INTERVENTIONAL RADIOLOGISTS PLAY
KEY ROLE IN ALL
ASPECTS OF
CANCER CARE

Using imaging modalities for guidance, interventional radiologists today play a major role in oncology care. "Our main guidance modalities are familiar to almost everyone-x-rays, fluoroscopy, ultrasound and CT scanning," says Malonnie Kinnison, MD, Director of Interventional Radiology. "We have an assortment of procedures that may involve one or more modality. Oncologists often have a variety of options with which to treat patients, from radiation to surgery to chemotherapy, and interventional radiology expands those options in a fairly minimally invasive way."  The following procedures demonstrate the wide range of interventional radiology's involvement in cancer care:

Diagnosis

• Tumor biopsy that usually involves a small needle and is done as an outpatient
• Aspiration of non-solid specimens from cysts and spinal fluid.
• Diagnostic angiography can assist a surgeon in determining if a patient is a surgical candidate. For example, it can show the proximity of vascular structures to a brain or pancreatic tumor.

Treatment

• Hepatic chemoembolization is a procedure that involves the insertion of a small catheter into the artery feeding a liver tumor and then uses the catheter to inject a very high dose of the medication plus an oily contrast agent and small particles directly into the tumor. This permits the drug to stay in the tumor for several days to weeks while limiting toxicity. Usually patients stay for only one night.
• Hepatic artery infusion catheters can also be inserted into the hepatic artery to deliver extended chemo infusion to the liver (usually for several days). 
• Radiofrequency ablation employs CT or ultrasound guidance to place a multi-pronged probe into a liver lesion; the probe is heated to destroy the tumor. This is usually an outpatient procedure.
• Delivery of chemotherapy that requires special access, such as to the spinal fluid.
• For patients with pleural effusions (fluid that collects in the chest due to tumor on lung surfaces), interventional radiologists can insert small drainage tubes.
• Pre-surgical embolization of a highly vascular tumor, typically in the brain, kidney, bone or soft tissues. Embolization (occlusion of feeding arteries) dramatically decreases the potential for blood loss during surgery.
• Interventional radiologists can often help treat complications associated with tumors. For example, if a tumor in the pelvis presses against the ureter and blocks urine flow, the interventional radiologist can place a stent through the blockage.

Management

• Placement of portacaths and PICC lines. These vascular access devices are used for a variety of treatments, including chemotherapy, antibiotic therapy and blood draws.
• Portacath and PICC line maintenance, such as declotting of the lines that occasionally become occluded. This obviates the need to replace the device.
• Placement of vena cava filters in the inferior vena cava to prevent clots from the pelvis or legs from travelling to the lungs. This procedure is particularly useful for oncology patients, many of whom are not candidates for blood thinners.

For further information, or to contact the Division of Interventional Radiology, call 443-849-2311.

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