Interventional radiology has undergone tremendous advances owing to the development of new imaging technologies and interventional devices. This has paved the way for applying IR to a vast number of medical conditions that are otherwise performed using invasive methods.

The Concept of Image guided Interventions:

Interventional radiology, a sub-specialty of radiology, utilizes various imaging techniques such as CT, MRI to guide percutaneous minimally invasive procedures for both diagnosis and therapy. Advances in IR have simplified most of the procedures while retaining safety and fewer traumas to patients. Besides angioplasty, drainage procedures, tumor ablations, and embolizations are now increasingly becoming image guided minimally invasive interventions with the refinement of technologies. Owing to minimized complications, morbidity, and cost of procedure, image guided ablation has emerged to be the primary treatment modality for cancer. The impact that the IR domain has had on traditional procedures is that it has enabled a novel confluence of minimally invasive diagnosis and therapy for cost-effective patient care. This successful evolution of IR procedures could be attributed to advances such as improved multidimensional (3D, four dimensional 4-D) imaging techniques, microcatheter technology, improved guidewires, small sized balloon catheters, vertebroplasty, drug eluting and flexible stents, removable vena cava filters. Additionally, the development of computer technologies, improved software for image processing and reconstruction, treatment planning and simulation are all expected to enable the diagnosis and treatment of diseases at much earlier and curable stages even before the symptoms begin to appear.

Snapshot of Emerging IR Trends:

Interventional radiology has undergone tremendous advances owing to the development of new imaging technologies and interventional devices. This has paved the way for applying IR to a vast number of medical conditions that are otherwise performed using invasive methods. A myriad of existing opportunities that are attracting physician and patient interest for interventional radiology applications include promising cancer therapies, fibroid therapy and uterine interventions, vascular and spinal interventions, and notable pharmacological therapies. Useful insights about emerging developments in IR are provided below:

• Angiography: IR procedures such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) have almost replaced conventional angiography for most of the vascular diagnostic procedures. Unlike catheter angiography, noninvasive CTA and MRA are less risky to patients and facilitate rapid diagnosis.
• Tumor ablation: Cancer therapy remains to be one of the fastest growing IR applications. Certain specific types of percutaneous tumor ablation including chemoablation, radiation therapy that uses radiofrequency waves, lasers, microwave, and high-intensity focused ultrasound along with cryotherapy, all
• of which induce cell death by coagulative necrosis has now become very common.
• Vascular interventions: Noninvasive IT techniques are believed to play a vital
• role in peripheral vascular interventions, intravascular brachytherapy, cutting
• balloon angioplasty, cryoplasty, and implantation of drug eluting stents.
• Percutaneous biopsy: Advances such as CT fluoroscopy, portable ultrasound, and MR-guided biopsies enable the procedure to be performed with relative safety on an outpatient basis.
• Drainage procedures: Image guidance has assisted the performance of percutaneous nephrostomy during which the placement of a drainage catheter into the renal collecting system is done. Another equally promising area of image guidance application would be in biliary intervention.
• Gastrointestinal Interventions: IR procedures such as stent placements and balloon dilations through fluoroscopic guidance have become routine techniques for interventions in the obstructed duodenum, esophagus, and the colon. One of the emerging trends observed in this sector is the miniaturization of introductory devices and the availability of flexible and retrievable metallic stents.
• Embolizations: Recently, interventional radiology has been successfully applied for arterial embolizations to treat conditions such as GI bleeding, trauma of pelvis, and abdomen. A few other important applications of IR embolization include the treatment of post-partum hemorrhage and embolization of hypervascular tumors prior to surgery. These mentioned advances have been made possible with micro catheter technology improvements and enhanced embolic materials.
• Thromboembolism: Patients requiring treatment for this condition are often subjected to systemic anticoagulation, which does not suits all patients and is
• associated with some treatment complications. Image guided placement of retrievable inferior vena cava (IVC) filters is emerging as an adjunct or as an effective prophylactic treatment for high-risk patients.
• Spine interventions: Excessive pain due to vertebral compression fracture,
• which is refractory to medical treatment, could now be treated with a promising IR procedure called vertebroplasty that is an X-ray fluoroscopy guided intraosseous injection of bone cements. Some noteworthy applications of X-ray and CT-guide interventions include percutaneous steroid injections into facet joints for back pain reduction, pain killer injections into selective nerve routes, and percutaneous nucleotomy along with nucleoplasty.
• Varicose veins ablation: Minimally invasive IR procedures for treating varicose veins ablation have emerged and these include sclerotherapy and endovenous thermal ablation using RF waves and lasers. Percutaneous thermal ablation using ultrasound guidance has become the most common IR procedure to treat varicose veins since the whole procedure requires less than an hour.

Unique Role of Medical Robotics:

A few years back, image guided biopsies were the predominant interventional procedures performed, however now the number of percutaneous procedures aided through image guidance tools like cannulae and probes has increased manifold. In addition to providing robotic assistance in all IR procedures, robots may also serve as potential alternatives to human operators who are at higher risk of unwarranted radiation exposure during brachytherapy. Robots could also be integrated with multimodality imaging systems and can be deployed for optical or mechanical position tracking, and for active guidance for path planning and treatment ution. In order for the medical robots to enter the clinical practice widely, they must evolve to be highly intelligent devices capable of independent functioning needing only minimal operator training. They must also be user-friendly, require less set-up timing, and speed up the current interventional procedures rapidly, and most importantly be costeffective. Medical robots such as MrBot and Acubot, and a few others are already being developed by a team of researchers in the west for image guidance applications. Medical robotics is at present a relatively young field that could in the long run be securing huge places in minimally invasive procedures.

Strategic Recommendations for IR Adoption:

1. Need for collaboration between academia and corporate sectors: Image guided interventional procedures are evolving from being single image guided procedures to being multimodality image guided interventions. The emerging practice is to derive completely useful clinical information from fused images of multivariate imaging techniques that have different resolutions and also images taken at different times during the courses of the disease. But to ute this practice successfully, there is a need for expediting the development and standardization of image processing techniques and software required for the same.
2. Capitalize on enabling technologies for providing effective training to radiologists: IGI procedures are undergoing rapid development and new techniques and instrumentation are being added to the IR protocols. For the interventionalists to stay abreast of technology, a formal training and acquisition of the required skills to perform these IGI procedures with maximum level of safety to patients is required. But as there is a decline of invasive diagnostic procedures with the advent of improved imaging techniques, radiologists are not finding enough opportunities for real-time training with patients. Also, apprentice training on real patients lengthen procedure times and requires close monitoring by experts all of which increase the final cost of the procedure. Hence it is becoming critical for radiologist training programs to make use of nonpatientbased training and learning.
3. Integration of Healthcare-IT with IR procedures: The integration of PACS and other HC IT solutions will enable effective clinical implementation of IGI. At present, technology and device development for IGI and development of IGI enabling HC-IT solutions are under way in an independent manner. Vendors should come forward to design solutions for integrating the two together in order to make them completely functional systems that can meet end- user demands.

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