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Interventional Radiology in Cancer Patients. C. Douglas Edmondson, M.D., FACR Interventional and Diagnostic Radiologist. What does IR do?. Diagnosis Primary treatment of cancer Treatment of cancer related complications or sequelae. Diagnosis. Image guided biopsy - PowerPoint PPT Presentation
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Interventional Radiology in Cancer Interventional Radiology in Cancer PatientsPatients
C. Douglas Edmondson, M.D., FACRC. Douglas Edmondson, M.D., FACR
Interventional and Diagnostic Interventional and Diagnostic RadiologistRadiologist
What does IR do?What does IR do?
DiagnosisDiagnosis Primary treatment of cancerPrimary treatment of cancer Treatment of cancer related Treatment of cancer related
complications or sequelaecomplications or sequelae
DiagnosisDiagnosis
Image guided biopsyImage guided biopsy Aspiration or Drainage of fluid Aspiration or Drainage of fluid
collectionscollections
Examples of Bx needleExamples of Bx needle
CT of needle in tumorCT of needle in tumor
Fluoroscopic image of needle in Fluoroscopic image of needle in lung tumorlung tumor
Ultrasound image of needle in Ultrasound image of needle in tumortumor
Malignant pleural fluid Malignant pleural fluid
Safe – T – Centesis CatheterSafe – T – Centesis Catheter
CXR before and after tapCXR before and after tap
Primary treatment of cancerPrimary treatment of cancer
Transcatheter chemoembolizationTranscatheter chemoembolization Transcatheter gene therapyTranscatheter gene therapy Central venous accessCentral venous access Tumor ablationTumor ablation
• SclerotherapySclerotherapy• Radiofrequency ablation (RFA)Radiofrequency ablation (RFA)• MicrowaveMicrowave• FreezeFreeze
ChemoEmboChemoEmbo
Typically in the hepatic artery for Typically in the hepatic artery for Hepatocellular Ca or susceptible Hepatocellular Ca or susceptible metastasis.metastasis.
Attacks the tumor with concentrated Attacks the tumor with concentrated dose of chemotherapy or radioactive dose of chemotherapy or radioactive beads and embolic materials to stop beads and embolic materials to stop blood flow to starve and poison the blood flow to starve and poison the tumor or fry it with Beta irradiation tumor or fry it with Beta irradiation OR all of these agents.OR all of these agents.
Before and after angiogramsBefore and after angiograms
CT scan of embolic material in liverCT scan of embolic material in liver
Radiofrequency AblationRadiofrequency Ablation
15 -18g needle or needles placed 15 -18g needle or needles placed into the tumor usually by CT into the tumor usually by CT guidance for best control.guidance for best control.
Radiofrequency applied across the Radiofrequency applied across the field and the tumor is coagulated and field and the tumor is coagulated and “cooked” at about 110 degrees.“cooked” at about 110 degrees.
Very promising results in many Very promising results in many applications. Ever expanding applications. Ever expanding indications.indications.
RFA needleRFA needle
CT of RFA in PlaceCT of RFA in Place
Before and After CT Scans of Before and After CT Scans of renal cell carcinomarenal cell carcinoma
Treatment of Cancer related Treatment of Cancer related complications or sequelaecomplications or sequelae
Pain ControlPain Control Vertebral interventionsVertebral interventions DrainageDrainage
Pain ControlPain Control
Pain usually arises from invasion Pain usually arises from invasion especially nerve involvement.especially nerve involvement.
Pancreatic cancer does not respond to any Pancreatic cancer does not respond to any conventional therapy when usually conventional therapy when usually discovered. Treat the terrible pain with discovered. Treat the terrible pain with celiac axis ablation.celiac axis ablation.
Other areas such as stelate ganglion in Other areas such as stelate ganglion in neck, spinal nerves as they leave the neck, spinal nerves as they leave the spinal foramina respond to image guided spinal foramina respond to image guided ablations.ablations.
Pancreatic Ca with Celiac axis Pancreatic Ca with Celiac axis ablationablation
Vertebroplasty/Vertebroplasty/KyphoplastyKyphoplasty
11 – 14 g needles placed into 11 – 14 g needles placed into vertebral body and PMMA cement vertebral body and PMMA cement injected.injected.
Eliminates pain in over 80% of Eliminates pain in over 80% of metastatic lesionsmetastatic lesions
Kills tumor with heat as cement Kills tumor with heat as cement hardenshardens
Stabilizes bone?Stabilizes bone?
Model of needle in vertebral bodyModel of needle in vertebral body
Needles and PMMA in the vertebra Needles and PMMA in the vertebra during Vertebroplastyduring Vertebroplasty
Needle and balloon in vertebra Needle and balloon in vertebra during Kyphoplastyduring Kyphoplasty
CT of PMMA in the boneCT of PMMA in the bone
Drainage and bypassDrainage and bypass
Biliary obstructionBiliary obstruction Ureteral obstructionUreteral obstruction Abcess and necrotic tumor mass Abcess and necrotic tumor mass
effecteffect Palliative thorocentesis or Palliative thorocentesis or
paracentesis (serial taps or paracentesis (serial taps or permanent catheter).permanent catheter).
Biliary Drain and StentBiliary Drain and Stent
Pleur-X drainPleur-X drain
SummarySummary
IR can aid with diagnosis, primary treatment, IR can aid with diagnosis, primary treatment, management of complications and palliation of management of complications and palliation of sequelaesequelae
IR can do many of these with equal or better IR can do many of these with equal or better success than conventional treatments success than conventional treatments
IR can do many procedures cheaper and with less IR can do many procedures cheaper and with less complications than more traditional approachescomplications than more traditional approaches
Nearly all procedures are OP and with local Nearly all procedures are OP and with local anesthetic and IVCS.anesthetic and IVCS.
Future procedures are on the bright horizon of IRFuture procedures are on the bright horizon of IR
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