Common Invasive Imaging Procedures

Question 1

What are two examples of biopsies taken under radiological guidance?

Answer 1

Core biopsy

Fine needle aspiration (FNA)

Question 2

Describe how a core biopsy is taken and why

Answer 2

Using 14-18 g needle

For histopathology

Question 3

Describe how an FNA is taken and why

Answer 3

Using a 20-25 g needle
For cytopathology
Can also be sent for microbiology

Question 4

Why may aspirations be taken?

Answer 4

Suspected abscesses

Joint effusions

Question 5

What two imaging modalities are most imaging guided biopsies and aspirations performed using?

Answer 5

Ultrasound

CT

Question 6

Why is a hook-wire or carbon track injection done in the breast (using ultrasound)?

Answer 6

Aid surgical excision of impalpable lesions

Question 7

Define pleurocentesis

Answer 7

Aspiration of pleural effusion

Question 8

Define paracentesis

Answer 8

Aspiration of ascites

Question 9

What sort of imaging are pleurocentesis and paracentesis usually performed using?

Answer 9

Ultrasound

Question 10

What is an antegrade pyelogram?

Answer 10

Needle injection of contrast into pelvicalyceal system
Initial step for insertion of 
- Nephrostomy drainage catheter
- Ureteric stent
- Stone removal

Question 11

What is nephrostomy?

Answer 11

Drainage catheter inserted into pelvicalyceal system usually to relieve obstruction

Question 12

What is suprapubic catheter insertion?

Answer 12

Urinary bladder catheter inserted

Used where urethral catheter can’t be passed/not desirable

Question 13

What is percutaneous transhepatic cholangiogram (PTC)?

Answer 13

Used in initial part of

• Transhepatic biliary drainage/stent insertion
• Stricture dilatation/stone removal

Question 14

What are two examples of percutaneous oncology treatments?

Answer 14

Tumour ablation
- Radiofrequency ablation
- Microwave ablation
Transarterial chemoembolisation/irradiation
- Chemotherapeutic/radioactive agents selectively delivered to arteries supplying tumour

Question 15

What are the common indications for an angiograph of the aorta?

Answer 15

Aneurysms
Dissection
Stenosis

Question 16

What are the common indications for an angiograph of the cerebral vessels?

Answer 16

Berry aneurysms

Haemorrhage

Question 17

What are the common indications for an angiograph of the carotid arteries?

Answer 17

Stenosis

Occlusion

Question 18

What are the common indications for an angiograph of the renal vessels?

Answer 18

Stenosis

Haemorrhage

Question 19

What are the common indications for an angiograph of the mesenteric vessels?

Answer 19

Haemorrhage

Question 20

What are the common indications for an angiograph of the peripheral vessels?

Answer 20

Stenosis
Occlusion
Aneurysm

Question 21

What are the common indications for an angiograph of the coronary vessels?

Answer 21

Stenosis

Occlusionq

Question 22

What is percutaneous transluminal angioplasty (PTA)?

Answer 22

Balloon dilatation of vascular stenosis

Question 23

What is a vascular stent?

Answer 23

Implanted metallic device for maintaining vascular lumen post angioplasty

Question 24

What is thrombolysis?

Answer 24

Dissolution of clot

Question 25

What is thrombectomy or embolectomy?

Answer 25

Removal of clot

Question 26

What is atherectomy?

Answer 26

Removal of atheroma

Question 27

What is embolisation?

Answer 27

Occlusion of vessels using particulate matter/fine coils; eg: to treat bleeding

Question 28

How does digital subtraction angiography (DSA) work?

Answer 28

1st exposure made just before contrast injected
Imaged subtracted from subsequent images
Only blood vessels with contrast shown
Create cleaner diagnostic image

Question 29

What is the check list for preparing for invasive radiological procedures?

Answer 29

Right procedure?
Right modality?
Bleeding risk issues
Explanantion and consent
Check renal function - if contrast needed
Check local policy on withholding metformin in diabetics
Fasting if sedation needed