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2000 RSNA Annual Oration in Diagnostic Radiology¹

The Future of Interventional Radiology

¹ From the Department of Research and Outcomes, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176. Received January 3, 2001; revision requested January 11; revision received February 28; accepted March 7. Address correspondence to the author (e-mail: gbecker318@aol.com).

View larger version (55K): [in a new window]   Figure 1. Dotter’s predictions in his 1964 article (1) on percutaneous transluminal angioplasty (PTA).

View larger version (49K): [in a new window]   Figure 2. Vascular conditions diagnosed and treated by interventional radiologists (IRs). PAD = peripheral arterial disease, PVD = peripheral vascular disease.

View larger version (51K): [in a new window]   Figure 3. Roles of interventional radiologists (IRs) in the treatment of cancer. IVC = inferior vena cava, RF = radio frequency.

View larger version (97K): [in a new window]   Figure 4a. Right-sided amaurosis fugax. (a) Right anterior oblique digital subtraction arteriogram of the right carotid artery bifurcation before intervention. Misregistered washer on the image at the angle of the mandible is an external calibration marker used in the measurement of the diameter and length of the diseased segment. Just anterior and superior to the washer is a severe right internal carotid artery stenosis (arrow) involving the bulb and proximal internal carotid artery. (b) Lateral digital subtraction arteriogram obtained after placement of a nitinol self-expanding stent (arrows).

View larger version (102K): [in a new window]   Figure 4b. Right-sided amaurosis fugax. (a) Right anterior oblique digital subtraction arteriogram of the right carotid artery bifurcation before intervention. Misregistered washer on the image at the angle of the mandible is an external calibration marker used in the measurement of the diameter and length of the diseased segment. Just anterior and superior to the washer is a severe right internal carotid artery stenosis (arrow) involving the bulb and proximal internal carotid artery. (b) Lateral digital subtraction arteriogram obtained after placement of a nitinol self-expanding stent (arrows).

View larger version (104K): [in a new window]   Figure 5a. Enlarging abdominal aortic and bilateral iliac artery aneurysms. (a) Anterior view of a three-dimensional shaded-surface display of a pretreatment contrast agent-enhanced CT scan delineates the aneurysms (arrowheads). (b) Posteroanterior aortogram obtained after placement of a bifurcated endograft (Excluder; W. L. Gore & Associates, Flagstaff, Ariz) and embolization of the left iliac artery with Gianturco coils (Cook, Bloomington, Ind). Arrows delineate upper (aortic) end and lower (iliac) ends of the endograft. Note that there is no flow seen outside of the endograft within the aortic aneurysm (ie, no endoleak), the upper end of the graft is well positioned in the upper aortic "neck" just below the renal arteries, and the embolization coils in the left internal iliac artery trunk are seen just below and medial to the left distal endograft attachment. Although the right internal iliac artery is patent and provides flow across the pelvis (depicted on later arteriographic frames, not shown), the coils prevent retrograde filling of aneurysms.

View larger version (139K): [in a new window]   Figure 5b. Enlarging abdominal aortic and bilateral iliac artery aneurysms. (a) Anterior view of a three-dimensional shaded-surface display of a pretreatment contrast agent-enhanced CT scan delineates the aneurysms (arrowheads). (b) Posteroanterior aortogram obtained after placement of a bifurcated endograft (Excluder; W. L. Gore & Associates, Flagstaff, Ariz) and embolization of the left iliac artery with Gianturco coils (Cook, Bloomington, Ind). Arrows delineate upper (aortic) end and lower (iliac) ends of the endograft. Note that there is no flow seen outside of the endograft within the aortic aneurysm (ie, no endoleak), the upper end of the graft is well positioned in the upper aortic "neck" just below the renal arteries, and the embolization coils in the left internal iliac artery trunk are seen just below and medial to the left distal endograft attachment. Although the right internal iliac artery is patent and provides flow across the pelvis (depicted on later arteriographic frames, not shown), the coils prevent retrograde filling of aneurysms.

View larger version (44K): [in a new window]   Figure 6. Pie chart shows distribution of specialization and subspecialization in radiology. Note that only 7.8% of radiologists (28% of the 28% who subspecialize) are interventional radiologists. (Adapted and reprinted, with permission, from reference 12.)

View larger version (59K): [in a new window]   Figure 7. Key elements of the American College of Radiology (ACR) policy statement (17).