Objectives of DSA imaging

 Elimination of superimposition of the structures

 Imaging the minute differences in density of the
anatomical structures and abnormalities
 Can demonstrate superior image quality
because of considerable reduction of scatter
radiation
 You can manipulate the image after the
procedure is completed
 They can measure densities of anatomical
structures
 Basic Functions of DSA imaging
 Ability to eliminate unwanted image on the
screen
 Ability to manipulate the image density and
contrast scale on the screen
 Ability to remove the tissue and bone structure
within the image
 Ability to perform fast image processing
 The image can be stored directly on the
computer
 Subtraction Technique
 Visualization of certain information an angiogram
by the removal of nonessential structures

 Important factors
 Keeping all radiographic factors constant
 same patient position
 Same radiographic distance
 Same exposure factor
Steps in Subtraction of Image
 Select a scout film (premilinary) for the
creation of a diapositive mask
 Prepare the diapositive mask (reversal film)
 Select one of the contrast filled angiogram
(series film) films and superimpose the film
over the mask – a process called registration
 When the diapositive mask is superimposed
over the contrast filled angiogram film which
is exposed for approximately 5seconds to
light, the positive and negative image of the
bones tend to negate each other, and only
the added contrast vasculativ is visualized
 Make the subtraction print. Place the
subtraction mask over the angiogram and
place the subtraction mask film on top of it
and exposed for 35 seconds to light.
 Order of Subtraction
 First order subtraction – simplest method of
photographic subtraction

 Second order subtraction – the complete

elimination of common structures for easily
visualization of the focus

 Mask subtraction – the method used in

performing digital subtraction angiography in
dark room by the use of ordinary light
Types of Imaging and interventional therapeutic
procedures likely to be conducted in an
Angiointerventional suite
IMAGING PROCEDURES INTERVENTIONAL
PROCEDURES
ANGIOGRAPHY STENT PLACEMENT
AORTOGRAPHY EMBOLIZATION
ANTERIOGRAPHY INTRAVASCULAR STENT
CARDIAC THROMBOLYSIS
CATHETERIZATION
MYELOGRAPHY BALLOON ANGIOSPLASTY
VENOGRAPHY ATHERECTOMY
 4 Techniques in DSA imaging
 Mask Subtraction

 Dual Energy subtraction – a method that

does not require the acquisition
before and after the arrival of CM

 Time interval differencing – a new mask

is chosen for each subtraction
 Syringe
A tube with a nozzle and piston or bulb for sucking
in and ejecting liquid in a thin stream , used for
cleaning wounds or body cavities , or fitted with
a hollow needle for injecting or withdrawing
fluids.
 Guide Wire
A wire or spring used as a guide for placement
of a larger device or prosthesis , such as a
catheter or intramedullary pin.
 Scalpel
Scalpel or a lancet , is a small and extremely sharp bladed
instrument used for surgery , anatomical dissection , and
various arts and crafts ( called a hobby knife) . Scalpels may
be single-use disposable or re-usable. Re-usable scalpels
can have permanently attached blades that can be
sharpened or more commonly , removable single use blades.
Disposable scalpels usually have a plastic handle with an
extensible blades (like a utility knife) and are used once, then
the entire instrument discarded. Scalpel blades are usually
individually packed in sterile pouches but are also offered
non-sterile. Double-edged scalpels are referred to as lancets.
 Catheter
In medicine, a catheter is a thin tube made from
medical grade materials serving a broad range
of functions. Catheters are medical devices that
can be inserted in the body to treat diseases or
perform a surgical procedure.
 Anaesthesia
Anaesthesia is a way to control pain during a
surgery or procedure by using medicine
called anaesthetics. It can help control your
breathing , blood pressure , blood flow , and
heart rate and rhythm.
The Procedure
Most angiography procedures are carried out
using local anaesthetics to numb are where the
catheter is going to be inserted. General
anaesthetic is sometimes used for young
children.

The procedure will be carried out by a

specialist, such as a cardiologist (a doctor who
specializes in heart disease) or a radiologist (a
doctor who specializes in using imaging
studies). A nurse may also be present to assist
with the procedure.
An intravenous (IV) line will be inserted into a vein
in your arm. It can be used to deliver sedatives or
any other medication as required. Electrodes
(small, metallic discs) may be placed on your
chest to record your heartbeat. A blood pressure
monitor may also be attached to your arm.

