1. Future directions in Radiology:   impact on general anaesthesia requirement
Dr Nicola H Strickland
Consultant Radiologist, Imperial College Healthcare NHS Trust
President Royal College of Radiologists

2. Radiology and Anaesthetics: interdependent specialties
future directions of radiology impact on anaesthetics
demands of anaesthetists (e.g. ITU)  impact on radiology
both regarded as “service specialties”
need to enhance profile with clinical colleagues and public

3. general anaesthesia: painful procedures
Current and future radiological procedures requiring anaesthetist support
general anaesthesia: painful procedures
ureteric stent insertion
endovascular aneurysm repair EVAR
venoplasty and venous stents
complex percutaneous transhepatic cholangiographic procedures PCTA
image guided bone biopsy
neurointervention – coil/balloon placement: subarachnoid haemorrhage, AVMs
interventional oncology
supervised pain relief and sedation→safe, stable conscious level
mechanical thrombectomy

4. Demands of anaesthetists on radiology
intubation
difficult airways
ITU
serial chest x-ray interpretation: radiologist “ward rounds”
simple ultrasound diagnoses: ascites, pleural effusions
ultrasound guided vessel location and on ward drainages
sudden intracranial pathology: CT, sometimes MR
acute deterioration – abdominopelvic pathology: CT
line retrieval

5. supervised pain relief and sedation
Current and future radiological procedures requiring anaesthetist support
general anaesthesia
supervised pain relief and sedation

6. Double J ureteric stents
courtesy Dr Steven Moser

7. EVAR: endovascular aortic aneurysm repair

8. EVAR: right and left renal artery stents
courtesy Dr Rob Thomas

9. EVAR: superior mesenteric artery stent

10. EVAR: final result with branch stents
2 left renal
artery stents
right renal
artery stent
sma stent

11. Aorto-oesophageal fistula

12. Aorto-oesophageal fistula – coated thoracic aortic stent placement
courtesy
Dr Rob Thomas

13. Venoplasty and venous stents
patient with metastatic adenocarcinoma of the right adrenal gland causing IVC obstruction

14. Coronal CT reconstructions showing IVC occluded by tumour

15. bilateral venogram showing occluded IVC and numerous venous collaterals
courtesy Dr Rob Thomas

16. Deployment of IVC filter

17. Deployment of IVC stents

18. Final result: patent stented IVC, filter removed

19. Neurointervention: aneurysmal bleed
p/w Lt hemianopia and confusion Delayed CTA

20. Neurointervention: aneurysmal bleed
anterior
aneurysm
courtesy
Dr Neil Rane

21. Neurointervention: aneurysm glue occlusion
Diagnosis:
Mycotic Aneurysm
History of endocarditis

22. Interventional oncology: RFA

23. general anaesthesia: painful procedures
Current and future radiological procedures requiring anaesthetist support
general anaesthesia: painful procedures
ureteric stent insertion
endovascular aneurysm repair EVAR
venoplasty and venous stents
complex percutaneous transhepatic cholangiographic procedures PCTA
image guided bone biopsy
neurointervention – coil/balloon placement: subarachnoid haemorrhage, AVMs
interventional oncology
supervised pain relief and sedation→safe, stable conscious level
mechanical thrombectomy

24. Mechanical thrombectomy: removal of thrombus from proximal left middle cerebral artery

25. Demands of anaesthetists on radiology
Intubation
ITU

26. 29y woman with severe endobronchialWegener’s granulomatosis

27. Hysteresis loop
expiration markedly flattened

28. CT reconstructions in subglottic stenosis

29. Subglottic tracheal stenosis

30. Demands of anaesthetists on radiology
ITU
Chest X-rays

31. Chest X-ray: pneumothorax
Supine
Erect

32. CXR: tension pneumothorax

33. Subtle pneumothorax: deep sulcus sign

34. If in doubt do a CT: subtle pneumothorax? bulla?
“crisp” cardiac silhouette

35. Demands of anaesthetists on radiology
ITU
acute deterioration

36. Acute intracerebral haemorrhage

37. ITU acute deterioration: closed loop obstruction

38. ITU: Hx “overdose, in cardiogenic shock, worsening ventilation, lactate rising, severe rhabdomyolysis. Progressive peripheral ischaemia”

39. Demands of anaesthetists on radiology
ITU
line retrieval

40. Fractured portacath in RV and pulmonary artery

41. Retrieval of fractured portacath

42. Conclusion:
Future directions in Radiology:   impact on general anaesthesia requirement
interventional radiology becoming increasingly more complex → greater GA requirement
cancer patients surviving longer, more interventional oncology → greater GA requirement
↑mechanical stroke thrombectomy