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Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial.
Table of contents

Anicka Slachta May 17, Care Delivery. Percutaneous ablation What it is: In percutaneous thermal ablation, either extreme heat or extreme cold are directly funneled to the cancerous site with the goal of irreversible tumor cell death. Why use it: All thermal ablation modalities, including cryoablation, microwave ablation and radiofrequency ablation, provide relief by deconstructing sensory fibers that supply the periosteum, decompressing tumor volume, eradicating cytokine-producing tumor cells and inhibiting osteoclast activity.

Vertebral augmentation and cementoplasty What they are: Both methods aim to reinforce structurally weak bones by injecting them with bone cement, providing pain relief without cell death. Why use them: The physical qualities of bone cement—most commonly seen as the polymer polymethylmethacrylate—are thought to promote pain relief with resistance to axial compression forces and adhesion fixation of microfractures.

Percutaneous internal fixation What it is: A treatment used to stabilize an existing fracture or prevent an impending fracture by placing metallic screws through small skin incisions to span the fracture or large tumor. Subscribe to Radiology Business News. Left An angiogram demonstrates nearly complete cessation of blood flow to the right hepatic lobe tumor. The common hepatic artery solid arrow is seen, as is artifact from the contrast-filled ureter open arrow. Right A CT scan obtained after multiple chemoembolization procedures demonstrates marked reduction in the size of the tumor arrow.

Note also the decreased density of the tumor, demonstrating necrosis secondary to the chemoembolization procedures.

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Final CT scan after resection of the right hepatic lobe tumor in the patient shown in Figures 2 and 3. The postoperative change in normal adjacent liver parenchyma arrowhead is seen. Hepatic transcatheter chemoembolization is especially useful in patients with primary hepatocellular carcinoma and in patients with hypervascular metastases that are confined to the liver. Patients who undergo transcatheter chemoembolization are typically hospitalized for only one or two days, and the procedure may be repeated multiple times in the same patient.

The most common side effects are low-grade fever and pain. These side effects, which occur in fewer than 5 percent of treated patients, generally are well controlled with conservative therapy. Until a few years ago, tumor ablation therapy consisted of the injection of sclerosing agents e. Although alcohol ablation therapy has been a successful mode of therapy, its use has generally been confined to patients with cirrhosis whose tumors are anatomically amenable to a percutaneous approach.

Radiofrequency ablation is a relatively new treatment modality. For this procedure, a small to gauge needle, attached to a radiofrequency device that heats the end of the needle, is inserted into a tumor, causing coagulation necrosis of the surrounding tumor.

Elevated cancer risk for rad techs working with interventional fluoroscopy

Early reports on the applications of this procedure in liver tumors have been quite promising, 12 — 16 with one-year disease-free survival rates often exceeding 50 percent. Studies comparing radiofrequency ablation and other modes of therapy are currently being conducted. In the near future, the clinical utility of and indications for radio frequency ablation are likely to expand rapidly to include the treatment of other types of tumors. Currently undergoing clinical investigation, interventional radiology is likely to play a highly significant role in gene therapy for the treatment of cancer.

1. Introduction

It will probably be used to deliver the gene-carrying vector to the tumor. At present, this delivery is confined to systemic intravascular administration or to percutaneous placement of vectors directly into a tumor through a needle. Although not a direct form of cancer therapy, the placement of central venous access devices is increasingly coming under the realm of interventional radiology. With imaging guidance and under sterile conditions, the placement of ports, tunneled catheters and nontunneled devices e.

Interventional Radiology at Johns Hopkins

Technical success rates for the imaging-guided placement of central venous access devices approach percent, and complication rates are typically more favorable than those for surgical placement. Complications arising from cancer include primary or metastatic disease causing pain or bleeding, obstruction of vital organs such as ureters and biliary ducts, infectious complications in immunocompromised patients, and thromboembolic disease of the lower extremities. Some treatments performed by interventional radiology for cancer complications e.

