From augmented reality to virtual reality to robotics to new procedural techniques – the future of interventional radiology is bright.
Interventional Radiology has grown exponentially in recent years. Embolization procedures were first performed in 1970. Three years later, balloon angioplasties were being performed. Then, in the 1980s, complex interventions, such as Transjugular Intrahepatic Portosystemic Shunt (TIPS) placements were introduced1. These therapies are now offered in nearly every hospital. Such growth has been facilitated by advances in technology, combined with the creativity of practitioners. Evolving advances in augmented reality, artificial intelligence (AI), imaging modalities, robotics, and procedural techniques will play a big role in the future and facilitate further exponential growth.
In augmented reality, virtual images can be seen alongside real images. In contrast to virtual reality where the field of vision includes no real images, augmented reality offers the ability to maneuver objects and interact with the real world. This powerful development has wide-ranging applications for image-guided interventions. For example, an interventional radiologist could visualize vital signs within the same field of vision, overlying the patient during a critical intervention. These numbers could potentially appear on command when performing a key step of a procedure or when the radiologist has a concern.
Needle placement or a procedure with an image-guided device is another application. For instance, the operator could also view a fused ultrasound image, during simultaneous visualization of needle insertion and ultrasound probe manipulations. Augmented reality can also be used to visualize anatomy underneath procedural drapes to guide an intervention when there is poor sonographic penetration or fluoroscopic guidance is insufficient. For example, a projected 3D hologram, recreated from a pre-programmed CT scan, can help the radiologist identify – and avoid – key structures during a percutaneous intervention, which may otherwise be invisible.
Recent developments in AI represent additional revolutionary opportunities of growth in the current and future practice of image-guided interventions. Utilizing AI, outcomes of interventions can be more accurately and quickly predicted, improving patient outcomes. Machine learning algorithms will be able to augment the interventional radiologist in guiding treatment decisions and selecting patient populations that would benefit most from interventions in areas, such as interventional oncology, where multimodal therapies abound.
Other future applications will include intraprocedural augmentation for the interventional radiologist. AI will enhance image guidance through anatomical recognition, to facilitate interventions and guide the operator through complex anatomy. Lastly, promising applications exist in the treatment of patients requiring time-sensitive interventions. Conditions, such as strokes and pulmonary embolisms, have been described to benefit from AI’s impact on expediting recognition and throughput to improve patient outcomes2.
Furthermore, continued enhancement of current image-guidance modalities and development of new ones will enhance future procedural practice. Limitations of current imaging modalities in interventional radiology include two-dimensionality and, oftentimes, radiation exposure. One new imaging guidance modality currently being pioneered is Fiber Optic RealShape (FORS)3. This imaging technology utilizes catheters embedded with light sensing technology. Currently, physicians are challenged by tortuous and diseased vasculature, which is difficult to visualize in 2D and often presents technical challenges to operators driving the catheter. Technologies, such as FORS and other evolving modalities, could optimize vascular imaging guidance, drastically decrease the procedural time, and radiation exposure for interventions, drastically increasing the safety for patients and practitioners alike in the future.
Another area with future potential in imaging-guided interventions is robotics, which has already been integrated into many fields of medicine. Oftentimes, in order for robotic systems to flourish in utilization, there must be a proven clinical benefit. For example, the DaVinci Surgical System results in smaller incision sites and higher surgical accuracy. These factors justify the cost.
Robotics have been applied to many endovascular procedures. Uterine artery embolization, cardiac ablation, and aneurysm repair have all been successfully performed with robotic navigation systems. Radiographic procedures are uniquely positioned to benefit from robotics due to added benefits to the operators. The interventionalists can work in a separate room from the procedural suite, thereby shielding them from radiation exposure and musculoskeletal injury from heavy protective aprons. More research, however, is needed to justify the cost of such systems, but it is expected that robotics will become more prominent in interventional suites. It is essential that benefits to the operator safety will not compromise patient outcomes, and quality-control studies continue to be rigorously applied and performed.
Lastly, the scope of practice of interventional radiology itself is expanding, as well. In addition to advancements in existing procedures and techniques, interventional radiologists are developing new procedures to address conditions, such as arthritis, obesity, and benign prostatic hypertrophy. Many of these procedures have been validated in small scale clinical trials. Chronic arthritis pain is being managed through embolization of hyperemic synovial tissue4. The left gastric artery has been embolized to decrease fundus blood flow, thereby restricting growth of ghrelin-producing cells and decreasing appetite5. Radiologists can also treat lower urinary tract symptoms through decreasing the size of the prostate with embolization6. Endovascular approaches continue to be identified as a way to treat conditions formerly managed with invasive surgeries and medication therapies. The future is bright as the value proposition of interventional radiology offering minimally invasive, high-quality, low-complication, cost-effective therapies aligns extremely well with the future of medicine and healthcare.
In summary, advancements in technology will foster improvements in efficiency, efficacy, and safety for interventional radiology and image-guided interventions. The degree of innovation and changing practice patterns will continue to be exponential, alongside exponential growth in technology. Interventional radiologists will be presented with ample opportunity to adapt and invent. This is an exciting challenge, and will mean a brighter future for patients.