A wider role for radiology in minimally invasive procedures

In a statement released at ECR, Gangi discussed how computer tomography (CT) - allowing a direct depiction of the inner body - has helped radiology take over a leading role in medicine.
"Interventional radiology is not used as a diagnostic tool, but rather to carry out minimally invasive therapy. The techniques of interventional radiology are multi-facetted and are constantly being developed," he said in the statement.
Discussing percutaneous tumour management, Gangi said it involved a minimally invasive procedure without an operation where special probes or needles are inserted percutaneously into the centre of the tumour tissue to be treated.
"In the period after the treatment, the destroyed tumour is broken down by the body and the treated tissue becomes scar tissue. In order to place the probe or needle as precisely as possible, the procedure is accompanied by computer tomography," he said.
"Local tumours or metastases can be treated by means of so-called radio frequency therapy. This method, which is also known as radio frequency ablation, is a hyperthermic erosive procedure, in which the tumour or metastasis is destroyed by heat. The heat is created by a probe that is inserted into the tumour with the guidance of ultrasound or CT surveillance."
Gangi described the tumour as being "burned away", so to speak, on the spot.
"The advantage of RF ablation lies in the small diameter of the probes (about two millimetres) and the achievable lesion size (up to five centimetres without moving the probe). After the successful treatment of the tumour, the punction path is coagulated during the removal of the probe. This avoids the spreading of tumour cells," he said.
"Because treatment of metastases or tumours with heat can be painful, depending on the location of the tumour, the treatment takes place under the generous dosage of analgesics or anaesthesia. This method of local destruction is especially suited to the early treatment of tumours of the liver, kidneys, lungs and chest, as well as bone tumours."
Gangi said the special advantage of the procedure lies in the fact that it can be repeated an unlimited number of times, as it has almost no side-effects - in contrast to radiation or chemotherapy.
He then discussed percutaneous pain treatment and CT-guided pain therapy, describing radiological findings in the treatment of unspecific back pain as largely insignificant.
"Over time, percutaneous pain therapy has proved a viable enhancement to conservative therapies, and in the meantime it has become an established alternative to operative procedures," he said.
Gangi said that for approximately 15-40% of sufferers with chronic pain syndrome in their backs the pain originates in the facet joints of the spine.
"Given the proper indications, such as pain after an operation to treat a slipped disc or degenerative changes in the spinal joints, the medicated infiltration of the joints is the treatment of choice," he said.
"In these procedures, CT-guided needle positioning has proved advantageous compared to the x-ray guided method. Through the exact localisation of the needle tip, the amount of the applied medication can be kept to a minimum and an unspecific flooding with medication can be avoided."
Gangi discussed how patients with specific types of slipped discs, such as a covered slipped disc that does not protrude into the spinal canal or one-sided disc curvature, can also profit from a "keyhole operation".
"The goal of this suction procedure is to stop the pain. The therapy reduces the inner pressure of the slipped disc, which has caused the nucleus to 'spill out'. The decisive advantage of this minimally invasive technique is that it largely avoids creating scar tissue, which can also cause pain," he said.
"The affected disc nucleus can be removed through a small opening in the skin with the help of a narrow high-tech tube, at the end of which a mini-camera, endoscope (light source) and small forceps are located. Using CT guidance, the examiner can check the condition of the disease-affected disc and use it to inject a contrast medium.
"Once the surgeon has removed the protruding disc tissue, he can "refresh" the nearby vertebrae surfaces by means of a special technique. In a period of about five weeks, new connective tissue cartilage can grow back, and the disc can regenerate. The operation is successful in about 80% of cases. In about 14 per cent of cases, a second procedure is necessary."
Gangi said excellent results have also been achieved in oncological pain therapy by removing the tumour. Percutaneous tumour reduction or neurolysis (destruction of the nerve root) can also be used to achieve a significant reduction of pain in advanced carcinomas.
Gangi also discussed the management of broken vertebrae, which can happen when osteoporosis attacks the spine and tumours affecting the skeletal apparatus or cancer metastases change bone structure.
He concluded by emphasising that a significant factor for efficient execution of all these minimally invasive procedures was precise imaging supervision.
"It is therefore important to emphasise to the public the role of interventional radiology as well as the diversity of treatment options," he said.