Interventional Radiology & Special Procedures
We provide interventional radiology and special procedures to assist in diagnosing and treating patients with diseases in an organ system. Using highly specialized radiographic equipment and devices, physicians are able to view arteries and veins to diagnose blockages and other blood vessel problems. Angiography can detect narrowing or blockage of a blood vessel, identify abnormally dilated blood vessels, and determine the site of internal bleeding. Specialized devices now allow a physician, in many cases, to treat a blocked blood vessel without surgery. This procedure uses the least invasive techniques to date to reduce risk, pain and recovery time, which can improve the overall health of patients.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The Radiologist will write the pre-operative orders. Pre-labs of CBC, PT, (PTT) may be ordered. The patient should continue all oral meds especially anti-hypertensive medications. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration during the procedure.
EXAM DESCRIPTION:
Using sterile technique, under local anesthetic, the A-V Fistula or graft is accessed and contrast media is injected. The graft/fistula as well as the central veins are evaluated for blockage or stenosis. If indicated, balloon angioplasty or stenting may follow the diagnostic graftogram.
LENGTH OF TIME INVOLVED:
The exam takes approximately 45 - 90 minutes.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The Radiologist will write the pre-operative orders. Patient may require a bowel prep or KUB to check for residual barium. Pre-labs of CBC, PT, (PTT), BUN & CREATININE will be drawn. An IV will be started. The patient should continue all oral meds, especially anti-hypertensive medications. Pre-op screening will give out patient orders and instructions. Coumadin needs to be held for 72 hours prior. The patient will receive moderate sedation for the exam and must be NPO to prevent aspiration during procedure.
EXAM DESCRIPTION:
The Radiologist performs, using sterile technique and local anesthesia, a femoral artery puncture. A catheter is introduced into the femoral artery and passed up into the abdominal aorta. Radiopaque contrast media is injected and serial films are taken. The contrast allows visualization of the kidneys and may show abnormal narrowing of the arteries in the legs or abnormal bulging areas (aneurysms).
LENGTH OF TIME INVOLVED:
The exam takes 90 - 120 minutes to perform.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The radiologist will write the pre-operative orders. Patient may require bowel prep or KUB to check for residual barium. Pre-labs of CBC, PT, (PTT), BUN & CREATININE will be drawn. An IV will be started. The patient should continue all oral meds, especially anti-hypertensives. Coumadin needs to be held for 72 hours. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration during the procedure.
EXAM DESCRIPTION:
Angioplasty is the dilation of a narrowed vessel using a balloon catheter. If, after angiography, it is decided that the patient may benefit from dilating a blood vessel, it may be performed at the same time as the angiogram. The area of narrowing or occlusion is traversed with a catheter. The balloon is inflated resulting in opening of the vessel.
A stent is a mesh tube made of metal that can be placed in a vessel (or a duct) to help support the vessel (duct) at an area of narrowing that cannot be corrected with angioplasty alone. Placement of the stent can also be completed at the same time as the angiogram.
Thrombolysis is the dissolution of a clot in a vessel. Thrombolysis can be accomplished with medications or with mechanical devices. Mechanical devices are utilized in the special-procedures suite while thrombolytic medications may be infused over a period of hours.
Embolization is a procedure done to block an artery from supplying blood to an area or to stop bleeding from an artery. After angiography has been performed and an appropriate area has been identified, blocking material is injected through the catheter. This material stays in the body and prevents blood flow to the area.
Pharmacotherapy is a procedure performed after angiography to inject certain medications in a particular area of the body.
LENGTH OF TIME INVOLVED:
This exam is variable on a specific time of the procedure.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The Radiologist will write the pre-operative orders. Pre-labs of CBC, PT, (PTT), and BUN & CREATININE will be drawn. An IV will be started. The patient should continue all oral meds, especially anti-hypertensive medications. Coumadin needs to be held for 72 hours prior to procedure. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration during procedure.
EXAM DESCRIPTION:
The Radiologist performs, using sterile technique and local anesthesia, a femoral artery puncture. A catheter is introduced into the femoral artery and passed up into the abdominal aorta to the arch. Radiopaque contrast material is injected and serial films are taken of the aortic arch. The arch, origins of the carotid, vertebral and subclavian arteries are demonstrated. For better visualization of specific arteries, selective catheterization of those arteries can be performed.
