1. Intro to Interventional Radiology
Justin McWilliams, MD
Version 1.2
Welcome.
Responsibilities
Read your packet.
You are in charge of IR1. Take responsibility for it and make it run smoothly. To that end:
Consent inpatients at first opportunity once they appear on the board
For outpatients, write their pre-procedure orders the day or night before (charts are with Jackie
and Gina until 4 pm, and are in the PTU after that)
Relevant things to know for any patient includes history, reason for study, labs (especially INR,
platelets, creatinine), consentability, blood thinners, and relevant imaging.
Write the procedure note, post-procedure orders, and dictate after the case is done (ask your
attending for guidance on what to write/dictate)
Follow up with patients at least the next day (if inpatient) or longer if there are ongoing issues
Sign out to on-call fellow any relevant issues
Keep a log of your patients.
Blood thinners should be stopped prior to IR procedures, unless there is a good reason not to.
Heparin: 4-6 hours
Coumadin: about 4-5 days, check INR
Aspirin: 1 week, though recent study suggests that this may not be as crucial as we once thought
Plavix: 1 week
Lovenox: 12-24 hours
Arixtra: 1-2 days
Antibiotics are given prior to some IR procedures. These vary with attending, but here are some oft-used ones:
Biliary interventions, non transplant: Ceftriaxone 1 gram IV or Cipro 400 mg IV + Flagyl 500 mg IV
Biliary interventions, transplant: Unasyn 3.375 grams IV
GU interventions: Ciprofloxacin 400 mg IV or ceftriaxone 1 gram IV
Ports: Ancef 1 gram IV; if PCN-allergic use Vancomycin 1 gram IV or Clindamycin 600 mg IV
G tubes, Permacaths and Hickmans: Same as Ports, or nothing at all
Solid organ embolization (spleen and kidney): Ceftriaxone 1 gram IV
TACE and RFA: Variable
These doses are for adults only; call pediatric pharmacy for peds doses (x77521)
Anesthesia
NPO for 8 hours prior to conscious sedation (2 hours for clear liquids).
If patient is not NPO, can usually receive “single dose” sedation – either narcotic or sedative but not both
General anesthesia, MAC, deep sedation (propofol) – done by anesthesiology, NPO for 8 hours prior
Tube care
Any indwelling tube should be kept dry, in general, to avoid infection
Drainage catheters, nephrostomy tubes, biliary tubes may need flushing with 5-10 cc sterile saline BID to
help maintain patency – ask your attending
Permacaths and temporary dialysis catheters are “locked” with full-strength heparin (1000 units/cc) using
a volume sufficient to fill the catheter (printed on the catheter hub); if heparin-allergic, can use tPA at a
concentration of 1 mg/mL to fill the catheter
PICC lines, Portacaths, Hickmans are “locked” with diluted heparin (100-200 units/cc)
Pain management/sedation

2. Narcotics (all doses listed are for approximate equivalent effect to 2 mg IV morphine)
Morphine 2 mg IV = 6 mg PO; duration 4-5 hours; can cause Sphincter of Oddi spasm
Dilaudid (hydromorphone) 0.3 mg IV = 1.5 mg PO; duration 4-5 hours
Demerol (meperidine) 15 mg IV = 60 mg PO; duration 3-5 hours; often causes nausea, can cause seizures;
good for post-procedure rigors; may be less likely to cause Sphincter of Oddi spasm
Fentanyl 25 mcg IV; duration 1-2 hours
Oxycodone (Oxycontin) 2-4 mg PO; duration 4-5 hours
Vicodin RS (500 mg acetaminophen + 5 mg hydrocodone) = 1 tab (approx)
Percocet (325 mg acetaminophen + 5 mg oxycodone) = ½ tab (approx)
Narcotics are reversed with Naloxone (Narcan). Naloxone can be given IV in 0.4 – 2.0 mg increments for
opioid overdose or respiratory/cardiac depression, with dose dependent on severity. 0.2 mg dose can be
tried if only partial reversal is desired. Onset of action is 2-3 minutes. If no effect is seen, can repeat dose
at several minute intervals. After reversal, keep in mind that the half life of naloxone is only about 60
minutes; so the naloxone may wear off before the narcotic!
Sedatives:
Versed – usually 1 mg to start, repeat as necessary. Sedative effects at 1-5 minutes, duration 2-6 hours.
Benzodiazepines are reversed with flumazenil (Romazicon). Give IV in 0.2 mg increments, injecting over
15 seconds. Onset of action is about 1 minute. If no effect is seen, can repeat dose each minute up to 1.0
mg total dose. Most patients respond to 0.6 – 1.0 mg.
Others:
Benadryl – has some sedative effect to go along with its antihistamine effect
Toradol – a powerful IV NSAID, particularly effective as an anti-inflammatory and often used post-UFE
IV contrast:
Omnipaque 350 – low-osmolar, cheaper
Visipaque 320 – iso-osmolar, slightly more expensive, slightly less risk of contrast nephropathy and
contrast reaction
Premedication for contrast allergy: Prednisone 32-50 mg PO 12 hours prior and 2 hours prior to
procedure; Benadryl 25-50 mg PO 2 hours prior to procedure.
Risks to consent for (NOT a comprehensive list, consult your attending)
All procedures: Infection, bleeding, target organ damage.
Angio procedures: Contrast risks, vessel damage (hematoma, pseudoaneurysm, thrombosis, dissection).
Lung procedures: Pneumothorax, systemic air embolism
Embolization procedures: Nontarget embolization, post-embolization syndrome
Sedation: Respiratory and cardiac depression, allergy
PLUS procedure-specific risks:
Biopsies: Nondiagnostic sample
TACE: Hepatic failure, biloma/abscess
GI embolization procedures: Bowel infarction
Pelvic embo: Buttock claudication, rectal/bladder ischemia, impotence
Biliary procedures: Biliary sepsis, bile leak
GU procedures: Urosepsis
RFA: Collateral damage to adjacent organs (especially bowel), biliary stricture, abscess, track seeding
IVC filter: Migration, perforation, IVC thrombosis
Thrombolysis: Severe bleeding including cerebral hemorrhage, reperfusion syndrome, distal embolization
G tube: Tube malposition (in peritoneum or colon), bowel damage
TIPS: Hepatic failure, encephalopathy, death
Venous access (Port, Permacath, Hickman): Air embolism
TJ liver biopsy: Capsular perforation (severe bleeding)
UFE: Premature menopause, reduced fertility, fibroid expulsion (submucosal)

3. Radiation safety
Most importantly, stand behind your fellow. Not behind me, as I will be standing behind both of you.
Keep the image intensifier as close to the patient as possible to reduce scatter.
Don’t forget your thyroid shield.
Step out of the room, or at least away from the patient, when DSA runs are being performed (higher
radiation than regular fluoro)
Minimize fluoro in logical situations (don’t fluoro until the wire/catheter is nearing the field of view, etc)
Use the hard cones/shutters to reduce radiation when full-screen exposure is unnecessary
Labs
For outpatients, the usual lab orders are a CBC, PT/PTT/INR, and BMP. If it is a biliary or liver procedure
add LFTs. For HCC cases an AFP may be useful as a pre-treatment baseline.
Many patients have recent labs in the system so check PCIMS. Labs within 2 weeks or so may be
sufficient, but it depends on the case and the patient. Certainly if the labs were abnormal or if the patient
has been on anticoagulation then repeating labs would be prudent.
INR: Should be <1.5 for most procedures. Can be repleted with FFP. If related to Coumadin therapy, can
also be reversed with Vitamin K, but Vitamin K takes minimum 6-12 hours to begin to take effect. Quick
chart on FFP reversal of high INR:
Beginning INR How much each unit of FFP will lower the INR (mean)
4.4 – 20 3.5
3.0 – 4.3 0.7
2.4 – 2.9 0.4
1.7 – 2.3 0.2
1.3 – 1.7 0.1
Platelets: Should be >50-75 for most procedures. Can be repleted by giving platelet transfusion (one unit
of single-donor platelets raises the platelet count by about 20, but effect is pretty variable). Also,
platelets are suspended in plasma, so a unit of platelets gives you close to a unit of FFP.
Creatinine: Depends on contrast load expected; higher creatinine increases risk of contrast nephropathy,
particularly if dehydrated and in diabetics. In cases of renal insufficiency (Cr >1.5 or so) where more than
a token amount of contrast is expected, it is prudent to pre-hydrate with IV fluids (NS is fine, be careful in
CHF); additional reasonable measures include bicarbonate and Mucomyst.
Bicarbonate protocol: 3 amps of NaHCO3 in 1 L D5W; administer at 3 cc/kg for the hour
immediately prior to the procedure, then 1 cc/kg/hr during the procedure and 6 hours after. In
diabetics, change the D5W to ½ NS.
Mucomyst protocol: 600 mg PO BID the day prior and the day of the procedure
Total bilirubin: Except in special circumstances, most liver RFA and TACE procedures are contraindicated
by a total bilirubin >3. Be sure your attending is aware.
Potassium: High or low potassium levels can predispose to arrhythmias including VFib and asystole.
Normal is 3.5 – 5.
Hyperkalemia: Particularly worrisome when the K exceeds 5.5-6. Treatment measures include:
Insulin: Give 10 units regular insulin + 50 cc of 50% dextrose, moves K back into cells
Bicarbonate: 1 amp over 5 minutes, useful when K is related to metabolic acidosis
Albuterol: 10-20 mg inhaled by nebulizer, moves K back into cells, caution heart disease
Kayexalate: 15-30 grams orally in sorbitol (or by enema), binds K in the gut, takes a few
hours to work
Calcium gluconate: 10 cc of 10% solution, preferably through a central catheter,
decreases myocardial excitability

4. Furosemide: 40-80 mg IV, increases renal excretion of K (not for patients in renal failure)
Dialysis: In patients with renal failure
Hypokalemia: Particularly worrisome when the K is less than 3.0. Treat with IV and/or oral K.
Dictations: Should be done the day of the procedure whenever possible.
PROCEDURE TITLE: Date
CLINICAL HISTORY: Be as complete as possible, and be sure you answer why the procedure is needed.
INTERVENTIONALISTS: List attending first.
CONSENT: After the risks, benefits and alternatives were discussed with the patient, including the
likelihood of technical success, and all of the patient's questions were answered, written informed
consent was obtained for both the procedure and for conscious sedation.
SEDATION: Conscious sedation in the amounts of _ mg Versed, _ mcg Fentanyl was administered by the
IR nurse, under continuous monitoring by the IR team, including the attending physician. Total
duration of time conscious sedation was administered was _ minutes.
OTHER MEDICATIONS: Antibiotics, Nitro, etc.
CONTRAST: Volume and type.
FLUOROSCOPY TIME:
PROCEDURE SUMMARY: Numbered list of procedures performed.
TECHNIQUE: Be descriptive and complete.
FINDINGS: The findings of every relevant picture or run should be described.
IMPRESSION: Tie things together, draw conclusions.
DISPOSITION: Immediate plan for the patient and follow-up.
Achieving hemostasis
Arterial puncture: At least 15 minute continuous hold (longer in some circumstances). Most recommend
occlusive or near-occlusive pressure on the artery just above and at the access site for the first couple
minutes, then slight decrease in pressure so you can feel the thrill of arterial flow beneath your fingers for
the remainder of the hold. Remember that the arteriotomy is usually at least 1 cm or so above the skin
nick. Release of pressure after 15 minutes should be gradual, not sudden, so as to not dislodge the
platelet plug. If there is continued oozing after 15 minutes, pressure should be re-applied; avoid releasing
and checking every few minutes. V-pad may be helpful in patients where hemostasis is a concern.
Venous puncture: Usually 5-10 minutes is sufficient, depending on the size of the venotomy and clotting
status of the patient.
Sheaths versus catheters versus guide caths versus microcatheters
Sheaths are sized according to what fits through them. So, a 5 French sheath will accommodate a 5
French catheter through it; the outer diameter of a 5 French sheath is between 6 and 7 French.
Catheters are sized by their outer diameter. Catheters have a relatively small inner diameter which only
accommodates wires and microcatheters.
Guide caths are sized by their outer diameter. They have thinner walls and larger inner diameters to
allow passage of balloons, stents, etc. Usually the inner diameter is 1-2 French smaller than the listed size
of the guide cath; so a 7 French guide cath can accommodate a 5 French catheter.
Microcatheters are usually sized by their inner diameter, in inches. Progreat is a 0.028, for example.
Microcatheters pass through 5 French catheters, and some pass through 4 French catheters.
Reading list (pick 1 or 2)
“Handbook of Interventional Radiologic Procedures” by Kandarpa
“The Requisites: Vascular and Interventional Radiology” by Kaufman and Lee
“Vascular and Interventional Radiology” by Valji
Phone numbers
Charge nurse IR3: 310-267-8754

5. Santa Monica angio: 310-319-4602
st
1 floor CSIR scheduling (Myrna’s desk): x78743
CSIR Charge nurse: x79772 (usually Pat)
Beth: x78770
Jackie/Gina (scheduling OP angio cases for WW and SMH): x78751
st
IR clinic (1 floor of MP 100) and Ronetta: 310-481-7545
Fax number for angio requisitions: x73891
Fax number for CSIR requisitions: x72694
Resident testimonials by some of our success stories:
Overview
The IR rotation at RRH is busy. Don't be fooled by the printed schedule. Add-ons are common, and staying until 7-8
pm is the norm. Residents are responsible for all of the cases in room IR1, which may be overwhelming, but it
really is the best way to experience interventional radiology.
[Santa Monica and VA: the resident works closely with the fellow on these rotations. This is a great opportunity to
learn bread and butter techniques, and fellows will serve as crucial resources. Ask them to show you the various
wires and catheters that are used, how to consent patients, how to manage the workflow, etc. Once fellows are
comfortable, they will often guide you through various procedures, with the attending observing from outside.]
Logistics
Arrive at 6:45 am (earlier if you need to write orders, consent or follow-up on inpatients). Pick up the day's
schedule from the front desk. You are responsible for making sure that your room runs smoothly. Prior to each
procedure and as early as possible: consent patients, check labs and imaging, coordinate with anesthesia (if
necessary) and the rest of the IR team, such as the tech and the nurse.
On Wednesdays, lectures begin at 7:00 am. On Thursdays, case conferences begin at 7:30 am. Both are in the
conference room by the IR office in RRH.
[Santa Monica and VA: not too different from Westwood. Just touch base with your fellow at the end of each day
and make sure you are both on board with what needs to be done. ]
Tips
*Each night, read up on at least one procedure that you will perform the next day. Kandarpa's handbook for IR is
especially practical and useful. Important things to pay attention to aren't so much the technical aspects of the
procedure itself, but: the clinical indication, contra-indications, major and minor complications, routine pre and
post-procedure care, such as prophylactic antibiotics and wound care. Knowing these facts will also facilitate
consenting patients.
*Review the anatomy relevant to the procedure you are performing. Also always look at prior imaging studies for
each patient.
*Use index cards to keep track of your patients. This is an easy way to follow-up on patients and to have a record
of the cases you performed. Also, some patients are repeat fliers, and having their information at your fingertips
will also improve your efficiency and the workflow.
