What is Interventional Radiology?
Pediatric interventional radiology (IR) is a medical field that specializes in minimally invasive diagnostic or therapeutic procedures using imaging guidance, in children. IR doctors guide small needles, catheters and other small medical equipment into the body through tiny incisions in the skin. These instruments are manipulated within in the body by the radiology doctors, who guide the instruments by seeing into the body, using X-ray, CT scan, ultrasound or MRI. The instruments are used to target and treat disease at its source in the body. In general, all the techniques applied to adults can be performed in children although the medical conditions in children may differ from those in adults. Abnormal blood vessels or cancerous and non-cancerous tumors are just a few of the types of medical problems that may be treated by IR.
A few examples of pediatric interventional procedures include:
- Guiding instruments into the tissue to take a sample in order to diagnose infection or tumor (biopsy or aspiration)
- Placing a tube into a blood vessel, organ or fluid collection to remove or replace fluids (venous access, -ostomy tube or drainage)
- Guiding small instruments into the body to directly deliver materials (such as medications, radiofrequency energy or laser) to destroy cancer or other abnormal tissues without harming the healthy tissues, by treating at the source of the disease (chemoembolization, sclerotherapy or ablation).
In some cases, IR treatments can solve problems faster and with smaller incisions than can other techniques, resulting in less pain and a shorter time to heal. In other cases, they can help treat medical problems which cannot be solved any other way. Pediatric and interventional radiologists are experts in these treatments and their follow-up in children, whose small size and special needs may require extra care.
A consultation with a pediatric interventional radiology doctor can help you learn whether such high tech minimally invasive techniques would be helpful for your child’s condition. To find a pediatric IR doctor near you, visit http://spirweb.org/find-a-pediatric-interventional-radiologist .
Is there an increased risk of cancer from medical radiation, including interventional radiology procedures that use radiation?
When the imaging needed during an interventional radiology procedure requires fluoroscopy (X ray) or CT guidance, which use radiation, appropriate steps should be taken for children to reduce their radiation exposure. While no one can point to a single individual and say that their cancer was caused by medical radiation, there is evidence that exposures to radiation levels found during some kinds of radiology procedures may slightly increase the risk of future cancer. The potential risk of developing future cancer is both unproven and very difficult to measure, as the chances are extremely low and only represent very rough estimates. Also, each procedure is fine tuned for each patient and their disease, so the radiation dose is different for each patient for each procedure. It is important to know that without any medical radiation exposure at all, an individual's baseline lifetime risk of developing cancer is 40%. Any tiny additional risk on top of this baseline risk is very difficult to detect.
If an interventional radiology procedure is suggested, should I let my child have it?
Like any medical procedure you consider, the benefit to your child should outweigh the risk of having the procedure performed. Interventional radiology procedures often are the only way, or the least invasive way, to treat certain conditions. In certain instances, imaging guidance such as ultrasound or, rarely, MRI can be effective and does not expose your child to any radiation. You should ask your interventional radiology physician whether these alternatives are appropriate for your child’s situation. If, however, an interventional radiology procedure using fluoroscopic or CT guidance does provide the most effective treatment for your child, then using appropriate low dose techniques minimizes radiation exposure during the test and lowers any potential risk for your child.
How can I be sure that my radiology facility is using appropriate reduced radiation techniques?
Some facilities typically perform interventional radiology on adults and less frequently in children. It is important for the radiologist to use radiation dose reduction techniques when treating children. You won’t know unless you ask, and it is reasonable and within your rights to do so. Your IR physician should be able to provide you with information about what they do to reduce radiation doses (
link to more information for radiologists here). You may also ask whether the doctor performing the procedure is a board-certified radiologist with interventional or pediatric experience
Who should I talk to about my concerns?
Any discussion should start with your child’s primary physician. They will know or can inquire if the interventional radiology center to which they refer utilizes appropriate pediatric techniques. If not, you should ask to speak with the technologist or radiologist at your interventional radiology facility so that your concerns and questions can be answered. Additional information can also be found throughout this website, and at the links provided.