Common non-vascular IR procedures

Gastrointestinal (GI) Procedures

Radiologically Inserted Gastrostomy (RIG)

This is a procedure where a feeding tube is inserted into the stomach through the abdominal wall. It is often performed in patients who are unable to eat or swallow normally. The tube allows for direct administration of nutrition and medications. This is a very similar procedure to the alternative of a Percutaneous Endoscopic Gastrostomy (PEG) performed by gastroenterologists.

Luminal stenting

This procedure involves the placement of a stent in the gastrointestinal tract to treat strictures or blockages. Stents are devices made of metal or flexible material that help to keep the area open, allowing for better food and fluid passage. Gastrointestinal stenting can be performed in the oesophagus, stomach, small intestine, or large intestine, depending on the location of the stricture or blockage.

Hepatobiliary (HPB) Procedures

Biliary interventions

Interventional radiologists can perform procedures to treat conditions affecting the bile ducts, such as biliary strictures or blockages. These procedures may involve the placement of stents or the use of balloon dilation techniques to restore proper blood flow and improve bile flow.

Percutaneous Transhepatic Cholangiography (PTC)

This is a procedure performed to examine the bile and diagnose conditions such as blockages or strictures. A contrast dye is injected into the bile ducts, and X-ray images are taken to evaluate the anatomy and identify any abnormalities.

Cholecystostomy

This procedure involves the placement of a drainage tube into the gallbladder to relieve symptoms of acute cholecystitis or to drain infected bile.

Gallbladder drain internalisation Using a Percutaneous Trans-Ampullary Stent (GUPTAS)

When people who are not fit for surgery to remove their gall bladder due to gallstones may have a drain placed between the gall bladder and the bowel to reduce the risk of further blockages, known as a GUPTAS procedure. This procedure is a more permanent option than a cholecystostomy which can put patients at risk of gallbladder infections as the drainage tube exits the body. This specialised procedure requires referral by specialist hepatobiliary colleagues and is performed under local anaesthetic and sedation. In some cases, it can be done as a day case procedure.

Genitourinary (GU) Procedures

Genitourinary interventional radiology procedures play a crucial role in the management of various conditions affecting the kidneys and urinary tract. Two commonly performed procedures in this field are nephrostomy and ureteric stenting.

Nephrostomy

Nephrostomy is a procedure that involves the placement of a tube directly into the kidney through the skin and into the renal pelvis to bypass a blockage in the urinary system, allowing urine to drain directly from the kidney into an external bag. It is often indicated in cases of kidney stones, tumours, or strictures that obstruct the flow of urine.

Ureteric Stenting

Ureteric stenting involves the placement of a small tube, called a stent, into the ureter. This is typically done under image guidance using fluoroscopy or ultrasound. The stent is usually made of a flexible material such as silicone or metal, and it is placed to bypass a blockage or narrowing in the ureter. The stent helps to keep the ureter open and allows urine to flow freely from the kidney to the bladder. Ureteric stenting can be performed for various reasons, such as kidney stones, tumours, or strictures.

During the procedure, the patient will be positioned prone on an angiography table, local anaesthetic is administered to numb the area on the back where the stent will be inserted. Using fluoroscopy or ultrasound for guidance, the interventional radiologist will advance a catheter or guidewire through the kidney into the ureter. Then, the stent will be inserted over the catheter and positioned in the appropriate location. Once the stent is inserted, the catheter or guidewire is removed, and the stent remains in place to provide urinary drainage.

Percutaneous Nephrolithotomy (PCNL)

A percutaneous nephrolithotomy is a procedure performed with the patient lying on their front to remove kidney stones through the skin often because the stones have become too big to be able to pass naturally through the urinary system. It is commonly a joint procedure performed by both a radiologist and a urology surgeon and is usually reserved for large stones of 2cm or staghorn calculi. Due to the high vascularity of the kidney and large size of the hole dilated in the kidney to release the stone(s), a common post-procedural complication is haematoma or haemorrhage sometimes necessitating re-intervention or embolisation.

Musculoskeletal (MSK) Procedures

Vertebroplasty

Vertebroplasty is a minimally invasive procedure used to treat compression fractures in the spine. During the procedure, a small needle is inserted into the fractured vertebra under imaging guidance. Bone cement is then injected into the vertebra to stabilise it and relieve pain.

