Stereotactic biopsy

Any abnormality seen on the mammography is usually followed with a stereotactic breast biopsy - wherein a small sample of tissue is removed from the abnormal part of breast using a needle and the sample is later analyzed in the laboratory. A special computer is used to guide the needle to the spot of abnormality. Mammography and ultrasound help the radiologist trace the accurate spot to place the needle. This procedure is carried out on an outpatient basis and there is hardly any scar left behind following the procedure. An x-ray is taken to ensure that the right portion of the breast is centered to the window in the pad.

Interventional Radiology

A sub-specialty of radiology, Interventional radiology - IR has contributed significantly to medical developments in recent years. Patients are diagnosed and treated using minimally invasive imaging techniques such as X-ray, MRI and ultrasound for guidance. In addition to diagnosis, new treatment options are offered by techniques in Interventional radiology (also known as Surgical Radiology)- patients are treated with lesser risk and shorter hospital stays.

The advantage of IR procedures is that they can be used in almost every organ system - be it abdomen, central nervous system, chest, heart and vascular, musculoskeletal, genito-urinary and other organs and soft tissues.

Interventional Radiologists

Patient evaluation and management are provided by Interventional radiologists, who are doctors trained in radiology and in minimally invasive procedures, skilled in interpreting X rays, ultrasounds and CT and other imaging techniques. While surgery was the only available option for a number of conditions a few years back, these days the expertise of Interventional radiologists with imaging technique enables them to guide small catheters, that are only a few millimeters in diameter and guide wires through blood vessels or other organ pathways to treat many conditions. Diseases and conditions are diagnosed and treated percutaneously with minimally invasive procedures.

Benefits and uses of Interventional radiology

This is an imaging technique using cutting-edge equipment for accurate diagnosis and treatment, a minimally invasive procedure through a small nick in the skin, minimizing the patient's discomfort and recovery time. These days, there is hardly any area in hospital medicine where IR has not impacted patient management.

These procedures require only local anesthesia, and short stays at the hospital. Sick patients who are unfit to undergo surgery can also undergo these techniques. Recovery post IR procedure is less painful than when the patient undergoes surgical procedures.

These image guided medical procedures use CT, MRI, fluoroscopy and ultrasound to view targeted areas. This makes the vessels clearly visible under imaging. A thin catheter is used to deliver the contrast material into a particular blood vessel and shows the inside of the vessel allowing the radiologist to locate blockages. Some examples of interventional radiology procedures include:

• Angiography or Angioplasty
  
• Stent placement
  
• Control bleeding with Embolization
  
• Tumor embolization
  
• Vertebroplasty and Kyphoplasty
  
• Needle biopsies for different organs including lungs and thyroid gland
  
• Tumor ablation
  
• Breast biopsy by stereotactic or ultrasound techniques
  
• Uterine artery embolization
  
• Feeding tube placement
  
• Venous access catheter placement

Using Interventional radiology

By minimizing the physical trauma to the patient, non-surgical interventions also reduce infection rates and recovery time and shorten hospital stays.

• Blood vessel disease such as narrowing of arteries leading to restricted flow of blood
  
• Expanded arteries at risk of rupture and bleeding
  
• Bleeding or hemorrhage which is the most common vascular emergency treated by IR.
  
• Blood clots in the lung
  
• Dilated veins or varicose veins that most commonly occur in the legs but can occur in the pelvis and scrotum and can be treated by blocking the vein by heat treatment or using embolization techniques.
  
• Tumor therapies in liver intended to shrink or destroy them in their primary site.
  
• Kidney and other tumors by destructive therapies
  
• Uterine fibroids which cause heavy menstrual bleeding and pain caused by benign tumors called fibroids
  
• Kidney stones that can cause pain
  
• Infection and blockage in the kidney and gall stones, one of the most common upper abdominal disorders.

