Miniature devices and X-ray vision allow interventional radiologists to shrink incisions and speed healing.
Interventional radiologists have emerged from X-ray labs into operating rooms, using minimally invasive techniques to treat hard-to-reach parts of the body and turning a low-profile specialty into a burgeoning surgical field with its own clinical and outpatient services. In the process, they're reducing costs, shortening recovery times and easing pain.
"Interventional radiology is perhaps the most interesting medical field that a lot of folks haven't heard about," says Dr. James Spain, chief of interventional radiology at The Ohio State University Wexner Medical Center. "We invented minimally invasive. We rarely make an incision over a quarter of an inch-just a nick in the skin-and we put a Band-Aid on at the end."
"If you think of the human body as a complex geography of tissue, blood vessels, neurons and bones, the equipment of today's interventional radiologists acts like the body's GPS system," says Dr. Brad Mullin, director of neurosurgery at Mt. Carmel East Hospital and adjunct assistant professor of neurosurgery at Ohio State.
Interventional radiology specialists are opening outpatient clinics to see patients and provide radiation, chemo, burn and cryo therapies. "Our direct interaction and treatment of patients has evolved quickly," said Dr. John Lippert, an interventional radiology and vascular specialist at Riverside Radiology and Interventional Associates, closely affiliated with OhioHealth.
This transformation follows the development of ever-smaller probes, catheters and instruments, with a breakthrough in reducing probe size in 2011. "We had been freezing tumors since the '60s, but the probe was as big as my finger. Now the technology means probes just a little bigger than an IV needle," Lippert says.
Significant dividends have been realized. The field has expanded the range of minimally invasive surgery now available, minimizing risks of infection from open surgery and limiting damage to healthy tissues surrounding a tumor, blockage or fragmented bone.
That means many interventional radiology procedures are available on an outpatient basis and typically don't involve general anesthesia. Those factors hasten recovery time, helping patients return to work and home. It yields productivity benefits for employers and savings for the healthcare system.
"We're talking about recovery times that in some cases are down to days and weeks instead of weeks and months," Lippert says. "Patients are surviving conditions once thought to be life-ending and going back to their jobs, their families and a better quality of life."
For cancer patients, miniature probes and catheters deliver radiation or chemotherapy, or alternatively provide precision burning or freezing of tumors to destroy malignant cells, avoiding nearby muscles, blood vessels and nerves. Specialists recently introduced TARE (trans-arterial radioembolization) via TheraSphere, a branded process of delivering microscopic glass particles filled with yttrium-90 directly to liver tumors, Spain says.
"In many cancers, particularly renal carcinoma where the kidney can get very large, there would be substantial blood loss if they take the kidney out, but not so much if we embolize it," says Spain. "So we release things into the artery feeding the kidney to cause it to be blocked. It could be a coil or small particles, each smaller than a grain of sand, and ultimately they stop the flow of blood to the capillaries."
For spinal injuries and disk deterioration procedures, Mullin now uses a fully portable BodyTom (a CT scanner) in the operating room at Mt. Carmel East, the only one in central Ohio to do so. The BodyTom feeds real-time information to a new spine mask by Stryker-another first-that displays detailed LED images of the spine, surrounding tissue and surgical instruments.
Pairing the devices in the operating room eliminates inaccuracies as patients change position from X-ray table to the OR. "It's like the difference between television and high-definition television," Mullin says.
Not all interventional radiology specialists work directly in the operating room. At the new James Cancer Hospital, IR specialists work close at hand in three new interventional radiology suites just down the hall from the fourth floor oncology surgical suites. The Riverside group IR specialists offer both clinical/outpatient treatment and in-hospital care.
In the future, new techniques will deliver microwave therapy by catheter, as well as minimally invasive techniques to treat benign prostate tumors while preserving sexual response, Spain says.
And interventional radiologists hope to guide connections between the brain and artificial limbs. "You need to do that minimally invasively, with computer technology and scans that are four generations from what we have today," Mullin says.
Mike Mahoney is a freelance writer.