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In 2000, the [[Society of Interventional Radiology]] (SIR) created a program named "Clinical Pathway in IR", which modified the "Holman Pathway" that was already accepted by the American Board of Radiology to including training in IR; this was accepted by ABR but was not widely adopted. In 2005 SIR proposed and ABR accepted another pathway called "DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training) Pathway" to help trainees coming from other specialities learn IR; this too was not widely adopted. In 2006 SIR proposed a pathway resulting in certification in IR as a speciality; this was eventually accepted by the ABR in 2007 and was presented to the [[American Board of Medical Specialities]] (ABMS) in 2009, which rejected it because it did not include enough [[diagnostic radiology]] (DR) training. The proposal was reworked, at the same time that overall DR training was being revamped, and a new proposal that would lead to a dual DR/IR specialization was presented to the ABMS and was accepted in 2012 and eventually was implemented in 2014.<ref>{{cite journal|last1=Kaufman|first1=John A.|title=The Interventional Radiology/Diagnostic Radiology Certificate and Interventional Radiology Residency|journal=Radiology|date=November 2014|volume=273|issue=2|pages=318–321|doi=10.1148/radiol.14141263|pmid=25340266|url=http://pubs.rsna.org/doi/full/10.1148/radiol.14141263}}</ref><ref>{{cite journal|last1=Siragusa|first1=DA|last2=Cardella|first2=JF|last3=Hieb|first3=RA|last4=Kaufman|first4=JA|last5=Kim|first5=HS|last6=Nikolic|first6=B|last7=Misra|first7=S|last8=Resnick|first8=SA|last9=Saad|first9=WE|last10=Vatakencherry|first10=G|last11=Wallace|first11=MJ|last12=Society of Interventional|first12=Radiology.|title=Requirements for training in interventional radiology.|journal=Journal of vascular and interventional radiology : JVIR|date=November 2013|volume=24|issue=11|pages=1609–12|pmid=24160820|pmc=4485607}}</ref><ref name=DiMarco2016>{{cite journal|last1=Di Marco|first1=L|last2=Anderson|first2=MB|title=The new Interventional Radiology/Diagnostic Radiology dual certificate: "higher standards, better education".|journal=Insights into imaging|date=February 2016|volume=7|issue=1|pages=163–5|pmid=26746975|pmc=4729716}}</ref> By 2016 the field had determined that the old IR fellowships would be terminated by 2020.<ref name=DiMarco2016/>
In 2000, the [[Society of Interventional Radiology]] (SIR) created a program named "Clinical Pathway in IR", which modified the "Holman Pathway" that was already accepted by the American Board of Radiology to including training in IR; this was accepted by ABR but was not widely adopted. In 2005 SIR proposed and ABR accepted another pathway called "DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training) Pathway" to help trainees coming from other specialities learn IR; this too was not widely adopted. In 2006 SIR proposed a pathway resulting in certification in IR as a speciality; this was eventually accepted by the ABR in 2007 and was presented to the [[American Board of Medical Specialities]] (ABMS) in 2009, which rejected it because it did not include enough [[diagnostic radiology]] (DR) training. The proposal was reworked, at the same time that overall DR training was being revamped, and a new proposal that would lead to a dual DR/IR specialization was presented to the ABMS and was accepted in 2012 and eventually was implemented in 2014.<ref>{{cite journal|last1=Kaufman|first1=John A.|title=The Interventional Radiology/Diagnostic Radiology Certificate and Interventional Radiology Residency|journal=Radiology|date=November 2014|volume=273|issue=2|pages=318–321|doi=10.1148/radiol.14141263|pmid=25340266|url=http://pubs.rsna.org/doi/full/10.1148/radiol.14141263}}</ref><ref>{{cite journal|last1=Siragusa|first1=DA|last2=Cardella|first2=JF|last3=Hieb|first3=RA|last4=Kaufman|first4=JA|last5=Kim|first5=HS|last6=Nikolic|first6=B|last7=Misra|first7=S|last8=Resnick|first8=SA|last9=Saad|first9=WE|last10=Vatakencherry|first10=G|last11=Wallace|first11=MJ|last12=Society of Interventional|first12=Radiology.|title=Requirements for training in interventional radiology.|journal=Journal of vascular and interventional radiology : JVIR|date=November 2013|volume=24|issue=11|pages=1609–12|pmid=24160820|pmc=4485607}}</ref><ref name=DiMarco2016>{{cite journal|last1=Di Marco|first1=L|last2=Anderson|first2=MB|title=The new Interventional Radiology/Diagnostic Radiology dual certificate: "higher standards, better education".|journal=Insights into imaging|date=February 2016|volume=7|issue=1|pages=163–5|pmid=26746975|pmc=4729716}}</ref> By 2016 the field had determined that the old IR fellowships would be terminated by 2020.<ref name=DiMarco2016/>


