING •ALLIANCE WITH •FIRST BALLOON BILL COOK •HIGH SPEED PERIPHERAL DEVELOPED RADIOGRAPHY ANGIOPLASTY-- NUMEROUS
    [Show full text]
  • Five-Year Results of a Merger Between Vascular Surgeons and Interventional Radiologists in a University Medical Center
    From the Eastern Vascular Society Five-year results of a merger between vascular surgeons and interventional radiologists in a university medical center Richard M. Green, MD, and David Waldman, MD, PhD, for the Center for Vascular Disease* Rochester, NY Objectives: We examined economic and practice trends after 5 years of a merger between vascular surgeons and interventional radiologists. Methods: In 1998 a merger between the Division of Vascular Surgery and the Section of Interventional Radiology at the University of Rochester established the Center for Vascular Disease (CVD). Business activity was administered from the offices of the vascular surgeons. Results: In 1998 the CVD included five vascular surgeons and three interventional radiologists, who generated a total income of $5,789,311 (34% from vascular surgeons, 24% from interventional radiologists, 42% from vascular laborato- ries). Vascular surgeon participation in endoluminal therapy was limited to repair of abdominal aortic aneurysms (AAAs). Income was derived from 1011 major vascular procedures, 10,510 catheter-based procedures in 3286 patients, and 1 inpatient and 3 outpatient vascular laboratory tests. In 2002 there were six vascular surgeons (five, full-time equivalent) and four interventional radiologists, and total income was $6,550,463 despite significant reductions in unit value reimbursement over the 5 years, a 4% reduction in the number of major vascular procedures, and a 13% reduction in income from vascular laboratories. In 2002 the number of endoluminal procedures increased to 16,026 in 7131 patients, and contributions to CVD income increased from 24% in 1998 to 31% in 2002. Three of the six vascular surgeons performed endoluminal procedures in 634 patients in 2002, compared with none in 1998.
    [Show full text]
  • Mastering Interventional Radiology & Cardiology Online Training
    Mastering Interventional Radiology & Cardiology Online Training Program FAQs Which procedures are covered in the course? The course is designed to cover all procedures types for the CIRCC exam: catheterization coding, diagnostic angiography/venography, angioplasty, stent, atherectomy, embolization, thrombectomy, thrombolysis, infusion therapy, IVC filters, TIPS, venous organ blood sampling, transcatheter foreign body removal, dialysis circuit coding, central venous access devices, tunneled peritoneal catheters, endovascular repair, diagnostic cardiac catheterization, coronary angioplasty, coronary stent, coronary atherectomy, coronary thrombectomy, vertebroplasty, kyphoplasty, facet joint injections, nerve blocks, epidural injections, epidurography, discography, myelography, lumbar puncture, urinary, gastrointestinal, biliary, biopsy, drainage, aspiration, sclerotherapy, ablation, arthrography. eDoes th course cover ICD‐10‐CM or ICD‐10‐PCS coding? No, only CPT® coding is covered in the course. Are there any pre‐requisites for enrolling in the course? There are no required pre‐requisites, however; it is strongly recommended that enrollees have hands on coding experience in one or more areas as well as at least one core coding credential (CCS, CCS‐P, CPC, COC, CIC, etc.) Prior to registering enrollees should have knowledge of anatomy and medical terminology. When is the course open for enrollment? Until recently we only opened enrollment once or twice per year. To better serve potential customers, we decided to remove the specific enrollment deadlines, however, we are still limiting the number of enrollees we will allow in the course at any given time. The number of seats available will vary depending upon how many enrollees complete the course early and how much support current students require during the studies. We want to be sure that everyone who enrolls has the best experience possible and that we can provide them the time and attention needed to be successful in the course.
