An X-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems; uses a catheter to enter the blood vessel and a contrast agent (x-ray dye) to make the artery or vein visible on the X-ray.

Preparation:
Do not eat any solid food after midnight on the night before your procedure. You may drink clear fluids. Most people can continue to take their prescribed medicines. If you are diabetic and take insulin, ask your doctor about modifying your insulin dose for the day of your procedure. If you are taking the oral anti-diabetic medicine glucophage (Metformin), you will need to discontinue use for up to 48 hours prior to the procedure and 48 hours following the procedure. Consult with your doctor about blood sugar control during this period. If you take blood thinner such as Coumadin, you must tell your doctor so that it can be stopped. Bring all your medications with you. If you are allergic to contrast (x-ray dye) or iodine, let your doctor know as soon as possible. If possible, let the interventional radiologist know about your allergy a few days before your angiogram. Your doctors can then plan to take special precautions during the procedure or prescribe special medications prior to the procedure. Do not smoke for at least 24 hours before your angiogram.

Blood tests are usually done the day before the angiogram. Before your procedure, you will dress in a hospital gown and an intravenous (IV) line will be placed in one of your veins. You may need to remove your jewelry, and any dentures or partials. The IV will be used to give you fluids and medicines during the procedure and will stay in place until after your angiogram is completed.

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Opens blocked or narrowed blood vessels by inserting a very small balloon into the vessel and inflating it. Used by interventional radiologists to unblock clogged arteries in the legs or arms (called peripheral vascular disease or PVD), kidneys, brain, or elsewhere in the body.

Biliary drainage is a procedure in which a catheter is placed through your skin and into your liver to drain your bile and is performed without surgery. A specially trained doctor, known as an interventional radiologist, performs the procedure in the radiology department. The doctor uses x-ray imaging to help precisely place the catheter.

Preparation:
Do not eat any solid food after midnight on the night before your procedure. You may drink clear fluids. Most people can continue taking their prescribed medicines. If you are a diabetic and take insulin, ask your doctor about modifying your insulin dose for the day of your procedure. If you take the blood thinner Coumadin, you must tell your doctor so that it can be stopped. Bring all your medications with you.

You will need to have a blood work before your biliary drainage. On the day of the procedure an intravenous (IV) line will be placed in one of your veins and antibiotics will be given. The antibiotics help to prevent infection. The IV will be used to give you other medicines and fluids during the procedure.

Before our biliary drainage begins, a member of the interventional radiology team (doctor, nurse, or technologist) will discuss the procedure with you in detail and answer any questions you might have. The team member will also ask you some general questions about your health and any possible allergies.

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Insertion of a tube beneath the skin and into the blood vessels so patients can receive medication or nutrients directly into the blood stream or so blood can be drawn.

Delivery of cancer-fighting agents directly to the site of a cancerous tumor; currently being used mostly to treat cancers of the endocrine system, including melanoma and liver cancers.

Delivery of clotting agents (coils, plastic particles, gel, foam, etc.) directly to an area that is bleeding or to block blood flow to a problem area, such as an aneurysm or a fibroid tumor in the uterus.

Epidural Steroid Injections (ESI) are performed for relief of low back pain with leg pain. The epidural space is a tissue space surrounding the nerves and spinal cord. The ESI distributes medication to several nerves and disc margins in the lower spine simultaneously. It can be directed to the side and the level felt to be the most likely source of symptoms. A series of three injections may be prescribed to obtain maximum benefit.

Preparation:
The Procedure
The patient is placed on his/her stomach. The skin is cleansed with antiseptic solution and injected with a local anesthetic. A needle is then passed into the epidural space using fluoroscopic guidance. A small amount of anesthetic with steroid medication is injected. X-ray contrast may be used. You may briefly experience your usual pain and may feel some pressure or mild discomfort during the injection. The procedure takes approximately 30 minutes to complete.

