The February Med School Café lecture featured Dr. Derek Samuels, assistant professor of radiology at the University of South Alabama College of Medicine and an interventional radiologist with USA Physicians Group.
Advanced Imaging Modalities
The University of South Alabama Medical Center (USAMC) and Children's and Women's Hospital have advanced imaging available. A combined positron emission tomography / computerized tomography scanner (PET CT) is an integral part of our Mitchell Cancer Institute.
Magnetic resonance imaging (MRI) is available for evaluation throughout the body, including magnetic resonance angiography (MRA) and venography (MRV). These two imaging techniques provide a less invasive method for screening and detecting vascular abnormalities, including aneurysms (weakening and out-pouching of the arteries or veins) or vessel narrowing (stenosis).
Additional imaging modalities include computerized tomography (CT) scanning, ultrasound, and mammography, all of which are performed with the latest techniques.
Conventional imaging, such as contrast studies with barium for evaluation of the GI tract as well as plain films, are also readily performed on both an inpatient and an outpatient basis.
Interventional Radiology And Minimally Invasive Surgery
Using the advanced imaging modalities of CT scanning, ultrasound, CT Fluoroscopy, and real time fluoroscopy, numerous minimally invasive therapies can be performed by our department. With our new angiography suites, we can also perform angioplasty (balloon dilation) of the arteries in the legs or pelvis for what is known as claudication (pain in the legs while walking), angioplasty of the renal (kidney) artery for high blood pressure, or arterial venous narrowing in numerous other areas of the body to include the carotid arteries, which supply the neck and brain, and the aorta (the main artery from the heart within the body). During the same procedure after the angioplasty, vascular stents can be placed to maintain the patency of the vessel.
Using ultrasound guidance, our Division of Interventional Radiology can easily place catheters of all types. These include catheters used for chemotherapy (tunneled catheters and ports), dialysis, and for more temporary venous access such as peripherally inserted central catheter (PICC) lines and triple lumen catheters. Real time ultrasound guidance is extremely valuable as the blood vessel of interest is directly visualized and not punctured blindly. This helps eliminate any problems of pneumothorax (popping of the lung) while attempting to place the catheter, while fluoroscopy assures the catheters are placed into the correct vessel as well as properly positioned so that they may function optimally. Also, ultrasound is used to perform percutaneous cholecystostomy (gall bladder drainage) in patients who are unable to have gallbladder surgery.
Other minimally invasive therapies performed by our division include the maintenance of arterial venous grafts used for dialysis. These are surgically placed connections between the arteries and veins within a hemodialysis patient. In association with nephrology and surgery, our division can help extend the life of these grafts through angioplasty and declotting procedures to maintain their flow. This is critical in preserving all possible access sites for these patients who may go years requiring dialysis.
Radiofrequency (RF) ablation is minimally invasive method that uses thermal energy to destroy tumor cells. Initially computed tomography or ultrasound is performed to locate the tumor. An ablation needle is introduced into the tumor using direct image guidance similar to a standard needle biopsy. The needle is attached to a radiofrequency generator, which sends radiofrequency energy through the needle. The RF energy generates heat in a sphere of tissue surrounding the needle. The heat generated kills the tumor. The procedure is generally performed using conscious sedation. Treatment can usually be done with a single overnight stay at the hospital. Certain treatments can be done on an outpatient basis.
Patients with multiple tumors or a single large tumor that cannot be resected surgically are considered candidates for RF ablation. This includes patients with metastatic disease. Patients who cannot tolerate surgery are also ideal candidates. Multiple types of tumors have been successfully treated with RF ablation. Liver tumors are the most common type of lesions treated. Liver tumors are treated by RF ablation in over 200 centers in the United States. Other tumor types such as lung, bone, kidney and adrenal are treated at only a few institutions. At the University of South Alabama we treat lung, liver, kidney, adrenal and bone lesions. We have plans to expand to other types of tumors as well. Treatment options are considered on a case by case basis. Patients can send their films to us to be reviewed for treatment planning.
|Scott Cox of Mobile, AL, tells the story of his neck injury during the Dauphin Island Regatta and how the injury changed his life. Dr. Brad Steffler, an interventional radiologist in the USA Health System, intervened with a minimally invasive pain relief procedure. Listen to Mr. Cox tell his story here.|
Pain Relief and Management
In conjunction with other departments at the University of South Alabama, our division is developing a number of procedures for pain management and relief. Currently, the major focus is chronic low back pain relief/management and addition of vertebroplasty. Vertebroplasty is a procedure designed to stabilize the vertebral body when it has been compromised by osteoporosis (age-related bone loss). Stabilization of the vertebrae can improve chronic back pain. Procedures currently available for the treatment of low back pain include epidural injections, facet joint injections and sacroiliac joint injections of steroids. Radiofrequency ablation of metastatic bone lesions are used for pain relief. To add to our repertoire of back pain therapies, we are actively pursuing intradiscal electrotherapy (IDET) for herniated discs. To learn more about this service, click here.
Our division is also able to perform CT and ultrasound guided biopsies of most nodules or masses within the body using local anesthesia and advanced imaging guidance. These are sent directly to pathology for immediate evaluation. Also, we are able to place drains into various organs to bypass any blockages that may be obstructing such organs as the kidneys, liver and bile ducts, just to name a few. We are able to supply tubes for long term feeding directly into the stomach (gastrostomy tube) or tubes for drainage of infections (abscesses).
Advanced procedures for liver-related disease, which have caused fluid collection within the abdomen (ascites) or bleeding from the mouth (varices), are performed at USAMC. A transluminal intravenous percutaneous shunt (TIPS) procedure allows blood to be re-channeled through a cirrhotic liver and helps with bleeding and control of ascites. Subcutaneous peritoneal catheter with a port can also be placed for repeated periodical ascites drainage for patient comfort.
Our division is offering therapy for uterine fibroids. This treatment, known as uterine fibroid embolization (UFE) is offered as a minimally invasive alternative to surgical hysterectomy. Laser treatment for varicose veins will be added soon. We also place fiducial markers for cyber-knife radiotherapy. This is the first such program in Alabama and allows highly effective radiation therapy using much higher tumor radiation dose. The Department also works closely with the USA Mitchell Cancer Institute. Some of our faculty, are also member physicians of the Mitchell Institute.
Most of these procedures are "same day" procedures with the patient able to go home the same day or at most the following morning after the procedure has been performed. Also, all these procedures are performed with local anesthetic with or without mild sedation. NO general anesthesia is required, helping to eliminate this risk factor.
For inquires regarding these procedures,
contact Drs. Brad A. Steffler or Derek Samuels at (251) 471-7157.