    [Show full text]
  • Anesthesia in Interventional Radiology
    medigraphic Artemisaen línea E A NO D NEST A ES Mexicana de IC IO EX L M O G O I ÍA G A E L . C C O . C Revista A N A T Í E Anestesiología S G S O O L C IO I S ED TE A ES D M AN EXICANA DE PROFESORES EXTRANJEROS Vol. 32. Supl. 1, Abril-Junio 2009 pp S172-S176 Anesthesia in interventional radiology Elizabeth AM Frost* *Professor, Mount Sinai Medical Center, New York, USA CASE Exclusion criteria An 88 year old female, 62 kg, with a past medical history • Vertebral body height loss 100% significant for early Alzheimer’s disease, hypothyroidism, • Posterior wall involvement gastroesophageal reflux disease and osteoporosis presented • Involvement of the spinal cord for percutaneous vertebroplasty. She had painfully disabling • Osteolytic metastatic lesion osteoporotic at T12-L2 fractures. She was scheduled as a • Bleeding diathesis same day admit for a 23 hour hospital stay • Inability to undergo emergency decompressive surgery Osteoporosis Stages of PV • Causes 1 million vertebral fractures annually in the US, affects 10 million • Vertebral puncture (access site) • Characterized by low bone mass and structural deteriora- • Spinal biopsy (rule out metastasis) tion of bone tissue • Mainly elderly, white women • Risk factors: poor nutrition, smoking, alcohol, steroids • Diagnose by bone density scan Vertebroplasty (PV) • Described in 1984 by Deramond • Palliative treatment for osteoporosis • Minimally invasive, needs sedation • Injection of polymethylmethacrylate to vertebral body • Fluoroscopic guidance • Dramatic decrease of pain in > 2000 case studies Selection criteriawww.medigraphic.com • New fracture • Pain refractory to medical management • Respiratory compromise • Potential for worsening of disease Vertebral body puncture S172 Revista Mexicana de Anestesiología Frost EAM.
    [Show full text]
  • Interventional Fluoroscopy Reducing Radiation Risks for Patients and Staff
    NATIONAL CANCER INSTITUTE THE SOCIETY OF INTERVENTIONAL RADIOLOGY Interventional Fluoroscopy Reducing Radiation Risks for Patients and Staff Introduction CONTENTS Interventional fluoroscopy uses ionizing radiation to guide small instruments such as catheters through blood vessels or other pathways in the body. Interventional fluoroscopy represents a Introduction 1 tremendous advantage over invasive surgical procedures, because Increasing use and it requires only a very small incision, substantially reduces the complexity of risk of infection and allows for shorter recovery time compared interventional fluoroscopy 1 to surgical procedures. These interventions are used by a rapidly expanding number of health care providers in a wide range of Determinants of radiation medical specialties. However, many of these specialists have little dose from interventional fluoroscopy 2 training in radiation science or protection measures. The growing use and increasing complexity of these procedures Radiation risks from interventional fluoroscopy 3 have been accompanied by public health concerns resulting from the increasing radiation exposure to both patients and health care Strategies to optimize personnel. The rise in reported serious skin injuries and the radiation exposure from expected increase in late effects such as lens injuries and interventional fluoroscopy 4 cataracts, and possibly cancer, make clear the need for informa- Physician-patient tion on radiation risks and on strategies to control radiation communication before and exposures to patients and health care providers. This guide after interventional fluoroscopy 4 discusses the value of these interventions, the associated radiation risk and the importance of optimizing radiation dose. Dosimetry records and follow up 4 Education and training 5 Increasing use and complexity of interventional Conclusion 5 fluoroscopy Reference list 5 In 2002, an estimated 657,000 percutaneous transluminal coronary angioplasty (PTCA) procedures were performed in adults in the United States.
    [Show full text]
  • Pregnancy and the Working Interventional Radiologist
    403 Pregnancy and the Working Interventional Radiologist Catherine T. Vu, MD1 DeirdreH.Elder,MS,CMLSO2 1 Department of Radiology, University of California Davis Medical Address for correspondence Catherine T. Vu, MD, University of Center, Sacramento, California California Davis Medical Center, 4860 Y Street, Suite #3100, 2 Department of Radiation Safety, University of Colorado Hospital, Sacramento, CA 95817 (e-mail: [email protected]). Aurora, Colorado Semin Intervent Radiol 2013;30:403–407 Abstract The prevalence of women radiologists has risen in the past decade, but this rise is not Keywords reflected in interventional radiology. Women are grossly underrepresented, and this ► interventional may be partly due to fear of radiation exposure, particularly during pregnancy. The radiology simple fact is radiation exposure is minimal and the concern regarding the health of the ► pregnancy developing fetus is unjustly aggrandized. Fully understanding the risks may help women ► radiation exposure to choose interventional radiology and practicing women interventionalists to stay ► radiation safety productive during their child-bearing years. To date, little has been published to guide ► occupational injury women who may become pregnant during their training and career. Objectives: Upon completion of this article, the reader will be choosing specialties such as family medicine, pediatrics, able to discuss the real risk of radiation to the pregnant and obstetrics and gynecology. This phenomenon has been working interventionalist and her fetus, and techniques to linked to the attraction of these specialties having the reduce radiation dose and work-related injuries. traditional “family-friendly” reputation, where women Accreditation: This activity has been planned and imple- can achieve the quintessential work–life balance.