A handful of programs have offered interventional radiology [[Fellowship (medicine)|fellowships]] that focus on training in the treatment of children.<ref>[http://www.pedrad.org/displaycommon.cfm?an=1&subarticlenbr=296 The Society for Pediatric Radiology<!-- Bot generated title -->]</ref>
A handful of programs have offered interventional radiology [[Fellowship (medicine)|fellowships]] that focus on training in the treatment of children.<ref>[http://www.pedrad.org/displaycommon.cfm?an=1&subarticlenbr=296 The Society for Pediatric Radiology<!-- Bot generated title -->] {{webarchive|url=https://web.archive.org/web/20120104095408/http://www.pedrad.org/displaycommon.cfm?an=1&subarticlenbr=296 |date=2012-01-04 }}</ref>


===Europe===
===Europe===
Line 87: Line 87:


==Further reading==
==Further reading==
* [http://www.miit.com/PDF/MIIT%202002/Historic%20Highlights%20of%20Interventional%20Radiology.pdf Historic Highlights of Interventional Radiology], by Josef Rösch of Dotter Interventional Radiology.
* [https://web.archive.org/web/20120425093314/http://www.miit.com/PDF/MIIT%202002/Historic%20Highlights%20of%20Interventional%20Radiology.pdf Historic Highlights of Interventional Radiology], by Josef Rösch of Dotter Interventional Radiology.
* Abrams’ Angiography: Vascular and Interventional Radiology. [[Herbert L. Abrams]] (Editor), Stanley Baum (Editor) and Michael J. Pentecost (Editor). Little Brown and Co., 2005. {{ISBN|0781740894}}
* Abrams’ Angiography: Vascular and Interventional Radiology. [[Herbert L. Abrams]] (Editor), Stanley Baum (Editor) and Michael J. Pentecost (Editor). Little Brown and Co., 2005. {{ISBN|0781740894}}
* Advanced Radiographic and Angiographic Procedures: With an Introduction to Specialized Imaging. Patrick A. Apfel, Marianne Rita Tortorici. F A Davis Co., 2010. {{ISBN|0803612559}}
* Advanced Radiographic and Angiographic Procedures: With an Introduction to Specialized Imaging. Patrick A. Apfel, Marianne Rita Tortorici. F A Davis Co., 2010. {{ISBN|0803612559}}

Revision as of 19:21, 15 November 2017

Interventional radiology
Balloon dilatation of the stenosed internal jugular vein (photo from an X-ray angiograph monitor). While pressure in the balloon is relatively low, stenosis prevents the balloon from inflating in the middle. Further increase in pressure will dilate the narrowing and restore the full blood flow.
MeSHD015642

Interventional radiology (IR), sometimes known as vascular and interventional radiology (VIR), is a medical specialty which provides

minimally invasive
image-guided diagnosis and treatment of disease. Although the range of procedures performed by interventional radiologists is broad, the unifying concept behind these procedures is the application of image guidance and minimally invasive techniques in order to minimize risk to the patient.

Training

Interventional radiologist
Occupation
NamesDoctor, Medical Specialist
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Radiologist

United States

Training for interventional radiology occurs in the residency portion of medical education, and has gone through developments.

In 2000, the

diagnostic radiology (DR) training. The proposal was reworked, at the same time that overall DR training was being revamped, and a new proposal that would lead to a dual DR/IR specialization was presented to the ABMS and was accepted in 2012 and eventually was implemented in 2014.[1][2][3] By 2016 the field had determined that the old IR fellowships would be terminated by 2020.[3]

A handful of programs have offered interventional radiology fellowships that focus on training in the treatment of children.[4]

Europe

In Europe the field followed its own pathway; for example in Germany the parallel interventional society began to break free of the DR society in 2008.[5] In the UK, interventional radiology was approved as a sub-specialty of clinical radiology in 2010.[6][7]

Procedures

Interventional radiologists commonly perform both diagnostic and therapeutic procedures, although diagnostic angiography is becoming less common as the quality and reliability of CT and MRI angiography has allowed for alternative forms of non invasive evaluation.

