Ascitic Tap

What are the prerequisites for having an ascitic tap done? Prior imaging is required to confirm the presence and accessibility of any intra-abdominal collection, free fluid or ascites before requesting an ascitic tap. This is usually via ultrasound or CT, and most often this will be ultrasound as this is better for showing small amounts... View Article

Biliary Drainage

General introduction to biliary drainage? Biliary drainage, sometimes also referred to as a PTC (percutaneous transhepatic cholangiogram), is an invasive procedure carried out by a radiologist for biliary obstruction. It is usually carried out for malignant biliary obstruction (i.e. due to cholangiocarcinoma or metastases), but benign biliary strictures can also occur. Authors:  Dr Mark Goodwin*... View Article

Breast Core Biopsy

What are the prerequisites for having a breast core biopsy done? Clinical breast examination and the appropriate imaging investigations should have been performed prior to a biopsy. If it is a nonpalpable abnormality the radiologist should have the imaging provided for review prior to performing the biopsy, especially to plan whether ultrasound or mammography will... View Article

Breast Fine Needle Aspiration (FNA)

What are the prerequisites for having a breast FNA done? In symptomatic women, a preliminary careful clinical examination and imaging investigation (ultrasound and/or mammograms) is necessary before a breast FNA. Ultrasound examination alone is recommended for young and pregnant women. For older symptomatic or asymptomatic women, bilateral mammograms are needed before any breast FNA and... View Article

Breast Hookwire Localisation

What is a breast hookwire localisation? A hookwire localisation is an imaging-guided procedure, carried out on the day of breast surgery, in which a radiologist will use imaging to place a hookwire into a breast lesion before surgery. This may be done with ultrasound, mammography or MRI to guide the wire placement. The choice of... View Article

Bursal Injection

What are the generally accepted indications for a bursal injection? The main indication for bursal injection is bursitis from any cause not responding to conservative measures (anti-inflammatories, activity modification and physical therapy). Common sites of inflammation include trochanteric bursitis, subacromial bursitis, pes anserine bursitis, prepatellar bursitis and olecranon bursitis. Occasionally, bursal injections are undertaken to... View Article

Carotid Stenting

What are the generally accepted indications for carotid stenting? Carotid stenting is one of two potential procedures for management of a transient ischaemic attack or stroke associated with a carotid stenosis of >70%. The alternative is carotid endarterectomy. The procedure is indicated where there are relative contraindications to carotid endarterectomy (see below) or patient preference... View Article

Carpal Tunnel Ultrasound and Injection

What are the generally accepted indications for a carpal tunnel ultrasound and injection? There are two main indications for carpal tunnel ultrasound: diagnosis of the condition and an aid for guiding therapeutic injection. Diagnosis of carpal tunnel syndrome is usually clinical, but might need to be confirmed in patients who are being considered for surgery... View Article

Embolisation of Head, Neck and Spinal Tumours

What are the prerequisites for having embolisation of head, neck and spinal tumours? Full blood examination and clotting profile (INR & APPT) are required for all patients. Thyroid function testing may be indicated and should be discussed with the radiologist. Pregnancy test should be performed in all women of reproductive age. Any relevant previous imaging... View Article

Image Guided Cervical Nerve Root Sleeve Corticosteroid Injection

What are the generally accepted indications for a cervical nerve root sleeve injection? Cervical radiculopathy from disc protrusion or degenerative disease narrowing the intervertebral foramen; inflammation of a cervical nerve root as a result of postoperative scarring after discectomy and/or fusion; as a diagnostic procedure to ascertain the cause of neck/shoulder/arm pain when exact root... View Article

Image Guided Facet Joint Corticosteroid Injection

What are the generally accepted indications for an image guided facet joint corticosteroid injection? Image guided facet joint corticosteroid injections can be used for diagnostic or therapeutic purposes. Diagnostic indications: pain with features of facet joint syndrome and thought to be of facet joint origin; contemplation of radiofrequency neurotomy. Therapeutic indications: known facet joint syndrome... View Article

