Interventional Radiology

Interventional radiology grew out of diagnostic imaging, and its doctors are radiologists with further training in performing procedures. Instead of opening the body, the interventional radiologist makes a small puncture, usually into an artery or vein at the wrist or groin, or directly through the skin over the target, and watches the needle or catheter move on a screen in real time. Through these narrow channels they can block a vessel, open one, deliver medicine or radioactive beads to a tumour, destroy tissue with heat or cold, or take a sample. Because there is no large incision, pain, blood loss and recovery time are often less than with open surgery. The specialty works closely with surgeons, oncologists, gynaecologists, urologists and vascular specialists, and the decision to treat is usually made jointly, so that the procedure fits the overall plan for your condition.

Vascular interventional radiology treats narrowed or blocked arteries in the legs, kidneys and other organs, bleeding vessels, abnormal tangles of vessels called malformations, and varicoceles, which are enlarged veins around the testicle. Interventional oncology treats tumours, especially in the liver, kidneys, lungs and bones, either through the artery that feeds them or with a needle placed directly into them. Women's health work centres on uterine fibroids and adenomyosis, and men's health work on an enlarged prostate that causes urinary symptoms. Non-vascular work includes biopsies of lumps in almost any organ, drainage of abscesses and fluid collections, relief of blocked bile ducts or kidneys with a tube or stent, and long-term venous lines for chemotherapy. Spine and bone interventions treat painful vertebral compression fractures. Neurointerventional radiology, which treats brain aneurysms and strokes, overlaps with neurology and neurosurgery and is often organised as its own service.

Uterine fibroid embolisation blocks the small arteries that feed fibroids, so they shrink and symptoms such as heavy bleeding and pressure ease while the uterus is kept. Prostate artery embolisation works in a similar way for an enlarged prostate. For liver tumours, chemoembolisation (TACE) delivers chemotherapy and blocking particles through the liver artery, and radioembolisation (TARE, also called Y-90) delivers tiny radioactive beads, planned together with nuclear medicine. Ablation destroys small tumours with heat from radiofrequency or microwave energy, or with extreme cold. Angioplasty widens a narrowed artery with a balloon, often followed by a stent to hold it open. Vertebroplasty and kyphoplasty inject bone cement into a collapsed vertebra to ease pain. Varicocele embolisation closes the enlarged vein without an incision in the scrotum. Image-guided biopsies, drains and stents complete the everyday work of the specialty.

Every procedure depends on imaging, both to plan it and to guide it. Before treatment, CT or MRI scans show the size and position of the target and the vessels around it, and a dedicated planning session may be needed before liver tumour treatment. During the procedure, digital subtraction angiography shows the blood vessels in fine detail by removing the bones from the X-ray picture, while ultrasound and CT guide needles into organs and lumps. Cone-beam CT, performed on the same table, adds three-dimensional views of vessels that are hard to reach. Some teams work in a hybrid operating room, which combines an angiography suite with full surgical equipment. Radiation exposure is kept as low as the task allows, and contrast dye is used with care in people with weak kidney function or a past reaction to contrast, so tell the team about either well in advance.

The first step is usually a remote review: send recent scans as image files, not only written reports, together with blood test results, a summary of your condition and a list of your medicines. Blood thinners and some diabetes medicines may need to be paused before the procedure, so share them early. Most patients see the interventional radiologist in clinic a day or two before treatment, have blood tests and any missing imaging, and then have the procedure in the angiography suite. Many treatments are day-case or need one night, while liver tumour treatment and fibroid embolisation often need one to three nights for pain control and observation. Plan to stay nearby for a few days afterwards before flying. Follow-up imaging is usually arranged weeks to months later, and the team can often review it remotely if you send it from home.