A small plastic tube called a sheath will be placed

into one of your arteries. A catheter (a long, thin
flexible tube) is inserted through the sheath and
on to the arteries being examined. Depending on
the area being examined, the catheter is usually
inserted into an artery in your wrist or groin.
X-rays are used to help guide the catheter to
the right place. Contrast agent will then be
injected through the catheter and a series of
X-rays will be taken. This will allow a map of
the arteries to be created.

The procedure isn't painful but you may feel a

slightly warm sensation, or a mild burning
sensation, as the contrast agent moves
through your blood vessels. It can take
between 30 minutes and two hours to
complete the procedure, depending on the
complexity of your condition and what the
radiologist finds.
In some cases, other procedures can be
carried at the same time, such as inserting a
balloon or a small tube called a stent through
the catheter to open up a narrowed artery.
This is known as angioplasty.

Once the procedure has been completed, the

catheter is removed and the incision is
closed using manual pressure, a plug or a
clamp.
HEMOSTAT

 A hemostat belong to a group of

instruments that pivot (similar to scissors,
and including needle holders, tissue
holders and various clamps) where the
structure of the tip determines the function.
 is a surgical tool used in many surgical
procedures to control bleeding.
PREP SPONGES

 Sentry Medical Foam Prep Sponges are

used for cleaning the incision site.
Antiseptic solution is sprayed onto the
site and wiped off with the foam sponge.
 ANTISEPTIC SOLUTION

 are antimicrobial substances that are applied to

living tissue/skin to reduce the possibility of infection
, sepsis, or putrefaction. Antiseptics are generally
distinguished from antibiotics by the latter's ability to
be transported through the lymphatic system to
destroy bacteria within the body, and
from disinfectants, which destroy microorganisms
found on non-living objects.
Scalpel BLADE

 A scalpel, or lancet, is a small and extremely

sharp bladed instrument used for surgery,
anatomical dissection, and various arts and
crafts(called a hobby knife).
 Scalpel blades are usually made of hardened
and tempered steel, stainless steel, or high carbon
steel; in addition, titanium, ceramic, diamond and
even obsidian knives are not uncommon.
SYRINGE AND NEEDLE

 Use for local anesthesia injection

BASIN AND MEDICINE CAPS
Sterile drapes and towels

 They are used to either create a

contaminant free area during an operation
or conceal the areas of the body not
affected by a procedure.
 creates an area free of contamination
during medical and surgical procedures
sterile image intensifier cover

 Round caps with elastics for holding.

Models for the protection of image
intensifier and of X-ray tube.
 BASIC PRINCIPLES

 Arterial Access, started in 1953, Sven Ivar

Seldinger, described a method of arterial
access that uses a catheter and makes a
surgery of the vessel unnecessary
 Seldinger needle - a gauge hallow to a
rubber catheter
 Stylet – metal rod is inserted to a rubber
catheter
Femoral artery – most often arterial
access n angiography
Guidwires – allow the safe introduction
of the catheter into vessel
J-tip – is a variation of configuration and
is used for atherosclerosis vessels
 CATHETER
 Just like guidewires, designed with
different shapes and sizes

 Catheters diameter is categorized in

French sizes (Fr) with 3 frequent
millimeter in diameter
 Example of Catheter
 H1 or Headhunter tip

 Simmons

 C2 or Cobra Catheter

 Pigtail

 Berenstein
 Types of Contrast Media
1. Ionic compound CM
-high concentration of iodine, more
reactions, high osmolality, more
physiological problems and much cheaper

