What is an interventional radiologist?
An interventional radiologist is a board certified physician who specializes in minimally invasive, targeted treatments. Interventional radiology is a subspecialty of radiology.

What is the function of an interventional radiologist?
Interventional radiologists perform targeted procedures while using imaging devices such as x-ray or ultrasound to guide them during the process. Considered “minimally invasive,” IR procedures have lower risk, less pain and shorter recovery time compared to open surgery. Click here to see some Common interventional procedures.

What are the benefits?
Because interventional radiology replaces the traditional tools of the trade – i.e., scalpels – with imaging-based procedures that are more precise and less intrusive, patients benefit from:
• smaller incisions
• little or no anesthesia
• much less cutting of skin, muscle or other tissues
• shorter hospital stays

Interventional Radiology
• Angiography / Angioplasty / stent
• Biliary Interventions
• Carotid Stent Placement
• Cerebral Angiogram and Neurointerventions
• Deep Vein Thrombosis (DVT)
• Gastrointestinal interventions
• Gynecological Interventions
• Image-Guided Back Pain Management
• IVC filter placement
• Thrombolysis and Embolization
• Ultrasound and CT guided procedures
• Urological interventions
• Vascular Access for Dialysis, Chemotherapy
• Vertibroplasty/Kyphoplasty /Nucleoplasty
• IR Resources and Links

VASCULAR INTERVENTIONAL RADIOLOGY AT OAKWOOD ANNAPOLIS HOSPITAL,
WAYNE, MICHIGAN

Interventional radiology is a rapidly growing vascular medicine sub speciality. Interventional radiologists specialize in performing medical procedures using imaging equipment such as X-rays, magnetic resonance (MR) imaging, ultrasound and computed tomography (CT) to diagnose and treat disease. IRs are board certified radiologists that are fellowship-trained in percutaneous interventions using image guidance. Their specialized training is certified by the America Board of Medical Specialties.

Under the guidance of Venkat C. Rudraraju, MD, Director of Interventional Radiology, and Purushottam Dixit, MD
Co-director of Interventional Radiology, Oakwood Annapolis Hospital at Wayne, Michigan, offers a full range of interventional radiology services.

Both Venkat C. Rudraraju, MD and Purushottam Dixit, MD Certified by the American Board of Radiology in Diagnostic Radiology, along with holding a Certificate of Added Qualification in Vascular and Interventional Radiology. Our Interventional Radiologists currently specializes in minimally invasive, image-guided diagnostic and therapeutic treatments in the following areas.
Venkat C. Rudraraju, MD
Director of Vascular Interventional Radiology
 
Purushottam Dixit, MD
Co Director of VIR

Vascular Services
• Arteriography and venography, angioplasty/stenting
• Arterial and venous thrombolysis, thrombectomy and embolization
• Vascular foreign body retrieval
• IVC filter replacement
• Venous access, including vascular ports, tunneled PICCS catheters

Tumor Treatments
• Uterine fibroid emboilization (UFE)
• Chemoembolization for hepatic neoplastic disease
• Radiofrequency and alcohol ablation of lesions
• CT or US guided biopsies (and drainages)

Back Pain Management
• Pain management fluoroscopic procedures: epidural, facette, sacroiliac and other joint injections

Other Services
• Peritoneal or pleural catheter placement
• Transjugular liver biopsy
• Percutaneous gastrostomy/gastrojejunostomy placement
• Percutaneous nephromstomy and biliary interventions
Image-Guided Biopsy
A biopsy is a small sample of tissue or fluid taken from the body. This sample can then be studied in a laboratory. Image-guided biopsy allows a sample to be taken from an abnormal mass without the need for surgery. This procedure is done by a specially trained doctor called an interventional radiologist.

Before the Procedure
Follow any instructions you are given on how to prepare, including:
• Do not eat or drink anything for 6 hours before the procedure.
• Tell your technologist what medications, herbs, or supplements you take; if you are, or may be, pregnant; or if you are allergic to any medications.

During the Procedure
• You will change into a hospital gown and lie on an x-ray table. You may lie on your back, front, or side, depending on the location of the area to be biopsied.
• An IV (intravenous) line is started to give you fluids and medications. You may be given medication through the IV to help you relax.
• The skin over the biopsy site is cleaned. A local anesthetic is applied to numb the skin.
• Using CT (computed tomography), x-ray, or ultrasound images as a guide, the radiologist puts a thin, hollow needle through the skin and guides it to the area to be biopsied.
• The needle is used to take a sample of tissue or fluid from the area. The needle is then removed. The sample is sent to the pathologist who looks for abnormal cells.

