Percutaneous Hepatobiliary Endoscopy in the Interventional Radiology Suite

Percutaneous transhepatic choledochoscopy and cholecystoscopy have a growing place in the interventional radiology suite. Patients with indwelling tubes who may have once been left with limited options for stone extraction, targeted biopsy, and/or chronic biliary stricture can now have comprehensive care of their disease process by an interventional radiologist. There are a variety of low-profile and large-profile devices available in the hospital that can be repurposed for use in the biliary system and gallbladder. In many situations, these tools can be used to render patients with limited transoral endoscopic options and chronic indwelling tubes, tube free. This article provides an introduction to biliary endoscopy and cholecystoscopy and their role for the interventional radiologist.

XperCT Sharpening Reconstruction for Cone-Beam Computed Tomography Guided Lung and Bone Interventions

C-arm cone-beam computed tomography (CBCT) is a valuable tool for three-dimensional navigation and mapping in the interventional radiology suite owing to its flexible gantry positioning, real-time three-dimensional volume acquisition, and reduced contrast and radiation use. Reports of CBCT-guided bone and lung interventions are relatively infrequent, however, possibly due in part to the lack of dedicated bone and lung reconstruction algorithms and concerns regarding insufficient lesion conspicuity. Two cases of an ad hoc intraprocedural CBCT sharpening reconstruction are presented in this article.

Interventional Radiology Suite: A Primer for Trainees

Familiarity with different instruments and understanding the basics of image guidance techniques are essential for interventional radiology trainees. However, there are no structured references in the literature, and trainees are left to “pick it up as they go”. Puncture needles, guidewires, sheath systems, and catheters represent some of the most commonly used daily instruments by interventional radiologists. There is a large variety of instruments, and understanding the properties of each tool will allow trainees to better assess which type is needed for each specific procedure. Along with understanding the tools required to perform various interventional radiology procedures, it is important for trainees to learn how to organize the room, procedural table, and various equipment that is used during the procedure. Minimizing clutter and improving organization leads to improved efficiency and decreased errors. In addition, having a fundamental knowledge of fluoroscopy, the most commonly used imaging modality, is an integral part of beginning training in interventional radiology.