2. Non-ionic compound CM
- low concentration ions, low osmolality,
cause fewer physcologic problems, and
fewer adverse reactions for patient and
much expensive than ionic CM
 Materials for Catheterization
 Needles
Types:
a. With a sharp, beveled outer cannula
and matching stylet
b. With a squared, blunt outer cannula and
a diamond-shaped or pencil point stylet
c. With a Teflon outer sheath
 Kinds:
a. AMPLATZ NEEDLE – for femoral artery and vein
puncture, brachial and axillary artery puncture
b. ANGIOCATH NEEDLE – for arterial and venous
puncture
c. BUTTERFLY NEEDLE – cubital vein puncture
d. POTTS- COURNAND NEEDLE – single wall
arterial puncture
e. SELDINGER-TYPE NEEDLE – arterial and
venous
f. TLA NEEDLE-transluminal angioplasty
g. PTA NEEDLE-peritonsilar needle aspiration
h. PORTAL VEIN/BILIARY DRAINAGE NEEDLE
 X-RAYS IN MOTION
―Viewing dynamic studies of the human body‖
HISTORY
 Thomas Edison, 1896
 Screen (zinc-cadmium sulfide) placed over patient’s body in
x-ray beam
 Radiologist looked directly at screen
 Red goggles-30 minutes before exam
 1950 image intensifiers developed
PRESENTLY….
 Fluoro viewed at same level of brightness as
radiographs (100-100 lux)
 X-ray tube under table/over table or in c-arm
 Image intensifier above patient in carriage
 Carriage also has the power drive control, spot film
selection and tube shutters
Fluoroscopy
 X-ray transmitted through patient
 The photographic plate replaced by fluorescent screen
 Screen fluoresces under irradiation and gives a life picture
 Older systems direct viewing of screen
 Nowadays screen part of an Image Intensifier system
 Coupled to a television camera
 Radiologist can watch the images “live” on TV-monitor; images
can be recorded
 Fluoroscopy often used to observe digestive tract
 Upper GI series, Barium Swallow
 Lower GI series Barium Enema
Machines and
Equipment
Conventional Fluoroscopic Unit
Modern Image Intensifier based
Fluoroscopy system
Modern Fluoroscopic System
Components
Modern Fluoroscopic Unit
Conventional Fluoroscopy and Red Goggles
RED GOGGLES?
The eye
 Light passes thru the cornea
 Between the cornea and lens is iris
 Iris acts as a diaphragm
 Contracts in bright, dilates in dark
 Light hits lens which focuses the light
onto the retina where the cones and
rods await
 Cones- central
 Rods - periphery
RODS CONES
 Sensitive to low light  Less sensitive to light
(threshold of 100 lux)
 Used in night vision
(scotopic vision)  Will respond to bright light
 Daylight vision (phototopic
 Dims objects seen better
vision)
peripherally
 Perceive color, differences in
 Color blind brightness
 Do not perceive detail  Perceive fine detail
FLUOROSCOPY X-RAY TUBES
 Operate at .5 to 5mA. Why do they operate at such low mA
stations?
 They are designed to operate for a longer period of time with higher
kVp for longer scale contrast.
 kVp dependent on body section
 kVp and mA can be controlled to select image brightness
 Maintaining (automatic) of the brightness us called ABC or ABS or
AGC (control,stabilization gain control)
Fluoro X-ray Tubes
 Fixed…may be mounted no closer than
15 inches or 38 cm to patient
 Mobile may be brought no closer than
12 inches or 30 cm to patient
IMAGE INTENSIFIER RECEIVE
REMNANT X-RAY BEAM, CONVERT IT TO
LIGHT…INCREASE THE LIGHT INTENSITY 5000-
30,000 TIMES
Image Intensifier
Image Intensifier Component

 Input screen: conversion of incident X Rays into light photons

(CsI)
 1 X Ray photon creates  3,000 light photons
 Photocathode: conversion of light photons into electrons
 only 10 to 20% of light photons are converted into
photoelectrons
 Electrodes : focalization of electrons onto the output screen
 electrodes provide the electronic magnification
 Output screen: conversion of accelerated electrons into light
photons
Functioning of
Image Intensifier
THE SEQUENCE
 Beam exits the patient
 Hits the input phosphore(cesium iodide CsI tightly
packed needles…produce excellent spatial
resolution)
 Converts x-rays to visible light
The sequence cont.
 Hits photocathode (Cesium and
antimony components)
 Emits electrons when struck by light
(photoemission)
The sequence cont
 The potential difference within the image
intensifier tube is a constant 25,000 volts
 Electrons are accelerated to anode
 Anode is a circular plate with hole for
electrons to go thru.
 Hits output phosphor which interact with
electrons and produce light
The Electron Path
 MUST BE FOCUSED FOR ACCURATE IMAGE PATTERN
 Electrostatic lenses (focusing devices)
 Accelerate and focus electron beam
 ―The engineering aspect of maintaining proper electron travel
is called electron optics‖
Continuing the sequence
 Electrons hit output phosphor (zinc cadmium
sulfide) with high kinetic energy producing an
increased amount of light
 Each photoelectron at the output phosphor has
50-75 more light photons
FLUX GAIN
 Ratio of number of light photons at the
output phosphor to the number of x-
rays at the input phosphor
 Flux gain =
# of output light photon
# of input x-ray photons
MINIFICATION GAIN
 Try the math
 Ratio of the square of the
diameter of the input phosphor  6 inches squared = 36
to the square of the diameter of  1 inch squared =1
the output phosphor OR
 Minification gain = 36
 # of electrons produces at large
input screen ( 6 inches)
squared, compressed into the
area of small output screen ( 1
inch) squared
BRIGHTNESS GAIN
 Minification gain x flux gain
 Increases illumination level of an image
 Ratio of the intensity of the illumination ot the output phosphor
to the radiation intensity at the input phosphor
 Brightness gain of 5000-30,000
 Maintaining (automatic) of the brightness us called ABC or ABS
or AGC (control,stabilization gain control)
CONVERSION FACTOR
 Ratio of intensity of illumination at the
output phosphor (measured in Candela
per meter squared) to the radiation
intensity at the input phosphor (mR per
sec)
 Cd/mr squared
mr/s
MULTIFIELD IMAGE
INTENSIFICATION

