In a series focusing on medical specialisms Dr Paul Crowe talks about interventional radiology.
Offering alternatives to traditional surgery
Interventional radiology is a new speciality, which treats patients using minimally invasive techniques, usually as an alternative to traditional surgery.
WHAT IS YOUR JOB?
I am a consultant interventional radiologist at Birmingham Heartlands Hospital, part of the Heart of England NHS Trust.
Having qualified as a doctor, I then spent three years in general medical training, then five years specialising in radiology with further training in interventional radiology.
Interventional radiology is a speciality that uses advanced state of the art imaging technology and miniaturised medical devices to perform minimally invasive procedures as alternatives to more traditional surgery.
We treat a wide variety of conditions ranging from narrowed arteries to malignant tumours in all parts of the body.
In each case the procedure is performed under local anaesthetic via a tiny pin-hole puncture of an artery either in the groin or the arm.
Patients are awake throughout the procedures and in many cases can go home the same day.
WHAT IS THE MOST COMMON CONDITION?
The most common condition is arterial narrowing or blockage due to atherosclerosis - or build up of cholesterol in the arteries - often the result of smoking.
This occurs most commonly in the arteries of the legs, leading to pain on walking or leg ulcers.
It also affects other arteries, such as those to the kidneys, or the carotid arteries in the neck that supply the brain. Narrowing or obstruction in these arteries can lead to stroke.
WHAT IS THE MOST COMMON PROCEDURE?
The most common procedure is angioplasty which involves passing a guide wire through the narrowed artery under x-ray guidance and then widening the artery with a tiny balloon passed over the guide wire.
This is often followed by stenting, deploying a metallic tube-like device that stays in place permanently to hold the artery open.
Other common procedures include embolisation, blocking a selected artery by injecting small particles, foam or glue to stop bleeding following trauma or to block the blood supply to a tumour.
WHAT IS THE HARDEST THING ABOUT YOUR JOB?
The hardest thing is keeping up with demand for the various procedures interventional radiology can now offer while at the same time juggling other commitments like teaching and research.
WHAT IS YOUR MOST SATISYING CASE?
Among my most satisfied patients are women having uterine artery embolisation for the treatment of fibroids, common non-cancerous growths of the womb.
Fibroid embolisation is a minimally invasive alternative to hysterectomy for these patients that allows them to return to normal activity and to work within days rather than weeks.
More importantly, it keeps open the possibility of having children, something for which many of them are extremely grateful.
WHY DID YOU CHOSE THIS SPECIALTY?
Interventional radiology is an exciting and rapidly evolving speciality that offers huge benefits to large numbers of patients.
To me, it provides a fantastic combination of direct patient contact and high-tech advances.
It's a real cutting edge speciality when it comes to early uptake of new technology and application of that technology to treating disease and improving the patient experience.
IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?
In a word, no.
HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?
Further advances in technology and collaboration between medicine and industry to develop new miniaturised devices will further increase the range of conditions that can be treated by interventional radiology techniques.
More specialists are being trained and we are already seeing more overlap between traditional surgical specialities and interventional radiology.
There is also increasing public awareness of what interventional radiology can offer, though not yet to the degree seen in North America.
Most patients given a choice will opt for a minimally invasive treatment.
CV - Dr Paul Crowe
1988: Graduated from Trinity College Dublin Medical School
1996: Fellowship of the Royal College of Radiologists
1998: Appointed Consultant Interventional Radiologist at Birmingham Heartlands Hospital