Interventional procedures involve the treatment of a variety of conditions in a minimally invasive manner. The best known of these procedures is the dilatation or placing of a stent (coil) in a narrowed artery, to re-establish good circulation. For example, narrowed arteries of the legs that are causing pain in the legs upon exercise or walking, can potentially be treated this way.
Angiography
Angiography is a common interventional radiology procedure that can help doctors diagnose blockages, bleeding or other disorders in blood vessels throughout the body. During an angiogram, the radiologist inserts a tiny catheter into a blood vessel using a minute puncture in your skin, then injects a dye to make the blood vessels visible during a special type of X-ray called fluoroscopy.
Catheter angiography
- Catheter angiography is a minimally invasive imaging test that helps physicians to diagnose diseases and disorders of the blood vessels in various parts of the body. The procedure involves inserting a thin plastic tube called a catheter into an artery through a small incision in the skin.
- The incision is usually in the groin or arm, and the procedure is performed under local anaesthetic.
- Once the catheter is guided to the area being examined, a liquid contrast material is injected through the catheter and X-ray images are captured.
- This produces superb images of the arteries and veins. Nowadays, conventional angiography is mostly performed as part of an interventional (intravascular treatment) procedure.
- These images define the blood vessels and assist us in diagnosing the problem
- Inform us of all your medical illnesses and any medication you are taking.
- Also inform us about your allergies, especially if you are allergic to iodine or contrast material.
- Inform us if you are breastfeeding, prior to the procedure. You may be advised to express breast milk prior to the procedure for use whilst your body is clearing the contrast material. Your doctor will advise you in this regard.
- A blood sample will be drawn before the procedure to ensure that your kidneys are working normally and that your blood will clot normally.
- If a sedative is to be used during the procedure, you may be required not to eat or drink anything for up to eight hours prior to your procedure.
- You will be requested to remove your clothing and to wear a gown during the procedure.
- You may be asked to remove jewellery, spectacles and any metal objects that might interfere with the X-ray images.
- Women should always inform the radiographer and/or radiologist if there is any possibility that they might be pregnant.
- Radiation can be harmful to the foetus. If the procedure is still deemed necessary, precautions will be taken to minimise radiation exposure to the foetus.
- You will be asked to empty your bladder immediately before the procedure.
- An intravenous line will be set up.
- You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line.
- The incision site in the groin or arm where the catheter is to be inserted will be shaved and cleaned.
- A local anaesthetic will then be injected in this area. This may cause a stinging sensation initially, but it will pass and you will not experience pain during the procedure.
- The radiologist will then make a small incision in the skin where the catheter can be inserted into an artery.
- The catheter is then introduced and guided to the area to be examined. You will not feel the catheter in your artery, but as the contrast material is injected, you may experience a warm or burning sensation.
- This is a transient sensation and disappears quite rapidly.
- While the contrast material is injected through the catheter into blood vessels being studied, several sets of X-rays are taken.
- You will be asked to remain very still during this period, either with or without holding your breath, as it assists to obtain images of high quality. Various sets of such images may be required.
A catheter angiogram usually takes less than an hour to perform but in certain, more complicated cases, the procedure may take considerably longer.
Once the required images are obtained, the catheter is removed and the incision site is closed by compressing the area for approximately 10 minutes. Your intravenous line will be removed.
Follow the instructions provided by the radiologist, especially with respect to your breathing and remaining motionless for short periods of time to enable the capture of high-quality images.
Following the procedure, you will be required to remain in hospital (overnight stay) for a period of observation. During this time, you should inform the nurse if you notice any bleeding, swelling or pain at the site where the catheter entered the skin. The incision site will be inspected prior to your discharge from hospital.
Biopsy
A biopsy is a procedure to remove a piece of tissue or a sample of cells from a patient’s body so that it can be analysed in a laboratory.
- In fine-needle aspiration (FNA), a small gauge needle is used to remove cells or fluid from the area of concern using mammographic ultrasound or CT guidance. The samples are placed on slides and interpreted by a cytologist or pathologist under a microscope.
- A core biopsy is the process whereby several small cylindrical samples (cores) of breast tissue are removed from the area of concern found on a mammogram or ultrasound, using an appropriate gauge needle. The tissue samples are then sent to a pathologist for evaluation.
