WEDNESDAY, March 23, 2005 (HealthDay News) -- New advances in surgery are starting to replace scalpels with imaging-based procedures. Add nuclear medicine and gene-based therapies into the mainstream and you have a rather significant change in the way medical treatment will be administered, experts say.
Much of the change is being driven by the emerging field of interventional radiology (IR).
According to the Society of Interventional Radiology, IR uses minimally invasive, targeted treatments performed with assistance from equipment such as X-rays, magnetic resonance imaging (MRI), ultrasound and computed tomography (CT) to guide small instruments through blood vessels or other pathways percutaneously -- through the skin.
IR procedures don't need the large incisions that have always been required to perform most operations. Instead, catheters -- tubes measuring just a few millimeters in diameter -- replace scalpels in many IR procedures. These procedures typically require little or no anesthesia and much less cutting of skin, muscle or other tissues. This results in much less blood loss and considerably less expense than traditional surgeries. Moreover, IR operations require shorter hospital stays -- in fact, many are performed on an outpatient basis -- and shorter periods of patient recovery.
Beginning in the mid-1970s with the invention of angioplasty and catheter-delivered stents, the field has rapidly expanded to encompass treatment of conditions once the sole responsibility of general or specialized surgeons: stroke, cancerous tumors, aneurysms, blood clots, uterine fibroids, postpartum bleeding, bilary (liver) blockage, fallopian tube blockage and peripheral vascular disease.
As these procedures have become more accepted, the number of physicians who perform them has also increased. The Society for Interventional Radiology reports there are now more than 5,000 interventional radiologists practicing throughout the United States.
"In the past 10 years, there has been a dramatic change in the use of imaging technologies to accomplish many outcomes that required conventional surgery in the past," said Dr. Ravi Jhaveri, who practices in Austin, Texas. "We are at the beginning of a wave that will bring even more changes, very rapidly. Clearly, IR is going to play an increasingly important role in the future of medicine."
Medical imaging professionals predict the next developments in interventional radiology might include the following:
- Fewer incisions:Researchers are currently testing high-intensity ultrasound to blast pre-cancerous breast lesions and fibroid tumors without making a single cut in the skin surface. In fact, in October 2004, the U.S. Food and Drug Administration approved a new device developed in Israel that uses magnetic resonance imaging to help find and destroy uterine fibroids. One day, such technology could replace hysterectomies and mastectomies and might be used for brain tumors.
- One-stop cancer care: Imaging experts foresee a future in which surgical biopsies are replaced by non-invasive imaging. Imaging systems could identify a "signature analysis of tissue" and determine whether it is cancerous. If so, imaging could then unleash energy or sound beams directly onto the site, eradicating the disease. One possibility: treatment at the doctor's office, and no more need for operating rooms.
- Greater surgical precision with robotics: One day patients may be all alone in the operating room -- providing a germ-free environment for surgery, say IR specialists. Robotic arms inside an advanced MRI machine that updates the image every second or less would perform the operation, allowing surgeons to view their progress in real time on a video monitor. Computers would provide surgeons with the exact coordinates of tissue to be repaired.
The future of IR treatment seems almost unlimited. Dr. Gary Mintz, an interventional cardiologist in New York City, believes these radiological advances will some day extend to all organ systems, including the cardiovascular system. He said that interventional cardiologists of the future are also likely to be able to close certain types of holes in the heart and address other complex cardiac conditions with IR methodologies.
"The drug-eluting stents seem likely to provide as much benefit as bypass surgeries," Mintz said.
Jhaveri noted that imaging technologies already help physicians diagnose and understand cancers, plan treatments, and deliver therapeutic interventions more precisely. And, he said, that's just the beginning.
"The next big thing I see is the use of catheter-directed gene therapy for presently unresectable tumors," he predicted. "That will allow us to place a small catheter into such tumors or other cancerous growths and administer a genetic intervention that makes them more amenable to chemotherapy, radiation or other existing treatments.
"It's an exciting time, added Jhaveri. "Surgery has changed and continues to change before our very eyes. I won't even venture to predict what the next big step in this field will be -- though I imagine it's likely to be something we haven't even dreamed of.
The U.S. Food and Drug Administration has more information about regulation of radiological devices.