This book is a concise introduction to the field of interventional radiology (IR), designed to help medical students and residents understand the fundamental concepts related to image-guided interventional procedures and determine the appropriate use of imaging modalities in the treatment of various disorders. It covers the history of interventional radiology; radiation safety; equipment; medications; and techniques such as biopsy and drainage, vascular access, embolization, and tumor ablation. The book also describes the indications, patient preparation, post-procedure care, and complications for the most common interventional radiology procedures. This second edition is fully updated throughout with the latest guidelines and recommendations. Specific updates include: the role of IR outpatient clinics and patient-centered care, prostatic artery embolization, Y90 embolization, embolization for joint disease, the role artificial intelligence plays in IR, and a new chapter on structured reporting in IR. Designed for students and trainees, chapters include key points or “tips and tricks” and review questions. This is an ideal guide for medical students and trainees interested in pursuing interventional radiology.
Author(s): Sriharsha Athreya, Mahmood Albahhar
Edition: 2
Publisher: Springer
Year: 2022
Language: English
Pages: 231
City: Cham
Acknowledgments
Contents
Part I: Introduction
Chapter 1: Interventional Radiology: The Early Days and Innovation
The Beginning
1960s–1980s
Percutaneous Transluminal Angioplasty
The Modern Age
References
Chapter 2: Basic X-Ray Physics
X-Ray Production
X-Ray Interactions with Biological Tissues
Somatic Effects
Genetic Effects
References
Chapter 3: Principles of Radiation Safety in Interventional Radiology
X-Ray Equipment in Interventional Radiology
Radiation Safety in Interventional Radiology
Time
Distance
Shielding
Further Recommendations
Estimated General Patient Exposures [4]
References
Chapter 4: Common Equipment in Interventional Radiology
Imaging Modalities
Fluoroscopy
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Contrast
Guidewires and Catheters
Guidewires
Length
Diameter
Stiffness and Coating
Tip Shape
General Types of Guidewires
Catheters
Vascular Dilator
Exchange Catheter
Selective Catheter
Puncture Needles
Type
Size Considerations
Biopsy Needles
Aspiration Needle
Cutting Biopsy Needle
Stents
References
Chapter 5: Medications Used in Interventional Radiology
Pre-procedural Medications
Anticoagulation
Prophylactic Antibiotics
X-Ray Contrast Media
Iodinated Contrast Complications and Side Effects
Peri- and Intra-procedural Medications
Vasoconstrictors
Vasodilators
Anxiolytic
Local Analgesics
Sedatives
Bowel Antiperistalsis Agents
Post-procedural Medications
Analgesics
Antimicrobial Therapy
Antiemetics
Anticoagulation
Summary
References
Chapter 6: Interventional Radiology Outpatient Clinics
Background
Infrastructure Requirements
Physical Space
Support Staff
Appointment Scheduling
Responsibilities of Interventional Radiologists in Clinical Practice
Advantages to Strong Clinical Practices
Pre-procedural Clinic and Initial Consults
Post-procedural Clinic and Follow-Up
Virtual Clinics in IR
Summary
References
Part II: Techniques
Chapter 7: Biopsy and Drainage
Percutaneous Needle Biopsy
Indications for PNB
Contraindications for PNB
Procedure
Outcomes
Complications
Drainage and Aspiration
Identifying Abnormal Fluid Collections and Abscesses
Indications for Drainage and/or Aspiration
Contraindications for Drainage and/or Aspiration
Procedure (Fig. 7.4)
Outcomes
Complications
References
Chapter 8: Arterial and Venous Access
Arterial Access
Anatomy
Procedure
Complications
Venous Access
Conventional Peripheral IV Lines
Central Catheters
