Sriharsha Athreya (editor) - Demystifying Interventional Radiology: A Guide for Medical Students

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I am extremely grateful to everyone who have contributed in bringing this book to print. My sincere thanks to the many medical students who supported the concept of this book on interventional radiology and to all the authors whose contributions helped pull this book together. I wish to thank our partners in industry for allowing us to use images of the equipment in the book. Your assistance is truly appreciated.

Finally, special gratitude to my parents, my wife, and two sons for being so patient, understanding, and supportive of me in this and all my endeavors.

For some, the birthplace of interventional radiology (IR) can be considered the Karolinska Institute in Sweden. There, in 1953, Swedish radiologist Dr. Sven Ivar Seldinger introduced the technique of using a hollow needle to puncture and gain access to a blood vessel, inserting an exchange wire through the hollow of this needle into the vessel, and then using this exchange wire to introduce medical devices such as catheters []. The eponymously named Seldinger technique was what allowed many early angiographers to expand their field of practice. Today, the Seldinger technique remains a commonly used technique across interventional radiology.

Ten years later, in 1963, American vascular radiologist Dr. Charles Dotter was conducting an abdominal aortogram in an individual who presented with renal artery stenosis when Dotter realized he had recanalized a right artery occlusion by simply passing the catheter through the occlusion []. For many others, this case can be considered the birth of interventional radiology, and Charles Dotter is considered by many the father of interventional radiology.

During his presentation in Czechoslovakia, Dotter discussed catheter biopsy, controlled catheterization, occlusion catheterization, and the basis for catheter endarterectomy []. He urged a change in paradigm, envisioning the diagnostic catheter as a means for delivering novel therapy. This radical shift was a shock for many, as angiographers at the time were trained to help referring clinical colleagues with diagnosis, not treat patients themselves with percutaneous methods.

Dotter led the charge: a paper published by Dotter and Melvin Judkins (his trainee at the time) in the November 1964 issue of Circulation outlined their 5-month experience with angioplasty [], with excellent results.

The term interventional radiology was coined by Alexander Margulis (a gastrointestinal radiologist) in an editorial in the American Journal of Roentgenology in 1967. At the time, radiologists worldwide were exploring the treatment of nonvascular disease through percutaneous methods. This included treatment of frozen shoulders by joint distension during arthrography, abscess drainage, intrauterine transfusion of the fetus under fluoroscopic guidance, pulmonary and liver biopsies, and transjugular cholangiography. Margulis realized that a new specialty was developing and, in his editorial, defined IR and also set requirements for its performance. Central to IR training was the need for specific training, technical skills, clinical education, and the ability to care for patients before, during, and after the procedure.