By: Jean Johnson for Fibroids1If the term interventional radiology is puzzling, join the crowd. Perhaps it’s the rather unfortunate choice of names. Then again maybe it’s because interventional radiology crosses so many traditional medical boundaries that it hasn’t a home in any. Whatever the case, a 2002 survey showed despite several decades of solid history behind it, interventional radiology is a secret unknown to most. Indeed, more than 98 percent of the 21,000 people polled about the field came up clueless.
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Interventional radiology can treat:
Uterine fibroids
Cancerous tumors
Aneurysms
Varicose veins
Abdominal abscesses associated with surgery
Problems associated with almost any organ including the kidneys and liver
Neurological situations
Bone procedures
Postpartum bleeding
Peripheral vascular disease
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According to professor of radiology and surgery, Frederick S. Keller M.D., the director of the Dotter Interventional Institute and chairman of the department of diagnostic radiology at Oregon Health and Sciences University (OHSU) in Portland, Ore., “OHSU is the birth place of interventional radiology. Charles Dotter M.D. performed the first angioplasty in 1964 and placed the first arterial stents during animal experiments in 1969 with the use of catheters thus opening the door to image guided interventional techniques.”
Since the mid-1960s the field has expanded beyond the arena of the heart and the circulatory system to include all parts of the body accessible via the arteries, bile ducts, and ureters.
As Keller’s wife puts it, “interventional radiologists are plumbers for the body.” They can enter any tubular structure via a small incision. With tiny catheters the thickness of spaghetti and thinner, they can thread their way to the abnormality and treat the problem. The most common imaging modality used by interventional radiologists is fluoroscopy. Essentially it is an x-ray television that enables interventional radiologists to see what they are doing.
In response to the question on the difficulty of the procedure, Keller said, “Yes, it does require dexterity and the ability to use visual feedback. It’s similar to the types of responses video games require.”
Interventional radiology rarely requires general anesthesia. It has shorter hospital stays and recovery times, and is less expensive than traditional surgeries. The technique can treat a range of problems from uterine fibroids to strokes, varicose veins to cancer. “In the past 10 years, there has been a dramatic change in the use of imaging technologies to accomplish many outcomes that required conventional surgery in the past,” said interventional radiologist in Austin, Texas, Ravi Jhaveri, M.D. “We are at the beginning of a wave that will bring even more changes very rapidly. Clearly IR is going to play an increasingly important role in the future of medicine.”
If interventional radiology is the next big thing and has been for some time, why then did people like Argelis Castillo of Portland opt for regular surgery when she needed a fibroid tumor removed from her uterus? “My GYN told me about the imaging technique, but I decided that since I’d been seeing him all along that I’d just have him do the surgery. He said he’s done many, many myomectomies and I’m comfortable with him.”
Keller agrees that once patients see other specialists for diagnostics they often are reluctant to then switch over to interventional radiologists for procedures. Also he is candid about turf jockeying within the field of medicine. “Early on and probably pretty much until recently, specialists tended not to send their patients to us, or if they did we’d get only very high risk cases that were bad candidates for success.”
Despite tendencies of traditional surgeons to guard their practices and patients’ inclinations to stick with methods their parents were comfortable with, word is getting around. If trends in the field of interventional radiology continue as Keller and Jhaveri expect, people like Castillo will most likely be choosing the less invasive, quicker rebound route for procedures in the future.
From unblocking carotid arteries to applying local chemotherapy to cancerous tumors interventional radiology seems to be paving a clear way into the future of medicine. Ungainly names aside, interventional radiology seems to be a science whose day has come.