LENGTH OF TIME INVOLVED:
The procedure takes 60 - 90 minutes.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The Radiologist will write the pre-operative orders. Pre-labs of CBC, PT, (PTT), and BUN & CREATININE will be drawn. An IV will be started. The patient should continue all meds, especially anti-hypertensive medications. Coumadin needs to be held for 72 hours prior to procedure. The patient may receive moderate sedation for the exam and must be NPO for 6 hours to prevent aspiration during procedure.
EXAM DESCRIPTION:
Using sterile technique and local anesthesia, the Radiologist will make a femoral artery puncture and introduce a catheter into the abdominal aorta and up into the right and left carotid and vertebral arteries. As each vessel is catheterized an injection of contrast material is made and films taken of the area. The lumen of the artery is visualized to demonstrate stenosis, occlusion, plaque or other abnormalities. By demonstrating the arterial system, abnormalities such as tumors can be demonstrated in the head also.
LENGTH OF TIME INVOLVED:
The exam takes approximately 90 - 120 minutes.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The radiologist will write the pre-operative orders. Pre labs of CBC, PT, (PTT), will be drawn. An IV will be started. The patient should continue all oral meds, especially anti-hypertensives. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration during the procedure.
EXAM DESCRIPTION:
Using sterile technique and local anesthesia in the skin over the neck and chest, the radiologist will make two small incisions. A catheter will be placed into a selected vein through one incision and then tunneled under the skin to the other incision site. Here, a "pocket" is formed under the skin to hold the port. The catheter is then attached to the port and then the port is sutured securely within the pocket. A few sutures are required to close the pocket once the port is in place. You will have a chest x-ray at the end of the procedure.
LENGTH OF TIME:
Scanning time is approximately 60 - 90 minutes.
PREPARATION:
The radiologist performing the procedure will indicate any pre-procedure orders. The patient will be instructed to have nothing by mouth (NPO) for 6 hours. An IV will be required. The patient will be NPO to limit aspiration potential when given moderate sedation.
EXAM DESCRIPTION:
In Special Procedures using sterile technique, local anesthesia and moderate sedation, the intervertebral disk is evaluated by contrast media injection into the nucleus pulposus. The patient must be able to tolerate prone positioning.
LENGTH OF TIME:
The exam takes approximately 60 - 90 minutes depending on the number of disk levels evaluated.
PREPARATION:
The Radiologist performing the procedure will indicate any pre-op orders and the patient will have nothing by mouth (NPO) for 6 hours prior to the exam. A recent CBC, PT and (PTT) will be necessary. The patient may receive moderate sedation for the exam and must be NPO for 6 hours to prevent aspiration during the procedure.
EXAM DESCRIPTION:
The patient will be brought to the Diagnostic Imaging Department and Ultrasound, fluoroscopy or CT will be used to visualize the area requiring drainage. Using sterile technique and local anesthetic, the Radiologist will place a drainage catheter into the area to be drained. The area may be completely drained at the time of the procedure or a catheter may be left in place and connected to a drainage bag that will be left in place for a period of time.
LENGTH OF TIME INVOLVED:
The exam may take approximately 60-90 minutes.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The radiologist will write the pre-operative orders. Pre-labs of CBC, PT, (PTT) will be drawn. An IV may be started. The patient should continue all oral meds, especially anti-hypertensives.
EXAM DESCRIPTION:
Temporary hemodialysis/plasmapheresis catheter placement: Using sterile technique and local anesthesia in the skin over the neck, chest or groin, depending on which vein will be used, a small needle will be placed into the vein. Ultrasound or contrast injection may be used to facilitate accessing the vein. Once the vein is entered, a wire and then a catheter will be placed into the vein. Several dilators may be used to make the opening in the vein larger before the dialysis/plasmapheresis catheter is placed. The catheter will be sutured to your skin and covered with a dressing. You may need a chest x-ray at the end of the procedure.
Permanent hemodialysis catheter placement: Using sterile technique and local anesthesia in the skin over the neck, chest or groin, depending on which vein will be used, a small needle will be placed into the vein. Ultrasound or contrast injection may be used to facilitate accessing the vein. Once the vein is entered, a wire and then a catheter will be placed into the vein. Several dilators may be used to make the opening in the vein larger. An additional area of skin will be numbed and small incisions made in the skin in order to place the catheter in a tunnel beneath your skin. The catheter will be sutured to your skin and covered with a dressing. You may need a chest x-ray at the end of the procedure.