Allows focal point change to reduce

field of view and magnify the image
Some facts about multifield image
intensifiers
 Standard component on most machines
 Always built in digital units
 Most popular is 25/17
 Trifield tubes are 25/17/12 or 23/15/10
MULTIFIELD IMAGE
INTENSIFICATION
 Numeric dimensions refer to the input
phosphor (25/17)
 Smaller dimension (25/17) result in
magnified images
 At 25-all photoelectrons are accelerated to
output phosphor
MULTIFIELD IMAGE
INTENSIFICATION
 Smaller dimension – voltage of focusing
lenses is increased
 Electron focal spot moves away from the
output.
 Only the electrons from the center of input
strike the output
PROS CONS
 Only central region of input  Minification gain is
is used reduced = dimmer
 Spatial resolution is better image
(think of it as the umbra!)
 Lower noise, higher  To compensate must
contrast resolution increase mA
 Increase patient dose
Image recording
 In newer fluoroscopic systems film recording replaced with
digital image recording.
 Digital photospots acquired by recording a digitized video signal
and storing it in computer memory.
 Operation fast, convenient.
 Image quality can be enhanced by application of various image
processing techniques, including window-level, frame
averaging, and edge enhancement.
 But, the spatial resolution of digital photospots is less than that
of film images.
Facts about digital
fluoroscopy
 Image acquisition is faster
 Can post process
 Similar equipment to a conventional
fluoro room except
 two monitors
 Operates in radiographic mode
Digital Fluoroscopy and
radiographic mode
 Hundreds of mA vs 5 mA
 Due to the high generator required for
DF
 the x-ray beam is pulsed progressive
fluoroscopy
PULSED PROGRESSIVE
FLUOROSCOPY
 Generator can be switched on and off
rapidly
 Interrogation time
 Tube switched on and meets selected levels of
kVp and mA
 Extinction time
 Time required for the tube to be switched off
 Each must have times of less than one 1
ms.
 What is Interventional
Radiography?
 Interventional
radiology (abbreviated IR or VIR for Vascular
and Interventional Radiology, also referred to as
Surgical Radiology) is an independent medical
specialty, which was a sub-specialty
of radiology until recently, that uses minimally
invasive image-guided procedures to diagnose
and treat diseases in nearly every organ
system. The concept behind interventional
radiology is to diagnose and treat patients using
the least invasive techniques currently available in
order to minimize risk to the patient and improve
health outcomes.
As the inventors of angioplasty and the catheter-
delivered stent, interventional radiologists
pioneered modern minimally invasive medicine.
Using X-rays, CT, ultrasound, MRI, and other
imaging modalities, interventional radiologists
obtain images which are then used to direct
interventional instruments throughout the body.
These procedures are usually performed using
needles and narrow tubes called catheters, rather
than by making large incisions into the body as in
traditional surgery.
 History
 Interventional radiologists pioneered modern
medicine with the invention of angioplasty and
the catheter-delivered stent, which were first
used to treat peripheral arterial disease. By
using a catheter to open the blocked artery, the
procedure allowed an 82-year-old woman, who
refused amputation surgery, to keep her
gangrene-ravaged left foot. To her surgeon’s
disbelief, her pain ceased, she started walking,
and three "irreversibly" gangrenous toes
spontaneously sloughed. She left the hospital
on her feet—both of them.
•The growth of interventional radiology was fueled by ties
between interventionalists such as Charles Dotter and
innovative device manufacturers like Bill Cook.
•Interventional radiologist Charles Dotter, MD, known as the
"Father of Interventional Radiology" for pioneering this
technique, was nominated for the Nobel Prize in Physiology
or Medicine in 1978.

