State of the Art Pediatric Interventional Radiology Brent Cully, MD
David M. Tabriz, MD - Coding Fiesta 2019 · David M. Tabriz, MD University of Florida College of...
30
1 Interventional Radiology: what we do. David M. Tabriz, MD University of Florida College of Medicine Department of Interventional Radiology What is an Interventional Radiologist? Newest recognized medical specialty Separate from diagnostic radiology 6 years of post-graduate medical training: Clinical internship (1 year) Diagnostic and Interventional radiology residency (4 years) Interventional radiology fellowship (1 years) What is Interventional Radiology? Diagnostic Radiology trained (head to toe) - Image interpretation (including prior studies) - Image consultation and protocolling - Disease process management - Recommended follow up (imaging, physician, etc.) Interventional Radiology additional training (head to toe) - Pre-operative consultation - Image interpretation (including prior studies) - Procedure - Diagnostic (minority) & therapeutic procedures - Post-procedure care Benefits: Decreased cost & post-procedural care Decreased morbidity & mortality Faster recovery Only Option Interventional Radiology: what we do. October 17, 2015 Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
Transcript of David M. Tabriz, MD - Coding Fiesta 2019 · David M. Tabriz, MD University of Florida College of...
1
Interventional Radiology:what we do.
David M. Tabriz, MD
University of Florida College of Medicine
Department of Interventional Radiology
What is an Interventional Radiologist?
Newest recognized medical specialtySeparate from diagnostic radiology
6 years of post-graduate medical training:Clinical internship (1 year)
Diagnostic and Interventional radiology residency (4 years)
Interventional radiology fellowship (1 years)
What is Interventional Radiology?
Diagnostic Radiology trained (head to toe)- Image interpretation (including prior studies)- Image consultation and protocolling- Disease process management- Recommended follow up (imaging, physician, etc.)
Interventional Radiology additional training (head to toe)- Pre-operative consultation- Image interpretation (including prior studies)- Procedure
- Diagnostic (minority) & therapeutic procedures- Post-procedure care
Benefits:Decreased cost & post-procedural care
Decreased morbidity & mortalityFaster recovery
Only Option
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
2
IR: tools of the trade.
Needles
Guidewires
Catheters
Contrast Agents
Drainage catheters/tubes
Stents
Angioplasty Balloon
Many, many more
Tools: Access Needles
IR: tools of the trade –Seldinger technique
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
3
Tools: GuidewiresMaterial
Thickness
Stiffness
Length
Tools: Catheters
Material
Thickness
Stiffness
Length
Flow rate
Tools: Contrast AgentsIodinated Contrast
MRI (Gadolinium) Contrast
Carbon Dioxide (Gas)
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
4
Tools: Drainages catheters/tubes
Type
Material
Length/Diameter
Tools: Stents
Type
Material
Covered
Length/Diameter
Confusing…
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
5
Tools: Angioplasty Balloon
Type
Pressure
Length/Diameter
Quick history.
1927 – First angiogram (Egas Moniz)1964 – First angioplasty (Charles Dotter)
“Father of interventional radiology”1966 – Embolization of tumors1967 – Coronary angiography (Melvin Judkins)1969 – First stent deployed1980 – Biliary interventions1982 – Interventional Urology1991 – Abdominal aortic stent grafts
“Operating room”Angio suite
IR suite
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
6
What is an Interventional Radiologist?
Like a surgeon taking consultations.
Diagnostic radiology interpretations guide procedure (head to toe).
Pre-, intra-, and post-procedure care.
Wide variety of practices.
E.g. Ultrasound guided abscess drainage.Fluoroscopic guided arteriogram and embolization.
IR CONTINUUM
Image
Access
Diagnose/Treat
Manage
IR CONSULT?
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
7
Common IR Practice
Access and Diagnose/Treat (head to toe): Vascular, GI, Urologic, Gynecologic, and Hepatobiliary
Trauma
Liver Disease
Pain management
Oncology
Cosmetic*
Interventional Procedures for Diagnosis
Biopsy and Drainage
Sentinel IR procedures that started it all.
