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David M. Tabriz, MD Interventional Radiology: what we do. October 17, 2015 Interventional Radiology: what we do. David M. Tabriz, MD University of Florida College of Medicine Department of Interventional Radiology What is an Interventional Radiologist? Newest recognized medical specialty Separate from diagnostic radiology 6 years of post-graduate medical training: Clinical internship (1 year) Diagnostic and Interventional radiology residency (4 years) Interventional radiology fellowship (1 years) What is Interventional Radiology? Diagnostic Radiology trained (head to toe) - Image interpretation (including prior studies) - Image consultation and protocolling - Disease process management - Recommended follow up (imaging, physician, etc.) Interventional Radiology additional training (head to toe) - Pre-operative consultation - Image interpretation (including prior studies) - Procedure - Diagnostic (minority) & therapeutic procedures - Post-procedure care Benefits: Decreased cost & post-procedural care Decreased morbidity & mortality Faster recovery Only Option Coding Fiesta 2015 David M. Tabriz, MD 1 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 IR: tools of the trade. Needles Guidewires Catheters Contrast Agents Drainage catheters/tubes Stents Angioplasty Balloon Many, many more Tools: Access Needles IR: tools of the trade – Seldinger technique Coding Fiesta 2015 David M. Tabriz, MD 2 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Tools: Guidewires Material Thickness Stiffness Length Tools: Catheters Material Thickness Stiffness Length Flow rate Tools: Contrast Agents Iodinated Contrast MRI (Gadolinium) Contrast Carbon Dioxide (Gas) Coding Fiesta 2015 David M. Tabriz, MD 3 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Tools: Drainages catheters/tubes Type Material Length/Diameter Tools: Stents Type Material Covered Length/Diameter Confusing… Coding Fiesta 2015 David M. Tabriz, MD 4 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Tools: Angioplasty Balloon Type Pressure Length/Diameter Quick history. 1927 – First angiogram (Egas Moniz) 1964 – First angioplasty (Charles Dotter) “Father of interventional radiology” 1966 – Embolization of tumors 1967 – Coronary angiography (Melvin Judkins) 1969 – First stent deployed 1980 – Biliary interventions 1982 – Interventional Urology 1991 – Abdominal aortic stent grafts “Operating room” Angio suite IR suite Coding Fiesta 2015 David M. Tabriz, MD 5 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 What is an Interventional Radiologist? Like a surgeon taking consultations. Diagnostic radiology interpretations guide procedure (head to toe). Pre-, intra-, and post-procedure care. Wide variety of practices. E.g. Ultrasound guided abscess drainage. Fluoroscopic guided arteriogram and embolization. IR CONTINUUM Image Access Diagnose/Treat Manage IR CONSULT? Coding Fiesta 2015 David M. Tabriz, MD 6 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Common IR Practice Access and Diagnose/Treat (head to toe): Vascular, GI, Urologic, Gynecologic, and Hepatobiliary Trauma Liver Disease Pain management Oncology Cosmetic* Interventional Procedures for Diagnosis Biopsy and Drainage Sentinel IR procedures that started it all. Usually performed by the Body Imaging Service. Coding Fiesta 2015 David M. Tabriz, MD 7 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Sclerotherapy Central Venous Access Common Procedure Dialysis and Central lines Tunneled and Non-tunneled Chronic Catheterization Damage Coding Fiesta 2015 David M. Tabriz, MD 8 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 http://www.scielo.oces.mctes.pt/img/r evistas/nep/v27n1/27n1a08f3.jpg http://interventions.onlinejacc.org/data/Journals /JCIN/22707/10021_gr6.jpeg Coding Fiesta 2015 David M. Tabriz, MD 9 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Coding Fiesta 2015 David M. Tabriz, MD 10 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 IVC filters and Pulmonary Embolism Thrombolysis Inferior vena cava filter barrier that allows blood flow through the IVC, but does not allow large clots Break up large volume clots in symptomatic and unstable patients Coding Fiesta 2015 David M. Tabriz, MD 11 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Coding Fiesta 2015 David M. Tabriz, MD 12 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Nephroureteral Obstruction Relieve mechanical obstruction Ureteral stricture dilation Urinary diversion Stone removal Coding Fiesta 2015 David