What are the different types of core biopsy procedures?
- Ultrasound-guided spring-loaded core biopsy: The abnormality is best seen on ultrasound. A spring-loaded biopsy needle is used to perform the biopsy under ultrasound guidance.
- Ultrasound-guided vacuum-assisted biopsy: The abnormality is best seen on ultrasound. A vacuum-assisted needle/device is used to perform the biopsy under ultrasound guidance.
- Stereotactic/tomosynthesis-guided vacuum-assisted biopsy: The abnormality is best seen on mammogram or tomosynthesis. A vacuum-assisted needle/device is used to perform the biopsy under mammographic or tomosynthesis guidance.
Fine needle aspiration
- You may eat and drink before the procedure.
- You must sign a consent form before the procedure.
- We recommend that you have someone drive you home after the procedure.
- Stop taking aspirin and ibuprofen products at least 7 days before the procedure.
- Stop taking anticoagulants/blood thinners at least 3-5 days before the procedure.
- Consult with your doctor before stopping any medications.
Please inform the radiologist or mammographer if:
- You have a bleeding tendency or history of bleeding problems.
- You are taking prescribed anticoagulants/blood thinners (Warfarin, etc.).
- You take anti-inflammatories (e.g., NSAIDs).
- You are allergic to local anaesthetic, latex, dressings and pain medication.
- You take herbal products (e.g., Vitamin E, Ginkgo Biloba, Glucosamine Sulphate, etc.).
- You regularly take products that contain aspirin or ibuprofen.
- The procedure should take approximately one to one and a half hours, including the aftercare. However, please note that biopsies are individualised and therefore allow for extra time, should your biopsy require more time.
- The performing radiologist will decide which modality-guided biopsy is most appropriate.
- You will sign a consent form prior to the procedure.
For the fine needle aspiration (FNA):
- You will lie on your back during the procedure.
- You will be awake during your FNA and should have little or no discomfort. Most patients report little or no pain.
- The area to be biopsied will be reviewed with ultrasound (or chosen modality) before the procedure.
- Cool antiseptic solution will be used to clean your skin.
- Local anaesthetic will be injected to anaesthetise the area of concern. This may sting for a few seconds followed by a numb feeling. Nothing will be administered to make you sleepy or drowsy.
- The performing radiologist will place a very small gauge needle into the abnormality.
- You may feel pressure as the needle is being placed; however, no pain.
- The number of samples that will be taken will depend on the size and location of the abnormality.
- After the sample has been taken, it will be placed on slides for the technologist (usually on site) to evaluate.
- You will be observed for approximately 20 minutes after the procedure.
- The biopsy site will be covered by gauze and waterproof dressing. The dressing can be taken off after 72 hours.
- Wear a bra for the first 24 hours post-procedure (a sports bra is preferable).
- An ice pack can be placed inside your bra, over the biopsy site during the first 24 hours. This will help decrease discomfort, swelling and bruising. Always make sure there is a layer between the skin and ice pack and alternate the ice pack on/off every 20 minutes. Do not leave the ice pack on for more than 20 minutes at a time.
- If bleeding occurs, apply pressure to the area manually. A pressure bandage can also be used.
- You may take paracetamol for any discomfort for the first 24 to 48 hours post-biopsy, if necessary.
- Do not take pain relief containing aspirin/ibuprofen for at least 48hours post-procedure.
- Relax for the rest of the day after your procedure. Avoid heavy lifting or strenuous exercise (jogging) for 3 days.
You may have some discomfort and a small amount of bruising post-biopsy but call your doctor or contact the radiology department during office hours if:
- There is excessive and continued bleeding, swelling and bruising of your breast.
- You experience pain that is not relieved with paracetamol or ice packs.
- There are signs of infection (heat, redness, swelling or discharge) at the biopsy site, usually 7 to 10 days post-procedure.
- You experience chills or fever.
If you cannot reach your doctor, go to the hospital emergency department.
- The biopsy results will go directly to your referring doctor within one week but usually sooner. Please make an appointment with your referring doctor to go over your results.
- A six-month follow-up imaging post-biopsy is usually recommended, unless otherwise advised by the referring doctor or performing radiologist.
Available at: Cape Gate, Durbanville, Louis Leipoldt, Paarl, Panorama, Tygervalley, Vredenburg
Ultrasound-guided core biopsy
- You may eat and drink before the procedure.
