Interventional procedures

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Interventional procedures using ionising radiation have revolutionised medicine in the past few decades for therapy and palliation, resulting in more patients being offered treatments that would not have been possible before with more invasive open surgery. The vast majority of interventional procedures are performed as “minimal invasive percutaneous therapies”.

As technology continues to advance, interventional procedures become more complex and some may take several hours to complete. New technologies with smaller catheters, guidewires, stents, filters and many other devices also present new challenges for radiological protection, such as aortic stent grafts, cardiac valve replacement, prostate embolisation, thrombus aspiration after stroke or selective internal radiation therapy (SIRT).

After CT, Interventional radiology is the second largest collective source of medical radiation exposure and, together with nuclear medicine the highest source of exposure to healthcare providers. ICRP has provided practical advice for physicians and other healthcare providers on the protection of patients and themselves involved in the interventions, for example in the following publications:

Physicians, assisted by nurses and radiographers, perform X-ray guided interventions as an alternative to conventional surgery. Most of these interventions are less invasive, the recovery periods are shorter, and for many types of interventions the complication rate is lower. In addition, some patients who may not tolerate anaesthesia and conventional surgery, as well as lesions that were not previously accessible, can now be treated by less-invasive image-guided interventions. In addition, interventional procedures offer new therapies where options of other medical specialties do not exist, such as embolization of liver tumours with chemical drugs or radioisotopes (SIRT).

The number of image guided interventions is increasing continuously in both developed and developing countries. New types of interventions are also of increased complexity, require extensive use of X-ray imaging, and raise new issues of occupational and patient protection.

Interventions are usually guided by fluoroscopy. Radiographic cine series or stored images from fluoroscopy are taken to document the outcome of diagnosis or treatment. Interventions can also be guided by computed tomography (CT) imaging, with images taken while the interventionalist steps behind a shield or out of the room, or by CT fluoroscopy, in which the interventionalist stays at the patient for obtaining images during device manipulation.

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