LENGTH OF TIME INVOLVED:
This exam takes approximately 60 to 90 minutes.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The Radiologist prior to the procedure will obtain consent. Patients may require a bowel prep or KUB to check for residual barium. Pre-labs of CBC, PT, (PTT), BUN & CREATININE will be drawn. An IV will be started. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration during procedure.
EXAM DESCRIPTION:
Under fluoroscopic guidance, using sterile technique and local anesthesia, the Radiologist performs a femoral or jugular vein puncture. A catheter is introduced into the femoral/jugular vein and passed into the inferior vena cava. A special filter is inserted from this catheter to trap blood clots from the lower extremities.
LENGTH OF TIME INVOLVED:
Approximately 90 minutes for this exam.
PREPARATION:
The radiologist performing the procedure will indicate any pre-procedure orders. The patient will be instructed to have nothing by mouth (NPO) 6 hours prior to the exam. An IV will be required. The patient will be NPO to limit aspiration potential while in prone position and if moderate sedation is utilized.
EXAM DESCRIPTION:
Under fluoroscopy using sterile technique, local anesthesia and possibly moderate sedation, a needle is placed into the subarachnoid space in the low back (L2). Cerebrospinal fluid is withdrawn and sent to the Lab for analysis.
LENGTH OF TIME:
Approximately 60 minutes for this exam.
PREPARATION:
The patient must have nothing by mouth (NPO) for 2 hours prior to the procedure. NPO will decrease the chance of aspiration with the patient being on their back.
EXAM DESCRIPTION:
Injection of the contrast material into the mediport for enhancement of the mediport to check for fibrin sheath or catheter patency. The Radiologist or Radiology Nurse will access the mediport for this exam or if the port is already accessed, leave the needle in place.
LENGTH OF TIME INVOLVED:
The examination can be completed in approximately 20 minutes.
PREPARATION:
The Radiologist performing the procedure will indicate any pre-op medication orders. The patient will be instructed to have nothing by mouth (NPO) for 6 hours prior to the procedure. An IV may be required. Some patients become nauseated during this procedure if there is food in the stomach. Some physicians prefer to give a pre-op to ease discomfort while others prefer to have the patient unsedated and therefore better able to cooperate. The patient may receive moderate sedation and must be NPO to prevent aspiration during the procedure.
EXAM DESCRIPTION:
In the Diagnostic Imaging Department, using sterile technique and local anesthesia, a spinal tap is performed and a small amount of cerebrospinal fluid is withdrawn. Water-soluble radiopaque contrast material is injected through the lumbar puncture (spinal tap) into the subarachnoid space. With the patient in a prone position, the head of the table is tipped downward allowing the contrast to move along the length of the spine to the area of interest. Images are obtained in different projections to demonstrate any defects caused by spine abnormalities.
LENGTH OF TIME INVOLVED:
The exam takes approximately 1 hour to complete depending on patient cooperation and ease of performing lumbar puncture.
PREPARATION:
The patient must have a barium-free abdomen. The patient must have nothing by mouth (NPO) 6 hours prior to exam. A Radiologist will obtain the consent prior to the exam. Pre-op labs, CBC, PT, (PTT), BUN and Creatinine will be required. Barium in GI tract could obscure visualization. The patient will receive moderate sedation. Having the patient be NPO will help prevent aspiration during procedure.
EXAM DESCRIPTION:
Using Ultrasound, CT and/or fluoroscopic guidance, sterile technique and local anesthetic, a nephrostomy tube is placed through the flank and into the renal pelvis. The urine is drained outside to a collection bag.
LENGTH OF TIME INVOLVED:
This exam and procedure takes approximately 1 hour. Delay can be related to patient's condition and degree of difficulty in placement of the nephrostomy tube.
PREPARATION:
The Radiologist who will perform the procedure will indicate any pre-op medication orders and whether patient should have nothing by mouth (NPO) 6 hours. A CBC, PT, (PTT) will be required. An IV will be started. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration.
EXAM DESCRIPTION:
Under sterile procedures and local anesthetic, using fluoroscopic guidance, a Chiba (thin-walled) needle is placed into the abdominal wall and directed to an intrahepatic bile duct. A dye injection is made to visualize the biliary tract to determine source of obstruction or stenosis. Radiographs are taken to record the images. A drainage catheter or stent may be placed at the time of the procedure.