- You must sign a consent form before the procedure.
- We recommend that you have someone drive you home after the procedure.
- Stop taking aspirin and ibuprofen products at least 7 days before the procedure.
- Stop taking anticoagulants/blood thinners at least 3-5 days before the procedure.
- Consult with your doctor before stopping any medications.
Please inform the radiologist or mammographer if:
- You have a bleeding tendency or history of bleeding problems.
- You are taking prescribed anticoagulants/blood thinners (Warfarin, etc.).
- You take anti-inflammatories (e.g., NSAIDs).
- You are allergic to local anaesthetic, latex, dressings and pain medication.
- You take herbal products (e.g., Vitamin E, Ginkgo Biloba, Glucosamine Sulphate, etc.).
- You regularly take products that contain aspirin or ibuprofen.
- The procedure should take approximately one to one and a half hours, including the after care. However please note that biopsies are individualised and therefore allow for extra time, should your biopsy require more time.
- The performing Radiologist will decide which modality guided biopsy is most appropriate.
- You will sign a consent form prior to the procedure.
For the ultrasound-guided core biopsy:
- You will lie on your back during the procedure.
- You will be awake during your biopsy and should have little or no discomfort. Most patients report little or no pain.
- The area to be biopsied will be reviewed with ultrasound before the procedure.
- Cool antiseptic solution will be used to clean your skin.
- Local anaesthetic will be injected to anaesthetise the area of concern. This may sting for a few seconds followed by a numb feeling. Nothing will be administered to make you sleepy or drowsy.
- The performing radiologist will place the spring-loaded or vacuum-assisted biopsy needle into your breast using ultrasound guidance.
- You may feel pressure as the needle is being placed; however, no pain.
- You will hear a "click" sound when the biopsy sample is taken using a spring-loaded needle or a "suction" sound when the biopsy sample is taken using a vacuum-assisted device.
- The number of samples that will be taken will depend on the size and location of the abnormality as well as the type of needle being used for the procedure.
- After the sample has been taken, a marker will be placed at the site of biopsy and left inside your breast. This is a tiny metal object that is completely safe to remain in the breast.
- Pressure and an ice pack will be applied over the biopsied area after the biopsy is done and you will be observed for approximately 30 minutes after the procedure.
- The biopsy site will be covered by gauze and waterproof dressing. The dressing can be taken off after 72 hours.
- Wear a bra for the first 24 hours post-procedure (a sports bra is preferable).
- An ice pack can be placed inside your bra, over the biopsy site during the first 24 hours. This will help decrease discomfort, swelling and bruising. Always make sure there is a layer between the skin and ice pack and alternate the ice pack on/off every 20 minutes. Do not leave the ice pack on for more than 20 minutes at a time.
- If bleeding occurs, apply pressure to the area manually. A pressure bandage can also be used.
- You may take paracetamol for any discomfort for the first 24 to 48 hours post-biopsy, if necessary.
- Do not take pain relief containing aspirin/ibuprofen for at least 48hours post-procedure.
- Relax for the rest of the day after your procedure. Avoid heavy lifting or strenuous exercise (jogging) for 3 days.
You may have some discomfort and a small amount of bruising post-biopsy but call your doctor or contact the radiology department during office hours if:
- There is excessive and continued bleeding, swelling and bruising of your breast.
- You experience pain that is not relieved with paracetamol or ice packs.
- There are signs of infection (heat, redness, swelling or discharge) at the biopsy site, usually 7 to 10 days post-procedure.
- You experience chills or fever.
If you cannot reach your doctor, go to the hospital emergency department.
- The biopsy results will go directly to your referring doctor within one week but usually sooner. Please make an appointment with your referring doctor to go over your results.
- A six-month follow-up imaging post-biopsy is usually recommended, unless otherwise advised by the referring doctor or performing radiologist.
Available at: Cape Gate, Durbanville, Louis Leipoldt, Paarl, Panorama, Tygervalley, Vredenburg (ultrasound-guided core biopsy)
Available at: Panorama, Durbanville (ultrasound-guided vacuum-assisted biopsy)
Stereotactic/tomosynthesis-guided core biopsy
- You may eat and drink before the procedure.