After Discharge
We suggest that someone drive you home after an epidural injection, as your legs may be weak. If you drive yourself, you must wait 30 minutes to make sure your legs are not weak. Normal activity can be resumed after the procedure, though it is best to take it easy and avoid those movements and activities that typically cause your pain the day of the procedure.

Side Effects
If you are diabetic, the steroid may increase your blood sugar levels for a few days. Please consult your family doctor or your diabetes doctor as to the treatment. The spread of anesthetic around the nerve can cause temporary weakness and/or numbness. An allergic reaction to the iodine in x-ray contrast can occur. Occasionally the needle is inadvertently passed to the next tissue layer where steroid should not be deposited. If this occurs you will be required to rest at the hospital for 2-3 hours and have the procedure rescheduled for several days later.

Facet pain is neck or back pain that is usually made worse by twisting the body or bending. The area is usually painful if it is pressed. The pain radiates (spreads out) from your back or neck. For example pain may extend from your low back to your hips or legs. The purpose of this procedure is to determine if the joint is a source of your pain and to provide pain relief. A series of three injections may be prescribed to obtain maximum benefit.

Preparation:
The Procedure
The patient is placed on his/her stomach. The skin is cleansed with antiseptic solution and injected with a local anesthetic. A needle is then passed to the facet joint using either CAT scan or x-ray guidance. A small amount of anesthetic and steroid medication are injected into the joint. X-ray contrast may be used. A minimum of two levels is injected. The level suspected to be causing the pain and the one above the area of suspicion. You will likely briefly experience your usual pain and may feel some pressure or mild discomfort during the injection. The procedure takes approximately 30 minutes to complete.

After Discharge
Normal activity can be resumed after the Procedure, though it's best to take it easy and avoid those movements and activities that typically provoke your pain the day of the procedure.

Side Effects
If you are diabetic the use of steroids may increase your blood sugar levels for several days. Please consult your family doctor or your diabetes doctor as to the treatment. Report any fever or worsening pain to the radiology nurse. You may have brief weakness or numbness due to the anesthetic spreading around the nerves. An allergic reaction to the iodine in the x-ray contrast can rarely occur. Please inform x-ray staff if you have had reactions to x-ray contrast.

Uses a catheter to open blocked fallopian tubes without surgery; a treatment for infertility.

A gastrostomy is performed to insert a tube directly into the stomach or small intestine of a person who cannot take food or medicine by mouth. Gastrostomy can be done surgically, or through an interventional radiology (IR) technique called "percutaneous gastrostomy," which requires only a tiny incision in the skin. Percutaneous gastrostomy can be performed safely in adults or children. Generally this is an outpatient procedure or may involve a short hospital stay.

Preparation:
You must not eat, drink or receive nasogastric tube feedings for at least six hours before the percutaneous gastrostomy procedure. However, you may take routine medications by mouth with small sips of liquid, or medications may be given through a nasogastric tube. More detailed instructions, based on your individual needs will be given to you by your interventional radiologist when your procedure is scheduled.

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Use of angioplasty or thrombolysis to open blocked grafts for hemodialysis, which treats kidney failure.

A needle biopsy is a medical test that can identify the cause of an abnormal lump or mass in your body. A specially trained doctor, known as an interventional radiologist, performs this procedure. Using imaging guidance, the interventional radiologist inserts a small needle into the abnormal area and removes a sample of the tissue, which is given to a pathologist, who examines it under a microscope. The pathologist can determine what the abnormal tissue is: a noncancerous tumor, cancer, an infection or a scar.

Preparation:
No preparation necessary.

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What is NRB? Nerve root blocks (NRB) are performed to relieve pain in one's neck, back or legs and to confirm whether one's pain and/or numbness arises from irritation of a particular nerve. The nerve root emerges from an opening near the spinal column and medication is deposited precisely at that site. A series of three injections may be prescribed to obtain maximum benefit.

