Innovations in Interventional Radiology

Can a set of new, fully equipped interventional radiology suites help meet service line demand?

Children’s Hospital Colorado Clinical Lead of Pediatric Interventional Radiology, Aparna Annam, DO, doesn’t mince words when it comes to her specialty.

“Interventional radiology is the backbone of the hospital,” she says. “It’s a crucial service line that supports virtually every department.”

Indeed, when it’s between performing another major surgery or using a minimally invasive technique that will achieve the same results and leave behind a mark no bigger than a centimeter, the choice is undeniable.

Demand for interventional radiology procedures, or IR, has led Children’s Colorado to significantly expand the department. A nearly two-year construction project recently produced a set of comprehensive suites complete with two new ultrasound machines, a dedicated outpatient area for clinic consults and follow-ups, and two state-of-the-art angiography machines (the ARTIS icono and pheno) from Siemens Healthineers.

The evolution of IR procedures

With the ARTIS icono, specialists can use image-guided therapy for neurointerventions, oncology procedures and advanced angiography. The ARTIS pheno is a robotic imaging system for combined interventional radiology and surgical procedures, allowing specialists to achieve better accuracy, visualization and collaboration between physicians.

IR has evolved, gradually becoming a distinct subspecialty with its own residency. The top-of-the-line tech and renovated service space align with that shift, affording Children’s Colorado the opportunity to completely redefine its approach to IR care, research and education.

“These state-of-the-art interventional radiology suites are integral to the care of the children in our community as well as the surrounding states,” says Sarah Milla, MD, Chief of Radiology at Children’s Colorado. “We are able to treat children with image-guided procedures that are less invasive than traditional surgical procedures, and we have the ability to introduce new and innovative oncology treatments and intravascular therapies.”

Cutting-edge oncology

Many modern tumor treatments focus on local therapies like transarterial embolization and tumor ablation techniques. With embolization, specialists can instill a chemotherapy agent or radiation directly into a tumor. Ablation involves inserting a probe into a tumor and destroying the cells using heat or cold. “These methods are just now filtering down into pediatrics and are continuing to be developed,” says Roger Harned, MD, Director of Interventional Radiology at Children’s Colorado. “The Siemens machines’ ability to really localize a tumor and blood flow will allow us to stay on the curve.”

Contrast-enhanced ultrasound

“If I use ultrasound to identify a lesion in the liver and biopsy it, I may not always see it that well,” says Dr. Annam. “It may not have the right kind of echotexture needed to differentiate it from the surrounding liver.” The benefit of these new ultrasound machines is that they are set to utilize contrast-enhanced ultrasound, which, similar to intravenous contrast for MRI and CT, enhances the appearance of an abnormality on an ultrasound. Unlike CT, however, ultrasound allows for biopsy sans radiation and ultimately proves safer for pediatric patients.

Increased inventory levels

A partnership with the University of Colorado Hemophilia and Thrombosis Center has made Children’s Colorado a regional hub for pediatric thrombosis. “Our equipment is very sophisticated in terms of what we can offer — we have a complete spectrum of tools to break down a clot, whether it’s acute or chronic, and facilitate clearing it out,” says Dr. Annam. Children’s Colorado also has a full-service, multidisciplinary Vascular Anomalies Center, treating everything from the simplest of malformations to the most complex syndromes using various techniques such as sclerotherapy, endovenous laser ablation, embolization, surgery and advanced medicines.

Those comprehensive service offerings require massive amounts of equipment. “We’ve probably tripled or quadrupled our storage space,” adds Dr. Harned, “giving us the capacity for a much larger supply of catheters, coils and other equipment.”

A unique collaboration

Neighbors on the Anschutz Medical Campus, Children’s Colorado and the University of Colorado are partners. “There’s a lot of cross pollination of patients and physicians throughout the two organizations,” says Dr. Harned. “Specifically for IR, as we increase the volume and capacity to do more cases every day with these new suites, it allows us to better train our IR residents.” The partnership also allows for sharing an attending who can perform neurointerventions to treat pediatric strokes and aneurysms in-house at Children’s Colorado using the new Siemens equipment. That’s a significant service expansion, considering patients were previously transferred to outside facilities for that treatment.