EDITORIAL
Imaging-guided intervention
Marcos Roberto de Menezes
Director for Service of Emergency Radiology at HC-FMUSP
The medical technology evolution continues to delete the boundaries between different medical specialties. The so-called interventional radiology will play a key role in the future medicine.
In the future, the imaging-guided interventional systems employing different modalities like magnetic resonance imaging, computed tomography and ultrasound will look very little like the current interventional radiology, but essentially they will combine diagnosis and minimally invasive therapy, associating shorter time and lower cost.
The technological progress is reshaping, redesigning and frequently deleting the boundaries of different medical practices with a tendency towards expertises convergence. In a not very distant past, the only way to treat a coronary artery occlusion was by means of an open surgery. Nowadays, many cardiac surgeons perform a reduced number of surgeries because a catheter angioplasty may be performed by interventional cardiologists. A more easily available and less expensive method multidetector computed tomography has replaced diagnostic angiographic procedures like angiotomographies, even in emergence situations, allowing the study of brain, abdominal and peripheral vessels.
Images digitization and distribution constitute significant aspects in this strategy, considering the necessity of post-processing and digital archiving of a great volume of information generated by this new technology.
Other imaging-guided procedures increasingly being employed in our environment and in line with the tendency towards lower invasiveness and proved effectiveness are the imaging-guided biopsy and drainage of fluid collections. Even with the huge development of surgical techniques and availability of wide-spectrum antibiotics, the treatment of intraperitoneal collections, particularly the infected ones, remains difficult. These collections constitute severe abnormalities, generally resulting from surgical procedures or inflammatory processes like appendicitis, diverticulitis or pancreatitis and may course with high mortality rates (about 75%98%) if not adequately treated. The success of treatment is dependent on an early and aggressive drainage of these collections associated with specific antibiotic therapy. Radiological evaluation by means of multiplanar sectional techniques like ultrasound, computed tomography and magnetic resonance imaging, allows a higher accuracy in detection and characterization of intraperitoneal collections if compared to conventional radiological methods, allowing an evaluation of the whole abdomen and retroperitoneum, of their relationship with neighbor structures and identification of an eventual association with tumors and fistulous tracts. Additionally, these methods provide a safe guidance for percutaneous drainage that has become a satisfactory alternative to conventional surgery, presenting high success rates, with lower cost, shorter hospital stays and lower morbidity/mortality rates.
Intrinsically and essentially, medicine is intervention. From Hippocrates to the current interventionists, physicians have always been highlighting the value of the early and rapid diagnosis and therapeutic intervention made possible by technology today. Currently, the imaging methods play a key role in the diagnosis, definition of therapeutic indication and many times as a guide in minimally invasive procedures.
Publication Dates
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Publication in this collection
26 Sept 2006 -
Date of issue
Aug 2006