Pain control is essential in patients with cancer. Pain often arises from local spread of a tumor, such as invasion of the celiac plexus in a patient with upper gastrointestinal or pancreatic cancer. Ablation of the celiac plexus with a sclerosing agent can be easily and safely performed under imaging guidance in the interventional radiology suite, and this procedure often greatly relieves the patient's pain. If a patient's pain arises from a hypervascular process, such as renal carcinoma that metastasizes to bone, transcatheter embolization injecting small sponge particles through a catheter placed into the artery supplying the tumor may significantly ease the patient's pain and decrease the likelihood of pathologic fracture Figures 5 and 6.

In one series, 25 palliative transcatheter embolization totally relieved bone pain in 63 percent of patients; in percent of treated patients, opiates were no longer required for pain control.

Angiograms obtained before embolization in a year-old man with severe refractory pain caused by metastasis of renal cell carcinoma to the left proximal femur. Left The diagnostic angiogram demonstrates multiple tortuous arteries arising from the superficial and deep femoral arteries and supplying the large hypervascular metastasis.

Right A selective angiogram, obtained after placement of a catheter in one of the large vessels feeding the femoral mass, shows the large number of abnormal blood vessels supplying the tumor. Angiograms obtained after embolization in the patient shown in Figure 5. Left Blood flow in the abnormal arteries has almost completely ceased. Selective embolization of multiple other feeding arteries was subsequently performed.

Right The final postembolization angiogram demonstrates a nearly normal appearance of the native femoral vessels and no evidence of significant residual flow to the tumor. An artifact from the contrast-filled ureter arrow is also seen. Vertebroplasty is a relatively new technique in which a strong glue is injected through a needle into a collapsed or weakened vertebra to keep the vertebra from collapsing further and causing symptoms of cord compression. In one study, 29 pain control was noted in 94 percent of patients immediately after vertebroplasty, and stable pain control was present in 73 percent of patients six months after the procedure.

Percutaneous placement of drainage catheters, such as percutaneous nephrostomy tubes and biliary drainage catheters, is performed under imaging guidance to allow external drainage of obstructed urine or bile for the purpose of preventing or treating organ failure and infection. In addition to placing external drains, it is often possible to place a stent in an obstructed organ to bypass the obstruction and facilitate internal drainage.

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The placement of metal and plastic stents in the interventional radiology suite is performed from an entirely percutaneous approach, precluding the need for surgery or endoscopy Figure 7. Internal biliary stent in the patient shown in Figure 1. The patient presented with obstructive jaundice, which was relieved by placement of a percutaneous external biliary drain. Because the patient was not a candidate for surgery, an internal stent was placed for palliation. This image, obtained after placement of the stent, demonstrates good flow from the decompressed biliary tree into the duodenum. The struts of the internal biliary stint long arrow are visualized.

Also seen are the intrahepatic biliary tree open arrow , gallbladder solid arrow and duodenum arrowhead. A relatively new interventional radiology procedure involves the placement of drainage catheters in pericardial fluid collections to allow drainage of the fluid and provide access to the pericardial space for the injection of sclerosing agents.

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The role of pericardial catheter placement and subsequent sclerosis is still being investigated. The role of interventional radiology in the care of patients with cancer continues to expand. Radiologists, who have traditionally been relegated to the role of diagnosis in cancer patients, are becoming more involved in the treatment of cancer and its complications. Family physicians are encouraged to communicate directly with an interventional radiology specialist to determine the utility of interventional radiology procedures in the individual patient. Resources for physician referrals or patient communications can be obtained from the Society of Cardiovascular and Interventional Radiology Lee Highway, Suite , Fairfax, VA ; telephone: ——; Web site: www.

Already a member or subscriber? Log in. Ray trained in diagnostic radiology at the University of Illinois at Chicago and in interventional radiology at Massachusetts General Hospital, Boston.

Address correspondence to Charles E. Ray, Jr. Reprints are not available from the author. The author thanks John Kaufman, M. Cost comparison of radiologic versus surgical placement of long-term hemodialysis catheters. A comparative analysis of radiological and surgical placement of central venous catheters.

Cardiovasc Intervent Radiol. Liver biopsy: review of methodology and complications. Dig Dis. CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure.