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Interventional Radiology

Pediatric Interventional Radiology (IR) at Cook Children's offers minimally invasive, image-guided diagnoses, treatments and therapies designed especially for kids.

Thanks to advanced technologies, many disease and injury assessments and treatments no longer require invasive surgeries. Today, many of the diseases and injuries that once required extensive surgery can be treated with minimal risk, less pain and faster recovery times.

Our board certified interventional radiologists have extensive training in both interventional radiology and pediatrics. In additions, our nurses and technicians all specialize in pediatrics and even our equipment is designed to meet the needs of children.

What to expect

When you choose Cook Children's you get more than pediatric care. You get a team of experts dedicated to delivering the best care possible so that your child can get back to doing what they do best: being a a kid. That's why we offer the latest testing and treatments available. Our minimally invasive interventional radiology services include:

Abscess drainage

An abscess is a collection of infected fluid (pus). To drain an abscess, a doctor may use a needle and syringe to suction the fluid or may place a drainage catheter. The doctor will use ultrasound or a CT scan to locate the abscess and decide where to insert the needle. After numbing the skin, the doctor will insert a needle into the abscess and draw out the fluid. The fluid will be sent to a laboratory to find out what caused the infection.

Depending on the location and size of the abscess and the type of fluid obtained in the collection, the doctor may place a small catheter to allow the area to continue to drain for several days. If the collection of fluid (abscess) is deep in the pelvis, sometimes the best route for the doctor to place a drainage catheter is through the child's rectum. This is called trans-rectal abscess drainage.

Angiography – cerebral or abdominal/visceral

Angiogram is a minimally invasive test that uses a special contrast solution (dye) and imaging technology to map the veins in a part of your child's body. The physician inserts a thin tube called a catheter into the body through an artery, most often in the groin area (upper leg). The doctor can move the catheter into other arteries to look at them.

For the X-ray images, the doctor injects dye, called contrast, through the catheter into the artery. With the contrast, the doctor can see the arteries on live X-ray (fluoroscopy) and take images. After the catheter is removed, a bandage is applied to the catheter insertion site.

Angioplasty/venoplasty

Angioplasty is a minimally invasive interventional radiology procedure in which imaging technologies are used to guide a catheter into an artery or vein to the point where it is narrow or blocked. The vessel is then enlarged with a balloon-tipped catheter.

Angioplasty is used as an alternative to surgery in order to enlarge an abnormally narrowed blood vessel. Examples include the narrowing of the arteries to the kidneys, which may cause high blood pressure and the constriction of central veins due to use of central venous catheters.

Biliary drainage/cholangiography/dilation

Cholangiography is an X-ray examination of the bile ducts using contrast (dye) to view the bile ducts. This is used to determine if the bile ducts are blocked or narrowed. Biliary dilatation (also called dilation) is a procedure to stretch bile ducts that are too narrow. Using ultrasound and live X-ray (fluoroscopy) for guidance, a radiologist inserts a hollow needle through the skin, into the liver and into one of the bile ducts.

A guide wire is threaded through the needle, into the duct and the needle is removed. A tiny, deflated balloon is threaded along the wire, into the duct and inflated to open up the narrow portion of the duct. Then a drainage catheter is placed into the duct to help the bile continue to drain. The catheter will be connected to a drainage bag and may stay in place for up to three months. During that time, your child will come to Interventional Radiology for X-rays to make sure the area is draining properly.

Biopsy – soft tissue, liver, bone and lung

A biopsy is a test that's performed to examine tissue or cells from a part of the body. It can be done by cutting or scraping a small piece of the tissue or by withdrawing a sample of tissue with a needle and syringe.

Central venous access

A central venous line (CVL) catheter is placed into a centrally located vein-typically in your child's neck, chest or groin so doctors can give him/her fluids, nutrients or medications over a long period of time. The end of the catheter (called the hub or clave) is outside the skin and the nurse will use that to access the vein, rather than having to place an IV each time. The Interventional Radiologist uses ultrasounds and a special type of X-ray technology, called fluoroscopy, to guide the placement of the catheter.

Cholecystostomy

Sometimes the gallbladder can become obstructed or infected. Treatment usually includes antibiotics and, if necessary, surgical removal. However, sometimes surgery is not an option because the patient is too sick or for other reasons. In these cases, an interventional radiologist will perform a cholecystostomy which is a procedure in which a drainage catheter is placed in the gallbladder. This catheter keeps the gallbladder from getting too swollen, until the child is well enough for surgery.

Using ultrasound and live X-ray (fluoroscopy) for guidance, the radiologist will insert a small needle through the skin and into the gallbladder and then place a tiny catheter into the gallbladder. The catheter will be connected to a drainage bag or bulb, which will be located outside of your child's body, at the right upper abdomen.

Embolization

Embolization is a minimally invasive procedure in which a doctor uses coils, glue, chemical agents or very small particles called polyvinyl alcohol particles to close (occlude) specific blood vessels (veins or arteries). The purpose of the procedure is to block blood flow to a specific area. It is used to treat a wide variety of conditions like aneurysms, arteriovenous malformation (AVM) or vascular malformations. In addition, embolization is sometimes used before a surgery, to minimize bleeding during the procedure.

