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Future directions in Radiology Future directions in Radiology

Future directions in Radiology - PowerPoint Presentation

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Uploaded On 2018-09-23

Future directions in Radiology - PPT Presentation

  impact on general anaesthesia requirement Dr Nicola H Strickland Consultant Radiologist Imperial College Healthcare NHS Trust President Royal College of Radiologists Radiology and Anaesthetics ID: 677153

procedures radiology ivc stents radiology procedures stents ivc aneurysm evar anaesthetists stent courtesy artery future pneumothorax thrombectomy itu venous mechanical impact oncology

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Slide1

Future directions in Radiology:  impact on general anaesthesia requirement

Dr

Nicola H Strickland

Consultant Radiologist, Imperial College Healthcare NHS Trust

President Royal College of RadiologistsSlide2

Radiology and Anaesthetics: interdependent specialties

f

uture directions of radiology

impact on

anaesthetics

d

emands of

anaesthetists

(e.g. ITU)

impact on radiology

b

oth regarded as “service specialties”

n

eed to enhance profile with clinical colleagues and publicSlide3

Current and future radiological procedures requiring anaesthetist support

g

eneral

anaesthesia

:

painful procedures

u

reteric stent insertion

e

ndovascular aneurysm repair EVAR

v

enoplasty

and venous stents

c

omplex percutaneous

transhepatic

cholangiographic

procedures PCTA

i

mage guided bone biopsy

n

eurointervention

– coil/balloon placement: subarachnoid

haemorrhage

, AVMs

i

nterventional oncology

supervised pain relief and

sedation

safe

, stable conscious level

mechanical

thrombectomySlide4

Demands of anaesthetists on radiology

i

ntubation

difficult airways

ITU

s

erial chest x-ray interpretation: radiologist “ward rounds”

s

imple ultrasound diagnoses: ascites, pleural effusions

u

ltrasound guided vessel location and on ward drainages

s

udden intracranial pathology: CT, sometimes MR

a

cute deterioration – abdominopelvic pathology: CT

l

ine retrievalSlide5

general anaesthesiasupervised pain relief and sedation

Current and future radiological procedures requiring anaesthetist supportSlide6

Double J ureteric stents

courtesy Dr Steven MoserSlide7

EVAR: endovascular aortic aneurysm repairSlide8

EVAR: right and left renal artery stents

courtesy Dr Rob ThomasSlide9

EVAR: superior mesenteric artery stentSlide10

EVAR: final result with branch stents

2 left renal

a

rtery stents

r

ight renal

artery

stent

s

ma

stentSlide11

Aorto-oesophageal fistulaSlide12

Aorto-oesophageal fistula – coated thoracic aortic stent placement

courtesy

Dr Rob ThomasSlide13

Venoplasty and venous stentspatient with metastatic adenocarcinoma of the right adrenal gland causing IVC obstructionSlide14

Coronal CT reconstructions showing IVC occluded by tumourSlide15

bilateral venogram showing occluded IVC and numerous venous collaterals

courtesy

Dr

Rob ThomasSlide16

Deployment of IVC filterSlide17

Deployment of IVC stentsSlide18

Final result: patent stented IVC, filter removedSlide19

p/w Lt hemianopia and confusion

Delayed CTA

Neurointervention

: aneurysmal bleedSlide20

anterior

aneurysm

Neurointervention: aneurysmal bleed

courtesy

Dr

Neil

RaneSlide21

Diagnosis

:

Mycotic

Aneurysm

History of endocarditis

Neurointervention

: aneurysm glue occlusionSlide22

Interventional oncology: RFASlide23

Current and future radiological procedures requiring anaesthetist support

g

eneral

anaesthesia

: painful procedures

u

reteric stent insertion

e

ndovascular aneurysm repair EVAR

v

enoplasty

and venous stents

c

omplex percutaneous

transhepatic

cholangiographic

procedures PCTA

i

mage guided bone biopsy

n

eurointervention

– coil/balloon placement: subarachnoid

haemorrhage

, AVMs

i

nterventional oncology

supervised pain relief and

sedation

safe

, stable conscious level

mechanical

thrombectomySlide24

Mechanical thrombectomy: removal of thrombus from proximal left middle cerebral arterySlide25

IntubationITUDemands of anaesthetists on radiologySlide26

29y woman with severe endobronchialWegener’s granulomatosisSlide27

Hysteresis loop

expiration markedly flattenedSlide28

CT reconstructions in subglottic stenosisSlide29

Subglottic tracheal stenosisSlide30

ITUChest X-raysDemands of anaesthetists on radiologySlide31

Chest X-ray: pneumothorax

Erect

SupineSlide32

CXR: tension pneumothoraxSlide33

Subtle pneumothorax: deep sulcus signSlide34

If in doubt do a CT: subtle pneumothorax? bulla?

“crisp” cardiac silhouetteSlide35

ITUacute deteriorationDemands of anaesthetists on radiologySlide36

Acute intracerebral haemorrhageSlide37

ITU acute deterioration: closed loop obstructionSlide38

ITU: Hx “overdose, in cardiogenic shock, worsening ventilation, lactate rising, severe rhabdomyolysis. Progressive peripheral ischaemia”Slide39

ITUline retrievalDemands of anaesthetists on radiologySlide40

Fractured portacath in RV and pulmonary arterySlide41

Retrieval of fractured portacathSlide42

Conclusion:Future directions in Radiology:  

impact on general anaesthesia

requirement

i

nterventional radiology becoming increasingly more complex

greater GA requirement

cancer patients surviving longer, more interventional oncology

greater GA

requirement

↑mechanical stroke

thrombectomy