What is Interventional Radiology?

Interventional radiologists are physicians who specialize in minimally invasive,

targeted diagnosis and treatments. They offer the most in-depth knowledge of

disease processes using least invasive methods of advanced diagnosis in complex

ailments and treatments via pin-hole accesses. To provide such advanced

management options, they require strong diagnostic and clinical experience across

several fields of medicine in all age groups. As the inventors of angioplasty and the

catheter-delivered stent, which were first used in the legs to treat peripheral

arterial disease, interventional radiologists’ pioneered minimally invasive modern

medicine. They use X-rays, MRI, CAT/CT, ultrasound and other imaging to

advance a catheter in the body to treat diseases at their source. Catheters are long

tiny plastic tubes which are advanced over a wire into the target organ via a pin

hole in the skin. Externally, there is no more than a tiny scar at the pin hole

marking the site of access. However, based on the organ at a distant to be treated,

the catheter is advanced using x-rays as road map. Using tactile sensations felt by

the radiologists at the skin site, the catheter tip is manipulated within the distant

organ. To map the blood vessels, x-ray dye is injected and images of the blood

vessels and blood flow is studied. Similarly, other structures like bile ducts within

liver, urine collecting system within the kidneys and other similar structures are

studied. This unique way of selectively studying certain structures within organs

deep inside the body using a pin-hole in the skin, provides unique exquisite

information on diseases that is not possible with other modalities. This method also

provides unique ways of treating localized diseases within these organs via the

same pin-hole.

For many years, surgery was the only treatment available for many conditions.

The landscape of medicine is constantly changing, and for the past 40 years,

interventional radiologists have been responsible for much of the medical

innovation and development of the minimally invasive procedures that are

commonplace today. The advances in this field has expanded the list of numerous

diseases that once required surgery but can now be treated less invasively by

interventional radiologists. Interventional radiology treatments thus offer less risk,

less pain and less recovery time compared to open surgery and in most

circumstances, with less cost. Few examples like opening a blocked artery using a

catheter, in a patient who is otherwise not fit for surgery; performing a lifesaving

procedure like stenting/embolization in a trauma patient; chemo/radio

embolization of cancers in organs like liver thereby extending the palliation or

bridging them to get ready for a transplant; emergency creation of blind tract and

stenting between an hepatic vein and portal vein in patients who are critical

condition due to continuous vomiting of blood due to liver failure; Nonsurgical

ablation of tumors to kill cancer without harming the surrounding tissue; Catheter directed

thrombolysis to clear blood clots, preventing disability from deep vein

thrombosis and stroke; Carotid artery angioplasty and stenting to prevent stroke,

etc.

Moving forward in the era where cost of healthcare is disproportionately

increasing, cost saving and waste reduction is of paramount importance,

Interventional radiologists’ unique blend of skills fosters innovation and enables

them to quickly adapt their imaging expertise to pioneer nonsurgical treatments

that are guided by imaging. They adapt a technique proven to work for one

problem and apply it to another. When it comes to the best practices for safely

performing minimally invasive treatments, interventional radiologists pioneered

the procedures and the standards for safety and quality. In addition to providing

unique treatment options, interventional radiology plays a key role in advancing

management and improving outcomes at a lower cost. Patient safety is

incorporated into the development of these advances because interventional

radiology and diagnostic radiology training programs include radiation safety,

radiation physics, the biological effects of radiation and injury prevention.

In 2008, 10,045 interventional oncology treatments were performed in the

Medicare population for various cancers with liver cancers account for the most.

Majority are these treatments were provided by radiologists trained in

interventional procedures. For example, amongst patients with liver cancer, more

than 50% of treatments included interventional procedures compared to 46% of

surgical treatments. There has been growing trend in the utilization of

interventional radiology services in the last decade amongst certain groups of

cancer patients. Most such treatments involved destroying cancer cells by either

placing a needle probe into the tumor or by injected chemotherapy directly into the

tumor via long small tubes called catheters advanced into the feeding blood

vessels. In spite of growing need for less invasive procedures and treatments that

are cost effective, the number of fellowship positions offering training remains a

meager number of 224/year.

With the ever growing population and the diseases, we need more doctors who are

specialized. Unfortunately, there is always a wide difference in the ratios with the

doctor’s numbers who are sub specialized being the low.

J Vasc Interv Radiol. 2010 Jul;21(7):1054-60

Identifying quality health care and cost savings for treating a disease that affects

millions is critical. It required high quality IR services for safe and

effective patient care and require networking to improve access. A good well resourced

IR service can contribute to significant savings (both financial and nonfinancial)

along care pathways in both planned and emergency care. The

opportunity exists to use improvement techniques of standard work and visual

management to create agreed standard operating procedures. This can support a

network approach to providing on-call across a number of organizations.

“Interventional Radiology Costs Less, Safer than Surgery for PAD”

January 03, 2012 | Interventional Radiology

Endovascular lower-extremity revascularization procedures performed by

interventional radiologists bring about less transfusion and intensive-care unit

use, shorter hospital stays, fewer repeat revascularization procedures, fewer

amputations, and lower costs compared to those done by vascular surgeons.

So, concludes a study published in the January 2012 edition of the Journal of

Vascular and Interventional Radiology that considered data from 14,000

Medicare patients.

It affects an estimated 10 million people in the United States (12 percent to 20

percent of Americans over age 65) and can lead to heart attack or stroke.

“We noted that the adjusted average one-year procedure cost when performed by

interventional radiologists was about $17,640. That’s a cost savings to Medicare

of approximately $1,000 per procedure – which means that in such a large

population, treatments for PAD by interventional radiologists could potentially

save taxpayers $230 million each year. And the patient outcomes are better,”

said Timothy Murphy, MD, an interventional radiologist and director of the

Vascular Disease Research Center at Rhode Island Hospital in Providence.

Murphy and colleagues reviewed Medicare claims data from more than 14,000

patients with PAD from 2005 to 2007 from Medicare’s Standard Analytical Files,

a large dataset that contains all services (physician, inpatient, and outpatient).

The authors compared outcomes of percutaneous PAD treatments in Medicare

patients according to the physician specialty type (interventional radiologist,

interventional cardiologist, vascular surgeon) and assessed mortality,

transfusion, intensive care use, length of stay, and subsequent restoration of

blood supply or amputation.

Murphy said the study provided strong evidence that treatment by interventional

radiologists provides numerous benefits to the PAD patient, such as less risk of

infection, less anesthesia, less pain and scarring, faster recovery and a quicker

return to normal activities.

This is an exciting time for our specialty. Interventional radiology has always been

at the fore of modern, technology-driven, image-guided medicine to improve

patient care. Today, with value and quality often driving treatment choices for

patients and health care systems alike, interventional radiology is often the best

option for a wide variety of disease conditions.

 

J Vasc Interv Radiol. 2010 Jul;21(7):1054-60