What Is Interventional Radiology?

A radiologist is a doctor you may never meet in person. You’ll see their name on the report next to a diagnosis after you get an X-ray, ultrasound, CT scan, or MRI. But most of the time, this doctor works behind the scenes on your behalf.

Radiologists are medical doctors who specialize in using medical imaging procedures—such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET) scans, and ultrasound—to diagnose injuries and illnesses.

In addition to completing at least 13 years of training, including medical school, internship, and residency, some radiologists pursue additional specialized training to learn how to use imaging to treat medical conditions. These doctors are known as interventional radiologists.

An interventional radiologist is a doctor who performs image-guided, minimally invasive surgical procedures in lieu of traditional open surgery. Instead of making an incision to access the part of the body where surgery would be performed, interventional radiologists do much of their procedures by making a small puncture in the skin where they can introduce image-guided instruments into a blood vessel and navigate painlessly inside the body. There are no stitches or noticeable scars. While a complex intervention may require general anesthesia, for many interventional radiology (IR) procedures, the patient remains semi-awake under what’s called moderate sedation for the entire procedure.

Though interventional radiology is not always the right option for every patient, these specialized radiologists can produce dramatic results, says Yale Medicine interventional radiologist Stacey Bass, MD, PhD.

"With these methods, we can cure liver and kidney cancers, shrink enlarged prostates that cause urine blockage [BPH] or uterine fibroids that cause bleeding or pain,” Dr. Bass says. “We can stop emergency bleeding. We can create blood vessel access for dialysis. We can treat painful spine fractures. We can unblock vessels clogged with clots [known as deep vein thrombosis, or DVT] and remove clots from people’s lungs [known as pulmonary embolism, or PE]."

Research has found that IR procedures can be safer, less painful, and less costly than traditional surgery with quicker recovery times—and for some patients, in some circumstances, they may be even more effective. Often, these procedures are an option for people who are not candidates for traditional surgery due to their overall health or age.

What’s more, “Patients can usually go home the same day,” Dr. Bass says, “wearing just a Band-Aid.”

IR doctors use fluoroscopy (real-time X-ray video), MRI, CT, and ultrasound technology to help them see inside the body as they perform procedures. They first map out the complex infrastructure of a patient’s veins, arteries, and/or organs using imaging technology, allowing them to outline the most efficient path to reach an exact location.

Then, through a small puncture in the wrist or the groin, they thread a small tube (catheter) to reach the targeted location. Once there, they can cut off the blood supply feeding fibroids, an enlarged prostate, or a tumor by injecting thousands of microscopic beads called “microbeads.” Or they can use a small vacuum device at the end of the catheter to suck out a potentially life-threatening blood clot in the lungs. These are just a few examples of a multitude of procedures that IR doctors can perform.

When someone is hemorrhaging from an accident or surgery, an IR doctor can cut off the blood supply using embolization, a minimally invasive procedure that prevents blood flow to an area of the body. “When a patient has internal bleeding from trauma to a body part such as the liver, kidney, or spleen, or a pelvic fracture, IR doctors can plug up the bleeding vessels by performing embolization procedures,” Dr. Bass explains. IR doctors also treat painful and disfiguring varicose veins in the legs, pelvis, or scrotum, by blocking blood flow to that vein, using laser or embolization techniques.

IR procedures are also available for people with kidney stones, for example—an interventional radiologist sometimes will route a catheter to the kidney to break up and remove the stones, relieving pain and preventing organ failure.

Yes. Interventional radiologists who specialize in targeted cancer treatments are known as interventional oncologists.

Interventional oncologists can navigate their way through the body’s vascular system or through the skin under imaging guidance to reach cancers and then treat them with chemotherapy, radiation, extreme heat (microwave ablation, radiofrequency ablation), extreme cold (cyroablation), electricity (irreversible electroporation), or noninvasive ultrasound (histotripsy).

The advantage of these targeted cancer treatments is that the patient can benefit from treatment directed precisely where it’s needed, avoiding some of the systemic side effects associated with chemotherapy or conventional radiation therapy (nausea, appetite loss, hair loss, skin and nail problems, among others). Interventional oncology treatments also can be used in addition to chemotherapy and/or immune therapy to help, or “boost,” its effects.

“These advanced, precise targeted cancer therapies offer image-guided local treatment options for tumors in areas that were unreachable and beyond the technology we had only few years ago,” says David Madoff MD, an interventional oncologist at Yale Cancer Center and Smilow Cancer Hospital. “Our minimally invasive cancer treatments may offer more options for patients with cancer, potentially leading to better outcomes and better quality of life while living with cancer—especially for those patients who aren’t surgical candidates.”

New treatments are on the horizon.

"Image-guided treatments are currently in development to treat some of the most common medical problems facing humankind today, including prostate cancer, breast cancer, and metastatic cancers,” Dr. Bass says.

Interventional radiology can also be used for arthritis. For example, image-guided treatment for knee arthritis is an emerging procedure in which microbeads or medications are injected into the arteries around the knee in order to reduce inflammation and lower nerve sensitivity and therefore pain. There’s no damage to cartilage or bone, and the treatment can provide pain relief without altering the joint.

“As the field of interventional radiology evolves, we can expect to see more innovative and minimally invasive treatment options for a wide range of conditions,” says Dr. Bass. “For patients, this means access to more options, better outcomes, and less pain and less risk.”