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Dr. M. Victoria Marx

The future of interventional radiology

by John W. Mitchell , Senior Correspondent
From the April 2019 issue of DOTmed HealthCare Business News magazine

Dr. M. Victoria Marx, 2018-2019 president of the Society of Interventional Radiology, has witnessed a transformation in interventional radiology and sees the pieces coming together that will push the specialty into new and uncharted territories.

The evolution of interventional radiology has been driven to a large degree by medical imaging technology advancements. Marx, who is also a professor of clinical radiology, vice chair for education and director of the diagnostic radiology residency training program at Keck Medicine of USC, cited examples including the development of cone beam CT to allow CT in the fluoroscopy suite and the increased use of intravascular ultrasound to improve the precision of vascular procedures such as transjugular intrahepatic portosystemic shunt (TIPS).

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“Before intravascular ultrasound, we made transhepatic needle passes with fluoroscopic guidance alone; this was very imprecise,” said Marx, of performing a TIPS procedure. “With the concurrent use of intra-vascular ultrasound in addition to fluoroscopy we can turn what had been five or six passes of a big needle through the liver into one pass. This means less risk and less radiation exposure for patients.”

Hybrid rooms that include angiography and CT for complex interventions have also emerged to help advance the quality of care that interventional radiologists can provide. Meanwhile, 3D imaging capabilities are being introduced with superior views over the 2D standard of many years.

“You might be threading a catheter out and you know you need to turn anterior, not posterior, although this might not be immediately obvious on a 2D image,” Marx explained.

Augmented reality is another new tool that is poised to push interventional radiology forward, where providers can use equipment such as Google Glass to “superimpose previous 3D imaging on the patient so that you use less fluoroscopy.”

Artificial intelligence will help elevate interventional radiology as well, but not in the same way it’s being deployed by her colleagues on the diagnostic imaging side. Marx observed that early work in diagnostic imaging has been to find common predictable abnormalities – such as pneumothoraces on chest X-rays – and to support a better prioritized worklist. On the IR side, she predicts the role of AI is going to be more related to information gathering, information sharing, and decision-making.

“If you have a patient in the clinic that has a particular type of tumor with these types of markers, which is better: ablation, immunotherapy, or chemoembolization?” Marx offered, as an example. “We can ask AI, and it will be able to give those answers quickly without having to do a time-consuming literature search … I think it will make treatment algorithms of higher quality and more uniformly carried out.”
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