What is Interventional Radiology?

Interventional radiologists are physicians who specialize in minimally invasive, targeted diagnostic and therapeutic procedures. They possess in-depth knowledge of using advanced imaging guidance to diagnose and treat complex disease processes via pin-hole accesses. Providing such advanced procedural options requires strong diagnostic and clinical experience across several fields of medicine in all age groups. As the inventors of angioplasty and the catheter-delivered stent, both first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine. They use X-ray, MRI, CAT/CT, ultrasound, and other imaging to advance needles, wires, and catheters in the body to diagnose and 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 position and distance of the organ 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 contrast dye is injected and images of the blood vessels and blood flow are studied. Similarly, other structures such as bile ducts within liver and the urinary collecting system within the kidneys are studied. This unique way of selectively studying certain structures within organs deep inside the body using a pinhole 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 pinhole access.

For many years, invasive, open 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 offer less risk, reduced pain, and decreased recovery time compared to open surgery and, in most circumstances, at lower costs. Few examples include:

  • Opening a blocked artery using a catheter in a patient who is otherwise not fit for surgery
  • Performing a lifesaving procedure like stenting/embolization to stop bleeding or further injury in a trauma patient
  • Chemo/radioembolization of cancers in organs like the liver thereby extending the palliation bridging them to get ready for a transplant
  • Emergency creation of tract and stenting between a hepatic vein and portal vein in patients who are in 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 to prevent disability from deep vein thrombosis and stroke
  • Carotid artery angioplasty and stenting to prevent stroke

and many more.

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 can adapt a technique proven to work for one problem and apply it to another.

In addition to providing unique treatment options, interventional radiology plays a key role in advancing management and improving outcomes at a lower cost. Especially in the era where healthcare costs are disproportionately increasing, cost saving and waste reduction is of paramount importance.

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.  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.

With the ever growing and aging population, and with a corresponding increase in chronic disease, more specialty-trained doctors are needed. Unfortunately, there is always a wide difference in the ratios with the number of sub specialized doctors being lower. Specifically, despite the growing need for less invasive procedures and treatments that are cost effective as provided by interventional radiologists, the number of fellowship positions offering training remains a meager number1.

Overall, identifying quality health care and cost savings for treating a disease that affects millions is critical. It requires 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 improved techniques of standard work and visual management to create agreed upon standard operating procedures. This can support a network approach to providing access across a number of organizations.

One area exemplifying the value of interventional radiology is in the cancer treatment paradigm, where has been a growing trend in the utilization of interventional radiology services in the last decade amongst certain groups of cancer patients. In 2008, 10,045 interventional oncology treatments were performed in the USA (Medicare population) for various cancers, with the majority being cancers of the liver. The majority of 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. 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.

Another potential growth area for IRs is in the treatment of peripheral arterial disease. 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 surgeons2

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.

  1. J Vasc Interv Radiol. 2010 Jul;21(7):1054-60
  2. J Vasc Interv Radiol. 2012 Jan; 23(1): P3-9.e14