Interventional Radiology Medical Student Introduction

Dr Nadeem ShaidaMBBS MRCS FRCR FHEA

Consultant Vascular & Interventional Radiologist

Overview

• What is Interventional Radiology?– Sub branch of Radiology– Using imaging to perform invasive procedures– Fluoroscopy (X-rays), CT, US, MRI main modalities– “Pinhole surgery”

Overview

• What is Interventional Radiology?– Sub branch of Radiology– Using imaging to perform invasive procedures– Fluoroscopy (X-rays), CT, US, MRI main modalities– “Pinhole surgery”

• Obvious advantages of minimal access– Quicker– Often under LA therefore shorter recovery time– Able to do procedures in sicker patients

History

• 1895 – First Xray Mrs. Roentgen• 1st Nobel Prize in Physics• 1914-18 “Mobile” Xray Unit• 1927 – First angiogram Egas Moniz• 1929 – First aortogram Reynaldo dos Santos

History

• 1895 – First Xray Mrs. Roentgen• 1st Nobel Prize in Physics• 1914-18 “Mobile” Xray Unit• 1927 – First angiogram Egas Moniz• 1929 – First aortogram Reynaldo dos Santos• 1953 – Seldinger technique• Key for obtaining access

History

• 1895 – First Xray Mrs. Roentgen• 1st Nobel Prize in Physics• 1914-18 “Mobile” Xray Unit• 1927 – First angiogram Egas Moniz• 1929 – First aortogram Reynaldo dos Santos• 1953 – Seldinger technique• Key for obtaining access • 1964 – Charles Dotter – “Father of IR”• First angioplasty• Links with industry forged early

IR = Innovation• Term“Interventional Radiology” coined in

1967• 1966 – Embolisation of spinal AVM• 1967 – Judkins coronary catheterisation• 1967 – Selective vasoconstriction for GI bleed• 1970s – Development of occlusive “coils”• 1973 – Embolisation for trauma• 1974 – Thrombolysis for arterial occlusion• 1977 – (Chemo)embolisation of liver tumours• 1980 – Cryoablation of tumours• 1982 – TIPSS Procedure• 1985 – Catheter delivered stent• 1990 – Radiofrequency ablation• 1991 – EVAR• 1999 – Islet cell transplanation• 2004 – Selective Internal Radiation Therapy

IR Today?

• Vascular • Non-vascular• Interventional Oncology• Neurointervention• MSK intervention• Many many other procedures!

Vascular IR

• Angioplasty– Balloon dilatation– Drug eluting balloon– Stent– Drug eluting stent– Biovascular scaffolds

Vascular IR

• Angioplasty• Aneurysm repair– EVAR– TEVAR– Visceral aneurysms– Ruptured AAA– Branched/Fenestrated EVAR

Vascular IR

• Angioplasty• Aneurysm repair• Haemorrhage control– GI tract– Pelvic trauma– Visceral trauma (Spleen/kidney/liver etc)– Haemoptysis (Bronchial)

Vascular IR

• Angioplasty• Aneurysm repair• Haemorrhage control• Venous interventions– Ilio-femoral DVT– PE– Pelvic congestion syndrome– Chronic venous occlusive disease

Non Vascular IR

• Drains/Biopsies• Nephrostomy• PTC & Biliary Drainage• Gastrostomy/ feeding procedures• IVC filters• Fibroid embolisation• Varicocoele• TIPSS Procedure

Interventional Oncology

• Transarterial embolisation of liver• Transarterial chemoembolisation• SIRT procedure (Radioembolisation)• Ablative procedures– RFA– Microwave– Cryotherapy

Neurointervention

• Aneurysms – Coiling v Clipping• Carotid stenting• AVM embolisation• Stroke thrombolysis• Venous stenting

IR Weekly Timetable

• Mon am – US list (Biopsy/Ablation assessment)• Mon pm – IR list (Fibroids/Varicocoele)• Tue am – Theatre (EVAR)• Tue pm – Vascular MDT• Wed am – TIPSS (Once/month)• Wed pm – Vascular MRI• Thu am – IR (TAE/SIRT/PVE/Biliary Stenting)• Thu pm – Liver tumour MDT• Fri am – IR (Angioplasty/Stenting/AVM embolisation)• Fri pm - CT

Whos It For?

• Everyone!

Whos It For?

• Everyone!• But it helps if…– Hand eye co-ordination– Adaptability– Prepared to improvise/innovate– Interested in emerging technologies– Teamworking– Coolness under pressure!

Career Pathway

• FY1/FY2– Taster week radiology

• Core training (Not essential)• Radiology training – Years 1-3 as normal– Final FRCR sat at beginning of year 4

• Since 2010 – New IR curriculum– Leads to CCT in Radiology (Interventional Radiology)– Years 4-6 IR training

Career Prospects

• Good!– Shortage of radiologists in general– Shortage of IR highly acute (BSIR 200 deficit)– Centralisation of services

• In UK national T & Cs• Other countries well remunerated• Downsides– On call – Specialty creep

Key Resources

• BSIR – Undergraduate curriculum– Medical student Links

• CIRSE

nadeem.shaida@addenbrookes.nhs.uk