Diagnostic

  • Angiography: Imaging the blood vessels to look for abnormalities with the use of various contrast media, including iodinated contrast, gadolinium based agents, and CO2 gas.[8]
  • Cholangiography: Imaging the bile ducts within the liver to look for areas of blockage.
  • Biopsy: Taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transvenous approach.[9]

Therapeutic

Vascular

  • Balloon angioplasty/stent: Opening of narrow or blocked blood vessels using a balloon, with or without placement of metallic stents to aid in keep vessel patent. [10]
  • Endovascular aneurysm repair: Placement of endovascular stent-graft across an aneurysm, in order to prevent expansion or progression of the defective vessel. [11]
  • Embolization: Placement of a metallic coil or embolic substance (gel-foam, poly-vinyl alcohol) to block blood through to a blood vessel, either to stop bleeding or decrease blood flow to a target organ or tissue.[12]
  • Thrombolysis: Catheter-directed technique for dissolving blood clots, such as pulmonary embolism, deep venous thrombosis) with either pharmaceutical (TPA) or mechanical means.
  • IVC filters
    : Metallic filters placed in the vena cava to prevent propagation of deep venous thrombus.
  • Dialysis related interventions: Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.[13]
  • TIPS: Placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for select indications in patients with critical end-stage liver disease and portal hypertension.[14]
  • Endovenous laser treatment of varicose veins: Placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency.

Biliary intervention[15]

Catheter placement

  • port catheters
    , hemodialysis catheters, translumbar and transhepatic venous lines).
  • Percutaneous Drain insertions
    : Placement of tubes into different parts of the body to drain fluids (e.g., abscess drains to remove pus, pleural drains). A common problem is that these tubes get clogged and have to be replaced or removed before all the material is drained.
  • Radiologically inserted gastrostomy or jejunostomy : Placement of a feeding tube percutaneously into the stomach and/or jejunum.[16]

Ablative[17][18]

  • Chemoembolization
    : combined injection of chemotherapy and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of chemotherapy, slowing "washout" of the chemotherapy drug, and also decreasing tumor arterial supply.
  • Radioembolization: combined injection of radioactive glass or plastic beads and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of radiotherapy
    , slowing "washout" of the radioactive substance, and also decreasing tumor arterial supply.
  • Radiofrequency ablation (RF/RFA): local treatment which uses a special catheter to destroy tissue by using heat generated by medium frequency alternating currents.
  • Cryoablation: local treatment which uses a special catheter to destroy tissue by using cold temperature generated by rapid expansion of compressed argon gas. This technique is mostly used for the treatment of small renal cancers and for the palliation of painful bone lesions.[19]
  • Microwave ablation: local treatment which uses a special catheter to destroy tissue by using heat generated by microwaves.

Genitourinary[20]

  • Percutaneous nephrostomy placement: Placement of a catheter through the skin, directly into the kidney in order to drain from the collecting system. This is typically done to treat a downstream obstruction of urine.

Pain management

  • Vertebroplasty: Percutaneous injection of biocompatible bone cement inside a fractured spinal vertebrae in order to restore vertebral body height and relieve pain.[21]

References

  1. PMID 25340266
    .
  2. PMID 24160820
    .
  3. ^
    PMID 26746975
    .
  4. ^ The Society for Pediatric Radiology Archived 2012-01-04 at the Wayback Machine
  5. PMID 28335057
    .
  6. PMC 4256234
    .
  7. ^ "Guidance on Training in Interventional Radiology" (PDF). Royal College of Radiologists. Retrieved 26 September 2017.
  8. ISBN 978-0-19-157556-3
    .
  9. ISBN 978-0-19-157556-3
    .
  10. ISBN 978-0-19-157556-3
    .
  11. ISBN 978-0-19-157556-3
    .
  12. ISBN 978-0-19-157556-3
    .
  13. ISBN 978-0-19-157556-3
    .
  14. PMID 26997084
    .
  15. ISBN 978-0-19-157556-3
    .
  16. ISBN 978-0-19-157556-3
    .
  17. ISBN 978-0-19-157556-3
    .
  18. PMID 28527529
    .
  19. ISBN 9781604063066
    .
  20. ISBN 978-0-19-157556-3
    .
  21. ISBN 978-0-19-157556-3
    .

Further reading

External links


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