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SJHH / Health Services/ Diagnostic Services/ Diagnostic Imaging/ Centre for Interventional Radiology and Oncology (CiRO)

Centre for Interventional Radiology and Oncology (CiRO)

What this program does...

Interventional Radiology

Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments. Interventional Radiology includes a vast range of procedures ranging from angioplasty to embolisation to radiofrequency ablation of tumours. Most of the procedures are performed using percutaneous approaches, which are image guided. These procedures can replace traditional surgical techniques with lower complication rates than conventional techniques and shorter hospital stays.

Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery. Many of the procedures require patient preparation and some diagnostic lab tests prior to Intervention. The section on patient preparation describes both the general preparation and specific preparation required for individual procedures. We have also included a section with all the patient information leaflets available for download.

Interventional Oncology

Interventional Oncology (IO) is a subspecialty of IR that uses imaging guidance to deliver minimally invasive therapies to patients with cancer. It is considered the "4th pillar" of cancer therapy alongside medical, surgical, and radiation oncology worldwide.

Scope of Services

The St. Joseph's Healthcare Interventional Radiology Service delivers high quality, innovative, patient focused clinical services supported by an active research environment.

The Interventional Service is founded on a team of specialist technologists, nurses and Interventional radiologists working in close collaboration with clinical colleagues; particularly nephrology, urology, vascular surgery, general surgery, thoracic surgery, ENT, obstetrics and gynecology and other medical specialties.

Interventional Radiology can have a life saving role for the acutely ill patient, particularly for the treatment of hemorrhagic emergencies. The Interventional service has a dedicated on call service to ensure continuous access to emergency treatment.

Interventional Radiology Outpatient Clinic

There is a formal radiology outpatient clinic to follow up with patients who have undergone certain IR procedures. This assists in the continuing care of the patient. The IR clinic helps to optimize patient care by providing the interventional radiologist with the opportunity to meet the patient prior to the procedure and to obtain a pertinent history and physical examination. The procedure can be explained to the patient in full and treatment options are discussed.

Addressing the need for pre-procedural labs, radiographs, or referral prior to any intervention reduces the chance of delay on the day of the procedure. Post-procedure follow-up is coordinated through the clinic.

Patient Preparation

Documentation

All patients attending the interventional suite require the following documentation:

X- ray requisition form with all the relevant clinical information
Case notes
Patient drug chart (CMAR)
Fluid prescription and fluid balance sheets if on IV fluids/output assessment
Baseline recordings including blood glucose if relevant
Name band

Blood Tests

A coagulation screen should be done based on the departmental guidelines.

Summary for US Guided Intervention

INR required in all procedures
PTT only in patients with heparin
Platelet count routinely required only for liver, renal biopsy, and RFA
Withhold Plavix only for 5 days - Liver biopsy and drainages
Withhold Aspirin/Plavix ONLY for Renal biopsy and RFA for 5 days
Warfarin should be stopped as per current practice (5 days) and INR rechecked
Fractionated heparin: withhold 24 hours or up to two doses for Renal biopsy/RFA

Summary for CT Guided Intervention

INR required in all procedures
PTT only in patients with heparin
Platelet count routinely required only for Renal Biopsy and RFA withholdPlavix only for 5 days

Lung Biopsy
Chest/Abdominal drainages

Withhold Aspirin/Plavix for Renal biopsy and RFA for 5 days
Warfarin should be stopped as per current practice (5 days) and INR rechecked
Fractionated heparin: withhold 24 hours or up to two doses for Renal biopsy/RFA

Summary for Angio Intervention

INR required in all procedures
PTT only in patients with heparin
Platelet count routinely required for:

New Nephrostomy
New PTC/Cholecystomy insertion

Withhold Plavix only for 5 days

Arterial angioplasty/stenting
G, GJ tubes
Dialysis line insertion
Embolisation

Withhold Aspirin/Plavix only

Nephrostomy/PTC for 5 days

Platelet count routinely for Nephrostomy, PTC
Warfarin should be stopped as per current practice and INR rechecked
Fractionated heparin: withhold 24 hours or up to two doses for renal biopsy/RFA

Consent

Patients will be asked for consent in the department by the Interventional Radiologist carrying out the procedure.

Fasting

Patients should fast for approximately 4 hours. If patients are having gastroduenal procedures, they should fast for 8 hours and hydrate accordingly.

Specific Preparations

Biliary Drainage

I.V fluids to hydrate pre-procedure
1.0g Ancef about 1 hour pre-procedure (unless allergy noted)

Gastrostomy/Jejunostomy

Ideally patients should have a nasogastric tube in situ (not always possible)

Pelvic Angiography/Procedures

Observation of the 10 day rule for women between 13 and 55.

We ask that you do not bring any valuables with you as the hospital cannot be responsible for lost or stolen personal items.

Patient Safety Checklist

IRPaSS Interventional Radiology Patient Safety Screening

The protocol and concept was adapted from the World Health Organization (WHO) Surgical Safety Checklist to reflect the nature of Interventional Radiology (IR). It is designed as a collaborative process and is currently in use by the entire IR team: Interventional Radiologists, Nurses and Technologists involved in all image guided interventional procedures. The checklist involves a safety checklist, “pause” prior to commencing the procedure, and involves a number of components that must be met prior to and after the procedure. In addition to the checklist, the protocol was implemented with a team brief at the beginning of the list of cases, and a debriefing at the end, as is the case in most surgical procedures. The checklist is divided into three main sections: patient information, pre-procedure information, and procedure related events. The patient information section includes initially identifying the “vitals” as per WHO recommendations – patient identification information. Other components of the pre-procedure section include: allergies/asthma, coagulation status, renal and liver function, cardiac history and in the case of radiological procedures, pregnancy. In addition, a procedure related section involves vital components of the procedure itself: consent, side marking, administration of procedural medications and vital parameters. The checklist is organized in such a way that the person completing it can tick one checkbox for “yes”, or “N/A”, initial, and include comments, if necessary. Initialing in each section of the checklist ensures accountability if different components of the checklist are performed by different members of the team. The simplicity of the process ensures consistency throughout the checklist, as well as between one procedure and the next. ??The procedure section includes the total fluoroscopy time and dose, as well as the total volume of contrast media administered. This allows for monitoring and future auditing to assure that patient safety is not compromised. This section also involves ensuring that the ward to which the patient is to be transferred has been informed and that aftercare instructions are communicated to the patient. The former represents a novel component to routine checklists, and is part of the attempt to ensure efficient and safe patient transfer, while reducing turnover time between one procedure and the next. After the procedure is completed, the checklist is scanned into the central Picture Archiving and Communication System (PACS).

Please click here to download the Safety Checklists & Protocols at St. Joseph's Healthcare.

Procedures Performed

Arterial Interventions