Central Lines
Peripherally Inserted Central Catheters (PICCs)
Infections
References
Chapter 9: Embolization Materials and Principles
Indications
Embolization Agents (Liquids, Particles, Gelfoam, and Coils)
Particles
Polyvinyl Alcohol (PVA) Particulates
Calibrated Microspheres
Gelatin Sponge Particles
Liquid Agents
Thrombin
Coils
Principles: Tips and Tricks
References
Chapter 10: Image-Guided Tumor Ablative Therapies
Non-thermal Ablative Therapy
Chemical Ablation
Indications
Contraindications
Procedure
Complications
Outcomes
Irreversible Electroporation
Indications
Device
Procedure
Outcome and Post-procedure Follow-Up
Complications
Emerging Non-thermal Ablative Techniques
Histotripsy
Mechanochemical Ablation
Thermal Ablative Therapy
Radiofrequency Ablation
Device and Technique
Procedure
Applications of RFA
Microwave Ablation
Device and Technique
Procedure
Applications of MWA
Cryoablation [2, 6, 12, 22, 38, 39]
Device and Technique
Procedure
Applications of Cryoablation
Renal Malignancy
High-Intensity Focused Ultrasound
Device and Technique
Procedure
Applications of HIFU
References
Part III: Common Interventional Radiology Procedures
Chapter 11: Thoracic Interventional Radiology
Percutaneous Thoracic Biopsy
Percutaneous Transthoracic Lung Biopsy
Indications
Contraindications
Pre-procedural Assessment and Imaging
Imaging Guidance
Procedure
Complications
Core Needle Biopsy Vs. Fine Needle Aspiration
Post-procedure Imaging
Outcomes
Mediastinal Biopsy
Indications and Contraindications
Image Guidance and Procedure: Ultrasound Vs. CT
Complications
Post-procedure Imaging
Percutaneous Drainage of Thoracic Fluid Collections
Indications
Contraindications
Procedure
Complications
Post-procedure Imaging and Procedural Outcomes
Vascular Interventional Radiology Procedures
Hemoptysis and Bronchial Artery Embolization
Pre-procedural Imaging and Diagnosis
Contraindications
Procedure
Common Embolization Agents Used
Outcomes
Complications
Post-procedure Imaging
Pulmonary Arteriovenous Malformations
Indications
Procedure
Outcomes
Post-procedure Imaging: CT
Complications
Superior Vena Cava Obstruction
Overview
Pre-procedural Imaging
Indications and Contraindications
Outcomes
Complications
References
Chapter 12: Gastrointestinal Interventions
Radiologically Inserted Gastrostomy (RIG)
Indications/Contraindications
Indications
Contraindications
Procedure
Pre-procedure
Procedure
Post-procedure
Gastrojejunostomy
Conversion from RIG to Gastrojejunostomy
Complications
Esophageal Stenting
Complications
Colonic Stenting
Complications
References
Chapter 13: Hepatobiliary and Pancreatic Interventions
Liver Biopsy
Patient Preparation
Percutaneous Biliary Drainage and Stenting
Indications and Contraindications
Procedure
Complications
Cholecystostomy Drainage
Transarterial Chemoembolization
Clinical Background
Diagnosis
Classification
Treatment Options
TACE
Contraindications
Common Embolic Agents
Treatment Outcomes
Complications
Imaging Required
Radioembolization
References
Chapter 14: Genitourinary Interventions
Kidney Biopsy
Indications and Contraindications
Patient Preparation
Procedure
Complications
Post-procedural Care
Transjugular Renal Biopsy
Indications
Procedure [1]
Post-procedural Care
Complications [1]
Percutaneous Nephrostomy Drainage
Clinical Background
Indications and Contraindications
Pre-procedure
Procedure
Post-procedure
Complications
Ureteral Stenting
Procedure
Complications
Suprapubic Catheter Insertion
Procedure
Complications
Renal Artery Angioplasty and Stenting
Prostatic Artery Embolization
References
Chapter 15: Dialysis Access
Background
Important Definitions
Arteriovenous Fistula
Overview
AV Fistula Maturation
AVF Locations
Graft Implantation
Overview
AVG Type and Location
