Radiology in healthcare is rapidly advancing and interventional radiology is a sub-speciality which shows great potential. It is being touted as a better and superior treatment option for several ailments and health conditions which earlier could be cured only through open surgery. Dr Pradeep Muley, Head & Senior Consultant Interventional Radiologist, Fortis Hospital, Vasant Kunj, New Delhi talks about the progress of interventional radiology, its various applications, benefits to patients and more, in an interaction with Lakshmipriya Nair
How has interventional radiology progressed over the years?
| Dr Pradeep Muley |
Interventional radiology is a subspeciality of radiology in which minimally invasive procedures are performed using image guidance. Some of these procedures are done for purely diagnostic purposes (for example, angiography), while others are done for treatment purposes (for example, embolisation). Images are used to direct these procedures, which are usually done with needles or other tiny instruments like small tubes called catheters. The images are like a map that allows the radiologist to guide these instruments through the body to the area where the procedure is to be done.
After the introduction of needle replacement of a catheter in 1953 by Dr Sven Seldinger’s, Dr Charles Dotter, at the University of Oregon, began to use catheters as surgical instruments. Dr Dotter said, “The angiographer who enters into the treatment of arterial obstructive disease can now play a key role, if he is prepared and willing to serve as a true clinician, not just as a skilled catheter mechanic. He must accept the responsibility for the direct care of patients before and after the procedure. In 2004, the American College of Radiology published a white paper on interventional radiology clinical practice. The white paper outlined the features and resource needs of interventional radiologists for providing patient care. As technology advances and high-quality imaging equipment becomes more widely available, interventional radiology is able to offer patients and referral physicians a host of new treatment options.
What have been the most notable achievements in this sphere in the last decade?
Interventional radiologists are specialists who use various imaging and catheterisation techniques in order to diagnose and treat vascular issues in the body. Interventionalist techniques include injecting arteries with dye, visualising these via X-ray, and opening up blockages. The rapid new development of imaging technologies, mechanical devices, and types of treatment, have certainl y been beneficial to the patient and without surgery various diseases can be treated like uterine fibroids, uterine adenomyosis, opening of blocked fallopian tubes, varicocele, chronic pelvic pain (pelvic congestion syndrome), varicose vein in leg, opening of blocked arteries, bleeding from mouth due to tuberculosis in chest. The most recent development is treating enlarged prostate by non—surgical method called as prostatic artery embolisation.
What are the benefits of interventional radiology over traditional surgery?
Interventional radiology has several benefits over conventional surgery. Some of the major ones are as follows:
- It is performed under local anaesthesia. No general anaesthesia.
- Requires only a tiny niche in the skin (no surgical incision of abdomen).
- Recovery in a very short time in comparison to any open surgery.
- Virtually no adhesion or scar formation has been found. But in surgery adhesions are common.
- Even two medical problems are treated in one sitting.
- Less expensive than surgery.
- Short hospitalisation.
- Emotionally, financially and physically—interventional radiological procedure have an overall advantage over surgical procedures for the patient as the body part is not removed.
What are the challenges in its advancement as a medical sphere? What are the measures to overcome them?
The development of interventional radiology leads to a tug of war between surgeon and interventional radiologist. If patient has uterine fibroids, the gynaecologist offers only removal of uterus not the non-surgical method called uterine artery embolisation. While these practitioners can be in competition with each other, cooperation and communication are the most advantageous methods to deal with these “turf wars.” All the interventionalists are needed to deliver the best medical care to patients, now and in the future.
Since when has Fortis Hospital, Vasant Kunj, Delhi been operating an interventional radiology department? What issues does it address (the various treatment offered through various technological advancements)?
The Interventional Radiology department is my brain child and since its inception in 2005, I have been taking care of the entire functioning of the department here. I am assisted by a team of trained nurses and practicing radiologists. Having done my specialisation in body and neuro interventional radiology from KEM Hospital Mumbai, AIIMS, Delhi, Johns Hopkins Medical Institute, US and Singapore General Hospital, I wanted to device techniques which required minimal surgery and takes less of patient’s time in hospital. Through the technique of interventional radiology, I am using a number of techniques here including uterine artery embolisation for fibroid/adenomyosis, varicose vein, infertility treatment for opening of blocked fallopian tube, varicocele, enlargement prostate, bronchial artery embolisation for bleeding lungs, chemo embolisation of liver tumour, lower limb blockage of artery.
You are a proponent of uterine artery embolisation. Can you please tell us more about the technique of and its advantages?
The interventional radiologist makes a small nick in the skin (less than a cm) at groin, inserts a catheter, identifies blocked artery by using angiography with contrast medium injection and then use balloon or inject embolisation particles (polyvinyl alcohol) that block the tiny vessels or open a diseased artery by balloon. The advantages are: – It is performed under local anaesthesia, requires only a tiny nick in the skin, recovery is shorter than any surgery, no scar, recurrent growth is uncommon, emotionally, financially and physically—non-surgical treatment have an overall advantage over open surgery as the body organ is not removed.
What is your message to other interventional radiologists?
All interventional radiologists are needed to deliver the best medical care to patients, now and in the future. Till today, I alone have treated more than 20000 patients without surgery with excellent results, and I am sure, these techniques will soon become the only popular treatment with little role of traditional surgeries.