Interventional Radiology Medical Student Introduction Dr Nadeem Shaida MBBS MRCS FRCR FHEA Consultant Vascular & Interventional Radiologist

Overview What is Interventional Radiology? Sub branch of Radiology Using imaging to perform invasive procedures Fluoroscopy (X-rays), CT, US, MRI main modalities “Pinhole surgery”

Overview What is Interventional Radiology? Sub branch of Radiology Using imaging to perform invasive procedures Fluoroscopy (X-rays), CT, US, MRI main modalities “Pinhole surgery” Obvious advantages of minimal access Quicker Often under LA therefore shorter recovery time Able to do procedures in sicker patients

History 1895 – First Xray Mrs. Roentgen 1st Nobel Prize in Physics 1914-18 “Mobile” Xray Unit 1927 – First angiogram Egas Moniz 1929 – First aortogram Reynaldo dos Santos

History 1895 – First Xray Mrs. Roentgen 1st Nobel Prize in Physics 1914-18 “Mobile” Xray Unit 1927 – First angiogram Egas Moniz 1929 – First aortogram Reynaldo dos Santos 1953 – Seldinger technique Key for obtaining access

History 1895 – First Xray Mrs. Roentgen 1st Nobel Prize in Physics 1914-18 “Mobile” Xray Unit 1927 – First angiogram Egas Moniz 1929 – First aortogram Reynaldo dos Santos 1953 – Seldinger technique Key for obtaining access 1964 – Charles Dotter – “Father of IR” First angioplasty Links with industry forged early

IR = Innovation Term“Interventional Radiology” coined in 1967 1966 – Embolisation of spinal AVM 1967 – Judkins coronary catheterisation 1967 – Selective vasoconstriction for GI bleed 1970s – Development of occlusive “coils” 1973 – Embolisation for trauma 1974 – Thrombolysis for arterial occlusion 1977 – (Chemo)embolisation of liver tumours 1980 – Cryoablation of tumours 1982 – TIPSS Procedure 1985 – Catheter delivered stent 1990 – Radiofrequency ablation 1991 – EVAR 1999 – Islet cell transplanation 2004 – Selective Internal Radiation Therapy

IR Today? Vascular Non-vascular Interventional Oncology Neurointervention MSK intervention Many many other procedures!

Vascular IR Angioplasty Balloon dilatation Drug eluting balloon Stent Drug eluting stent Biovascular scaffolds

Vascular IR Angioplasty Aneurysm repair EVAR TEVAR Visceral aneurysms Ruptured AAA Branched/Fenestrated EVAR

Vascular IR Angioplasty Aneurysm repair Haemorrhage control GI tract Pelvic trauma Visceral trauma (Spleen/kidney/liver etc) Haemoptysis (Bronchial)

Vascular IR Angioplasty Aneurysm repair Haemorrhage control Venous interventions Ilio-femoral DVT PE Pelvic congestion syndrome Chronic venous occlusive disease

Non Vascular IR Drains/Biopsies Nephrostomy PTC & Biliary Drainage Gastrostomy/ feeding procedures IVC filters Fibroid embolisation Varicocoele TIPSS Procedure

Interventional Oncology Transarterial embolisation of liver Transarterial chemoembolisation SIRT procedure (Radioembolisation) Ablative procedures RFA Microwave Cryotherapy

Neurointervention Aneurysms – Coiling v Clipping Carotid stenting AVM embolisation Stroke thrombolysis Venous stenting

IR Weekly Timetable Mon am – US list (Biopsy/Ablation assessment) Mon pm – IR list (Fibroids/Varicocoele) Tue am – Theatre (EVAR) Tue pm – Vascular MDT Wed am – TIPSS (Once/month) Wed pm – Vascular MRI Thu am – IR (TAE/SIRT/PVE/Biliary Stenting) Thu pm – Liver tumour MDT Fri am – IR (Angioplasty/Stenting/AVM embolisation) Fri pm - CT

Whos It For? Everyone!

Whos It For? Everyone! But it helps if… Hand eye co-ordination Adaptability Prepared to improvise/innovate Interested in emerging technologies Teamworking Coolness under pressure!

Career Pathway FY1/FY2 Core training (Not essential) Taster week radiology Core training (Not essential) Radiology training Years 1-3 as normal Final FRCR sat at beginning of year 4 Since 2010 – New IR curriculum Leads to CCT in Radiology (Interventional Radiology) Years 4-6 IR training

Career Prospects Good! In UK national T & Cs Shortage of radiologists in general Shortage of IR highly acute (BSIR 200 deficit) Centralisation of services In UK national T & Cs Other countries well remunerated Downsides On call Specialty creep

Key Resources BSIR CIRSE nadeem.shaida@addenbrookes.nhs.uk Undergraduate curriculum Medical student Links CIRSE nadeem.shaida@addenbrookes.nhs.uk