    [Show full text]
  • Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy
    Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy Proceedings of an international conference held in Málaga, Spain, 26–30 March 2001, organized by the International Atomic Energy Agency and co-sponsored by the European Commission, the Pan American Health Organization and the World Health Organization RADIOLOGICAL PROTECTION OF PATIENTS IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY, NUCLEAR MEDICINE AND RADIOTHERAPY a PROCEEDINGS SERIES RADIOLOGICAL PROTECTION OF PATIENTS IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY, NUCLEAR MEDICINE AND RADIOTHERAPY PROCEEDINGS OF AN INTERNATIONAL CONFERENCE HELD IN MÁLAGA, SPAIN, 26–30 MARCH 2001, ORGANIZED BY THE INTERNATIONAL ATOMIC ENERGY AGENCY AND CO-SPONSORED BY THE EUROPEAN COMMISSION, THE PAN AMERICAN HEALTH ORGANIZATION AND THE WORLD HEALTH ORGANIZATION INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2001 c Permission to reproduce or translate the information contained in this publica- tion may be obtained by writing to the International Atomic Energy Agency, Wagramer Strasse 5, P.O. Box 100, A-1400 Vienna, Austria. © IAEA, 2001 VIC Library Cataloguing in Publication Data International Conference on Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy (2001 : Malaga, Spain) Radiological protection of patients in diagnostic and interventional radiol- ogy, nuclear medicine and radiotherapy : proceedings of an international con- ference held in Malaga, Spain, 26–30 March 2001 / organized by the International Atomic Energy Agency...[et al.]. — Vienna : The Agency, 2001. p. ; 24 cm. — (Proceedings series, ISSN 0074–1884) STI/PUB/1113 ISBN 92–0–101401–5 Includes bibliographical references. 1. Diagnosis, Radioscopic—Safety measures—Congresses. 2. Interventional radiology—Safety measures—Congresses. 3. Nuclear medicine—Safety measures—Congresses.
    [Show full text]
  • About Interventional Radiology
    FACT SHEET Contact Maryann Verrillo, (703) 460-5572 Ellen Acconcia, (703) 460-5582 Nonsurgical Interventional Radiology Procedures Offer Less Risk, Less Pain and Less Recovery Time Compared to Open Surgery What Is Interventional Radiology? The landscape of medicine is constantly changing, and for the past 30 years, interventional radiologists have been responsible for much of the medical innovation and development of the minimally invasive procedures that are commonplace today. Interventional radiologists pioneered modern medicine with the invention of angioplasty and the catheter-delivered stent, which were first used to treat peripheral arterial disease. By using a catheter to open the blocked artery, the procedure allowed an 82-year-old woman, who refused amputation surgery, to keep her gangrene-ravaged left foot. To her surgeon’s disbelief, her pain ceased, she started walking, and three “irreversibly” gangrenous toes spontaneously sloughed. She left the hospital on her feet—both of them. Charles Dotter, M.D., the interventional radiologist that pioneered this technique, is known as the “Father of Interventional Radiology,” and was nominated for the Nobel Prize in medicine in 1978. Angioplasty and stenting revolutionized medicine and led the way for the more widely known applications of coronary artery angioplasty and stenting that revolutionized the practice of cardiology. Today many conditions that once required surgery can be treated nonsurgically by interventional radiologists. Through a small knick in the skin, they use tiny catheters and miniature instruments so small they can be run through a person’s network of arteries to treat at the site of illness internally, saving the patient from open invasive surgery.
