Non-vascular interventional radiological procedures

Question 1

List em

Answer 1

Image guided biopsies: US, CT, Fluorscopy, MR, Hybrid (CT/MR)
Fine needle
Core biopsy

Image guided drainage or ethanol treatment of cysts.

Mammotomy - 8 gauge needles can be used to totally remove some very small breast cancers

Percutaneous tumor destruction
With ethanol, PEIT percutaneous ethanol inj therapy

RFA: Radiofrequency tumor ablation. Best for Liver tumors, but also for Lung, Kidney, and Bone
Placing an electrode in the tumor and ablating it with heat generated by the electrode. Ideal for small lesions <3cm, not next close to a medium or large vessel.

Microwave tumor ablation, also generated by a local electrode placed onto the lesion.

Laser tumor ablation - with a neodynium-YAG laser. placed next to the tumor

Cryoablation - via needle. liquid N2

Radiotherapy - X-rar radiotherapy, proton beam, neutron bean

Percutaneous cholecystic and choledochal interventions.

• Percutaneous transhepatic cholangiography
• Percutaneous transhepatic drainage
• Percutaneous choledochal stone removal
• Percutaneous cholecystostomy.

Balloon expansion and/or stenting of GI strictures and stenoses.

- bridging therapy before surgery
- symptom relief for inoperable bowel obstructions
- covered stenting to treat GI fistulas between large/small bowel or bowel and bladder

Percutaneous gastrostomy
- to empty stomach or esophagus in the case of emptying disorders due to nerve damage or CNS lesions.

Urinary tract, percutaneous nephrostomy to allow for drainage in benign or malignant ureter stenosis.

CT guided vertebroplasty to inject bone cement into vertebrae to prevent compression fractures

Question 2

When is Ultrasound guided biopsy used

Answer 2

Thyroid, Prostate, Ovary, Breast,

Question 3

X-ray guided biopsy

Answer 3

For breast biopsies on cancers that are poorly seen by US.

Question 4

When is MR guided biopsy used

Answer 4

For intracranial tumors

Question 5

When is CT guided biopsy used

Answer 5

For thoracic, mediastinal, retroperitoneal, or pelvic samples.

1st a CT scan is done to determine best orientation for needle insertion.
Then it is inserted along the planned path to the planned depth. and a second CT scan is done to confirm the position and biopsy is taken. Not real time constant imaging.

Question 6

What are the two techniques for abscess drainage

Answer 6

Trocar drainage and Seldinger drainage

Seldinger: pretent the abscess is a vessel and use a needle, then a guidewire, then a catheter to plant a permanent catheter for drainage.

Trocar: The trocar sheath and cannula are inserted at the same time and then thecannula is removed, leaving the sheath in place.

Question 7

Contraindications for biopsies and drainage

Complications

Answer 7

The patient cannot clot their blood.
An unavoidable blood vessel blocking the needle path.
No patient cooperation - anesthetize them

Hemorrhage
Pneumothorax
Intestinal perforation (you cannot perform core biopsy for lesions behind the intestines)
Tumor cell dissemination along the biopsy canal path.

Question 8

Describe Percutaneous transhepatic cholangiography

Answer 8

An X-ray or US guided procedure to inject contrast material into the extrahepatic biliary tree.

Question 9

Describe PTD - drainage

Answer 9

Percutaneous transhepatic drainage
After PTC, the stricture causing the bile buildup is expanded and stented to allow drainage to the intestine, or an extyernal drain is placed.

Question 10

Percutaneous stone removal

Answer 10

By percutanous expansion of the bile duct or pushing the stone out of the bile duct into the duodenum (stone needs to be small enough not to cause damage)

Question 11

Percutaneous cholecystostomy

Answer 11

placing a drainage catheter into the gall bladder to drain it, commonly used in elderly patients with cholecystitis to relieve pressure.
Must be done through the parenchymal side to prevent peritoneal bile leakage.