Image Guided Liver Biopsy

What are the prerequisites for having an image guided liver biopsy done? Image guided liver biopsy can be targeted to a specific lesion (such as a suspected tumour) or be non-targeted in patients with suspected parenchymal liver disease, such as chronic hepatitis or cirrhosis. Non-targeted biopsies are carried out to make the diagnosis, assess the... View Article

Image Guided Lumbar Epidural Corticosteroid Injection

What are the generally accepted indications for an image guided lumbar epidural corticosteroid injection? Short term (i.e. up to 3 months) relief of radicular back pain; causes may include spinal stenosis, foraminal stenosis, disc protrusion, annular fissure in the disc and traumatic disc tear;The procedure has been used as an interim measure to delay surgery,... View Article

Image guided lumbar nerve root sleeve injection

What are the generally accepted indications for a lumbar nerve root sleeve injection? Radicular leg pain with good clinical localisation and imaging confirmation; no acute motor weakness. Patients with long-standing weakness, and radicular pain, may be considered for this procedure; imaging showing root compromise in the foramen or lateral recess; awaiting surgery to decompress the... View Article

Inferior Vena Cava Filters

What are the prerequisites for having an inferior vena cava filter done? Essentially high risk of pulmonary embolism or severe consequences of pulmonary embolism. These include: iliofemoral DVT; large pulmonary embolus; poor pulmonary or cardiac reserve with PE or DVT; DVT or PE; contraindication to anticoagulation. Prophylactic indications include previous PE’s with surgery and trauma... View Article

Interventional Radiological Treatment of Intracranial (Brain) Aneurysms

What are the prerequisites for having interventional radiological treatment of intracranial aneurysms done? Aneurysm diagnosis may be with CT, CTA, MRI, MRA, or DSA. DSA is required for endovascular treatment and may be a separate diagnostic procedure prior to aneurysm treatment or performed immediately prior to definitive treatment under the same general anaesthetic.Consultation with a... View Article

Joint Injection

What are the prerequisites for having a joint injection done? Generally the patient will require at least a plain X-ray of the joint and often an ultrasound, CT scan, or MRI. These imaging studies should be brought to the appointment. Reasonable suspicion of synovitis as cause for the patient’s symptoms, and a failure to respond... View Article

MRI Enterography or Enteroclysis

What are the prerequisites for having an MRI enterography or enteroclysis done? Most gastroenterologists will investigate the upper and lower GI tract, often by endoscopy, before considering small bowel imaging. This may establish a diagnosis and so eliminate the need for the test. However, in established Crohn’s disease, this is not always so. In women,... View Article

Nephrostomy

What are the prerequisites for having a nephrostomy tube insertion? Nephrostomy is the creation of a communication between the skin and kidney. Placement of a nephrostomy catheter from the skin via this tract into the renal pelvicalyceal system or via the collecting system of the kidney into the ureter allows therapeutic drainage of an obstructed... View Article

Pleural Aspiration

What are the prerequisites for having a pleural aspiration done? Pleural fluid may require aspiration as a therapeutic procedure (for relief of dyspnoea) or to help in making a diagnosis (to obtain material for microscopy and culture, biochemical or other analysis). Carrying out this procedure under imaging guidance reduces the likelihood of failure to remove... View Article

Radiofrequency Ablation

Background: Surgery is considered as the curative treatment for most malignant and benign tumours. However, several factors, including patient comorbidity or the anatomy of the lesion, may preclude surgery in some patients. Radiofrequency ablation is one of a number of locoregional therapies that can be used to treat such patients. Radiofrequency ablation uses a high-frequency... View Article

SAH Vasospasm Endovascular Treatment

What are the prerequisites for having a SAH Vasospasm Endovascular Treatment done? Consultation with the treating specialist (neurosurgeon or neurointerventionist) followed by referral to the neurointerventionist. The aim is early detection, as the likelihood of a good outcome from treatment is highest within the first 1-3 hours, and decreases dramatically thereafter. Most sites would initiate... View Article

