interventional radiography (IR)
Interventional radiography is the use of imaging to highlight a specific body system for diagnosis and treatment. The procedures are minimally invasive and are an alternative to surgery; generally, interventional procedures involve less risk, pain, recovery time and expense. IR includes the following procedures: kyphoplasty, vertebroplasty and steroid injections. Intravascular procedures include uterine fibroid embolization, stroke intervention, venous access and angioplasty/stenting. This specialty also includes needle-directed biopsies, embolization of arteries to control bleeding or treat malignancies, and radio frequency ablation (RFA) of tumors. Interventional radiography is a rapidly growing area of medicine.
- Uterine Fibroid Embolization (UFE): Fibroids are common benign tumors of the uterus that affect up to 40% of women over the age of 30. Although the majority of women may not know that they have fibroids, many women may suffer from a variety of symptoms including heavy menses (menorrhagia), heavy and frequent menses (menometrorrhagia), pelvic pain, frequent urination or painful intercourse (dyspareunia). UFE is a minimally invasive treatment that may avert the need for surgical hysterectomy.
UFE treatment is performed by an interventional radiologist using catheters and embolic material under fluoroscopic guidance. Via a small incision in the inguinal region, a catheter is used to select the uterine arteries which supply the fibroids. Small embolic particles are then delivered to cut off the blood supply to the fibroids while retaining the viability of the uterus. UFE is performed at the hospital under conscious sedation. Recovery is relatively short and some patients may be admitted overnight for observation and discharged the next morning. UFE procedures are safe and provide excellent results for relieving heavy menses and/or pelvic pain.
Contrast-enhanced MRI pelvic exams are performed before and after UFE. Typically the treated fibroid should significantly decrease in size after three months.
- Y-90 is an interventional procedure that uses yttrium-90 radioembolization to treat liver cancer. Studies show that treating liver tumors with doses of Y-90 is safe, provides results when chemotherapies have failed, preserves the patient's quality of life, and can be done on an outpatient basis. The treatment combines the radioactive isotope Y-90 into microspheres (small beads about the width of five red blood cells) that deliver radiation directly to a tumor. The microspheres are injected through a catheter from the groin, and the beads become lodged within the tumor vessels where they cause the cell to die. This technique allows for a higher, local dose of radiation, with no danger from radiation to the healthy tissue in the body.
- Kyphoplasty: Over 700,000 new cases of vertebral compression fractures (VCF) occur each year, typically affecting elderly men and women with osteoporosis. Younger patients may also suffer from VCF due to fragile bones from chronic steroid use. For many elderly, VCF typically means debilitating constant pain, reduced mobility, narcotic pharmacotherapy and reduced quality of life. Although surgical options exist, spinal surgery is invasive, difficult and risky and therefore is not typically applicable, except as a last option.
Kyphoplasty is a relatively new treatment available for painful compression fractures. Using fluoroscopic guidance, an interventional radiologist first expands the vertebral body with a balloon, and then delivers a bone cement mixture (PMMA) into the broken vertebra percutaneously without a surgical incision. Kyphoplasty is an outpatient procedure and often performed in under one hour. Typically, pain is resolved within a few days, allowing patients to return to daily activities.
- Vertebroplasty is also a procedure to repair spine fractures typically caused by osteoporosis. The procedure involves placing a small needle into the fractured bone. Bone cement is injected into the bone to secure it. Several fractures can be treated at the same time. The interventional radiologist guides the needle into position using fluoroscopic equipment, thus avoiding open surgery. The procedure takes about one hour and is usually done using only numbing medication. Vertebroplasty is safe and patients can usually leave the hospital a few hours after the procedure is completed. The bone cement used to secure the broken bone is safe. Patients with tumors on the spine may be at slightly higher risk of complications.
Preparing for an Interventional Procedure
You should inform your physician of any medications you are taking and if you have any allergies, especially to contrast material. Depending on the severity of a contrast allergy, medication can be administered to mitigate a reaction. Also, inform your physician about recent illnesses or other medical conditions.
You may be asked to remove some or all of your clothes and wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the X-ray images.
Women should always inform their physician or X-ray technologist if there is any possibility that they are pregnant or if they are nursing.
If you are going to be given a sedative during the procedure, you may be asked not to eat or drink anything for four to six hours before your exam. If you are sedated, you should not drive for 24 hours after having your exam and should arrange for someone to drive you home. Because an observation period is necessary following the exam, you may be admitted to the hospital for an overnight stay if you live more than an hour away.