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Interventional Procedures

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

Biopsy

Facet block

Myelography

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:

  • About your 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.  Conventional angiography is now a days mostly performed as part of an interventional (intravascular treatment) procedure.
    • These images define the blood vessels and assist us in diagnosing the problem
  • Before your Catheter Angiography

    • 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 respect.
    • 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 to not 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.
  • Let the Radiographer know

    • Women should always inform the radiographer / radiologist if there is any possibility that they are pregnant.
    • Radiation can be harmful to the foetus.  If the procedure is still deemed necessary, precautions will be taken to minimize radiation exposure to the foetus.
  • What to expect

    • 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.
  • How long does it take?

    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.

  • For best results

    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.

  • After your procedure

    Follow 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 catherer entered the skin.  The incision site will be inspected prior to your discharge from hospital. 

Biopsy

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.

Stereotactic Breast

Lumps or abnormalities in the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous.

A stereotactic breast biopsy is performed when a mammogram shows a breast abnormality such as:

  • a suspicious solid mass
  • micro-calcifications (a tiny cluster of small calcium deposits)
  • a distortion in the structure of the breast tissue
  • an area of abnormal tissue change
  • a new mass or area of calcium deposits is present at a previous surgery site.

Stereotactic breast biopsy uses mammography to help pinpoint the spot in the breast that needs to be removed.

Available at:  Panorama

  • Before your biopsy

    • You should not wear deodorant, powder, lotion or perfume under your arms or on your breasts on the day of the exam.
    • Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anaesthesia.  Your physician will advise you to stop taking aspirin or a blood thinner three days before your procedure.
    • Also, inform your doctor about recent illnesses or other medical conditions.
  • Let the Radiographer know

    Women should always inform their physician if there is any possibility that they are pregnant.

  • What to expect

    • You will be awake during your biopsy and should have little or no discomfort.  Most women report little or no pain and no scarring on the breast.
    • Some women find that the major discomfort of the procedure is from lying on their stomach for the length of the procedure, which can be reduced by strategically placed cushions.  Some women may also experience neck and/or back pain as the head is turned to the side when the breast is positioned for the biopsy.
    • When you receive the local anaesthetic to numb the skin, you will feel a slight pin prick from the needle.  You may feel some pressure when the biopsy needle is inserted.
    • The area will become numb within a short time.
    • You must remain still while the biopsy is performed.
    • As tissue samples are taken, you may hear clicks from the sampling instrument.
    • Tissue samples are then removed using one of two methods.
    • After the sampling, the needle will be removed.
    • A final set of images will be taken.
    • A small marker may be placed at the biopsy site so that it can be located in the future if necessary.
    • Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing.  No stitches are needed.
    • A mammogram may be performed to confirm that the marker is in the proper position.
      • With a vacuum-assisted device (VAD), vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, eight to ten samples of tissue are collected from around the lesion.
      • In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with 'cores' of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.
    • After the sampling, the needle will be removed.
    • A final set of images will be taken.
    • A small marker may be placed at the biopsy site so that it can be located in the future if necessary.
    • Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing.  No stitches are needed.
    • A mammogram may be performed to confirm that the marker is in the proper position.
  • After your procedure

    • If you experience swelling and bruising following your biopsy, you may be instructed to take an over-the-counter pain reliever and to use a cold pack.  Temporary bruising is normal.
    • You should contact your referring doctor if you experience excessive swelling, bleeding, drainage, redness or heat in the breast.
    • If a marker is left inside the breast to mark the location of the biopsied lesion, it will cause no pain, disfigurement or harm.
    • You should avoid strenuous activity for 24 hours after the biopsy.  After that period of time, you will usually be able to resume normal activities.

Ultrasound guided biopsy:

Image-guided biopsy is performed by taking samples of an abnormality under some form of guidance such as ultrasound, MRI or mammographic guidance.

In ultrasound-guided breast biopsy, ultrasound imaging is used to help guide the radiologist's instruments to the site of the abnormal growth.