AVF Versus AVG
Outcomes and Complications with AVF and AVG [1, 6]
Fistulograms and Assessment of Access Function
Preoperative Evaluation
Dialysis Access Patency
Factors Affecting Dialysis Access Patency
Interventions
Percutaneous Transluminal Angioplasty
Endoluminal Stent Placement
Chemical (Pharmacologic) Thrombolysis and Mechanical Thrombectomy
Collateral Vessel Embolization
Summary
References
Chapter 16: Interventional Radiology in Women’s Health
Uterine Leiomyoma (Fibroid) Embolization (UFE)
Definitions
Epidemiology
Indications/Contraindications
Pre-Procedure Patient Work-Up
Laboratory Tests
Diagnostic Imaging
Ultrasound
Contrast-Enhanced MRI
Pre-Treatment Patient Information
Procedure Overview
Vascular Access
Angiography
Angiographic Appearance
Immediate Complications
Delayed Complications
Outcomes
Treatment Failure
Postpartum Hemorrhage
Definition and Epidemiology
Etiology of PPH
Preliminary Management
Indications/Contraindications
Procedure
Outcomes and Complications
Placenta Accreta
Definition
Epidemiology and Risk Factors
Management
Pre- and Intra-Balloon Vessel Occlusion Procedure, Outcomes, and Complications
Procedure
Outcomes
Complications
Uterine Artery Embolization Procedure and Complications
UAE Outcomes
Pelvic Congestion Syndrome (PCS)
Overview
Epidemiology
Diagnosis and Pre-Procedure Imaging
Procedure
Outcomes
Complications
Inferior Vena Cava (IVC) Filters in Pregnancy
Overview
Indications
Procedure and Equipment
Complications
Uterine Arteriovenous Fistula (AVF)
Overview
Etiology and Epidemiology
Management
Outcomes
Complications
Fallopian Tube Recanalization
Definitions
Overview
Epidemiology
Indications/Contraindications
Procedure
Intra-Procedural Imaging Guidance and Procedure Success
Complications
References
Chapter 17: Musculoskeletal Interventions
Percutaneous Image-Guided Musculoskeletal Biopsy
Background
Indications and Contraindications
Preparation for Biopsy
Procedure
Post-Procedural Care
Complications
Facet Joint Injection
Clinical Background
Indications and Contraindications
Imaging Required
Pre-Procedure
Procedure
Post-Procedure
Complications
Percutaneous Vertebral Augmentation
Pre-Procedure
Post-Procedure
References
Chapter 18: Interventional Oncology
Interventional Oncology Procedures
Role of Imaging in Interventional Oncology
Tumor Board/Multidisciplinary Rounds
Current Trends in Interventional Oncology
References
Chapter 19: Peripheral Vascular Intervention
Risk Factors
Differential Diagnosis
Arterial Claudication
Diabetic Neuropathy
Spinal Stenosis
Hip Arthritis
Anatomy
General Principles
Indications
Contraindications
Specific Revascularization
General Principles
Iliac Artery Disease [1]
Infrainguinal Disease
Balloon Angioplasty Versus Stenting of SFA
Tibial and Peroneal Disease
Classification
Procedure
Complications
Outcomes
Femoropopliteal Stenting Versus PTA
Iliac Artery PTA Versus Stenting
Infrapopliteal Stenting Versus PTA
Intimal Hyperplasia
General Principles: Procedure Preparation
References
Chapter 20: Lymphatic Interventions
Diagnostic Lymphangiography
Pedal Lymphangiography
Intranodal Lymphangiography
Non-Contrast MR Lymphangiography
Dynamic Contrast-Enhanced MR Lymphangiography
Therapeutic Procedures
Sclerotherapy
Embolization
Lymphopseudoaneurysm Embolization
Closest Upstream Lymph Node Embolization
Direct Upstream Lymphatic Vessel Embolization
Chylothorax
Chylous Ascites
Lymphocele
References
Chapter 21: Structured Reporting in IR
Headings and Categories
Data Entry
Advantages
Disadvantages
References
Chapter 22: Role of Technology in IR
The Future of Technology in IR [1]
Imaging
Embolization
Augmented Reality and Artificial Intelligence
Virtual Reality and Education
Virtual Reality in Practice
References
Index
