On 8 November 1895, Wilhelm Conrad Roentgen discovered X rays and revolutionised the practice of medicine. With this discovery, radiology was born and later became the backbone of medical practice. Nobel Laureate William Henry Bragg once said “The discovery of X-rays has increased the keenness of our vision 10,000 times.” It has been the most technological speciality in medicine evolving from X-rays to high-tech imaging modalities and interventions.

The evolution of modern Interventional Radiology as a sub-speciality of radiology began over half a century ago with a very simple question — would it be possible to use diagnostic imaging tools to guide the real-time treatment of diseases? The answer was an emphatic yes!

The use of image guidance led to rapid advances in treatment. By utilising imaging, some patients could undergo targeted minimally invasive procedures and avoid major surgeries. The breadth of these changes now encompasses all of medicine and has forever changed the way we think about diseases.

The main advantage of this stream is that it can treat many conditions as an alternative to surgery or when surgery is not possible. Since it is minimally invasive, discomfort to the patient is considerably reduced. Recovery time and hospital stay are also less thereby improving the quality of patient care.

Like Alice entered the wonderland through a very small door, we enter our body through a very small needle puncture. No cuts or incisions are needed. After we enter, imaging roadmaps are used under the guidance of X-ray, CT or Ultrasound. These help to navigate the blood vessels to reach the disease site with the help of long tubes called catheters. After the target area is reached, a dye is injected through this catheter and images are taken for diagnosis. Based on these images, appropriate treatment is given via these catheters.

No wonder that Interventional radiologists are considered to be the plumbers of the human body! A wrench and pipe was the logo of the founding father of Interventional Radiology, Dr Charles Dotter.

With new sets of advanced tools like Artificial Intelligence, robotics, fusion imaging and augmented reality, the future looks brighter for interventional radiology.  A very wide spectrum of conditions can be treated by Interventional Radiology. Here are a few examples

Emergency interventions

When there is massive bleeding in any part of the body, Embolisation is used to block the bleeding vessels. There are many materials available for blocking these vessels like coils, particles and stent-grafts. Many times, patients are too sick to undergo major surgery and in many cases, the area of the disease may be inaccessible to the surgeon. Interventional Radiology can come to the rescue in these cases.

Revascularisation

Blocked vessels in the body due to various disease processes can cause manifold issues and excruciating pain. Interventional Radiology is used to reopen blocked vessels. The process is called angioplasty or stenting. This is life-saving in some instances and others, it dramatically improves the quality of life.

Stroke 

Stroke is a condition when a major blood vessel to the brain. Timely intervention by reopening the blocked vessel can dramatically alter the patient’s future and restore their quality of life.

Many malignancies which are not treatable surgically can be addressed by interventional radiology. These tumours can be treated by blocking the tumour vessels by embolisation or by directly ablating the tumour under ultrasound or CT guidance by using RFA, microwave, Cryotherapy etc. Also, chemotherapy can be avoided or its dose significantly reduced. It can also help with pain management in various intractable cancers. The pain-causing nerves can be destroyed by injecting alcohol or by ablating them under ultrasound or CT guidance.

Embolisation

The method of blocking blood vessels can be adapted to treating uterine fibroids. Fibroids can be shrunk by blocking the vessels which feed these fibroids. A significant advantage is that a hysterectomy (uterus removal) can be prevented. Similarly,  enlarged prostates can also be treated. The latest adaptation of this procedure is in treating patients with knee or shoulder arthritis who are not candidates for surgery and helping them attain significant pain relief.