8 nov 2021

International Day of Radiology

Interventional Radiology

A few pioneers of interventional radiology in the spotlights

The Seldinger technique is a medical procedure to obtain safe access to blood vessels and other hollow organs. It is used for angiography, insertion of chest drains and central venous catheters, insertion of PEG tubes using the push technique, insertion of the leads for an artificial pacemaker or implantable cardioverter-defibrillator, and numerous other interventional medical procedures. Seldinger first published this technique for obtaining percutaneous access to blood vessels in 1953 for the publication Acta Radiologica. This has been described as a "substantial refinement" of a procedure first described by Dr. P.L. Farinas in 1942. This new technique introduced the practice of using a flexible wire to guide a catheter to previous unreachable vascular areas of the body.

Dotter invented angioplasty and the catheter-delivered stent, which were first used to treat peripheral arterial disease. It was Dotter who, in 1950, developed an automatic X-Ray Roll-Film magazine capable of producing images at the rate of 2 per second.  On January 16, 1964, at Oregon Health and Science University Dotter percutaneously dilated a tight, localized stenosis of the superficial femoral artery (SFA) in an 82-year-old woman with painful leg ischemia and gangrene who refused leg amputation. After successful dilation of the stenosis with a guide wire and coaxial Teflon catheters, the circulation returned to her leg. The dilated artery stayed open until her death from pneumonia two and a half years later.[4] He also developed liver biopsy through the jugular vein, initially in animal models and in 1973 in humans.

Moniz hypothesized that visualizing blood vessels in the brain with radiographic means would allow for more precise localization of brain tumors. During his experiments, Moniz injected radiopaque dyes into brain arteries and took X-rays to visualize abnormalities. In his initial tests, Moniz used strontium and lithium bromide in three patients with a suspected tumor, epilepsy, and Parkinsonism, but the experiment failed and one patient died. In the next set of trials, he achieved success using 25% sodium iodide solution on three patients, developing the first cerebral angiogram. Moniz presented his findings at the Neurological Society in Paris and the French Academy of Medicine in 1927. He was the first person to successfully visualize the brain using radiopaque substances, as previous scientists had only visualized peripheral structures. He also contributed to the development of Thorotrast for use in the procedure and delivered many lectures and papers on the subject. His work led to the use of angiography to detect internal carotid occlusion, as well as two Nobel Prize nominations in this area.

The Italian neurosurgeon Guido Guglielmi carries out the first intervention in wich a detachable coil—out of platinum—is placed in a cerebral blood vessel in order to seal an aneurysm. This can prevent the aneurysm from bursting and causing a cerebral haemorrhage.

Forssmann hypothesized that a catheter could be inserted directly into the heart, for such applications as directly delivering drugs, injecting radiopaque dyes, or measuring blood pressure. The fear at the time was that such an intrusion into the heart would be fatal.[2] To prove his point, he decided to try the experiment on himself.

Grüntzig's first successful coronary angioplasty treatment on an awake human was performed on 16 September 1977, in Zurich, Switzerland. He expanded a short, about 3 mm, non-branching section of the Left Anterior Descending (LAD) artery (the front branch of the left coronary artery) which supplies the front wall and tip of the heart (see coronary circulation) which had a high grade stenosis, about 80%, of the lumen. Grüntzig presented the results of his first four angioplasty cases at the 1977 American Heart Association (AHA) meeting, which led to widespread acknowledgement of his pioneering work.

Margulis served as Professor and Chair, Department of  Radiology, University of California, San Francisco (UCSF), creating a model academic clinical department of radiology that included many outstanding basic scientists. Under his enlightened and steadfast leadership, the members of his department added many new dimensions to the field of biomedical imaging, establishing the discipline of radiobiology through federally-funded laboratory work, and pioneering a range of new imaging technologies and applications, from MRI to interventional radiology (both terms that Dr. Margulis coined).

Prof. Dondelinger can be considered as the pioneer of the Belgian radiology. As a tremendous hard working radiologist he introduced different interventional techniques, wrote several books and received international recognition for his work.

Sources: Wikipaedia — Siemens Healthineers