Preparation:
Procedure
The patient is placed on his/her stomach. The skin is cleansed with an antiseptic solution and numbed with a local anesthetic. A needle is passed to the nerve root using either x-ray or CT scan guidance. A small amount of contrast may be used. Anesthetic and steroid medication are then injected into the area surrounding the nerve. The procedure takes approximately 30 minutes.

After Discharge
If you drive yourself, you must wait 30 minutes to make sure your legs are not weak. You may drive yourself after a cervical or thoracic nerve root block. Normal activity can be resumed after the procedure, though it is best to avoid those movements and activities that typically provoke your pain.

Side Effects and Risks
If you are diabetic, the use of steroids may increase your blood sugar levels for several days. Please consult with your family doctor or your diabetes doctor as to the treatment. Report any fever or worsening pain to the radiology nurse. You may have temporary weakness or numbness due to the anesthetic's effect on the nerves. You may have an allergic reaction to the iodine in the x-ray contrast. Please inform x-ray staff if you have had reactions to x-ray contrast.

Registration and Location
We are located just behind the emergency room on the second floor of Valley Medical Center. Most patients are called prior to their test and pre-registered over the phone. If you have not been pre-registered prior to your exam, please arrive 20 minutes early to register at the front desk in x-ray for each exam.

A passport is a tube that can be used for intravenous medications, fluids, or nutritional solutions. Blood can also be drawn from it. The passport is placed in a blood vessel and attached to a dome shaped portal. The entire system is placed in the arm, under the skin.

Preparation:
The Procedure
You will check in at ATU (ambulatory treatment unit) ¸ hour before the procedure, where an IV will be started in your hand or forearm. Have nothing to eat or drink 4 hours before the procedure is scheduled. The procedure will take approximately one hour. You will be taken to the radiology department and placed on your back. Your skin is cleansed with an antiseptic solution. An incision is made just above the bend of the arm and a small catheter (tube) is threaded into the blood vessel while viewing under fluoroscopy (x-ray). The catheter is attached to the dome which is placed underneath the skin. The skin is closed with a clear polymer adhesive.

After Dishcarge
Do not allow your blood pressure to be taken or an IV to be started in the arm with the passport. Do not allow blood to be drawn in this arm unless the the passport is used. If there is drainage place a dry sterile dressing over the incision. Change this dressing daily until the drainage is gone. Do not place tape over the incision. The arm containing the passport should not be used for any significant work for 48 hours after placement. Ibuprofen (motrin) 400 mg. taken three times per day for two days may help decrease the swelling. Consult your primary care provider before taking motrin.

Side Effects
Please call the radiology nurse if your incision is red, hot to touch, swollen, or has drainage. Also call if you have a fever or increased pain. Some bruising is normal. however if your bruise extends below the bend in the elbow or half the way between your elbow and your shoulder, please call the radiology nurse at 425-251-5183. Also call if there is any difficulty in the use of the passport.

Use of radiofrequency (RF) energy to kill cancerous tumors.

A small flexible tube made of plastic or wire mesh used to treat a variety of medical conditions (e.g., to hold open clogged blood vessels or other pathways that have been narrowed or blocked by tumors or obstructions).

Reinforces a ruptured or ballooning section of an artery (an aneurysm) with a fabric-wrapped stent; a small, flexible mesh tube used to "patch" the blood vessel. Also known as an endograph.

Dissolves blood clots by injecting clot-busting drugs at the site of the clot.

A life-saving procedure to improve blood flow and prevent hemorrhage in patients with severe liver dysfunction.

Tumor Ablation

Radiofrequency ablation is a minimally invasive treatment for cancer. It is an image-guided technique that heats and destroys cancer cells. Computed Tomography(CT) and ultrasound are used to help guide a needle electrode into a cancerous tumor.