Possible format:
HEADING: date, patient's name, MRN, pt location, procedure, attending.
ALLERGIES:
BODY: short and pertinent clinical history, indication for procedure, prior IR procedures
OBJECTIVE DATA: pertinent imaging and labs, particularly CBC, Creatinine, Coags; some procedures will also have
other pertinent labs, such as LFTs for TACE.
FOLLOW-UP: follow-up on your patients. If they are inpatients, check up on them the next day. If they have been

6. discharged, follow
them up on PCIMS and make sure there are no complications.
*Not mandatory, but try to help out the fellows as best you can. This could entail consenting their patients, jotting
down a short note for them, or writing the pre-orders for their next day's patients. Talk to the fellows, befriend
them, and see what you can do to make everyone's lives easier. It makes for a more collaborative environment,
and you'll often find that fellows will return the favor.
*There is a huge learning curve the first week. The first few times, try and shadow the techs when they prep the
patient and the table. Also, to get a better sense of the technical aspects of IR, try not to rely too heavily on the
macros on powerscribe. Instead, print out the templates, and read out the entire dictation. This is a really good
way to remember the steps, wires, catheters, sheaths, etc that are commonly used.
*To help the day run smoothly, do as much as you can the day/night prior. This often entails consenting patients
and checking labs/imaging.
*scrub in! if there is nothing going on in your room, ask the fellow if you can scrub into their case. Assist when
necessary, but keep in mind that it is the fellow's room, and they should be allowed to direct the case. Fellows
should also show you the same regard.
*In many respects, being an IR resident requires that you tap into your intern skills. Figure out what you need to do
to make things happen. Also, as best as you can, try to empathize with your patients. Many of them are nervous
and need reassurance. As little as 5 extra minutes at the bedside can be enough to assuage their fears and build
rapport.
Tips from a second success story:
IR is different from any diagnostic radiology rotation. Treat it as you would any surgical rotation that you did in
medical school. This means a couple of things:
-Develop a list of patients that you are following with their labs, important info, prior procedures, check boxes of
what needs to be done, prior imaging etc
-Round on pts in the morning before you start your procedures
-Know important info about each pt, meds, vitals, important labs, allergies (keep this in mind when prescribing
abx) etc.
-I prefill out the H&P with all the info I can find in PCIMS the day before so I can just go in and just verify the info
and do the physical. Also this helps me know everything that could be going on with the patient well in advance.
-do everything that you can yourself, even if that means helping the tech or nurse. This will help you learn the
basic things too.
-If there is a central line on the floor ie-emergency line in the MICU that they call you about because they can't get
access, take the ultrasound machine up and go do it (check with attending first). Struggling with the little issues
that may come up with things like this will teach you how to troubleshoot your way out of situations later.
-Don't be afraid to be the clinician. If the BP is up, know how to deal with this (we were all interns once,
remember?). Rx some labetalol or nitropaste, or whatever you like to use.
-If you have a pt that has had a major procedure (not necessarily ports or permacaths), go and round on them
again before you leave at night.
-Remind yourself how to do physical exams (ie-TACE pts- palpate the RUQ, ck for asterixis, etc) and write notes in
the chart if you get a chance.

7. Basic catheters
Sos Omni: For visceral selection, particularly SMA and other acutely angled arteries.
Omniflush: For nonselective angiography and selection of contralateral iliac artery.
Cobra: For basic visceral selection, particularly celiac and renals.
Mickelson: For more difficult selections, particularly bronchials, intercostals and lumbars. Must be reformed.
Simmons: Excellent stability for difficult selections. Must be reformed.
Progreat microcatheter: 0.028” inner diameter, OK for gelfoam if cut small or well slurried, great for particles up
to 900 microns, not as great for 0.018” coils which sometimes (rarely) get bound up in the catheter.