•Alexander Margulis coined the term "interventional" for

these new, minimally invasive techniques. He emphasized
that to continue to be on the forefront of innovation,
interventional radiologists must possess special training,
technical skill, clinical knowledge, ability to care for patients,
and closely collaborate with surgeons and internal medicine
subspecialists
•Development of stents began slowly. In 1969, Dotter
conceived the idea of expandable stents with an intra-arterial
coil spring.
•The first stents developed by Dotter and Andrew Craig were
made of nitinol. Gianturco introduced his self-expandable Z
stent.

• Hans Wallsten introduced a self-expandable mesh stent,

Ernst Strecker a knitted tantalum stent and Julio Palmaz his
balloon expandable stent, which was later perfected and
introduced to clinical practice.

• Angioplasty and stenting revolutionized medicine and led

the way for the more widely known applications of coronary
artery angioplasty and stenting that revolutionized the
practice of cardiology.
•After introduction of selective vasoconstrictive infusions by Baum, Josef
Rösch introduced selective arterial embolization for treatment of
uncontrollable bleeding in the early 70s.

• Anders Lundequist treated variceal bleeding with the technique of

transhepatic variceal embolization in the mid 70s. Interventions in the
biliary tract were developed by several pioneers.

• Interventional Radiologist Joachim Burrhenne invented and perfected

the technique of percutaneous removal of retained billiary stones.
• Plinio Rossi and Hall Coons enriched biliary interventions with their
work using biliary stents.

•The innovative interventionalists Kurt Amplatz, Willi Castaneda and

Dave Hunter pioneered percutaneous uroradiologic interventions. They
popularized nephrostomy drainage, percutaneous stone extraction, and
ureteral stenting.
 Imaging Modalities
 Common interventional imaging modalities
include fluoroscopy, computed
tomography (CT), ultrasound (US), and magnetic
resonance imaging (MRI) as well as traditional
(plain) radiography:

1. Fluoroscopy and computed

tomography use ionizing radiation that may be
potentially harmful to the patient and the
interventional radiologist. However, both methods
have the advantages of being fast and
geometrically accurate
2. Ultrasound is frequently used to guide needles during vascular access and
drainage procedures. Ultrasound offers real-time feedback and is inexpensive.
Ultrasound suffers from limited penetration and difficulty visualizing needles,
catheters and guidewires.
3. Magnetic resonance imaging provides superior tissue
contrast, at the cost of being expensive and requiring
specialized instruments that will not interact with the magnetic
fields present in the imaging volume.
Disorders
Vascular
 Varicose veins
Pooling of blood in the veins from weak valves resulting in enlarged, swollen
vessels causing pain and cosmetic complaints. Interventional endovenous
laser treatment or sclerotherapy may be used to heat the vein from the inside,
sealing it closed. Other healthy veins carry blood from the leg to reestablish
normal flow.
 Peripheral artery disease (PAD)
Most commonly a result of atherosclerosis, occlusion of normal blood flow in
the upper and lower extremities may result in pain, skin ulcers,
or gangrene. Stenting,angioplasty, and mechanical atherectomy are available
interventional treatments.
 Deep vein thrombosis (DVT)

The formation of a thrombus, or blood clot, in the deep leg veins which may lead to
swelling, discoloration, and pain. DVTs can result post-thrombotic
syndrome andpulmonary embolism. Post-thrombotic syndrome is irreversible damage
from a long standing DVT in the affected leg veins and valves, leading to chronic pain,
swelling, and severe skin ulcers. Pulmonary embolism is a life-threatening condition
which occurs when a deep vein thrombus (DVT) breaks off and travels to the lungs,
resulting in difficulty breathing. Catheter-directed thrombolysis, balloon angioplasty,
or stenting may be performed in the affected vein to dissolve the clot and restore normal
blood flow.
 Pulmonary embolism