Learn More visit www.radiologyinfo.org

Percutaneous Vertebroplasty (PV) is an outpatient procedure performed for compression fractures of the spine. It can also be used for bone pain related to cancer. Compression fracture is the collapse of the individual bones of the spine (vertebrae) usually due to osteoporosis. Osteoporosis is the loss of bone structure in which bone becomes more porous. As the bone becomes increasingly fragile, the weight of the body compresses the vertebrae causing pain. When conservative treatment (pain medication, bedrest, a brace) doesn't work, or the pain is severe and debilitating, percutaneous vertebroplasty can be performed.

Preparation:
The Procedure
Patients check in at the Ambulatory Treatment Unit (ATU) at Valley Medical Center. The doctor will talk with you before beginning the procedure to answer any questions. An IV is started in the arm for sedation. You are then taken to the Special Procedure room in the Radiology Department. Once on their stomach, patients are given pain medications and sedative, but they are often awake during the procedure. The collapsed vertebrae is viewed under Fluoroscopy (x-ray). A bone cement (polymethylmethacrylate) is mixed and injected into the bone. The cement hardens in 20 minutes. Multiple vertebrae may be treated at this time. The total procedure takes approximately 1-2 hours. Patients return to the ATU to lie on their back for about 1 hour. The second hour they can slowly begin to move, and are then discharged to home in 2-4 hours. Someone must drive you home after the procedure.

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After Discharge
In the first 24 hours after the procedure plan to rest and do not drive a car. The day after the procedure, expect soreness. Within 48 hours your pain should be markedly reduced. 80% of patients report marked reduction in pain by day two. You should be able to resume your normal activity slowly. Feel free to call if you have concerns. It is important that you follow up with your primary care provider to begin medicines to help treat the osteoporosis; may be given to help to build bone, and reduce bone loss.

Side Effects and Risks
There is a risk of infection anytime a needle is inserted into the body. If you have fever, redness, discharge at the needle insertion site, increased pain, or new pain, you need to report this to the radiology nurse. There is a small risk of nerve damage which the doctor will explain at the time of the procedure.

For further information, please check out www.vertebroplasty.com.

Uterine Fibroid Embolization (UFE) has been available since 1992 to spare the uterus by treating uterine fibroids. Fibroids are benign tumors of the muscular wall of the uterus. Approximately 10-20% of fibroids cause symptoms. Patients report heavy, prolonged bleeding and cramping, pelvic pain and pressure, frequent urination and bowel movements, and painful intercourse. With the UFE procedure, patients experience 80-95% relief of symptoms. There is an average 50% reduction in fibroid size within 3 months. Patients followed up to 6 years have shown no regrowth of fibroids.

Preparation:
The Procedure
Women report to the (ATU) Ambulatory Treatment Unit at 7 am the morning of the procedure. Patients should have had nothing to eat or drink for at least six hours. An IV is started, antibiotics and fluid are administered. Other medications to prevent pain and nausea will also be given. The treatment is performed in the Radiology special procedures suite. Under local anesthesia, a needle is used to gain access to the femoral artery in the right groin. Through this artery, a small tube is directed to reach the two arteries supplying the uterus. Small particles are injected to block these arteries and interrupt the blood supply to the fibroid tumors. When the tube is removed, the patient will return to the ATU.

Reprinted with permission of the Society of Interventional Radiology, www.sirweb.org

After Discharge
In the first 24 hours after the procedure, plan to rest and do not drive a car. During this time, you can expect soreness. Within 48 hours, your pain should be markedly reduced. 80% of patients report marked reduction in pain by day two. You should be able to resume your normal activity slowly. The radiology nurse will call you at intervals of 2 weeks, 2 months, and 6 months. Feel free to call earlier if you have concerns.

Side Effects and Risks
There is a risk of infection anytime a needle is inserted into the body. If you have fever, redness, discharge at the needle insertion site, increased pain, or new pain, you should report it to the radiology nurse. There is a small risk of nerve damage, which the doctor will explain at the time of the procedure.

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