Dr V Maheswaran, Consultant Interventional Radiologist, Assistant Professor, Dept. of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore
The field of interventional radiology has come a long way from the days when simple table-top fluoroscopy was used for guiding procedures, to the present day state-of-the-art cath labs. The technological advancement from ordinary C-arm to current generation 3-D bi-plane cath labs is tremendous and still evolving. The number of procedures possible has also grown exponentially with the technological advancement. With the present technology, many very-high-risk procedures are being performed with few complications, which were considered to be impossible a few years ago.
On market trend
With advancement in the diagnostic imaging technology and increasing awareness of patients to seek medical help at the earliest, the number of patients diagnosed with diseases, which require interventional radiology treatment, is constantly on the rise. There are pathologies, like intracranial aneurysms, which are diagnosed incidentally before they manifest themselves with grave symptoms. These factors have generally contributed the ever-increasing demand for interventional radiological procedures.
On technology trends
Interventional radiology procedures, especially the intracranial procedures, in spite of being minimally invasive, are complex and time consuming. As these procedures are done in very small blood vessels which supply vital and critical organs like brain, they require high level of precision. Hence a good DSA is of paramount importance. Newer technologies like flat panel detector system which replaces the conventional IITV have improved the image quality tremendously. Another technological advancement bi-plane system has enabled the interventionist to tame more complex and challenging vascular interventions.
Technology also aims at reducing the radiation dose to the patient and the operator, which is considered to be the major deterrent of utilizing these X-ray based equipment. This is made possible by improving the X-ray tube technology, and newer soft wares, which can improve the image quality with least possible radiation exposure. There are software that can reduce noise, enhance the image automatically, and correct motion artifacts by pixel shifting and auto exposure control. Advanced techniques like 3-D rotational angiograms, image fusion (like X-ray MR fusion, ultrasound X-ray fusion) and road map have contributed in boosting the confidence of the interventionist while doing complex risky procedures.
On buyer's perspective
With explosion of technology, the buyer is actually spoiled with choices. However, the investment in the modern cath lab systems is huge. Hence the buyer should choose the system carefully considering the kind of endovascular work as to neurovascular or cardiovascular work for which the system is being procured. If the system is primarily intended for neurovascular specialty, a bi-plane system with explicit 3-D angiogram capability, good road map, multiple reference monitors, with a flat panel detector system, and low radiation dose protocols is ideal. If the primary work is on abdominal and thoracic radiology, then a hybrid operation theater with capability to perform conventional surgical procedures along with interventional imaging suite would fulfill the requirement. On the other hand, for primary cardio-vascular work, single-plane with flat panel detector system is ideal and financially viable.
On challenges and opportunities
The major challenge in the field of interventional neuroradiology, especially in our part of the world, is equipment cost. In addition, the cost of the consumable hardware like catheters and guide wire is also phenomenal, which adds to the cost of the procedure to the patient. This problem can be partly overcome by developing the technology indigenously. The problem of scarcity of manpower with required skill set is another challenge.
On future outlook
In spite of the challenges posed, the specialty of interventional radiology is set to grow in view of the increase in the detection rate and incidence of the disease and better affordability by the patients.