Using ultrasound and live X-ray for guidance, the doctor inserts a small guide wire and catheter through a blood vessel (usually in the groin area or the arm) and directs it to the area of interest. Then X-ray dye (contrast) is injected and images taken to confirm catheter placement. The doctor then injects particles, coils, glue or chemical agents into the blood vessel through the catheter. If more than one blood vessel supplies the area to which we are trying to block flow, the doctor will move the catheter to those blood vessels and inject more of the embolization material.

Finally, the doctor injects more X-ray dye and looks at the movement of the dye on live X-ray (fluoroscopy) to determine if blood flow has been adequately blocked. When all images have been obtained, the catheter will be removed and a bandage is placed over the insertion site. Embolization is performed by interventional and neurointerventional radiologists who are highly experienced in this procedure, specifically with infants and children.

Fine needle aspiration (FNA)

Fine needle aspiration is a type of biopsy procedure. In FNA, a thin needle is inserted into an area of abnormal-appearing tissue or body fluid. As with other types of biopsies, the sample collected during fine needle aspiration can help make a diagnosis or rule out conditions such as cancer. It is possible to do these with or without sedation.

Joint injections or aspiration

Joint injections or aspirations (taking fluid out of a joint) are performed in an office or hospital setting, often with a cold spray or other local anesthesia. After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. At this point, either joint fluid can be obtained (aspirated) and used for appropriate laboratory testing or medications can be injected into the joint space. This technique also applies to injections into a bursa or tendon sheath to treat bursitis and tendonitis, respectively.

Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, base of the thumb and small joints of the hands and feet. Hip joint injection may require the aid of an ultrasound or X-ray called fluoroscopy for guidance. Some small joints may also be more easily aspirated or injected with aid of ultrasound.

Liver biopsy

A liver biopsy is a quick test that helps see how healthy your child's liver is. During a percutaneous liver biopsy, a needle is inserted through the skin and into the liver with ultrasound guidance. A small sample of liver tissue is then taken. The tissue is sent to the lab to be studied.

Using ultrasound for guidance, the doctor inserts the needle into the liver to obtain small pieces of tissue. The doctor then inserts a substance called Gelfoam® into the liver to minimize bleeding into the tract (where the needle went into the liver). The body absorbs the substance, which is harmless. A bandage is applied over the site of the injection.

Lumbar puncture

To perform a lumbar puncture your child is placed on his side or stomach and a local numbing medicine is injected into the area around the spine. Using ultrasound or live X-ray (fluoroscopy) for guidance, the doctor inserts a needle into the spinal space. Once the needle is in the correct position, fluid will be removed and sent to the laboratory and/or medicine will be injected.

Lymphangiogram

During lymphangiography, the physician will place small needles into lymph nodes in the groin area. A small amount of a contrast agent (a safe, injectable dye) will be injected into the needles and tracked by MRI, X-ray or fluoroscopy as it travels upward through the lymphatic system. This allows physicians to see the anatomy of the lymphatic system, as well as the direction and speed of lymphatic flow.

In patients who will need a lymphatic interventional procedure, the physician will typically access the duct using a thin needle inserted through the abdomen. Less frequently, the physician may access the thoracic duct through a vein by catheterizing the duct where it empties into the systemic veins at the top of the chest.

The physician will then place a tiny tube (catheter) inside the duct and inject X-ray dye (contrast agent). This helps to confirm the position of the abnormality or leak. The small catheter will then be moved to the area that needs to be treated, and the leak will be embolized, or sealed, during either a thoracic duct embolization or selective lymphatic duct embolization.

Several different types of embolization agents may be used during a thoracic duct embolization or a selective lymphatic duct embolization. These agents, which include tiny metal coils, an oily contrast agent or a special glue, can be injected through the catheter to stop the leak and seal abnormal lymphatic vessels.

Nasojejunal (NJ) tube

A nasojejunal (NJ) tube is a small tube that is passed through the nose and guided into the jejunum (small bowel). The tube is used to feed children who are not able to get enough nutrients by eating.

After a gel is placed on the nose, a small tube will be guided down the nose and into the jejunum (small bowel) using fluoroscopic (X-ray) guidance. To help visualize the stomach and small bowel, a small amount of contrast (X-ray dye) will be injected through the tube. Once positioned, the tube will be secured to the cheek with adhesive tape.

Needle biopsy

A needle biopsy is a procedure that takes tissue samples from an area in order to make a diagnosis. The tissues are taken under image guidance, which means that images or pictures taken through CT, ultrasound or X-ray are used to guide the placement of the needle into the abnormal tissue with minimal risk of damage to adjacent organs. The imaging technique used depends upon the area of the body being examined. The needle will take out a tiny piece of tissue, which will be tested by the appropriate laboratory.

Nephrostomy tube placement

A percutaneous (through the skin) nephrostomy is a therapeutic procedure in which a catheter is placed through the skin into the fluid containing structures inside the kidney. Ultrasound and X-ray are used to guide the placement of the catheter.