Usually performed by the Body Imaging Service.
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
8
Sclerotherapy
Central Venous Access
Common Procedure
Dialysis and Central lines
Tunneled and Non-tunneled
Chronic Catheterization Damage
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
9
http://www.scielo.oces.mctes.pt/img/revistas/nep/v27n1/27n1a08f3.jpg
http://interventions.onlinejacc.org/data/Journals/JCIN/22707/10021_gr6.jpeg
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
10
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
11
IVC filters and Pulmonary Embolism Thrombolysis
Inferior vena cava filter barrier that allows blood flow through the IVC, but does not allow large clots
Break up large volume clots in symptomatic and unstable patients
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
12
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
13
Nephroureteral Obstruction
Relieve mechanical obstruction Ureteral stricture dilation
Urinary diversion Stone removal
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
14
Percutaneous Biliary Intervention
Cholangitis Bile duct strictures
Pancreaticobiliary malignancyRepair of surgical injury
Biliary stones
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
15
Arterial Injury and Flow Limitation
Trauma
Post Operative
GI bleeding
Atherosclerotic disease
Vascular compression
Anticoagulation related
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
16
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
17
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
18
http://www.fda.gov/ucm/groups/fdagov‐public/documents/image/ucm372843.jpg
http://www.fda.gov/ucm/groups/fdagov-public/documents/image/ucm372843.jpg
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
19
Vascular Malformations
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
20
Example Case: Vascular Malformation
Vascular Malformations
Portal Hypertension: Ascites and Variceal Hemorrhage
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
21
Musculoskeletal and Pain Interventions
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
22
Why Interventional Oncology?
Many patients are medically inoperable
Surgical, regional, and systemic salvage
Low risk, less expensive, and quick recovery
Test of time for potentially under staged patients
Synergistic (not an either/or situation)
Repeat therapy is well tolerated
Palliation
EVIDENCE IS GROWING
Percutaneous Ablation
Radiofrequency
Cryoablation
Microwave
Irreversible Electroporation
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
23
StarBurst® Talon
Images courtesy of Dr. Matt Callstrom, MD, PhD
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
24
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
25
Endovascular Oncology
Transarterial Chemoembolization
Drug Eluting Bead Chemoembolization
Radioembolization
Bland Embolization/Intravascular ethanol
Percutaneous Hepatic Perfusion
Portal Vein Embolization
Bland Embolization
Removal of tumor blood supply alone, typically with bland particles
Embolization of benign disease for bulk reduction and symptom control (ex.
uterine leiomyomata)
UFE
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
26
Drug Eluting Bead Chemoembolization (DEBTACE)Chemotherapeutic agent is adsorbed to flexible particles that impregnate tumor vascular supply
Several studies have indicated an overall survival benefit for unresectable HCC as well as reduced liver toxicity and drug related adverse events
More permanent and aggressive embolic agent which may make up for less total chemotherapeutic dose
Extended antibiotic prophylaxis for incompetent biliary system or severe liver diesease
Radioembolization
External beam radiation therapy is challenged by the sensitivity of normal liver radiation
Hepatic treatmnent dose estimated from 50-70 Gywhile the liver tolerance dose is 35 Gy
Selective intra-arterial yttrium-90 beta emission enables doses over 120 Gy without liver toxicity
Well tolerated, single session, outpatient treatment
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
27
Multifocal Liver Involvement
Radioembolization
POINT SOURCE BRACHYTHERAPY WITHIN TARGET ORGAN: EFFECTIVE (3-12 mm margin)
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
28
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
29
Pre Y-90 (Tc-99m MAA)
Post Y-90 (Bremsstrahlung)
Cosmetic IR
Varicose vein ablations
Laser liposuction
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
30
What is an Interventional Radiologist? Recap.
Like a surgeon taking consultations.
Diagnostic radiology interpretations guide procedure (head to toe).
Pre-, intra-, and post-procedure care.
Wide variety of practices.
Questions?
THANK YOU
Interventional Radiology: what we do. October 17, 2015
Coding Fiesta 2015 David M. Tabriz, MD University of Florida College of Medicine
