Summary of the article
What is an interventional examination ?
Interventional radiology provides access and visualize different organs in order to perform a diagnostic or therapeutic procedure. Performed under radiological guidance (radioscopy or fluoroscopy) and under local or general anesthesia, it is a good alternative to more invasive surgery.
Its field of intervention is broad and covers a range of specialties. Thus, radiologists practicing interventional radiology while cardiologists involved in interventional cardiology and neurologists in interventional neurology. Interventional radiology is also used in other medical fields such as urology, vascular, gynaecology and senology, osteoarticular, gastroenterology and paediatrics.
The various interventional techniques can be coupled with surgical and endoscopic techniques, which allows, at the same time as progressing towards the organs under fluoroscopic guidance, direct access to them by surgery or endoscopy.
The interventional radiology room is made up of an X-ray tube which is articulated around the patient to transcribe live images through the acquisition of micrographs or scans. It is also equipped with an examination table and a special sterile equipment for invasive procedures.
When interventional procedures are performed in an MRI or CT scan, the rooms are specially equipped to comply with the strict medical setting.
How is an interventional procedure performed ?
There are several interventional procedures, each of which requires special care.
Generally, you are taken care of by the medical staff who ask you to remove your clothes, install you on the examination table and then give you an infusion.
Depending on the organ being examined and the type of examination prescribed, a local or general anaesthetic may be used. The examination is carried out under optimal conditions of safety and hygiene.
The examination lasts from 30 minutes to about an hour. Afterwards, your health may need to be monitored and you may have to stay in hospital for between half a day and 48 hours.
During the examination, a contrast medium is injected and images are taken to highlight pathologies in the vessels, joints or other organs targeted by the procedure. A therapeutic procedure may be performed depending on the images obtained and whether or not the conditions are favorable.
Do not hesitate to report any problems to medical personnel during the examination.
Preparing for an interventional examination
When you make your appointment, remember to mention your treatments, especially if you are on anticoagulants, as well as your medical history. A blood test will be prescribed.
If you have allergies, the doctor will prescribe tablets to be taken the day before and the day of the examination.
If the operation is planned to be performed under anesthesia, you will need to consult an anesthetist beforehand, at least 10 days before the examination. Other tests may be prescribed (blood tests, electrocardiogram, chest x-ray, etc.).
Most of the time you should not eat or drink or smoke for four to six hours before the examination.
On the day of the examination, please remember to present the following documents to the secretariat
Your health insurance card ("carte vitale") and complementary health insurance card ("mutuelle")- Your prescription
- The contrast medium if it has been prescribed
- Your previous reports and images related to the condition which will allow a comparison and a better follow-up (X-ray, ultrasound, scanner, MRI...)
- Your blood test results
Which contrast medium ?
The product used during an interventional examination depends on the imaging technique.
When the equipment uses X-rays to visualise the organs, the contrast medium injected is iodine-based. In the case of magnetic resonance imaging, a gadolinium-based solution is used.
The injection is a very common procedure and it is generally very well tolerated.
Most of the time, you will be prescribed a creatinine level to check your kidney function.
When the iodine is injected, you may feel a warm sensation throughout your body with more or less a strange taste in the mouth. This will last on average less than one minute.
Generally well tolerated, there are some small risks associated with the injection :
- Hematoma caused by the placement of a peripheral venous voice. Without gravity, it will subside in a few days
- Subcutaneous leakage of the contrast product. This is due to the pressure during the injection and generally present no serious consequences.
- Nausea or vomiting.
- Urticaria which is more rare.
- A rare allergic reaction like eczema, asthma or cardio-respiratory disorders
- Nephrogenic systemic fibrosis, which occurs exceptionally in cases of renal insufficiency.
These unpredictable reactions of intolerance to the contrast medium occur more frequently in patients with a history of allergies. They are generally transient and not serious.
Depending on the severity of the reaction, you will be given a treatment and referred for allergy screening.
In all cases (unless otherwise advised by your doctor), if you have been given a contrast agent, drink two liters of water after the examination. This will help to eliminate the medication quickly.
Image interpretation
The results will be given at the end of the review by the specialist. He or she will give you a commentary, explain what to do next and prepare a written report for you and your doctor.
If a tele-radiology service is implemented, the results will be communicated via a web platform. You will then have a login ID to access your reports and images online via a secure connection to a patient portal.
Categories of interventional procedures
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What are the risks of interventional examination ?
Despite the strict hygiene conditions, the introduction of the catheter can very rarely be responsible for complications of infectious origin. A hematoma may form at the puncture site.
The risks associated with contrast medium injection are low : see Which contrast medium ?.
General anesthesia is a potential risk. The pre-anesthetic consultation will allow it to be carried out in the best possible conditions.
X-rays do not represent a danger given the very low doses used. However, pregnancy is a major contraindications. It is therefore imperative to report any possible or current pregnancy so that precautions can be taken.
At MRI, there is no known biological risk related to the magnetic field, but the presence of a pacemaker, heart valve or any metallic foreign body implanted in your body (particularly in the head) represents a major risk factor if it is not reported to the medical team.
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