Basic Interventional Procedures: Practice Essentials

Abstract

There has been an increasing demand in image-guided minimally invasive procedures and these have become an integral part of present-day clinical practice. Basic interventional radiology (IR) procedures have greatly reduced the need for invasive procedures for sampling as well as treating conditions like abscess and fluid collections. Owing to their minimally invasive nature, most of these procedures may be performed on the outpatient patients as daycare procedures. Some of these procedures in critically ill patients may be lifesaving. Basic interventional radiology (IR) procedures consist of image-guided fine-needle aspiration cytology and biopsy, tru-cut (core) biopsy, needle aspiration/drainage and percutaneous catheter drainage. This review aims to provide practice requisites for basic IR procedures.

Keywords: Core biopsy; fine-needle aspiration; interventional radiology; per-cutaneous drainage.

Figure 1 (A-C)

Photograph (1A) showing spinal needle of varying caliber commonly used for FNA, (1B) shows a 22G Chiba needle and (1C) shows images of coaxial needle, semiautomated and automated biopsy gun

Figure 2

Photograph 2 showing hardware needed for percutaneous drainage using Seldinger technique

Figure 3

Image showing needle placement for FNA under ultrasound guidance (white arrows)

Figure 4 (A-C)

Ultrasound image (A) shows initial puncture of the abscess cavity using 18G needle, (B) shows guide wire within the abscess cavity and (C) shows malecots catheter (white arrows) within the abscess cavity

Figure 5 (A-C)

CT image in supine position shows (A) markers placed on the anterior chest wall to ascertain the point of entry for biopsy of lung nodule (B) biopsy needle within the lung nodule and (C) post biopsy image with no pneumothorax

Figure 6 (A and B)

CT image in prone position shows (A) markers placed on the posterior abdominal wall to ascertain the point of entry for sampling of retroperitoneal lymph node (RPLN) and (B) the biopsy needle within the RPLN while avoiding all vital structures

Figure 7 (A and B)

CT image in supine oblique position shows (A) a needle with guide wire placed in a large peripancreatic collection using posterior oblique (retroperitoneal approach) avoiding the colon and perirenal fat and (B) needle replaced with a malecots catheter for continuous drainage

Figure 8 (A and B)

CT image (A) shows abscess in the rectovesical pouch (black star) with multiple routes to access and drain the collection. White dotted arrow shows the anterior approach, white solid arrow shows the posterior (transgluteal approach) and black arrow shows transrectal approach (needs endorectal ultrasound guidance). Ultrasound image (B) shows drainage catheter placed in the abscess cavity through anterior paravesical approach (white arrows) after emptying the urinary bladder