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A Look into Diagnostic and Interventional RadiologyANGELA NASH MSPA, DHA

Objectives

To understand the role of diagnostic imaging and its benefits

To become familiar with the terminology and basic overview of diagnostic imaging

To understand the role of interventional radiology

To become familiar with the general scope of interventional radiology procedures

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CT (Computerized Axial Tomography)

Ultrasound

MRI (Magnetic Resonance Imaging)

Xray/Fluoroscopy

Xray/Fluoroscopy Radiographic Films

Think 3 dimensional

Fluoroscopy

Allows for real-time visualization of

the patient

Diagnostic and Interventional

Always know what question you are

trying to answer.

If we are going to radiate the patient and/or the person performing the study

(provider/nurses/tech), there needs to

be a reason

Ultrasound Single organ

Soft tissue

Axilla/groin

Peds – Intussusception, pyloric stenosis, appendicitis peds

Gallbladder and biliary tree

Ascites, pleural effusion

Transvaginal (Non-ob & PG)

Testicular

Vascular

Arterial duplex

Venous duplex

AAA screening

Hepatic doppler

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MRI and CT

MRI

Does not use ionizing radiation

Preferred in children & PG pts

Greater range of soft tissue

Smaller risk of lethal allergic reactions

Spine - spinal cord, nerves, eval of

acute fractures

Brain – cancers, dementia or

neurological disorders

Joints – tendons and ligaments

Restrictions with some metals

Narrow tube (anxiety, body habitus)

CT

More readily available on an

emergency basis

Faster than MRI

Traumas or stroke

Less costly

Better detailed evaluation of cortical

bone

Accurately detect calcifications and

metal foreign bodies

Better at examining lung tissue

CHEST

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Looking at a CXR:

A: Airway

B: Bones

C: Cardiac

D: Diaphragm

E: External

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ABDOMEN

Abdomen/Pelvis

Radiograph

Bowel Gas:

Location (stomach, small bowel, colon)

Amount of gas/stool

Air-Fluid levels

Lack of Bowel Gas

Free Gas—may be EMERGENCY

Calcifications

Bones and Soft Tissues

Lung Bases

NEED UPRIGHT FILM TO DIAGNOSE FREE GAS !!

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Musculoskeletal

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Transverse

SpiralOblique

Comminuted

Compound

Neuroimaging

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5 Emergency Questions

1. Is middle of brain in middle of head?

2. Is there symmetry?

3. Is the suprasellar cistern a star?

4. Is 4th ventricle midline & symmetric?

5. Is lateral ventricle effaced?

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Things to consider

Avoid ordering tests when the results will not impact patient care.

Review tests previously performed to answer current questions.

Order the best test to maximize quality, efficiency, and cost-effectiveness.

Prepare your patient to minimize delays in getting studies done.

Hemodynamically stable

Able to cooperate as active participants

Provide the necessary clinical information

Consult your radiologist when unsure about next imaging steps, the meaning of a radiology report, or the significance of a negative or incidental finding.

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Interventional Radiology

A medical sub-specialty of radiology utilizing minimally-invasive image-

guided procedures to diagnose and treat diseases in nearly every organ system.

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Any “Tube”

Arteries

Veins

Biliary ducts

Ureters

Intestine

Bronchi

Fallopian tubes

➢ Open narrowings (stenoses)

➢ Unclog (usually thrombus)

➢ Clog it up (embolize)

➢ Create new connections

➢ Retrieve foreign bodies

➢ Drain fluid (usually pus)

Any Other Part of the Body

Liver

Bone

Kidney

Lung

Nerves

Lymph nodes

Muscle

➢Biopsy

➢Destroy tissue (ablate)

➢Drain fluid (usually pus)

➢Reinforce (bone)

Angiography

Arteriography / venography: visualizing the inside of a blood vessel by injecting contrast material

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Angioplasty

Use of a balloon to open a narrowed vessel

Atherosclerotic disease

Post-injury stenosis

Arteries

Veins

Ureter

Biliary ducts

Synthetic bypass grafts and AV

grafts

Stents

Mesh metal tube used to prop open a narrowed vessel.

Indications:

- Poor angioplasty result

- Dissection flaps

- Early recurrent stenosis post angioplasty

- Luminal invasion or compression

- Trapping of ulcerated plaques

Basic Metal StentCovered Stent (Stent Graft)

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Thrombolysis/Thrombectomy

Embolization

Blocking a vessel (or other tube) to stop flow

Why EmbolizeActive bleeding

GI bleeding

Traumatic pelvic bleeding

Bleeding anywhere

Aneurysms / pseudoaneurysms

Splenic, internal iliac, etc

Starve a tumor

Therapeutic

preoperative

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Uterine Fibroid Embolization

Alternative to hysterectomy or myomectomy

IVC Filter - DVT or PE

TIPS (Transjugular Intrahepatic

Portosystemic Shunt)

Cirrhosis

Intractable ascites

pleural effusion

variceal bleeding

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Central Venous Access

Non-tunneled catheters

PICC (Peripherally Inserted Central Catheter)

Central Line

VasCath (HD, apheresis, high flow)

Tunneled Catheters

Perm Cath (HD)

TriFusion (apheresis)

Hickman/Groshong/Hohn

Port-A-Cath

Optimal Tip Location

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Biopsy

Percutaneous: CT, US, MRI

Radiofrequency & Cryo- Ablation

Ablation: destruction of tissue

Radiofrequency: extreme heat (cautery)

Cryo – freezing temperatures

Drainage Catheters

Intra-abdominal abscess

Kidney

Liver

Gallbladder

Biliary

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Vertebral Augmentation

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