Renegade microcatheter: 0.021” inner diameter, a bit small for gelfoam, OK for particles up to 700 microns, good
for coiling, slightly smaller OD so can get into smaller vessels slightly easier than Progreat

8. 035 wires (in approximate order of most to least used)
Amplatz – stiff wire with a floppy straight tip. Great for exchanges, drain placements, also good as a working wire
for vascular interventions. Stiffness can help straighten out tortuous anatomy.
Bentson – low-medium stiffness, very floppy tip straight tip, atraumatic. Often used for vascular access, catheter
exchanges, etc.
Glide – medium stiffness, angled or straight tip, hydrophilic. You can get anywhere you want to go with this wire.
You also can get lots of places you don’t want to go. Handle with care to avoid dissection. Not ideal for exchanges
as it easily slips between fingers.
Rosen – medium stiffness, J tip. Often used as a working wire for vascular interventions (stents and balloons) due
to the atraumatic tip and good stiffness.
Stiff glide – same as a glide, but stiffer, and gets even more places you don’t want to go. I like it for GJ exchanges
and Permacath exchanges as the smooth hydrophilic surface and stiff body make these long tubes glide in easily;
but, keep a good grip on it!
Roadrunner – similar to a straight stiff glide, but with a tapered tip. Nice for occlusions that refuse to be crossed
any other way.
Coons – basically like a stiffer Bentson. Often used for biliary drain exchanges.
J wire – comes with the Accustick set, has low-medium stiffness and a J-shaped tip. It is too soft to be a good
exchange wire in my opinion, but may be useful in collections which are too small to get an Amplatz to coil into.
Lunderquist – the “coat hanger”. A very stiff wire. Rarely used outside of aortic interventions where extreme
stiffness is necessary.
014 microwires
Transend – good first choice wire, not too expensive, pretty directable, is the only wire needed in most
microcatheterizations
Synchro – expensive, extremely floppy and directable tip, if you can’t get somewhere with this wire you probably
just can’t get there
Fathom (actually an 016 wire) – supposedly combines some of the good features of the preceding two wires; I
have not yet been impressed.
018 microwires
Cope – comes with the micropuncture kit. Atraumatic, but the spring coil tip is kind of rough and can get caught
on the needle, may not advance smoothly, etc.
Nitrex – longer than the Cope wire, with more body and a smoother tip. Good choice if the Cope wire isn’t doing
what it’s supposed to.

9. Resident Survival Guide to the UCLA CSIR Rotation
Daily Responsibilities:
1) Familiarize yourself with all scheduled cases either the night before or first thing in the morning.
Obtain a copy of the scheduled cases for the day from the nurses binder
Preview requisition and imaging for all scheduled cases and plan approach
2) Consent patients
a) The first case usually starts at 7:30 am so consents should be obtained by 7:15 am.
b) Prior to seeing the patient, you should:
Review the requisition to understand what the referring MD is asking for
Review prior imaging
Review the medical record
Check labs and medications (Inpatients: check cView, Outpatients: ask the patient for their list)
c) During the patient encounter, you should:
Explain the procedure
Detail the benefits and risks
Assess for comprehension and answer any questions
Review medications, allergies, and obtain H&P if needed
3) Complete pre-procedure paperwork.
a) Prior to starting the procedure, the following should be completed:
H&P short form (not needed if there is an H&P with ROS in the medical record within one month
from the date of procedure)
Procedure consent
Sedation consent
Blood transfusion consent (when necessary)
Top portion of the procedure note
FNA cytopathology, surgical pathology, microbiology, and chemical analyses forms when needed
Time out
Make sure patient has received appropriate antibiotics, transfusion, etc when necessary
4) Scrub in, prep patient, and observe, assist or perform the procedure.