- You must sign a consent form before the procedure.
- We recommend that you have someone drive you home after the procedure.
- Stop taking aspirin and ibuprofen products at least 7 days before the procedure.
- Stop taking anticoagulants/blood thinners at least 3-5 days before the procedure.
- Consult with your doctor before stopping any medications.
Please inform the radiologist or mammographer if:
- You have a bleeding tendency or history of bleeding problems.
- You are taking prescribed anticoagulants/blood thinners (Warfarin, etc.).
- You take anti-inflammatories (e.g., NSAIDs).
- You are allergic to local anaesthetic, latex, dressings and pain medication.
- You take herbal products (e.g., Vitamin E, Ginkgo Biloba, Glucosamine Sulphate, etc.).
- You regularly take products that contain aspirin or ibuprofen.
- The procedure should take approximately one to one and a half hours, including the after care. However please note that biopsies are individualised and therefore allow for extra time, should your biopsy require more time.
- The performing Radiologist will decide which modality guided biopsy is most appropriate.
- You will sign a consent form prior to the procedure.
For the stereotactic (mammographic)/tomosynthesis-guided core biopsy:
- You will be seated or lie down on your side and your breast will be compressed as for a regular mammogram.
The mammographers will do all that they can to help make you feel comfortable. - Images will be taken of your breast. These images will be reviewed by the performing radiologist prior to the procedure to ensure the correct position.
- Cool antiseptic solution will be used to clean your skin.
- Local anaesthetic will be injected to anaesthetise the area of concern. This may sting for a few seconds followed by a numb feeling. Nothing will be administered to make you sleepy or drowsy.
- The performing radiologist will place the vacuum-assisted biopsy needle into your breast under stereotactic (mammographic) or tomosynthesis guidance.
- You may feel pressure; however, no pain as the needle is being placed.
- You will hear a "suction" sound when the biopsy samples are being taken using a vacuum-assisted device.
- The number of samples that will be taken will depend on the size and location of the abnormality.
- After the samples have been taken, a marker will be placed at the site of biopsy and left inside your breast. This is a tiny metal object that is completely safe to remain in the breast.
- Pressure and an ice pack will be applied over the biopsied area and you will be observed for approximately 30 minutes after the procedure.
- A post-procedure X-ray of the sample will be taken.
- A very light-pressure post-biopsy mammogram will be performed after the biopsy to assess the biopsy site and marker placement.
- The biopsy site will be covered by gauze and waterproof dressing. The dressing can be taken off after 72 hours.
- Wear a bra for the first 24 hours post-procedure (a sports bra is preferable).
- An ice pack can be placed inside your bra, over the biopsy site during the first 24 hours. This will help decrease discomfort, swelling and bruising. Always make sure there is a layer between the skin and ice pack and alternate the ice pack on/off every 20 minutes. Do not leave the ice pack on for more than 20 minutes at a time.
- If bleeding occurs, apply pressure to the area manually. A pressure bandage can also be used.
- You may take paracetamol for any discomfort for the first 24 to 48 hours post-biopsy, if necessary.
- Do not take pain relief containing aspirin/ibuprofen for at least 48hours post-procedure.
- Relax for the rest of the day after your procedure. Avoid heavy lifting or strenuous exercise (jogging) for 3 days.
You may have some discomfort and a small amount of bruising post-biopsy but call your doctor or contact the radiology department during office hours if:
- There is excessive and continued bleeding, swelling and bruising of your breast.
- You experience pain that is not relieved with paracetamol or ice packs.
- There are signs of infection (heat, redness, swelling or discharge) at the biopsy site, usually 7 to 10 days post-procedure.
- You experience chills or fever.
If you cannot reach your doctor, go to the hospital emergency department.
- The biopsy results will go directly to your referring doctor within one week but usually sooner. Please make an appointment with your referring doctor to go over your results.
- A six-month follow-up imaging post-biopsy is usually recommended, unless otherwise advised by the referring doctor or performing radiologist.
Available at: Panorama, Durbanville
Facet block
A facet block involves injection of the facet joints which are on each side of and connect the vertebrae. This is usually performed in the lower back but occasionally also in the neck.
A facet block provides pain relief but may also be used to distinguish between back pain originating from the facet joints vs other causes such as a pinched nerve.