    [Show full text]
  • AMSER GUIDE to APPLYING for INTERVENTIONAL RADIOLOGY RESIDENCY VERSION 1 – AUGUST 2016 DEVELOPED and EDITED by Kyle J. Cooper, M.D.; Minhaj S
    AMSER GUIDE TO APPLYING FOR INTERVENTIONAL RADIOLOGY RESIDENCY VERSION 1 – AUGUST 2016 DEVELOPED AND EDITED BY Kyle J. Cooper, M.D.; Minhaj S. Khaja, M.D., M.B.A.; Sravanthi Reddy, M.D., Kate Klein, M.D. WITH HELP AND INPUT FROM OTHER AMSER MEMBERS INTRODUCTION This document is intended to provide guidance for students considering applying to a residency in interventional radiology, known to many as IR/DR). It includes answers to the most common questions that advisors and program directors have been asked, as well as some “hard data” from the national websites. Some advice reflects personal opinion of the authors. WHY INTERVENTIONAL RADIOLOGY? Unfortunately, many medical students are not exposed to interventional radiology until their third or fourth year of medical school, if at all. This can make it difficult for students to decide if this is the specialty choice for them. The following is general information about the specialty and the sort of personalities that tend to enjoy it as a profession. Careers in Medicine® (CiM) Vascular and interventional radiologists use their expertise in interpreting X-rays, ultrasound, and cross-sectional imaging other medical modalities to guide small instruments such as catheters and wires through the blood vessels or other pathways to treat disease percutaneously. These procedures are typically much less invasive and much less costly than traditional surgery. These radiologists diagnose and treat diseases by various radiologic imaging modalities including fluoroscopy, digital radiography, computed tomography, sonography, and magnetic resonance imaging. Common interventional radiological procedures include: angioplasty; thrombolytic therapy for blood clots; chemoembolization--delivery of chemotherapy directly to the site of the tumor; infection and abscess drainage; uterine fibroid embolization; removal of a urinary tract or fallopian tube obstruction; needle biopsy; and radiofrequency ablation.
    [Show full text]
  • Can an Interventional Radiologist Survive in Today's Turf War?
    UNIVERSITYUNIVERSITY OF WISCONSIN–MADISON OF WISCONSIN–MADISON Can An Interventional Radiologist Survive In Today’s Turf War? John Swietlik, MD, Paul H Yi, MD, Nathan Kim, MD & Jie Nguyen, MD, MS Department of Diagnostic Radiology University of Wisconsin-Madison UNIVERSITY OF WISCONSIN–MADISON Disclosures The authors have no financial disclosures relevant to this electronic exhibit. University of Wisconsin–Madison 2 UNIVERSITY OF WISCONSIN–MADISON Introduction • Increasing numbers of imaging-assisted endovascular and cardiac procedures are being performed by non-Interventional Radiologists. “Between 1997 and 2002, procedure volume in percutaneous peripheral arterial interventions grew at faster rates among cardiologists, vascular surgeons, and other physicians than it did among radiologists.” • This trend has raised concerns amongst Interventional Radiology (IR) physicians regarding the financial viability of the field. University of Wisconsin–Madison 3 UNIVERSITY OF WISCONSIN–MADISON Let the Turf Wars Begin • As a result, there has been concern about turf wars between IR and other endovascular and cardiac procedure-oriented fields for decades. University of Wisconsin–Madison 4 UNIVERSITY OF WISCONSIN–MADISON Goals & Objectives • The purpose of this study was to assess the differences in maximum Medicare reimbursements to IR, VS, and Cardiology physicians. In other words… Can the field of IR remain financially viable in today's healthcare market? University of Wisconsin–Madison 5 UNIVERSITY OF WISCONSIN–MADISON Methods • The Medicare Provider Utilization and Payment Database is a publicly available database provided by the Centers for Medicare & Medicaid services (US Government organization) that discloses all Medicare payments by dollar amount to physicians from 2012 to the present. • This database was queried for all IR, VS, and Cardiology physicians who received Medicare reimbursements in 2014.
    [Show full text]