IMAGING SCIENCES AND INTERVENTIONAL RADIOLOGY

.care of patients undergoing procedures in
              imaging sciences and interventional radiology

INTRODUCTION

The imaging sciences and interventional radiology (ISIR) has gained an extremely important place in the medical field. The ISIR is handling a large number of diagnostic procedures such as  X- ray, Computed tomography scan (CT) scan, CT angiography, magnetic resonance imaging (MRI), MR angiography, functional MRI, ultrasonography, doppler study, carotid angiography, aortogram, peripheral angiogram and spinal angiogram and interventional procedures like angioplasty stenting and embolisation etc.

Imaging tools

CT SCAN

·         CT scan – Brain, Chest, Abdomen, Pelvis, Joints, Vertebrae

·         CT Angiography – Brain, Chest, Abdomen, Pelvis, Extremity

·         CT guided biopsy and fine needle aspiration cytology (FNAC) of different organs under LA/GA

·         CT guided Laser Ablation of lesions

·         Post Vertebroplasty Scanning

·         Injection of Sclerotic Agents under CT Guidance

·         CT scan for navigation and planning the surgery CT scan contrast study is done with thin slices and data collected in a CD, which is fed in the operation planning system in Neurosurgery navigation protocol, which aids the surgeon to perform the surgery with minimal invasive techniques.

·         CT scan for stereotactic Biopsies, Pallidotomy and DBS implantation

·         Cardiac CT will be installed in the near future.

Magnetic resonance imaging (MRI scan)

MRI Brain, Chest, Abdomen, Pelvis, Peripheral Angio 3D, and Cardiac MRI are available. For children and non-cooperative adults, MRI is done under general anesthesia. Also patient who has claustrophobia, movement disorders, or memory impairment sedation is used under the care of anesthetist. MRI under GA is done on IP basis only. For MR Angiography and contrast-enhanced studies, patients’ renal function test (RFT) is done. Patient is given hospital attire. In MRI room MR combatable articles only is allowed. The patients with pacemaker or non-combatable heart valve prosthesis are not taken in. Oxygen cylinders, metallic patient trolley, wheel chairs are not allowed in the MRI room.

All ornaments, dentures, cochlear implants are to be removed before entering the MRI room. Food and fluids are allowed except for GA and sedation. Psychological preparation helps to avoid fear and anxiety. The sound of the machine creates a fear in some patients. The staff attending the patients also must be aware of these features.MR contrast media reactions are very rare but we must be ready with all emergency drugs and equipment all through out.MRI under GA is done weekly twice.

Ultrasound and Doppler scan

Ultrasound abdomen, pelvis, ultrasound guided biopsy, aspiration. Doppler scan is done for neck vessels, peripheral and  renal vessels.Patients are given prior appointment for the study. Fasting is essential in case of abdomen and renal studies. For pelvis scan food and fluid is allowed and full bladder is essential.

Common emergencies

Contrast media reactions

A great variety of reactions may occur after the rapid injection of intravascular contrast. This may be a minor or major reaction. Accurate and detailed history, proper explanation, instituting test dose, titrate the amount of contrast used, proper hydration and frequent monitoring should be practised.

Minor reactions

It may be nausea, headache, pruritus or vomiting. It is of short duration and usually self-limiting. Only reassurance is needed. Patient should be informed in each instance by a simple description of the kind of sensation that he will experience and the duration of sensation. If there is vomiting or nausea, slow the rate of injection and re-assure the patient that no serious reaction is going to happen. If it is severe, Inj.chlorpromazine is given. If angioneurotic edema or utricaria occurs, give hydrocortisone. For hypotension, start fluids, oxygen and vasopressor drugs such as dopamine. If bronchospasm occurs, broncho dilators like aminophylline and hydrocortisone is given. Pain at injection site, thrombophlebitis, salivation, weakness, chills and fever, hiccups, swelling of the salivary gland and extravasation needs to be managed accordingly.

Major reactions

In case of any major anaphylatic reaction, immediately administer oxygen and start intravenous fluids. Monitor pulse and blood pressure carefully because development of hypo tension and shock may produce venous collapse. The clinician should be called to handle any major reaction, the specific approach depends on the nature of reaction.

Equipment and drugs for emergency

Emergency drugs and equipments must be available throughout and easily accessible as time is a crucial factor in emergency management. 

Accessories for artificial ventilation and endotracheal intubation, provision for oxygen administration and suctioning, IV cannula, IV fluids, infusion and transfusion sets etc should be readily available.

Special role of a nurse in ISIR

The nurse informs the technologist or radiologist of any unusual patient needs and performs specialized nursing duties, such as administering intravenous sedation or analgesia during special procedures and closely monitoring patients with cardiac monitoring and pulse oximeters. Radiology nurses devote a lot of time to quality improvement and infection control programs. Collecting  data, keeping records and reporting results are also the responsibility of nurse. Because radiology nursing is relatively new, the nurse may be called upon to help write patient care policies, design flow sheets and patient instruction sheets and develop protocols. Radiology nurses utilize skills gained from other nursing specialties and incorporate them in the radiology setting.

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