The procedure is performed under imaging guidance, either with CT or dynamic real-time X-rays (fluoroscopy).
- Allow at least 15 minutes before your study to check in at the radiology reception desk. Please also arrange for somebody to drive you home after the procedure.
- Inform our staff of any allergies and if you suspect that you may be pregnant.
- You will be asked to put on a gown and to remove all metal objects like jewellery.
- You will probably be asked to use the restroom before the procedure.
- You will then be positioned on your stomach or side on a special fluoroscopic or CT table that will give radiologists easy access to the injection site(s). The radiographer will help to make you as comfortable as possible, both during and after the procedure.
- The procedure is performed by a radiologist, assisted by a radiographer and/or a nurse.
- The skin over the lower back (or neck) is cleaned and draped.
- Local anaesthetic may be administered in the skin.
- It may be necessary for the table to move in and out of the CT “tunnel” as the radiologist adjusts the needle position.
- Using CT images or fluoroscopy guidance, a needle is placed with the tip in or immediately adjacent to the facet joint. Severely degenerative facets may not be directly accessible.
- A small volume (1 - 2 ml) mixture of local anaesthetic and steroids is injected into or around each facet joint. This may be uncomfortable due to distention of the joint capsule.
- Following the injection, you may have temporary numbness or weakness of your extremities lasting up to 6 hours. Sometimes it may be difficult to walk due to a lack of sensation in your foot and for this reason you should not drive immediately after the procedure. As this subsides, some patients report increased discomfort. This can be related to irritation from the steroid and will resolve.
- You should begin to notice pain relief from the facet injection after 2 to 3 days.
- Some patients do not experience significant pain relief after a facet block and may require different treatment methods to manage the pain or inflammation.
- Note that facet blocks are only a temporary fix. At most, they last for two to three months and may be repeated up to three times per year.
Available at: Panorama, Cape Gate, Louis Leipoldt, Durbanville, Vredenburg, Paarl, Worcester
Myelography
A myelogram is a diagnostic imaging examination used to evaluate diseases of the spine and spinal cord. It involves a lumbar puncture and the injection of contrast material (dye) into the spinal canal, around the spinal cord and nerve roots. This is usually followed by a CT (CT myelography) or occasionally MR (MR myelography).
MR and CT myelography are diagnostic examinations of the spine which are now rarely performed due to the high-quality images produced by conventional MR imaging. However, it is still used in patients who cannot undergo MR imaging, including patients with certain pacemakers or medical implants.
Myelography, with or without CT/MR imaging, is also used to find the site of spinal fluid leakage when this is suspected clinically, or on brain imaging.
Lumbar myelography
- It is recommended that a myelogram be performed as a day admission as you should ideally lie flat for up to four hours afterwards.
- Inform our staff of any allergies and if you suspect you may be pregnant.
- You will be asked to put on a gown and to remove all metal objects like jewellery.
- Depending on your specific circumstances, you may be asked to lie on your side or stomach or sit up on a fluoroscopy (screening) table at the beginning of the study.
- The skin over the lower back will be cleaned and local anaesthesia may be injected.
- A long, thin spinal needle is positioned under X-ray guidance with the tip of the needle in the spinal canal.
- A small amount of spinal fluid will be drained after which approximately 10 ml contrast agent will be injected.
- The needle is removed after the injection.
- We may place you in various positions to ensure that the contrast is sufficiently distributed in the spinal canal.
- Afterwards you are transferred by bed to the CT/MR room for your scan. Depending on the specific indication, there may be up to an hour delay between the myelogram injection and scan in order for the contrast to sufficiently distribute.
- It is recommended that you remain flat, with the head of the bed raised, for the next four hours.
- You should refrain from strenuous physical activity and from bending over for two days.
- You may experience mild headache and some people feel some nausea. Staying flat with your head raised lessens the risk of these side effects.
- You will not be allowed to drive home. Please arrange for someone to take you home. You may not go back to work on the same day.
- You should contact your referring doctor should you experience prolonged or severe headaches, especially if worse when upright. This may indicate leakage of spinal fluid from the puncture site which is the most common complication of a lumbar puncture.
Available at: Panorama, Cape Gate, Louis Leipoldt, Durbanville, Vredenburg, Paarl, Worcester
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SCP’s services are offered at medical aid rates.