 A potentially life-threatening
occlusion of the arteries
supplying the lungs with blood
clots, manifesting in shortness
of breath, fatigue, palpitations,
and fainting. Catheter-
directed thrombolysis may be
performed for this condition,
where a catheter is inserted
into the leg, threaded up to
the lung, and then used to
infuse "clot-busting" drugs into
the occlusion.
 IVC filter placement
 Patients who have a history of, or are at risk for, pulmonary
embolism may receive temporary or permanent inferior vena cava
(IVC) filters to prevent the migration of blood clots to the lungs,
and consequently prevent recurrence of pulmonary embolism.
 Abdominal aortic aneurysms (AAA)
 A weakening and dilatation of the abdominal aorta wall that can result in abdominal
or back pain, and potentially life-threatening bleeding if it ruptures. Interventional
treatment of this condition via non-surgical means is endovascular aneurysm repair,
using angiography and stenting to occlude the AAA and prevent its continued
growth.
 Thoracic aortic aneurysms (TAA) and Aortic dissection
 Aneurysms, or dilatations, of the thoracic (chest cavity) aorta may be caused
by atherosclerosis, syphilis, trauma, or multiple other conditions. Aortic
dissections are tears in the thoracic aorta resulting from trauma or weakening of the
aortic vessel walls from conditions such as hypertension, atherosclerosis, and
congenital conditions such as Marfan syndrome. Interventional treatments for TAAs
and aortic dissections utilize stent grafts, sometimes in combination with surgery, to
prevent blood flow from enlarging the diseased area or rupturing the aorta.
 Acute limb ischemia
The sudden disruption of blood flow to an arm or a leg due to
arterial occlusion by a blood clot or other debris, potentially
treated with catheter-directed thrombolysis or
mechanical thrombectomy
Acute mesenteric ischemia

A medical emergency resulting from interruption of the blood supply to the abdominal
organs due to blockage of the mesenteric arteries or veins by thrombus, embolus, or
aortic dissection. Treatment varies by etiology of the ischemia, but may include
thrombolysis, stenting, or angioplasty.
Aneurysms of visceral arteries
Dilatation of visceral arteries supplying organs such as the spleen,
liver, or gastrointestinal tract can result in pain and life-threatening
bleeding. Stenting, embolization, liquid occlusion, and thrombin
injection are the available interventional therapies for these
disorders.
Arteriovenous malformations (AVMs)
Aberrations in normal vascular anatomy treatable by
embolization which may cause pain, bleeding, heart
problems, or cosmetic concerns.
 ONCOLOGIC
Various interventional therapies exist to treat cancers.
Tumor type, size, extent of disease, operator
experience, and involvement of anatomical structures
all factor into deciding which therapy is most
appropriate. Some therapies, such as transarterial
chemoembolization, block the blood supply to tumors.
Other techniques--radiofrequency ablation (RFA),
microwave ablation, cryoablation, irreversible
electroporation (IRE), and high-intensity focused
ultrasound (HIFU)—directly damage the cancerous
tissue. All of these treatments are delivered locally,
minimizing damage to nearby tissue and avoiding the
systemic side-effects of chemotherapy.
Liver cancer
For liver cancer, curative treatment is liver resection or
liver transplant; however, cryoablation, radiofrequency
ablation, percutaneous ethanol injection,
chemoembolization, and radioembolization are options
for patients that are poor candidates for resection or
transplantation.
Lung cancer
Surgery (lobectomy) remains the reference for treating early stage
lung cancer; however, most patients are not surgical candidates at
the time of diagnosis. For these patients, minimally invasive
treatment options, including high-dose radiation therapies and
percutaneous thermal ablation therapies such as radiofrequency
ablation, microwave ablation, and cryoablation have emerged as
safe and effective treatment alternatives.
Kidney cancer is a type of cancer that starts in the cells in the
kidney.

The two most common types of kidney cancer are renal cell
carcinoma (RCC) and transitional cell carcinoma (TCC) of the
renal pelvis. These names reflect the type of cell from which the
cancer developed.
Breast cancer is cancer that develops from breast tissue. Signs of
breast cancer may include a lump in the breast, a change in
breast shape, dimpling of the skin, fluid coming from the nipple, or
a red scaly patch of skin. In those with distant spread of the
disease, there may be bone pain, swollen lymph nodes, shortness
of breath, or yellow skin
A bone tumor, (also spelled bone tumour), is a
neoplastic growth of tissue in bone. Abnormal growths
found in the bone can be either benign (noncancerous)
or malignant (cancerous).
Neurologic
 Stroke
• A neurological condition occurring when the brain is starved of
oxygen and nutrients resulting from the blockage of blood
vessels supplying it (ischemic stroke) or from bleeding
(hemorrhagic stroke). Symptoms include language, motor,
sensory, and vision deficits.
• Interventional neuroradiologists play a critical role in
determining the type of stroke (ischemic or hemorrhagic) using
non-contrast computed tomography (CT) imaging or magnetic
resonance imaging (MRI), and then treating the stroke using
minimally invasive treatment, if possible.