Lumbar Puncture (LP)

This procedure is performed to obtain a sample of cerebrospinal fluid (CSF) for diagnostic purposes. A small needle is inserted into the lower back, between the lumbar vertebrae, and fluid is withdrawn for analysis.

Injections

Epidural Steroid Injections: This involves the injection of corticosteroids into the space around the spinal cord to reduce inflammation and alleviate pain associated with conditions such as herniated discs or spinal stenosis.

Spinal Nerve Blocks: These injections target the nerves in the spine to relieve pain and inflammation. They can be used to diagnose the source of pain or provide therapeutic relief for conditions such as sciatica or facet joint arthritis.

Facet Joint Injections: These injections deliver medication directly into the facet joints of the spine to reduce pain and inflammation caused by conditions such as facet joint syndrome or arthritis.

Interventional Oncology

Tumour Embolisation

Tumour Embolisation is a minimally invasive procedure used to treat certain types of tumours by blocking the blood supply to the tumour. This procedure involves the injection of small particles called embolic agents into the blood vessels that supply the tumour, causing them to clot and preventing the tumour from receiving oxygen and nutrients. Tumour embolisation can be performed in various parts of the body, including the liver, kidney, lung, and bone. It is often used as a palliative treatment to shrink tumors and relieve symptoms in patients with advanced cancer.

Tumour Ablation

Ablation is the targeted destruction of abnormal tissue. Commonly ablated tumours include, liver, kidney and thyroid. There are several different modes of ablation which include but are not limited to heating up, cooling down or chemically destroying the abnormal tissue. Hyperthermic methods include microwave, laser and radiofrequency ablation and high-intensity focused ultrasound (HIFU) also known as histotripsy. Destruction of cell membranes is performed in cryoablation (freezing) and irreversible electroporation (IRE). Percutaneous ethanol ablation (chemical burning) is a technique most commonly used for cystic thyroid nodules but can be used to obliterate other cysts too.

Ultrasound and Computed Tomography Guided IR (US/CT)

Ultrasound Guided Biopsies

These biopsies are a minimally invasive procedure used to obtain tissue samples from various organs or structures in the body. During the procedure, an ultrasound machine is used to guide a needle into the targeted area, allowing the radiologist to collect a sample of tissue for further analysis. This technique is commonly used to diagnose conditions such as liver, kidney, or thyroid abnormalities, as well as to guide the treatment of certain cancers. Ultrasound-guided biopsies offer real-time imaging and precise targeting, making them a valuable tool in interventional radiology.

Ultrasound Guided Drains

Ultrasound Guided Drains are used to drain fluid or pus from a specific area in the body. During the procedure, an ultrasound machine is used to guide the placement of a small tube or catheter into the targeted area, allowing for the drainage of fluid or pus. This technique is often used to treat conditions such as abscesses or fluid collections. Ultrasound-guided drains can be placed in various locations, including the abdomen, chest, or pelvis. Transvaginal and transrectal drainage can be done by ultrasound guidance for abscesses or collections in hard to reach locations in the pelvis. The drainage tube can be left in place for a period of time (usually days to weeks) to ensure proper drainage.

Computed Tomography (CT) Guided Biopsies and Drains

Computed Tomography (CT) Guided Biopsies are similar to ultrasound-guided biopsies, but they use cross-sectional imaging instead of ultrasound. These scans provide detailed cross-sectional images of the body, which allows the radiologist to precisely locate the target area for biopsy. A needle is then inserted through the skin and guided to the desired location using real-time imaging. Tissue samples are collected for further analysis. They are commonly used to diagnose conditions in organs such as the lungs, liver, or bones, where the cross-sectional scan provides clear visualisation of the target area.

Similarly to a biopsy, Computed Tomography can be used to guide placement of a drainage tube where ultrasound is not suitable. A good example of this is CT guidance for peripancreatic necrotic collections which require extreme precision and a large bore drainage tube (20 French).

Bites

Vascular procedures include angioplasty, stenting, embolisation, and endovascular aneurysm repair for various conditions.
Venous interventions encompass fistuloplasty, stenting, and filter placement.
Non-vascular techniques cover gastrointestinal, hepatobiliary, genitourinary, musculoskeletal, and oncology procedures.
Neuroradiology procedures address carotid and cerebral issues, with a focus on stroke treatment.
Ultrasound and CT-guided interventions involve biopsies and drains for precise diagnosis and treatment.

IR Bites menu

Radiology Basics

Join 10k+ newsletter subscribers