How interventional radiology supports patient outcomes and care
Traditionally, radiology was known as a modality only concerned with diagnoses. Interventional radiology changed this. Since American radiologist Charles Dotter first used a guidewire and catheter to perform a through-the-skin procedure in 1964, radiologists have become actively involved in interventions.
Today, minimally invasive procedures are routinely performed in radiology departments, ranging from marker placements, biopsies, and embolisation to joint injections and nerve blocks.
In many cases, says SCP radiologist Dr Arthur Winter, these procedures provide patients with treatment options that significantly impact them for the better, minimising disruption of their daily lives or helping them regain a degree of comfort.
โTake uterine fibroid embolisation (UFE) and nerve blocks as examples,โ he says. โThey are vastly different in their purpose and technique but equally striking examples of treatment options that are minimally invasive and bring patients significant relief. And both became more widely available, including in radiology practices, with the development of sophisticated medical imaging.โ
Dr Winter is well experienced in both and explains:
Nerve blocks as pain management
Simply put, interventional radiologists can use precisely targeted injections to intervene in the bodyโs perception of pain. This is of particular benefit to patients suffering from chronic pain. โThese patients often use high doses of opioid painkillers that may cause nausea, constipation, anorexia and addiction. Other painkillers may also irritate the stomach lining and cause kidney problems,โ says Dr Winter.
The alternative that interventional pain management offers, targets very specific nerves or nerve groups.
โMost of these interventions prevent nerve impulses or pain signals from being transmitted, using long-acting local anaesthetics. The effect is usually temporary, but the addition of cortisone โ or steroids โ often brings longer-lasting relief. In some cases, it could be appropriate to follow the temporary block with neurolysis, which is a permanent disruption or destruction of the target nerves.
โThanks to the availability of specialised imaging equipment, radiologists now have the tools and skill to do procedures under sophisticated image guidance. With CT guidance, some procedures can be performed with great accuracy while avoiding blood vessels and non-target organs. A lower dose of medication is also needed if the needle is placed accurately next to the target nerves. It is therefore not surprising that this is increasingly becoming a responsibility of interventional radiologists.โ
Dr Winter says poor quality of life and depression are often seen in patients with underlying cancer and little relief from chronic pain. โIt is especially these patients who should be considered for interventions. There are, for example, very effective procedures to manage pain caused by pancreatic and pelvic cancers.
โSpecialists like oncologists and neurologists recognise the value of interventional radiology in pain management and work with us closely to support their patients. It is a growing branch of radiology that offers a minimally invasive solution, and itโs quite rewarding to see patients regain some quality of life.โ
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Uterine fibroid embolisation as alternative to surgery
UFE, or uterine artery embolisation (UAE) as it is also known, works by blocking the blood flow to fibroids (non-cancerous growths) in the uterus, causing them to shrink and alleviate symptoms such as heavy bleeding, pelvic pain, and pressure.
During the procedure, a catheter is guided into the blood vessels through a small incision in the skin. Tiny particles are then injected through the catheter to block the blood supply to the fibroids while leaving the uterus and other surrounding tissues intact. The procedure does require hospitalisation but most patients are only kept overnight for pain management. Most patients can also return to their normal daily activities after a week or two.
โWomen with symptomatic fibroids are usually referred for UFE by their gynaecologists after more conservative treatment such as hormonal therapy was ineffective,” says Dr Winter. “Women who would previously be considered for surgical removal of the fibroids, or even hysterectomy, now have an option that not only has a much quicker recovery time but also keeps the uterus intact.
โOf course, not all patients are eligible for UFE, but one can imagine the impact on those who are eligible and can avoid hysterectomy and its associated risks.โ
From diagnostic to treatment interventions
โThere are many more examples of how interventional radiologists are increasingly playing a role in patient care,โ says Dr Winter. โNot all of them are as striking as the above examples but all of them have a specific role to play in support of our referring clinicians and their patients.
โThe scope of our work includes procedures that are in the diagnostic space, just like our imaging services are, but we also perform various treatment interventions at SCP and we invite our referring clinicians to speak to us about how we can support them as well as the patients in their care.โ
For a selection of available interventional services, refer to the table below.
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โข This article is intended to create awareness and none of the information it contains should replace the need for seeking personal advice from a qualified medical practitioner.
โข Apart from selected screening examinations, all radiology procedures are performed upon referral from a qualified medical professional.