• Strokes caused by blood clots can be treated by intra-arterial

thrombolysis or by mechanical thrombectomy. Strokes caused
by bleeding resulting from ruptured aneurysms may be treated
by embolization, most commonly using tiny metal coils.
 Carotid artery stenosis

A narrowing of the carotid artery supplying

the brain which can lead to stroke and
disability. Carotid artery stenting (CAS) is an
alternative to surgical carotid
endarterectomy (CEA) which may be
performed in patients who have
symptomatic carotid atherosclerotic disease
but who are poor candidates for open
surgery.
 Multiple Sclerosis

Angioplasty of the cervical veins has been

suggested as an interventional treatment of
chronic cerebrospinal venous insufficiency
(CCSVI) that, hypothetically, contributes to the
pathogenesis of multiple sclerosis. This
hypothesis is highly controversial and treatment
of CCSVI by methods of interventional radiology
is encouraged only in context of research.
Spinal fractures

Vertebroplasty and kyphoplasty, the

percutaneous injection of biocompatible cement
into fractured vertebrae, are two available
treatments for vertebral fractures.
 Hepatobiliary

Portal hypertension

A condition in which the normal flow of blood through the

liver is slowed or blocked by scarring (cirrhosis) or other
damage (e.g. hepatitis). Patients with the condition are at
risk of internal bleeding or other life-threatening
complications. Transjugular intrahepatic portosystemic
shunt (TIPS) formation is a minimally invasive treatment
to alleviate this impaired blood flow.
 Bile Duct Obstruction

Patients with liver cancer, bile duct cancer,

cholecystitis, cholangitis, or other hepatobiliary
pathology may experience obstruction of bile
ducts. Interventional radiologists commonly
perform procedures such as percutaneous
transhepatic cholangiography (PTHC or PTC) to
image these obstructions, and may treat these
conditions using percutaneous transhepatic
biliary drainage (PTBD), wherein catheters or
stents are placed through the skin and into the
bile ducts to drain the bile for prolonged periods
of time or until surgery.
Procedures
Angiography
Imaging the blood vessels to look for
abnormalities with the use of various contrast
media, including iodinated contrast, gadolinium
based agents, and CO2 gas.
Balloon angioplasty/stent
Opening of narrow or blocked blood vessels
using a balloon; may include placement of
metallic stents as well (both self-expanding and
balloon expandable).
Cholecystostomy
Placement of a tube into the gallbladder to
remove infected bile in patients with cholecystitis,
an inflammation of the gallbladder, who are too
frail or too sick to undergo surgery.
Drain insertions:
Placement of tubes into different parts of the body
to drain fluids (e.g., abscess drains to remove
pus, pleural drains). A common problem is that
these tubes get clogged and have to be replaced
or removed before all the material is drained.
Embolization:
Blocking abnormal blood (artery) vessels (e.g., for the purpose of
stopping bleeding) or organs (to stop the extra function e.g.
embolization of the spleen for hypersplenism) including uterine
artery embolization for percutaneous treatment of uterine fibroids.
Various embolic agents are used, including alcohol, glue, metallic
coils, poly-viny alcohol particles, Embospheres, encapsulated
chemo-microsphere, and gelfoam.
Chemoembolization
Delivering cancer treatment directly to a tumour through
its blood supply, then using clot-inducing substances to
block the artery, ensuring that the delivered
chemotherapy is not "washed out" by continued blood
flow.
Radioembolization
Embolization of tumors with radioactive microspheres of
glass or plastic, to kill tumors while minimizing exposure
to healthy cells.
Thrombolysis
Treatment aimed at dissolving blood clots (e.g.,
pulmonary emboli, leg vein thrombi, thrombosed
hemodialysis accesses) with both pharmaceutical (TPA)
and mechanical means.
Biopsy
Taking of a tissue sample from the area of interest for
pathological examination from a percutaneous or
transjugular approach.
Cryoablation
Localized destruction of tissue by freezing
IVC filters
Metallic filters placed in the inferior vena cavae to
prevent propagation of deep venous thrombus, both
temporary and permanent.
: