Interventional Radiology: A Growing Field
Guest: Dr. Bayne Selby – Radiology, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Bayne Selby, who is Professor of Radiology and an interventional radiologist here at the Medical University of South Carolina. Dr. Selby, let’s talk about the field of interventional radiology. A lot of people may not know exactly what that is. Describe it, please.
Dr. Bayne Selby: Interventional radiology is, I think, the most exciting field in medicine today. Hopefully, everybody thinks the same way about whatever it is that they do. I’m pretty firmly convinced that this is it. And that’s one reason why I ended up here.
It began quite awhile ago. And it was kind of an outgrowth of some procedures that were done in radiology that were simply diagnostic procedures. And, back in the 60s and 70s, when people were just taking x-rays, they found they could get more information if they could pass little tubes, or catheters, into the blood vessels and then take pictures of the of the blood vessels directly. And it wasn’t very long before people said, well, as long as you’re in there doing that, maybe you can do some things to fix things. And it just sort of went from there.
Nowadays, we use x-ray guidance, or even ultrasound guidance, or CT (CAT) scan guidance to do any number of surgical procedures. In fact, our name, we’ve worked long and hard to get people to understand what interventional radiology is. And yet it’s still a name that doesn’t tell most people what we do. If we just wanted a descriptive name, we would probably call it image-guided surgery. If you looked at the procedures we do all day long, you’d day, well, you’re a surgeon, aren’t you? And we’d say, no, we’re interventional radiologists, but we do minimally invasive procedures using imaging guidance.
Dr. Linda Austin: Give some examples of the range of procedures you do.
Dr. Bayne Selby: We use different structures within the body to access other places. So, if you have any tubular structure that we can go through, we can place a little tube, or catheter, to get to some place and do some procedure. So, the blood vessels are the main ones. And people have been doing angiograms for 50 years. And they’ve been doing actual therapeutic procedures using access to a blood vessel for 30 or 40 years. We do that by poking a little needle into a blood vessel, then sliding a tube into that blood vessel. Then, we can literally go any place in the cardiovascular system.
So, almost everybody by now has known somebody that’s had an angiogram. A heart cath is the same thing as an angiogram. And we can go all through those structures. We do the same thing with other tubular structures in the body. For instance, in your liver, there are bile ducts. Bile ducts are also little tubular structures that have branching patterns. So, if we poke into a bile duct, we can run a little tube through all the rest of your biliary tree. Of course, all these things are called trees because they act like a tree. So, it’s a good way to think of it. It’s kind of like going up through a tree and going to all the different branches. And we can do it in the kidneys, and many other parts of the body.
The other we can do is to do sort of basic biopsy-type procedures, where you just can’t see what’s going inside the body, so you use ultrasound or CAT scan, or MRI, to get something lined up where you can do a biopsy. And then you can, again, put a little needle through the skin and get some tissue without having to do major surgery.
I should say that every one of these procedures that I’m talking about; even though they’re minimally invasive, we, of course use a sterile technique; just like in an operating room, and we give people a local anesthetic in the skin before we ever poke a needle into them. And we even use conscious sedation, where we give them medication through their IV, which makes them pretty relaxed and sleepy for the whole thing.
Dr. Linda Austin: You mentioned that you can go into any tube, and you talked a lot about blood vessels. When I think of tubes, I also think of the GI tract.
Dr. Bayne Selby: Yeah, the GI tract is certainly a series of tubes. We go in there, probably, less frequently. And the main reason is that there’s an alternative that may be even better. The tubular structures we get into are sort of small and hard to get into. Anybody that’s been to see their gastroenterologist; the GI doctor, knows that they now have scopes that can go in through that set of tubes, into the bowel and into the stomach. So, that’s usually the first order of business if you need to get something looked at. If you had a stomach ulcer, the first thing to do would be to have an endoscopy, or something, by the gastroenterologist.
Having said that, though, we can do the same things there. For instance, some people need a feeding tube placed into their stomach because they may have some kind of blockage in their esophagus. And it’s very easy for us to put a little tube into the stomach and then thread it down through the bowel, and then they can use that for feeding. So, sure, we use it there too.
Dr. Linda Austin: How is a decision made as to whether a patient will have a procedure such as you’ve described from an interventional radiologist versus some other specialist?
Dr. Bayne Selby: That’s an area that’s really changed a lot in just the last ten years. For most of my career, the way that you found an interventional radiologist was that you went through at least one; and usually two or three, doctor before they said, hey, I know this specialist you need to go see. So, we were kind of like a tertiary referral. And that was, on the one hand, kind of neat to think that you could do things that were a little more unusual. But it was also sort of frustrating, because you’d see patients that could probably benefit from one of our simpler procedures, and they couldn’t get to you.
What’s changed in the last ten years is that people still may not know a lot about interventional radiology, but with everything else, with patients taking more of an active role in their healthcare; going on the internet and using other resources to find out about things, we’re finding, more and more, that people are asking their physicians about procedures we do; we do less invasive procedures. And they sort of help to get themselves referred to us. Sometimes they’ll even approach us directly. When we do that, we usually double check with whoever their physician is and make sure we have everybody on board. Along with that comes the sort of added clinical responsibility of us making sure that we see the patient before and after the procedure.
When I first started out in this field, we’d usually get a patient referred in by somebody who had done the history and physical. They’d worked up the patient. They decided they needed a particular procedure that we could do. They’d come to us, we’d do it, and send them immediately back to the other doctor, and oftentimes wouldn’t see them again. Although it worked pretty well in those days, and for the number of procedures we did, it certainly doesn’t translate well when you’re doing a lot of procedures; and a lot more complicated procedures. And, certainly, I think that patients get a lot more benefit out of being able to talk to you beforehand, talk to you afterwards. It has probably made us better at we do also.
Dr. Linda Austin: Dr. Selby, thank you so much for talking with us.
Dr. Bayne Selby: You’re welcome.
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