Interventional Radiology

Interventional Radiology (IR) is a medical sub-specialty of radiology that uses image-guided keyhole surgery and other minimally-invasive procedures to diagnose and treat a wide variety of conditions in adults and children. It was first developed as a specialty in the 1960s.

Dr Alex Barnacle BM MRCP FRCRCharles Dotter, known as the ‘Father of Interventional Radiology’ pioneered many of these techniques and was awarded the Nobel Prize for his work in 1978.

Medicine has evolved in a whole host of directions over the last 40 years but many would say that IR has been at the forefront of this, introducing the concept of minimally invasive procedures and innovating at an extraordinary rate. The first interventional radiologists developed vascular catheters and stents to treat peripheral arterial disease in adults and used X-rays to ‘see’ these catheters in the bloodstream as they threaded them around the body to the site of disease. It became clear that these basic techniques could be applied in other parts of the body to treat other conditions and IR went on to develop treatments for gastrointestinal tract bleeds, bile duct disease, liver tumours, bone tumours and fractures, and kidney stones. Much of IR remains centred on the vascular system, where IR can treat aortic aneurysms, abnormalities of the blood vessels of the brain, narrow renal arteries causing hypertension and vascular malformations. Today, many conditions that once required surgery can be treated non-surgically by interventional radiologists, leading to shorted hospital stays and better outcomes for patients.

It has taken a long time for these techniques to be applied to diseases in children. Many of the original techniques have had to be adapted and industry has had to match our innovations with significant changes in the size and capability of their equipment to make it physically possible to treat small children and babies.

Traditionally, IR uses X-rays to guide procedures; in paediatrics we have had to work with industry and amongst ourselves to find ways to reduce radiation dose during our procedures and develop new, safer forms of image-guidance. These days, ultrasound is used as much as X-rays to guide what we do.

Paediatric IR offers a host of diagnostic techniques that allow prompt diagnosis so that treatment can start early. These include biopsy of organs to detect tumours, infection and diseases such as renal failure. Angiography of abnormal blood vessels gives a roadmap of the circulation and allows conditions such as vasculitis, aortic disease, cerebral vasculopathy, arteriovenous malformations (AVMs) and renal hypertension to be detected and in many cases treated. Paediatric IR also has a key role in supporting children’s health while they are undergoing other treatments in the hospital, such as the placement and management of gastric feeding tubes and the placement of central venous catheters for iv drugs, feeds and chemotherapy. Beyond the cardiovascular system, paediatric IR uses image guidance to treat a huge range of conditions such as arthritis, oesophageal disease, abscesses, trauma, renal stones and tumours.

Being part of this evolving specialty is very exciting. It requires close collaboration with experts in all fields of medicine and with industry, as well as building up the trust of patients and families. Much of what we do involves research and innovation but it is also the day to day work with children to support them in their journey and get them better that makes the job worthwhile.