An ultrasound-guided breast biopsy can be performed when a breast ultrasound shows an abnormality such as:

  • a suspicious solid mass
  • a distortion in the structure of the breast tissue
  • an area of abnormal tissue change

Available at:  Panorama, Cape Gate, Louis Leipoldt, Durbanville, Vredenburg, Paarl

  • Before your biopsy

    • Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anaesthesia.  Your physician will advise you to stop taking aspirin or a blood thinner three days before your procedure.
    • Also, inform your doctor about recent illnesses or other medical conditions.
  • What to expect

    • You will be awake during your biopsy and should have little or no discomfort.  Most women report little or no pain and no scarring on the breast.
    • When you receive the local anaesthetic to numb the skin, you will feel a slight pin prick from the needle.  You may feel some pressure when the biopsy needle is inserted.
    • You must remain still while the biopsy is performed.
    • As tissue samples are taken, you may hear clicks from the sampling instrument.
    • After this sampling, the needle will be removed.
  • After your procedure

    • If you experience swelling and bruising following your biopsy, you may be instructed to take an over-the-counter pain reliever and to use a cold pack.  Temporary bruising is normal.
    • You should contact your physician if you experience excessive swelling, bleeding, drainage, redness or heat in the breast.
    • If a marker is left inside the breast to mark the location of the biopsied lesion, it will cause no pain, disfigurement or harm.
    • You should avoid strenuous activity for 24 hours after the biopsy.  After that period of time, you will usually be able to resume normal activities.

Fine needle aspiration biopsy

Nodules or abnormalities in the body are often detected by imaging examinations.  However, it is not always possible to tell from these imaging tests whether a nodule is benign (non-cancerous) or cancerous.

A needle biopsy, also called a needle aspiration, involves removing some cells—in a less invasive procedure involving a hollow needle—from a suspicious area within the body and examining them under a microscope to determine a diagnosis.

Available at:  Panorama, Cape Gate, Louis Leipoldt, Durbanville, Vredenburg, Paarl

  • Before your biopsy

    • Please notify your physician if you are taking any blood thinning medication.
    • Usually, no special preparations are required for this procedure.
  • What to expect

    • Image-guided, minimally invasive procedures such as fine needle aspiration of the thyroid are most often performed by a specially trained radiologist with experience in needle aspirations and ultrasound.
    • In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
    • Samples of the cells are then obtained and put on a slide for review by the pathologist.
  • After your procedure

    • Once the biopsy is complete, pressure will be applied to the area to decrease the risk of bleeding.  A bandage may be placed if necessary.
    • Aftercare instructions vary, but generally you can resume normal activities and any bandage can be removed within a few hours.
    • The biopsy site may be sore and tender for one to two days.
    • You may take non-prescription pain medicine to relieve any discomfort.

Facet Block

A Facet Block is an anaesthetic or anti-inflammatory injection targeted toward a certain nerve or group of nerves to treat pain.  The purpose of the injection is to "turn off" a pain signal coming from a specific location in the body or to decrease inflammation in that area.

People who suffer from either acute or chronic pain might have a Facet Block injection to achieve temporary pain relief.  Often, such pain originates from the spine, but other areas commonly affected include the neck, buttocks, legs and arms.  Delivering a Facet block injection allows a damaged nerve time to heal itself from a state of constant irritation.  Additionally, Facet blocks can provide diagnostic information to the doctor.  By performing a Facet block and then monitoring how the patient responds to the injection, the doctor can often use this information to help determine the cause or source of the pain.

Imaging guidance, such as fluoroscopy or computed tomography (CT or "CAT" scan), may be used to help the doctor place the needle in exactly the right location so that the patient can receive maximum benefit from the injection.

Available at:  Panorama, Louis Leipoldt, Durbanville, Cape Gate, Vredenburg, Paarl

  • Before your Facet Block

    • Usually, no special preparation is required prior to arrival.
    • 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 radiologist easy access to the injection site(s).  The radiographer will help to make you as comfortable as possible, both during and after the procedure.
  • What to expect

    • The injection itself will be administered with a syringe much like one that would be used for a routine vaccination.
    • The doctor will fill the syringe from a small vial of medication.  The type of medication used depends on individual patient needs.
    • The medication delivered by the injection will be placed as close to the nerve causing the pain as possible.  It will then "shut down" the pain receptors within the nerve(s) causing the problem.  Imaging can help the radiologist place the needle in exactly the right spot.  The imaging itself is painless.
    • The effects of the injection are usually immediate.  It only takes a short time for the medication to achieve pain relief.
    • However, facet blocks are only a temporary fix—they typically last for up to one or two weeks and then wear off as they are absorbed by your body.
    • Some patients undergo several rounds of facet blocks before they feel a more permanent sense of relief.
    • Others may not receive any permanent pain relief from this type of injection and may require different treatment methods to manage the pain or inflammation.
  • How does the procedure work?

