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Medical Imaging > 9. Nonvascular interventional radiology > Flashcards

9. Nonvascular interventional radiology Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the advantages of US guidance in interventional radiology?

A
  • availability
  • continuous and real-time scanning
  • any imaging plane
  • feasible for bedside
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2
Q

What are the disadvantages of US guidance in interventional radiology?

A
  • depth resolution is limited
  • certain structures (bone, air) produce acoustic shadowing
  • operator-dependent
  • needs practice
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3
Q

What are the advantages of fluoroscopy guidance in interventional radiology?

A
  • real-time guidance
  • high spatial resolution
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4
Q

What are the disadvantages of fluoroscopy guidance in interventional radiology?

A
  • radiation exposure (ionizing)
  • soft tissue contrast is poor
  • 2D display
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5
Q

What are different planes for US guidance?

A

in-plane needle visualization: needle is parallel to US beam

out-of-plane needle visualization: needle is perpendicular to the US beam

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6
Q

What is fluoroscopy guidance used for?

A

vascular, lymphatic, bile duct, genitourinary, gastrointestinal and musculoskeletal interventions

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7
Q

What are the advantages of CT guidance in interventional radiology?

A
  • approach deeper areas that aren’t visible on US
  • 3D display
  • good spatial resolution
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8
Q

What are the disadvantages of CT guidance in interventional radiology?

A
  • radiation exposure (ionizing)
  • time-consuming
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9
Q

What are the advantages of MR guidance in interventional radiology?

A
  • approach deeper areas than US
  • 3D display
  • non-ionizing
  • great soft tissue contrast
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10
Q

What are the disadvantages of MR guidance in interventional radiology?

A
  • availability
  • cost
  • MRI compatible instruments
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11
Q

What are the advantages of fusion imaging guidance in interventional radiology?

A

identifying lesions that are barely visible on US

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12
Q

What are the disadvantages of fusion imaging guidance in interventional radiology?

A
  • time consuming
  • special instruments
  • need for softwares
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13
Q

How to choose the imaging modality for biopsy?

A
  • use the imaging that demonstrates the lesion most clearly (if possible)
  • if there is more than one that provides good visualization then choose the simpler/available one
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14
Q

Overview of FNAB

A
  • 21-23G needle
  • local anesthesia is not required
  • used for both solid and cystic lesions
  • SAFE: simple, accurate, fast and economic
  • major disadvantage: relatively small sample and cannot differentiate b/w in situ cc. or invasive cc. (cytological only)
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15
Q

Overview of core biopsy

A
  • 14-20G needle
  • local anesthesia and small incision is required
  • used for solid lesions only
  • vacuum-assisted core biopsy for breast microcalcifications
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16
Q

What are the drainage methods?

A
  • trocar technique: usually US guided, and there is a trocar used for direct punture to place tubes and drains
  • Seldinger technique: two step process
17
Q

What are the ablation techniques?

A
  • thermal ablation: uses heat or cold (cryoablation) to destroy tissue
  • nonthermal ablation: chemical ablation by processes such as irreversible electroporation
18
Q

What is radiofrequency ablation?

A
  • an electric circuit is formed within the patient’s body for concentrated heat generation that can destroy tissue
  • “heat sink” effect is when the effectiveness is limited because a large vessel is near the target and the flow of blood produces a cooling effect
19
Q

What is microwave thermoablation?

A
  • rotating, frictional movement of water molecules generates heat
  • radiofrequency/microwave ablation can be used in combination with other therapies, in case of tumors smaller than 3cm
20
Q

What is cryoablation?

A
  • application of extreme cold by liquid nitrogen (or He-Ar) to destroy tissue
  • usually for kidney, breast and prostate tumors
  • important for renal tumor ablation when the patient has comorbidities that contraindicate surgery, or when the patient requests minimally invasive treatment
21
Q

What is laser ablation?

A
  • optical fibers are used through a needle to transmit a laser light that destroys tissue
  • less traumatic ablation method, and has least risk of bleeding
22
Q

Overview of percutaneous chemical ablation

A
  • direct puncture and injection of chemical compounds to coagulate or dehydrate cells
  • 96% ethanol is most often used
23
Q

Overview of irreversible electroporation

A
  • micro-millisecond electric pulses that increase cell membrane permeability and thus lead to cell death
  • no “heat-sink” effect
24
Q

What are the indications for biliary interventions?

A
  • biliary obstruction
  • bile leakage
  • biliary stone removal
25
Q

What is percutaneous transhepatic biliary drainage?

A
  • procedure to drain bile and release pressure in the bile ducts
  • external: bile is diverted into an external bag
  • internal: bile is diverted in the direction of the small intestines
26
Q

How are biliary strictures treated?

A
  • balloon dilation: mostly used for benign strictures (balloon is inflated then deflated and removed after dilation)
  • stenting: self-expanding metal stents are used for malignant strictures (stenting is a metal scaffolding that remains in place to keep the ducts open)
27
Q

What is percutaneous nephrostomy?

A
  • minimally invasive procedure that provides symptomatic relief of obstructive uropathy by allowing urinary diversion, decompression of obstructed/infected collecting system
  • usually fluoroscop/US guided
  • used to treat obstructive uropathy
28
Q

Management of hemostasis in case of interventional radiology

A
  • due to bleeding risk, antiplatelet and anticoagulant therapies must be withheld for a few days according to the risk of bleeding
    - low risk: withhold for 3-5 days (aim for INR < 2.0)
    - moderate/high risk: withhold warfarin for 5 days (aim for INR < 1.5)
  • aspirin and NSAIDs just need to be withheld prior to high-risk procedures
  • referral physician will plan for this

Medical Imaging (17 decks)

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