DID YOU KNOW RADIOLOGISTS TREAT CERTAIN CONDITIONS?

Since the discovery of X-rays in 1895, radiology – the use of medical imaging for diagnosis and treatment – has been continuously evolving to include ever more sophisticated technology and procedures.

Initially radiology simply aided diagnosis, providing a look inside the body to help find a possible cause for symptoms. But in 1953 Dr. Sven-Ivar Seldinger (a Swedish radiologist) developed a technique to use medical imaging for treatment. Using fluoroscopy, a type of medical imaging that displays a continuous X-ray image on a monitor, Dr. Seldinger was able to place a small tube within a blood vessel without having to make a surgical incision.

For the first time a radiologist was able to use medical imaging to treat a patient. This process, which was less invasive and could ensure treatment was targeted to the specific area of concern, eventually led to the creation of a sub-specialty within the field of radiology called interventional radiology (IR). Interventional radiologists are able to use medical imaging to perform minimally invasive procedures that treat a variety of conditions.

Interventional radiology procedures can utilize a wide variety of medical imaging, such as ultrasound, nuclear medicine imaging, magnetic resonance imaging (MRI), and computed tomography (CT), not to mention X-ray fluoroscopy.

HOW DO IR PROCEDURES WORK?

Interventional radiology involves the use of small catheter tubes and wires, or small needles, to precisely target areas of concern. This is sometimes called a pinhole procedure and can be an alternative to open and laparoscopic surgery.

For example, IR can be used to treat an enlarged prostate through prostate artery embolization (PAE). This procedure shrinks an enlarged prostate by using X-ray guidance to move a small plastic tube into the small arteries which feed the prostate and inject tiny plastic particles to block them, starving the prostate of its blood supply and shrinking it. Compare PAE to a common surgical option.

Uterine fibroid embolization (UFE) is a similar procedure for women, which treats fibroid tumors of the uterus – muscular tumors of varying sizes that grow in the wall of the uterus. In this instance, the small arteries which are feeding the fibroids are blocked to starve the fibroid of its blood supply, shrinking it.

Interventional radiology also includes pain management procedures, treatment of pain through targeted, image-guided injections of medications, and biopsies, inserting a very small needle into an area of concern to remove cells for microscopic examination.

WHY DO RADIOLOGISTS PERFORM IR PROCEDURES?

A radiologist is a physician, who after obtaining a medical degree undergoes further training in radiology. An interventional radiologist has completed additional specialized training in performing minimally invasive procedures using imaging. This means they are trained to not only interpret images created by the various types of medical imaging, but also in using medical imaging to navigate small instruments through blood vessels and organs to treat a variety of conditions.

ARE IR PROCEDURES SAFE?

Interventional radiology procedures can reduce the risk of complications, provide shorter hospital stays, and enable quicker convalescence and return to work, compared to open surgery. The procedures are usually safer than the surgical alternatives.

Specifically for UFE and PAE embolization procedures, the area of concern is slowly deprived of its blood supply so it may take up to six months for you to see the full benefit, although you should start to feel better after a week. There is also a chance that the interventional radiologist will not be able to position the catheter adequately to block blood flow or the injection particles do not go into the correct area. Other general risks include infection, allergic reaction, bleeding, pain, etc.

For pain management procedures, the effects can be immediate, or may take up to a week to take full effect. Results may vary from weeks to months depending on the joint or body part involved, severity of the disease, and the cause of your pain. Some people may get complete relief that is permanent, while others may need further treatments or evaluation.

IR procedures are minimally invasive and can be utilized to treat conditions affecting a variety of areas and organs in the body. In Calgary, Mayfair’s interventional radiology team has been performing pain therapy procedures in our clinics since 2012 and some in-hospital IR procedures for over 30 years.

HOW DO I GET AN IR PROCEDURE?

To determine whether IR procedures are appropriate for you, your doctor will often review your medical and family history, risk factors, how long symptoms have been present, and how they affect daily activities. If a pain management procedure has been chosen as the best next course of action, your doctor will need to fill out a requisition for pain management procedures. Our booking team will then contact you to arrange an appointment at one of our pain management clinics.

For IR procedures performed in hospital, they are covered under the Alberta Health Care Insurance Plan. (We do accept out-of-province patients, but you will need to speak to your provincial plan administrator about reciprocal billing.) For PAE, UFE, or other IR in-hospital procedures, your doctor or specialist will need to fax a consultation request to Rockyview General Hospital’s Diagnostic Imaging department at 403-592-4852. Once the information has been received our interventional radiology team will review the request and contact you to arrange a consultation to determine if the procedure is appropriate based on your medical history. There may also be imaging required.

REFERENCES

John Hopkins Medicine (2021) “Is Uterine Fibroid Embolization (UFE) the Right Treatment for You?” www.hopkinsmedicine.org. Accessed April 1, 2022.

Mayo Clinic Staff (2022) “Transurethral resection of the prostate (TURP).” www.mayoclinic.org. Accessed April 1, 2022.

Murphy, T. P. and Soares, G.M. (2005) “The Evolution of Interventional Radiology.” Seminars in Interventional Radiology. 22(1):6-9. Accessed April 1, 2022.

Radiological Society of North America (2017) “Professions in Interventional Radiology.” www.radiologyinfo.org. Accessed April 1, 2022.