Interventional radiology

The capabilities of interventional radiology are developing faster than perhaps any other branch of medicine. Coupled with and fuelled by parallel advances in computer technology, medical physics and developments in endovascular catheter technology, interventional radiologists are innovating not only replacements for open surgeries, but entirely new therapies as well. This has, however, provided a range of new potential complications for the patient and, in contrast to other areas, presents risks for the anesthesiologist as well.

The techniques involved in interventional radiology have found applications throughout not only medicine but surgery in particular. Here there has been a medicalization of surgical procedures. CT scanning has evolved to the extent that it is now possible to utilize multislice CT scanners, ones with multiple, flat panel digital detectors, to provide real time CT fluoroscopy. Similarly this technology has facilitated the construction of hybrid iMR/X-ray systems, thus enabling dual modality imaging without moving the patient. Another facet of the new breed of iMR systems is their integration in real time with computerized, frameless stereotactic navigation systems. This has enabled the radiological image to keep pace with the changes in anatomy consequent to anesthetic and surgical manipulations.

In the light of these new developments in interventional radiology there is much research to be done. Further developments in imaging and computer processing technology will doubtless make possible the real time integration of anatomical image with metabolic state and functional anatomy. The impact of the hazards of these new techniques on the safety of anesthesia has, however, been the subject of virtually no research. A particularly needy area will be the ergonomics of the delivery of anesthesia care in these new environments.