Selective Internal Radiation Therapy [SIRT]: SIR-Spheres®

What are the prerequisites for having SIRT done? For patients to undertake SIRT they must have inoperable liver tumours. The Australian approved indication for SIRT includes treatment of both primary liver cancer (hepatocellular cancer) and secondary tumours (metastatic tumours). SIRT has been performed on a wide range of secondary metastatic tumours and trials are ongoing... View Article

Spinal Cord Embolisation (AVM/DAVF)

What are the prerequisites for having a Spinal Cord Embolisation (AVM/DAVF) done? The patient will need: FBE, U&E, clotting Profile (INR & APPT), group and hold (in case transfusion is needed), thyroid function test if indicated (see “Relative Contraindications”, below), exclude pregnancy, any relevant previous imaging tests. As a minimum there should be a recent... View Article

Thyroid fine needle aspiration (FNA)

What are the generally accepted indications for a thyroid FNA? Thyroid nodule fine needle aspiration biopsy is generally carried out in the setting of a palpable nodule or ultrasound-detected thyroid nodule in order to confirm or exclude a malignant nodule. It is the most cost-effective initial method for guiding the clinical management of patients with... View Article

Transarterial Chemoembolisation (TACE)

What is a transarterial chemoembolisation? Transarterial chemoembolisation (TACE) is a procedure performed by interventional radiologists where chemotherapy and embolic agents are delivered directly into primary or secondary liver cancers via catheters placed in the hepatic artery. TACE is generally indicated in the setting of unresectable hepatocellular carcinoma. Where curative options for hepatocellular carcinoma (such as... View Article

Ultrasound Guided Prostate Biopsy

What are the generally accepted indications for an ultrasound guided prostate biopsy? The generally accepted indications for an ultrasound guided prostate biopsy are: raised or rising PSA (especially if the PSA velocity is high. The PSA velocity is the rate at which the PSA is rising). Whilst a cut-off PSA level of 4 is generally... View Article

Uterine Fibroid Embolisation

What are the prerequisites for having a Uterine Fibroid Embolisation done? The patient will need to have symptomatic fibroid disease such as heavy bleeding, pain and bladder and bowel fullness, then undergo consultation with the interventional radiologist at some date prior to the planned procedure. The majority of fibroid uteruses can be managed with UFE.... View Article

Vacuum-Assisted Core Biopsy

What are the prerequisites for having a vacuum-assisted core biopsy done? Recent previous imaging that has identified an abnormality requiring vacuum-assisted core biopsy must be available prior to the procedure, for planning purposes. If the patient is of childbearing age, pregnancy status should be indicated. A negative pregnancy test result should be available. What are... View Article

Varicose Vein Ablation

Indications for varicose vein ablation: Varicose vein ablation can help to treat patients with symptoms of chronic venous insufficiency. The procedure is often carried out due to cosmetic concerns. What are the prerequisites for having varicose vein ablation done? Consultation for referral purposes with a GP, vascular physician or vascular surgeon. Preprocedural consultation with an... View Article

Vascular Closure Devices

What are the prerequisites for having vascular closure devices inserted? A vascular closure device is a mechanical closure of the arteriotomy designed to provide immediate haemostasis after an angiogram. Devices can either be a piece of collagen, a metallic clip or a suture. The decision to use a vascular closure device at the completion of... View Article

Venous Access

What are the prerequisites for having a venous access device inserted? Interventional radiologists are often asked to assist in achieving central venous access. This document outlines key decisions required in gaining assistance from an interventional radiologist in achieving the appropriate access for the clinical condition. Venous access catheters can be tunnelled or non-tunnelled and are... View Article

Vertebroplasty

What are the prerequisites for having a vertebroplasty done? Confirmation of an active fracture without nerve root compression. This is most effectively done with an MRI study of the area. CT and nuclear bone scan are less reliable unless there is an historical imaging record showing progressive collapse. Bone scans may remain ‘hot’ long after... View Article