Risks and Complications
Potential risks and complications of image-guided biopsy include:
• Bruising or bleeding at the needle insertion site
• Bleeding internally
• Damage to structures along the path of the needle

After the Procedure
• You will most likely be able to go home within a few hours.
• Care for the insertion site as directed.

Therapeutic and diagnostic image-guided services at OAH
These and other therapeutic and diagnostic image-guided services – including vertebroplasty, myelography, and discography – are offered in the Oakwood Annapolis Hospital, Department of Interventional Radiology and can be scheduled directly by contacting Central Scheduling at 734-467-4174.
Peripheral Angioplasty
Talk to your doctor about the risks and complications of angioplasty.
Peripheral angioplasty is a procedure that helps open blockages in peripheral arteries. These vessels carry blood to your lower body and legs.

Before the Procedure
• Tell your doctor about all medications you take and any allergies you may have.
• Don’t eat or drink after midnight the night before the procedure.
• Arrange for a family member or friend to drive you home.

During the Procedure
• You may get medication through an IV (intravenous) line to relax you. After an injection numbs the site, a tiny skin incision is made near an artery in your groin.
• Your doctor inserts a catheter (thin tube) through the incision (insertion site), then threads it into an artery while viewing a video monitor.
• Contrast “dye” is injected into the catheter. X-rays are taken (angiography).
• A tiny balloon is pushed through the catheter to the blockage. Your doctor inflates and deflates the balloon a few times to compress the plaque. A stent (small metal or mesh tube) may be placed to help keep your artery open. The balloon and catheter are then removed.

After the Procedure
You’ll be taken to a recovery area. Pressure is applied to the insertion site for about 15 minutes. You will need to keep your leg still and straight for a few hours. You will go home that day or spend the night in the facility. You will be instructed what to do when you go home.

Call Your Doctor If:
• You notice a lump or bleeding at the site where the catheter was inserted.
• You feel pain at the insertion site.
• You become lightheaded or dizzy.
• You have leg pain or numbness.

A balloon is inserted
The balloon is inflated
Blood flow is improved
Peripheral Venous Thrombolysis
A blood clot that forms in a vein in the leg or arm can block blood flow and cause swelling and pain. In certain cases, the clot may break off and travel to the lungs (pulmonary embolism). This can be fatal. Peripheral venous thrombolysis is a procedure to dissolve a blood clot in a leg or arm vein, relieve symptoms, and prevent pulmonary embolism. The procedure is often done by a specially trained doctor called an interventional radiologist.

Before the Procedure
Follow any instructions you are given on how to prepare, including:
• Do not eat or drink anything for 6 hours before the procedure.
• Tell the technologist what medications, herbs, or supplements you take; if you are, or may be, pregnant; or if you are allergic to contrast medium
(x-ray dye) or other medications.

During the Procedure
• An IV (intravenous) line is put into a vein to give you fluids and medications. You are given medication to help you relax and make you sleepy. A local anesthetic is given to keep you from feeling pain where the catheter (thin, flexible, tube) will be inserted.
• A very small incision is made over the insertion site. (This is often behind the knee.) A catheter is inserted through the incision into the vein.
• Contrast medium is injected through the catheter into the vein. This helps the vein show clearly on x-ray images. Using these images as a guide, the radiologist moves the catheter through the vein to the clot.
• When the catheter reaches the clot, medication to dissolve the clot is sent through the catheter. This is done slowly, over a period of a few hours. The catheter is left in place until the clot has dissolved. This can take up to 72 hours.
• When the procedure is finished, the catheter is removed. Pressure is put on the insertion site for 15 minutes to stop bleeding.

After the Procedure
• You may be told to lie flat and keep the insertion site still for 6 hours to prevent bleeding.
• You may stay in the hospital for a few hours or overnight.
• Drink plenty of fluids to help flush the contrast medium from your system.
• After you go home, care for the insertion site as directed.
Potential Risks and Complications
• Bleeding internally or at the insertion site
• Bruising at the insertion site
• Damage to the vein
• Problems due to contrast medium, including allergic reaction or kidney damage
Uterine Fibroid Embolization
Fibroids are benign (not cancerous) growths of muscle tissue on or inside the uterus. Uterine fibroid embolization shrinks a fibroid by cutting off its blood supply. The procedure is done through a catheter (long, thin, flexible tube) placed into a blood vessel through a small incision. The procedure is often done by a specially trained doctor called an interventional radiologist.



Before the Procedure
To prepare for your embolization:
• Do not eat or drink anything for 4 hours before the procedure.
• Tell your doctor if you have allergies to any foods, medications, or contrast medium (x-ray die).
• Tell your doctor about any medications, supplements, or herbs you're currently taking and ask whether you should stop taking them before the procedure.

