RP Interventional Radiography Lecture

Week 10A Interventional Radiography

Course Overview

  • Institution: GCU Glasgow Caledonian University

  • Lecturer: William MacGregor

  • Subject: Radiographic Principles (RP)

Aims of the Lecture

  • **Understanding: **

    • Machinery used in Interventional Radiography

    • Relevant anatomy and pathology

    • Patient care and radiation protection

Relevance of Interventional Radiography

Learning Objectives

  • Understand operations of fluoroscopic machinery within:

    • Interventional labs

    • Cardiac labs

Importance of Knowledge

  • Helps in understanding patient pathway

  • Facilitates readiness in high-pressure environments as per HCPC responsibilities

Machinery in Interventional Radiography

Fluoroscopy Equipment

  • Cross-over machinery from fluoroscopy in theatre settings, but with advanced features needed for:

    • High spatial and contrast resolution

    • Large Field of View (FOV)

    • At least 1024 x 1024 pixel matrix

  • Fluoroscopy Settings:

    • Fixed Fluoroscopy Units:

      • Modern, motorized, and capable of maneuvering around a fixed point (isocentric)

      • Built-in skin dose monitoring

      • Multiple HD projection monitors

      • Radiolucent patient tables to reduce X-ray absorption

Biplane Fluoroscopy Units

  • Challenging to maintain a sterile environment

  • Provides excellent imaging but poses radiation protection challenges and equipment mobility concerns

Interventional Radiology Overview

Definition

  • Interventional Radiology:

    • X-ray guided techniques to repair, sear, or unblock anatomy

    • Utilizes vascular system for access to body parts

    • Enables minimally invasive procedures, reducing the need for major surgery

Cath Lab Information

  • Under the purview of cardiology

  • Focuses on the heart and its vessels

  • Benefits of procedures conducted within the Cath Lab and concerns of external locations

Role and Advantages of Interventional Radiology

  • Minimally Invasive Procedures:

    • Targeted treatment with reduced recovery times

    • Outpatient or one-night stays are common

Comparison of Advantages and Disadvantages

Advantages:

  • Live imaging for surgical precision

  • Less invasive, lower risk compared to open surgery

  • Cost-effective for NHS and fast recovery

  • Often no follow-up required

Disadvantages:

  • Radiation exposure

  • Risk of infection and complications such as PE, stroke, and bleeding

Procedures Using Fluoroscopic Equipment

Common Examples

  • Radiology (Intervention) Procedures:

    • Diagnostic Angiographic Studies

    • Percutaneous Coronary Intervention (PCI)

    • Endovascular procedures (e.g., EVAR)

Additional Procedures

  • Angioplasty, stenting, embolization, IVC filter placement, biopsy, and TACE

Gaining Vascular Access Techniques

Seldinger Technique Steps

  1. Puncture the artery with a hollow needle

  2. Introduce a flexible guidewire through the needle

  3. Remove the needle while leaving the guidewire in place

  4. Insert an arterial catheter over the guidewire

  5. Withdraw the guidewire while the catheter remains

Considerations for Access Location

  • Access points include the femoral artery and the radial artery

  • Importance of understanding anatomy for successful procedures

Cardiology Procedure Overview

PCI Pathways

  • Primary PCI for STEMI:

    • Scheduled based on symptoms and ECG findings

    • Immediate or elective intervention based on findings

Statistics and Outcomes

  • UK PCI statistics: over 100,000 annually, predominantly via radial access

  • Majority of procedures are day cases

Patient Care and Positioning

Importance of Positioning

  • Patient positioned supine for comfort during imaging

  • X-ray tubes positioned to optimize visualization

Whole Body Imaging Views

  • Common projections include:

    • PA, LAO, RAO views

    • Importance of moving the machine rather than the patient for efficient imaging

Team Composition in Cath Lab

Key Roles in Interventional Radiology Team

  • Roles include:

    • Consultant Interventional Cardiologist

    • Radiographer

    • Cardiac Physiologist and nursing staff

Team Dynamics

  • Emphasizes communication, adaptability, and preparedness

Radiation Safety and PPE

Assessing Dose Levels

  • Importance of radiation dose monitoring

  • Key principles to minimize radiation exposure:

    • Time: Reduce exposure duration

    • Distance: Maintain distance from radiation source

    • Shielding: Use protective equipment and barriers

Personal Protective Equipment (PPE)

  • Emphasis on the necessity of wearing PPE in high-radiation areas

Conclusion

  • Final notes on the importance of understanding radiographic principles in interventional settings and the role it plays in patient care.