    When finished, you will be allowed to rest for 15 to 30 minutes to let the medication take effect.  You will be monitored to ensure you don't have any unexpected side effects before you leave the doctor's office.

Myelography

Myelography is an imaging examination that involves the introduction of a spinal needle into the spinal canal and the injection of contrast material in the space around the spinal cord and nerve roots (the subarachnoid space) using a real-time form of X-ray called fluoroscopy. Followed by a CT examination. Myelography (Myelogram) is a diagnostic examination of the spine. A special X-ray sensitive contrast dye is injected to illuminate the spine, allowing identification of problems within the spine, spinal cord and nerve roots.

Available at:  Panorama, Cape Gate, Louis Leipoldt, Durbanville, Vredenburg, Paarl

Lumbar Myelography

  • Patient will be admitted as a day patient
  • After the examination: patient must lie on their back for 4-6 hours with the head slightly elevated
  • About your Myelography

    • Myelography is the injection of a contrast agent, visible on X-ray images, into the fluid that is contained in the dural sack in spinal canal.
    • The nerves in the bony canal, inside spine, are bathed in this fluid, known as cerebro-spinal fluid.
    • The bony canal protects the nerves, but also means that limited space is available.
    • If a disc herniated into the canal or a growth forms in the canal, the nerves become compressed which causes significant pain or even loss of function of the legs or arms.
    • A myelogram assists us in determining the type and level of pathology that is causing the nerve compression.
    • The procedure is similar to a lumbar puncture.  X-ray imaging is captured during the procedure and these are often followed by a CT scan of the levels where pathology is detected.
    • The CT provides detailed three-dimensional anatomical information of the pathology.  In current modern medical practice the need for myelography has been replaced, in the vast majority of cases with MR scanning.
    • Myelography is nowadays reserved for people who cannot undergo MR scanning and for certain specialised cases.
  • Before your Myelography

    You will be admitted to hospital for the day.

    Allow at least 15 minutes before your study to check in at the radiology reception desk and 1 hour before at the hospital reception desk.

    You will be asked to put on a gown.  You will be asked to remove your watch, jewellery, cellphone, all metal objects including your purse and credit cards, but it is best to bring only the bare essentials with you.  These items will be locked for safe-keeping.

  • During your Myelography

    • You will receive a sedative before the start of the procedure.
    • You will be asked to lie on your side or sit up on a fluoroscopy (screening) table at the beginning of the study.
    • The study is performed under sterilised conditions.
    • Your back will be cleaned with a sterilising agent and the puncture site will be injected with a local anaesthetic.
    • The puncture is then performed under x-ray screening control to ensure accurate placement.
    • A small amount of spinal fluid will be taken off before the contrast agent is injected.
    • The needle is removed after the injection.  We then proceed to capture the necessary X-ray images.
    • During this phase of the procedure it is of the utmost importance that you co-operate fully and follow instructions accurately, to ensure a successful study.
    • We need to place you in various positions, to obtain the correct X-rays, and need your full co-operation to achieve this.  Once the study is completed, you will be moved onto a bed.
    • You need to stay flat, with the head of the bed raised, for the next four hours.
  • Let the Radiographer know

    • For the success of the procedure and for your safety, tell the radiographer:
    • If you are pregnant or suspect you may not be able to have the myelogam for other reasons.
    • If you had previous X-rays of your spine, please bring these with you.  Comparing previous X-rays to current ones assists in more accurate diagnosis.
  • After Myelography

    • Myelography is often combined with CT scanning of the area of interest.  This will be the next step.  It is usually done an hour or so after the myelogram.
    • Once the study and/or CT scan is completed you will be admitted to a hospital bed for at least four to six more hours.
    • During this time you have to stay flat with your head raised.  You may experience mild headache and some people feel some nausea.
    • Staying flat with your head raised lessens the risk of these side effects.
    • Darkening the room also helps to treat any headache that might occur.  Painkillers and anti-nausea medication will be prescribed if you need any.  Our nursing sister or Radiologist will discharge you after 4 to 6 hours.
    • 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.
    • For best results stay at rest at home for the remainder of the day and night.
  • Myelography Tips

    • Come to the hospital prepared with what you will need for a short admission.
    • Enquire from your doctor about the continuation of any medication that you are taking.
    • Many medical aids will not fund an overnight stay after myelography.
    • It is therefore best that you ensure your appointment is in the morning, so that we will be able to discharge you on the same day.

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