LENGTH OF TIME INVOLVED:
The exam can take from approximately 90 - 120 minutes, depending on the degree of difficulty in locating the necessary duct.
PREPARATION:
No prep. PICC lines are placed by Radiology after the patient has been evaluated by the PICC Team Nurses.
EXAM DESCRIPTION:
Using sterile technique and local anesthesia, a needle is inserted into a deep vein. Through this needle, a catheter is placed which goes into one of the main veins in the chest. The catheter is secured to the skin with Steri-strips and an occlusive dressing. Ultrasound or a contrast injection may be used to identify the deeper veins in the arm prior to placement. The location of the tip of the catheter will be verified with fluoroscopy and will be documented in the patients record prior to the patients return to his unit.
LENGTH OF TIME INVOLVED:
Procedure time is approximately 30 - 60 minutes.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. It is important that the patient is not dehydrated. Pre-labs of CBC, PT, (PTT), BUN & Creatinine will be drawn. An IV will be started. The patient may continue oral meds. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration during procedure.
EXAM DESCRIPTION:
This exam is performed using sterile technique and local anesthetic, via a femoral vein puncture. A catheter is inserted and contrast is injected to visualize the pulmonary arteries. The exam is performed to determine the presence of pulmonary emboli, after a Lung Scan has been done and is inconclusive for pulmonary embolism.
LENGTH OF TIME INVOLVED:
The exam can take between 90 - 120 minutes depending on difficulty in catheterizing the vein.
PREPARATION:
A Radiologist in Interventional Radiology performs this procedure. The Nephrologist should write all orders on the patient's chart. The patient is brought to the department per cart. CBC, BUN Creatinine, PT and PTT results are on chart. A member of the Diagnostic Imaging staff will see the patient and obtain consent. The patient will be monitored during the biopsy per ECG and non-invasive BP.
EXAM DESCRIPTION:
With the patient on their stomach, the kidney is localized with Ultrasound. The Radiologist will then perform the biopsy by passing the needle through the back. Specimens are sent to the Lab for testing. Specific post biopsy activity orders are sent to the floor with the patient.
LENGTH OF TIME INVOLVED:
Depending on the difficulty encountered localizing the kidney with the biopsy needle, the procedure may take up to 1 hour.
PREPARATION:
The patient must have nothing by mouth (NPO) 6 hours prior to the exam. The Radiologist will write the pre-operative orders. Patient may require a bowel prep or KUB to check for residual barium. Pre-labs of CBC, PT, (PTT), and BUN & Creatinine will be drawn. An IV will be started. The patient should continue all oral meds, especially anti-hypertensive medications. The patient may receive moderate sedation for the exam and must be NPO to prevent aspiration during procedure.
EXAM DESCRIPTION:
Using sterile technique and local anesthetic, a femoral vein puncture is made by the Radiologist and a catheter inserted into the vena cava. Contrast material is injected and the vena cava and branches are visualized for abnormalities. Select veins can be catheterized and injected for better visualization.
LENGTH OF TIME INVOLVED:
The exam takes approximately one hour.
PREPARATION:
While it is important that the patient is well hydrated for this exam, they must have nothing by mouth (NPO) for at least 2 hours before the exam. The patient being NPO is to prevent aspiration during the procedure.
EXAM DESCRIPTION:
The patient is placed on an angled radiographic table. A radiopaque contrast material is injected into a vein on the anterior surface of the foot or hand to help evaluate the size and condition of the veins.
LENGTH OF TIME INVOLVED:
The exam takes approximately 30 minutes.
PREPARATION:
The radiologist performing the procedure will indicate any pre-op medication orders. The patient will be instructed to have nothing by mouth (NPO) for 6 hours prior to the exam. An IV will be required. The patient will be prone for the procedure and then supine for an extended period and will receive moderate sedation. The patient being NPO limits aspiration potential.
EXAM DESCRIPTION:
In Interventional Radiology using sterile technique, local anesthesia and moderate sedation, the vertebral body is accessed with a needle. Through this needle a liquid cement product is instilled to stabilize a fractured (compression) vertebrae. The patient must be able to tolerate prone positioning.
LENGTH OF TIME INVOLVED:
The exam takes approximately 90 minutes.