Radiology's sublime intervention
Radiology's image, excuse the expression, is of doctors who look but don't cure. But a band of subspecialists is moving beyond diagnosis into treatment that is short of open surgery, to be sure, but can be just as effective.
Interventional radiology, or IR, grew out of diagnostic procedures to track down disease in blood vessels. If a blocked artery is suspected, a radiologist threads a narrow tube, or catheter, into a blood vessel and up to the area of interest, delivering a squirt of dye so any blockage will stand out on X-rays. It was a short step, says Scott Trerotola, head of IR at the Hospital of the University of Pennsylvania, to start fixing the problems they found.
Beads and blasts. Interventional radiologists have learned how to inject tiny polyvinyl beads into arteries to shut off the blood supply to uterine fibroid tumors and can insert a probe into liver and kidney tumors and blast them with radio waves. "Almost everything we do now is clinical," says Trerotola. "It's based on imaging technology, but that's the only thing that connects this to radiology."
The main hospital at Penn has 10 interventional radiologists, who work in five operating rooms set up specifically for IR. Many IR procedures are short and can be done without an overnight stay. Today Trerotola will treat Jennifer Fisher, a woman in her 40s with hereditary hemorrhagic telangiectasia. The rare genetic disorder has wreaked havoc with the blood vessels in her lungs. The network of tiny capillaries linking arteries and veins has weakened, creating a large shunt that could allow bacteria and cell debris, which normally are filtered out, to pour through. They could cause an abscess or stroke if they reach the brain.
Trerotola first takes detailed X-rays of the blood vessels in Fisher's lungs to map the exact location of the problem. Using ultrasound to guide the way, he slides a catheter into Fisher's femoral vein through a tiny nick. He eases it up into the heart, out through the right pulmonary artery into the right lung, and finally to the target, following his progress on two X-ray monitors.
Now for the fix. Trerotola passes a trio of platinum coils through the catheter and into the malformation, where they unwind and block the errant blood flow with a fringe of Dacron fibers. A decade ago, Fisher would have suffered through removal of a sizable chunk of the lung and months of rehabilitation. Instead, she will be lightly sedated for an hour or so and go home two hours later, sporting a bandage.
Many IR procedures are refinements of surgical techniques, Trerotola says, so he and his colleagues have had to fight a few turf wars to gain acceptance. He is unapologetic. "For most of the stuff we do, I think we do it better," he says--and adds: "Competition is the American way." -Thomas Hayden
This story appears in the July 12, 2004 print edition of U.S. News & World Report.