Using ultrasound, the interventional radiologist will locate the kidney and insert a special hollow needle through the skin into the kidney. With live X-ray (fluoroscopy) for guidance, the doctor will guide a small catheter into the kidney. The portion of the catheter on the outside of the skin will be connected to a drainage bag. A small stitch (suture) and/or an adhesive clip will hold the catheter in place on the surface of the skin.

Primary gastro/jejunostomy placement

A primary percutaneous (through the skin) gastrojejunostomy is a procedure in which a tube is placed through the abdominal wall into the stomach and then through the duodenum into the jejunum. This allows feeding directly into the stomach or intestines.

The gastrojejunal (GJ) tube placement is a minimally invasive, image-guided technique in which a special soft-feeding catheter is placed through an existing hole in the stomach (gastrostomy) into a part of the small intestine (jejunum).

A tube feeding into the stomach is a gastrostomy tube, or G-tube; a tube feeding into the intestines is a gastrojejunostomy tube, or GJ-tube. The doctor will use ultrasound and/or X-ray to guide the placement of the tube into the proper position.

Radiofrequency ablation (RFA)

A technique that allows placement of an electrode through a needle to "burn" certain bone lesions and tumors, reducing pain, and usually eliminating the need for major surgery. RFA procedures are performed through image guidance (X-ray, CT scan or ultrasound) by our Interventional Radiologist in our specialized IR suite.

Salivary gland botulinum injections

Using ultrasound for guidance, the physician inserts a small needle directly into the gland and injects a small amount of botulinum toxin type A. Sometimes a small bandage will be applied to the injection site.

Sclerotherapy

Sclerotherapy is used to treat certain types of vascular and lymphatic malformations. The physician injects a liquid medication into the malformation. The liquid causes inflammation, and then, over time, shrinking of the malformation. Sometimes malformations become enlarged again and require repeat sclerotherapy.

Using ultrasound for guidance, the physician will insert a small needle into the malformation. Next, the physician will inject X-ray dye (contrast) and the liquid medication (sclerosant) into the malformation. Depending on the size of the malformation, sclerosant may be injected into several sites. For larger lesions, small drainage catheters may be placed.

Thrombolysis/thrombectomy

Thrombolysis is a procedure used to break up abnormal blood clots that restrict blood flow in veins and arteries. For chemical thrombolysis we inject a medication, such as tissue plasminogen activator (tPA) or urokinase, through a catheter to dissolve the clot.

For mechanical thrombolysis we use a machine to break up and suction out the clot. Your child's doctor will make a small incision, usually in the knee or arm, and guide a catheter (a thin tube) into the blood vessel (the vein or artery). Using live X-ray for guidance, the doctor will maneuver the catheter to the area where the clot has formed.

The doctor will inject X-ray dye (called contrast) and take a series of X-rays of the clot's placement. Then the team reviews the images and decides how best to treat the clot. The catheter will remain in place for several days so we can evaluate the effectiveness of the treatment and repeat it if needed. To avoid disrupting the catheter's precise placement at the clot, your child's movement will be restricted; the arm or leg where the catheter is inserted must remain still.

When the clot is gone, or no further improvement can be made, we will stop the medication and remove the catheter. Your child will have to lie quietly for some time after as we apply pressure to the catheter-entry site to prevent bleeding.

Vascular foreign body removal

Foreign body retrieval is the removal, retrieval or manipulation of an item that has been introduced from the outside using image guidance. Foreign bodies are objects that originate outside the body and are usually the result of other medical procedures, such as endovascular (meaning in the arteries or veins) devices which have broken into smaller pieces, have become displaced or were mistakenly placed in the wrong area. Foreign bodies can also occur in extravascular locations, such as the biliary or urinary system and soft tissues.

The technique used in the procedure depends on whether the procedure aims to remove or reposition the foreign body, as well as on the type and location of the item. There are a number of systems and grasping devices which may be used for the procedure.

The most common tool for endovascular removal is a snare device which consists of a snare wire loop, a snare catheter, a device used to insert a catheter and a device which helps move wires around during difficult procedures. The device is positioned in a blood vessel to capture the foreign body, which is then retrieved inside the introducer and out of the body.

Percutaneous foreign body retrieval is usually performed as an in-patient procedure, requiring an overnight stay. The site of the puncture and your vital signs will be monitored for the first 4-6 hours following the procedure.

We're here to help

Interventional radiology is ordered through your doctor's office.

Referring physicians: To schedule your patient (inpatient/outpatient), call 682-885-1201. After 3:30 p.m. and on holidays and weekends, call 817-321-0404 (on-call IR physician). You'll find referral forms on our appointments page.

Patients: For questions regarding your child's appointment, to reschedule or cancel, please call 682-885-2429. Schedulers are available 8 a.m. to 5 p.m. Monday through Friday. Your doctor's office may have given you some directions to follow. If these directions are not followed correctly, your child's appointment may be delayed or rescheduled.

Preparing for your visit

If your child has been referred to us for a test and/or procedure, we will contact to you to schedule an appointment. At that time you will also be given any special instructions necessary to prepare for your visit, depending on what services your child will be receiving.