Radiology And Interventional Radiology

Department’s Achievements

Visiting faculty to the department in 2018

Interventional Radiology

Interventional radiology (IR) is the minimally invasive, image-guided treatment of complex medical conditions without surgery. IR delivers precise, targeted treatment to complex and sometimes life-threatening diseases and conditions. Interventional radiology (IR) is one of the biggest advances in medical practice, offering treatments with less risk, less pain, shorter recovery times and hospital stay. IR is particularly relevant for patients who are in frail health and unfit for surgery.
IR offers treatment for diseases and conditions affecting liver, biliary tract, pancreas, spleen, bowel, and kidney like hepatocellular carcinoma (Radio Frequency Ablation-RFA, Microwave ablation-MWA, Trans-arterial chemo embolization-TACE), portal hypertension (Trans-Jugular Intra-hepatic Porto-systemic Shunt-TIPS), HVOTO (DIPS, angioplasty, stenting), abscesses, inducing remnant liver hypertrophy and preventing post-operative liver failure (portal vein embolisation), refractory hepatic encephalopathy (Balloon-occluded retrograde transvenous obliteration of varices-BRTO, PARTO), mesenteric ischemia and portal vein thrombosis (thrombolysis, angioplasty, stenting), traumatic bleeding and collections (embolisation, PCD), post liver and kidney transplant complications, post-surgical complications, benign and malignant biliary strictures (PTBD and stenting), cholecystitis (percutaneous cholecystostomy), acute pancreatitis (percutaneous necrosectomy), hypersplenism (splenic artery embolisation), GI bleed (embolisation), renal artery stenosis (angioplasty±stenting), renal tumors (ablation), dialysis fistula related complications (fistuloplasty, central venoplasty), dialysis access creation (permcath, peritoneal dialysis catheter), diagnostic studies (FNAC, biopsy, diagnostic angiography, HVPG, transjugular liver and kidney biopsy). We also have the expertise to manage aneurysms and pseudoaneurysms, arteriovenous malformations, deep vein thrombosis, pulmonary embolism (IVC filter), hemoptysis (bronchial artery embolisation), and uterine fibroids (uterine artery embolisation).
Our department is one of the few in country performing some of the innovative procedures like plug assisted retrograde transvenous obliteration (PARTO) to minimise the post procedural compliactions and monitoring time, per-cutaneous trans hepatic antegrade gastro/lienorenal shunt occlusion for patients with complex venous vascular anatomy, endobiliary RFA for opening biliary stents which get blocked by tumor in-growth and transjugular kidney biopsy (TJKB) in patients with low platelet count and increased prothrombin time (especially in patients with liver cirrhosis).

Services Rendered

New Services and Facilities added

World class Myrian French liver volumetry software was incorporated into existing MDCT and MRCP scans, to provide MEVIS like in-house reformats for the liver transplant workup. On site training at Paris was also given to faculty regarding operations of the same.

Liver volumetry software Myrian™ XP-Liver uses unique segmentation algorithms to isolate entire hepatic vascular systems, healthy parenchyma and lesions and calculate their volume with high precision. It generates highly accurate, dependable and reproducible measurements, as well as three-dimensional images which facilitate interdepartmental communication. This software has set new standards in decision-making for living donor liver transplant surgery and interventional radiology procedures.

3D reconstrcuctions for evaluating the liver anatomy and volume rendered image for pre transplant evaluation as shown below:

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO):

This procedure was introduced in the mid-1990s in Japan and is being practiced mostly in Asian subcontinent. It is a minimally invasive, highly effective treatment for gastric varices. It is an effective treatment option for portal-systemic encephalopathy secondary to extrahepatic portalsystemic shunts. Although, its use in India is not widely popular, ILBS is amongst the very few centers where the procedure is being frequently performed with excellent clinical outcomes. The multidisciplinary team at ILBS consisting of the Hepatologist and Interventional Radiologists is proud to have performed one of the highest number of BRTO procedures in the country.

Per-cutaneous trans hepatic antegrade gastro/lienorenal shunt occlusion:Large spontaneous porto-systemic shunts in the setting of liver cirrhosis may sometimes lead to recurrent severe hepatic encephalopathy. Patients who do not respond to medical management require closure of these shunts. Patients with complex venous vascular anatomy may require percutaneous access of portal vein and further cannulation of the shunt and closure of the same. A rare and challenging procedure which our team has succesfully performed in few cases.

TIPS shunt reduction:Hepatic encephalopathy is the most common complication seen in patients with TIPS. Those patients having recurrent severe hepatic encephalopathy require either closue or reduction of TIPS shunt. While closure of the shunt may lead to recurrence of the symptom (UGI bleed / Ascites), reduction of the shunt remains the most reasonable treatment. Although challenging task but our interventional team has done few of these procedures using novel parallel stent technique.

Transjugular renal biopsy: Renal biopsy is one of the most important invstigation for a nephrologist to determine appropriate therapy. However percutaneous biopsy may be risky in patients with low platelet count and increased prothrombin time (specially in patients with liver cirrhosis) and in such cases biopsy may be safely performed via jugular route. Our institute is amongst few to initiate and perform this procedure on regular basis.

Courses Offered :

This abdominal imaging PDCC program is in accordance with the mandate of the Institute “in developing patterns of teaching in postgraduate medical education in as many branches as possible and to provide specialists in several disciplines of medicine”. The main objective of the course would be to develop an interest in abdominal imaging and facilitate learning in terms of establishing research oriented diagnostic algorithms in hepatobiliary imaging.

Educational Activities

Details of the Educational CME/Conf/workshop hosted by the department in 2017 under following headings:

Department’s Achievements

Dr Arpit Taunk got best paper award at Interventional Radiology CME organized by IRIA, Delhi Chapter