Acoustic Neuroma

An Acoustic Neuroma also known as Vestibular Schwannoma is a slow growing tumor that develops on the cranial nerve that connects the ear to the brain. Cranial nerves are those nerves that arise directly from the brain. An acoustic Neuroma is a benign (non-cancerous) growth that forms on the sheath covering of the eighth cranial nerve called vestibulocochlear nerve. The eighth cranial nerve has two divisions, the vestibular nerve that controls the balance and the cochlear nerve that takes care of the hearing function. These two nerves are lined by Schwann cells and acoustic neuroma occurs when there is a large production of Schwann cells forming into a tumor.

Schwannoma that occurs in other peripheral nerves are largely benign unless it is a Neurofibrosarcoma - a malignant form of cancer.

Symptoms of acoustic neuroma

• The early signs of the condition include hearing impairment in the affected ear and the balancing difficulties. Since nerves of eighth cranial are responsible for hearing and balance, the problems related to these functions are the first to surface in the initial stages of acoustic neuroma. Patient may also feel heavy or fullness in the affected ear. Hearing loss either progressively or suddenly in the affected ear is the most obvious symptom of acoustic neuroma.
  
  
• Tinnitus is an ear condition where the patient experiences constant buzzing or ringing sounds in the ear. Though Tinnitus is a common symptom associated with acoustic neuroma, not all the cases will develop this symptom. It is also to be noted that all those who experience tinnitus do not have tumor growing on the ear nerve.
  
  
• Vertigo and unsteadiness is the common symptom with acoustic neuroma.
  
  
• When the tumor becomes large, it may compress the brainstem and result in headaches.
  
  
• Though not very common, acoustic neuroma may cause facial numbness and paralysis. Large tumors may compress the fifth cranial nerve (facial nerve) called trigeminal nerve, resulting in facial numbness, pain and facial paralysis.
  

Diagnosis and Treatment

Diagnosing acoustic neuroma is a daunting task as the symptoms explained above are associated with many other medical conditions and it could easily be mistaken for middle ear disorder. Once suspected, doctor will advise MRI, the only test conducted to prove the presence of acoustic neuroma. Few of the hearing (audiometry) and balancing (nystagmus) tests are also conducted to assess the hearing and balance functions.

There are three options available to treat acoustic neuroma. The choice of treatment depends upon the size of the tumor, it's location and patient's age and fitness.

Micro surgery involves removing the tumor either partially or totally through surgery. Partial removal is considered when the tumor is large and the total removal leads to the damage of the facial nerve. In case of partial removal, the patient has to undergo repeated MRI scans at regular intervals to ensure that tumor is not growing again. When the tumor does not pose a risk to the adjacent nerves, one can opt for a total removal of the tumor. Though surgery is the most preferred choice of addressing the acoustic neuroma, utmost care should be taken to preserve the hearing function and the facial nerve of the patient.

Radiation is the second best option for treating acoustic neuroma. Radiation is a non-invasive treatment that uses precisely focused, narrow beams of radiation to shrink the acoustic neuroma. Currently, radiation is either delivered as single fraction stereotactic radio surgery (SRS) or as multi-session fractionated stereotactic radiotherapy (FSR). These techniques deliver high doses of radiation to the tumor and also ensure that surrounding areas and organs like brain, skull and skin receive minimum or no radiation.

SRS involves a single dose of radiation wherein multitude of radiation beams are delivered to the tumor in one single sitting. Patient need not return for treatment except for a follow up. Though SRS is very effective, it may not preserve the hearing function in most cases.

In FSR, smaller doses of radiation are given every day, over a period of three to four weeks. FSR method has better chances of preserving the hearing function compared to SRS method.

Sometimes doctors may just ask the patient to wait and watch than begin a treatment for acoustic neuroma. Holding back the treatment is most ideal when the tumor is not producing any symptoms and is small in size (less than 2 cm). Acoustic Neuroma does not require any medical intervention if the tumor is not growing rapidly. The growth of the tumor is normally observed by going for repeated MRI on a regular basis for few years. Wait and watch approach also best suits older patients with small tumors that have stopped growing. They will only be monitored periodically with the help of diagnostic tests.