5) Complete post-procedure paperwork.
a) At the end of the procedure, the following should be completed:
Procedure note including: instruments and materials, ablation/specimen description (location,
number, volume, analyses requested)
Post-procedure orders
Dictation: include medication doses, monitored time, fluoroscopy time
6) Discharge patient:
a) While the patient is being observed in PTU:
Review post-procedure imaging (CXR after lung biopsies, MRI after liver/renal RFA)
Review results of the procedure with patient and family.
b) In consultation with the attending, patients may be discharged if they meet the discharge criteria:
Vitals stable, pain well-controlled, able to tolerate PO’s, ambulating
c) Give patient instructions: wound care, tube care, pain management, follow-up instructions, return
precautions
7) Triage new requests throughout the day with fellow
Review the requisition
Review the imaging and patient record
Review labs, meds, time of last PO intake
Present case to attending and plan approach
8) Sign pre-op orders for the following day’s scheduled cases

10. 9) Sign out to the on-call IR fellow if necessary
10) Optional: Ask US techs to page you for thoracenteses and paracenteses
11) Optional: Attend clinic
Conferences:
IR Didactics: Wednesday 7:00 am, IR conference room
IR Interesting Cases: Thursday 7:30 am, IR conference room
GI Interesting Cases: Friday, 8:00 am, RHH 1621
Ablation Conference: Every other Friday, 12:00 pm, RRH 1621
Hepatobiliary Interdisciplinary Conference: Every other Wednesday, 5:30 pm, Radiation Oncology
Conference Room, MP 200, B2 Level
Reading:
1) Texts:
Valji, K. Vascular and Interventional Radiology. W. B Saunders, Philadelphia, 2006.
Kaufman, J.A. and Lee, M.J. Vascular and Interventional Radiology: The Requisites. Mosby, 2004.
2) Liver Ablations
Clark et al. Staging and Current Treatment of Hepatocellular Carcinoma. RadioGraphics 2005
25:S3-S23.
Mendiratta-Lala, et al. Strategies for Anticipating and Reducing Complications and Treatment
Failures in Hepatic Radiofrequency Ablation. RadioGraphics 2010.
Park et al. Spectrum of CT Findings after Radiofrequency Ablation of Hepatic Tumors.
RadioGraphics 2008 28:379-390.
3) Renal Transplants
Kobayashi et al. Interventional Radiologic Management of Renal Transplant Dysfunction:
Indications, Limitations, and Technical Considerations. RadioGraphics 2007 27:1109-1130.
4) Renal Ablations
Zagoria RJ. Imaging-guided Radiofrequency Ablation of Renal Masses. RadioGraphics 2004
24:S59-S71.
Wile et al. CT and MR Imaging after Imaging-guided Thermal Ablation of Renal Neoplasms.
RadioGraphics 2007 27:325-339.
Kawamoto et al. Sequential Changes after Radiofrequency Ablation and Cryoablation of Renal
Neoplasms: Role of CT and MR Imaging, RadioGraphics 2007 27:343-355.
5) Lung Interventions
Gupta et al. Imaging-guided Percutaneous Biopsy of Mediastinal Lesions: Different Approaches
and Anatomic Considerations. RadioGraphics 2005 25:763-786.
Dupuy et al. Clinical Applications of Radio-Frequency Tumor Ablation in the Thorax.
RadioGraphics 2002 22 :S259-S269
6) Drains:
Maher et al. The Inaccessible or Undrainable Abscess: How to Drain It. RadioGraphics 2004
24:717-735
Harisinghani et al. CT-guided Transgluteal Drainage of Deep Pelvic Abscesses: Indications,
Technique, Procedure-related Complications, and Clinical Outcome. RadioGraphics 2002
22:1353-1367
7) Biopsies:
Gupta et al. Various Approaches for CT-guided Percutaneous Biopsy of Deep Pelvic Lesions:
Anatomic and Technical Considerations. RadioGraphics 2004 24:175-189
Thanks to Sophie Chheang, MD; Amy Asandra, MD; and Mailan Cao, MD for their contributions to this guide.