During the Procedure
• You'll change into a hospital gown and lie on an x-ray table. An IV (intravenous) line is started to give you fluids and medications. You may be given medication to help you relax.
• The skin at the insertion spot is numbed with local anesthetic. Then, a needle with a thin guide wire is inserted into the femoral artery (a blood vessel near the groin). A catheter is placed over the guide wire into the blood vessel.
• Contrast medium is injected through the catheter. This helps the arteries and catheter show up better on x-rays. The movement of the catheter can then be watched on a video monitor.
• Using x-ray images as a guide, the radiologist moves the catheter through the blood vessel into the artery that supplies blood to the uterus.
• Once the catheter is near the fibroid, the radiologist then performs the embolization by injecting tiny grains of plastic or spongy material into the artery. These grains flow to the smaller vessels that supply the fibroid, blocking blood from flowing. The procedure is repeated on the other side of the uterus.
• The entire procedure takes around 1 to 2 hours.

Potential Risks and Complications
• Infection or bruising around the catheter insertion site
• Blood clot in a blood vessel
• Problems due to contrast medium, including allergic reaction or kidney damage
• Infertility or premature menopause
• Injury to the uterus, requiring a hysterectomy

After the Procedure
You may stay in the hospital for a few hours or overnight. For up to a week, you will likely feel pain and cramping. You will be prescribed medications to help control this pain. Some vaginal spotting is common for a few days. You may feel tired and have nausea and a fever for a few days after the procedure. During your recovery, care for the insertion site as directed. You may be able to return to work within 1 to 2 weeks after the procedure.
State of the art Neurointerventional procedures by world known Neurointerventional radiologist Bharat Mehta,MD

Procedures:
• Vertebroplasty, kyphoplasty, Nucleoplasty, Spinal Cord stimulaters, spine interventions
• Cerebral aneurismal coiling, Stroke management
• Carotid stenting, Embolizations AV malformations, vascular tumors
• Many More

Image Guided Back Pain Management LINK
This article discusses the options offered by interventional radiology for controlling back pain. Written for an audience of physicians and other health care professionals, it nonetheless offers insights for anyone interested in back pain management or seeking back pain relief.

Determining the etiology
Back pain is one of the most common conditions for which patients seek care. As many structures in the 'back' can cause pain, the etiology should be determined with certainty. In addition to a thorough history and physical, imaging can aid in diagnosing a spinal etiology, such as impression by bone, disk or even post-op scar in or adjacent to the spinal canal. The majority of back pain cases resolve spontaneously and only a minority of these requires surgical intervention. Therefore, at first, conservative treatment is usually sought.
Administering image-guided relief
“With the advent of image guidance... we can achieve a more accurate delivery of the pharmaceuticals to the appropriate region.”
“With the advent of image guidance... we can achieve a more accurate delivery of the pharmaceuticals to the appropriate region.”

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A select group of patients may benefit from a direct administration of steroids (and local anesthetic) to remove the extra-inflammatory burden, superimposed on the mechanical compression. The relief achieved from these injections, in treating both localized pain and radiculopathy, can be dramatic, but may add diagnostic information for the referring physician.

Injection options include:

• Epidural steroid injections have been performed for over a century without image guidance, utilizing patient positioning, landmarks and a 'loss of resistance' to the syringe, as the endpoint. However, other nearby anatomic structures into which the needle can traverse may mimic that sensation, including the thecal sac. With the advent of image guidance and the use of a minimal contrast agent for epidurography we can achieve a more accurate delivery of the pharmaceuticals to the appropriate region.
• Selective nerve root injections are indicated if the radiculopathy originates lateral to the epidural space, or from within the neural foramina. Fluoroscopic control and 'radiculography' where contrast is injected into the nerve root sheath for positional confirmation, is important, to insure selectivity and avoid epidural reflux. Although the latter may also achieve relief, response to blockade of a specific nerve can be important for diagnostic purposes as well. Moreover, in the cervical spine, needle position is critical as injectate placed into the nearby vertebral artery, thecal sac or spinal cord, etc. can be potentially lethal.
• Other image-guided steroid injections are similarly intended to relieve back pain emanating from associated joint spaces, including the Sacro-iliac joints and Facet joints. In the latter, the innervating median branch of the Dorsal Ramus is also treated (wherein neurolysis or radiofrequency ablation can then be considered.)
With proper utilization of these image-guided back pain injections, immediate and even potentially long term relief can be experienced. However, they are intended to supplement other phases of management prescribed by physicians whose patients suffer with back pain.