M. Tabriz, MD 13 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Percutaneous Biliary Intervention Cholangitis Bile duct strictures Pancreaticobiliary malignancy Repair of surgical injury Biliary stones Coding Fiesta 2015 David M. Tabriz, MD 14 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Arterial Injury and Flow Limitation Trauma Post Operative GI bleeding Atherosclerotic disease Vascular compression Anticoagulation related Coding Fiesta 2015 David M. Tabriz, MD 15 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Coding Fiesta 2015 David M. Tabriz, MD 16 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Coding Fiesta 2015 David M. Tabriz, MD 17 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 http://www.fda.gov/ucm/groups/fdagov‐public/documents/image/ucm372843.jpg http://www.fda.gov/ucm/groups/fdagov- public/documents/image/ucm372843.jpg Coding Fiesta 2015 David M. Tabriz, MD 18 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Vascular Malformations Coding Fiesta 2015 David M. Tabriz, MD 19 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Example Case: Vascular Malformation Vascular Malformations Portal Hypertension: Ascites and Variceal Hemorrhage Coding Fiesta 2015 David M. Tabriz, MD 20 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Musculoskeletal and Pain Interventions Coding Fiesta 2015 David M. Tabriz, MD 21 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Why Interventional Oncology? Many patients are medically inoperable Surgical, regional, and systemic salvage Low risk, less expensive, and quick recovery Test of time for potentially under staged patients Synergistic (not an either/or situation) Repeat therapy is well tolerated Palliation EVIDENCE IS GROWING Percutaneous Ablation Radiofrequency Cryoablation Microwave Irreversible Electroporation Coding Fiesta 2015 David M. Tabriz, MD 22 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 StarBurst® Talon Images courtesy of Dr. Matt Callstrom, MD, PhD Coding Fiesta 2015 David M. Tabriz, MD 23 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Coding Fiesta 2015 David M. Tabriz, MD 24 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Endovascular Oncology Transarterial Chemoembolization Drug Eluting Bead Chemoembolization Radioembolization Bland Embolization/Intravascular ethanol Percutaneous Hepatic Perfusion Portal Vein Embolization Bland Embolization Removal of tumor blood supply alone, typically with bland particles Embolization of benign disease for bulk reduction and symptom control (ex. uterine leiomyomata) UFE Coding Fiesta 2015 David M. Tabriz, MD 25 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Drug Eluting Bead Chemoembolization (DEBTACE) Chemotherapeutic agent is adsorbed to flexible particles that impregnate tumor vascular supply Several studies have indicated an overall survival benefit for unresectable HCC as well as reduced liver toxicity and drug related adverse events More permanent and aggressive embolic agent which may make up for less total chemotherapeutic dose Extended antibiotic prophylaxis for incompetent biliary system or severe liver diesease Radioembolization External beam radiation therapy is challenged by the sensitivity of normal liver radiation Hepatic treatmnent dose estimated from 50-70 Gy while the liver tolerance dose is 35 Gy Selective intra-arterial yttrium-90 beta emission enables doses over 120 Gy without liver toxicity Well tolerated, single session, outpatient treatment Coding Fiesta 2015 David M. Tabriz, MD 26 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Multifocal Liver Involvement Radioembolization POINT SOURCE BRACHYTHERAPY WITHIN TARGET ORGAN: EFFECTIVE (3-12 mm margin) Coding Fiesta 2015 David M. Tabriz, MD 27 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Coding Fiesta 2015 David M. Tabriz, MD 28 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 Pre Y-90 (Tc-99m Post Y-90 (Bremsstrahlung) MAA) Cosmetic IR Varicose vein ablations Laser liposuction Coding Fiesta 2015 David M. Tabriz, MD 29 University of Florida College of Medicine Interventional Radiology: what we do. October 17, 2015 What is an Interventional Radiologist? Recap. Like a surgeon taking consultations. Diagnostic radiology interpretations guide procedure (head to toe). Pre-, intra-, and post-procedure care. Wide variety of practices. Questions? [email protected] THANK YOU [email protected] Coding Fiesta 2015 David M. Tabriz, MD 30 University of Florida College of Medicine .
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