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  • 1. GE HealthcareTiP-TV® Training in PartnershipProgram Supplement and Testfor Imaging ProfessionalsXR: Introduction to InterventionalRadiologyPublication Date: February 5, 20091.0 ASRT-approved Category A CE Credit imagination at work
  • 2. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestTABLE OF CONTENTSProgram Summary .......................................................................................................................................................................3Continuing Education Credit and Video File Download (**NEW**) ..........................................................................4Introduction.....................................................................................................................................................................................5History of IR .....................................................................................................................................................................................5 Radiology and Interventional Milestones ....................................................................................................................5IR Equipment, Accessories, and Team .................................................................................................................................7 Imaging Equipment ..............................................................................................................................................................7 Digital Subtraction ................................................................................................................................................................8 Interventional Tools ..............................................................................................................................................................8 The Interventional Radiology Team ...............................................................................................................................9IR Procedures .............................................................................................................................................................................. 10Case Studies................................................................................................................................................................................. 13Appendix A: Presenters ................................................................................................................................................................... 15Appendix B: Resources .................................................................................................................................................................... 15Appendix C: Glossary ........................................................................................................................................................................ 16Appendix D: Post-Test ...................................................................................................................................................................... 18© 2009 General Electric Company. All rights reserved. 2 of 20
  • 3. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestProgram SummaryThis page provides an overview of the program content and learning objectives. The Table of Contentsprovides a detailed list of the topics covered. Please keep a copy of this Program Summary and the Table ofContents with your continuing education certificate. It is also recommended that you provide a copy of thisinformation to your manager as a record of your educational achievement.Program Description and Target AudienceDiagnostic imaging professionals seeking new challenges may find them within the world of interventionalradiology (IR). But if you are not quite sure if IR is right for you, this program presents an interventionalradiologist who describes what it is like to practice in this imaging specialty. Also discussed are the history ofinterventional radiology, common practices and procedures, the role of the technologist, and casepresentations.The course objectives specifically target radiologic technologists considering a change to interventionalimaging.Program ObjectivesBy the end of this program, the viewer should be able to:1. Discuss the achievements made by key contributors to the field of interventional radiology.2. Identify the modern IR practice model.3. Describe the basic equipment and instruments used during interventional radiology procedures.4. State the role of the radiologic technologist in interventional radiology.5. Explain several procedures commonly performed in the IR suite.Continuing Education Credit1.0 ASRT-approved Category A CE CreditNOTE: While the technical content is most effective for the target audience, other technologists and medical personnel may also benefit from viewing this course. Regardless of your imaging specialty, you may apply for continuing education credit. Refer to the Continuing Education Credit page for additional information.© 2009 General Electric Company. All rights reserved. 3 of 20
  • 4. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestContinuing Education Credit and Video File Download (**NEW**)Online Process for CE Credit (hls.gehealthcare.com)In order to receive continuing education credit, you must log into the GE Healthcare Learning System (HLS)and complete all of the required steps. Please refer to the online TiP-TV Quick Start User Guide (click the UserGuides link on the HLS Welcome page) for additional information on how to use the GE HLS as needed.1. View the entire program video online or download the video file for later viewing (refer to the process below). This supplement is not intended to replace watching the video.2. Go to the GE HLS web site at hls.gehealthcare.com and complete the feedback form. NOTE: The Feedback Form link is not activated until the View Video Now module has been completed. This provides valuable information regarding your thoughts on the program’s quality and effectiveness.3. Complete the program post-test without aids or assistance of any kind; this is an individual effort. You have up to three attempts to successfully complete the test with a minimum passing score of 75% (ASRT-approved programs) or 80% (SNM-approved programs). The post-test measures knowledge gained and/or provides a self-assessment on a specific topic.4. Upon successful completion of the online CE information, you can instantly print a certificate.5. Florida residents: The process for submitting CE credit to the FL DOH can be found online in the Related Documents tab on the bottom of the program’s Item Details page.Video Download Process (**NEW**)For programs with an original start date of September 1, 2008 or later, the GE HLS includes an option todownload the TiP-TV program video file. You can then watch the program on your personal computer ortransfer the video file to your portable video player for viewing.NOTE: Please refer to the TiP-TV Video Download Quick Start Guide for complete details (click the User Guides link on the GE HLS Welcome page).• With the desired program in your GE HLS Learning Plan, launch the program content to view the Online Content Structure. In the Video Download (Optional) area, click the Download Video to View Later link.• Save the video file on your personal computer, using your existing video download software.• View the program on your personal computer or transfer it to your portable video player for later viewing.• After viewing the entire program, log into the HLS and complete the CE activities as noted above.Continuing Education Credit Eligibility — Important Notice!A GE Healthcare TiP-TV course may be available in several different formats, such as an online web course orCD/DVD. You may only be able to receive CE credit once for a particular course, regardless of the format inwhich it was viewed. If you have already received credit for a course, you are encouraged to contact your CEcertification organization (ARRT, NMTCB, ARDMS, etc.) to determine if you can repeat this course for CE credit. Thank you for choosing GE Healthcare as your continuing education partner. We hope you will join us for other TiP-TV programs in the future. For more details and program schedule information, please visit our education web site (www.gehealthcare.com/education). Please forward any questions or comments to: PSTIPApps-xr@med.ge.com© 2009 General Electric Company. All rights reserved. 4 of 20
  • 5. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestIntroductionInterventional radiology is a relatively young medical specialty, but one that has had a great impact ontoday’s clinical medical environment. Many interventional techniques use catheters and instruments smallenough to be passed through a patients arteries and veins to access and treat a diseased area within thebody. The fact that many conditions previously corrected with open surgery are now treated with minimallyinvasive interventional procedures, makes IR a major advance in medicine for patients.This program chronicles a lecture given by Dr. James Walker at an educational session of the WisconsinSociety of Radiologic Technologists. Dr. Walker is an interventional radiologist with Milwaukee RadiologistsLtd., providing IR services at two major hospitals in southeastern Wisconsin. Dr. Walker addresses thefollowing topics:• The history of interventional radiology.• Basic equipment used during interventional procedures.• An explanation of a variety of procedures.• Specific case studies.NOTE: Dr. Walker displays and discusses a number of interventional accessories and procedures. Due to the image rich nature of the program, it is necessary to view the video to completely comprehend the content.History of IRInterventional radiologists are board certified physicians with advanced training in image-guided, minimallyinvasive, targeted treatments. Their knowledge of all the imaging modalities, coupled with their experienceusing catheters and angiographic tools, laid the groundwork for non-surgical intervention. A bit of historyhelps to understand the transition from diagnostic to interventional radiology.Radiology and Interventional Milestones• 1895 – Wilhelm Roentgen discovers x-ray.• 1896 – the limitations of x-ray were recognized because of the inability to see soft tissue and blood vessels. – Haschek and Lindenthal perform the first angiogram on an amputated hand.• 1929 – Dr. Werner Forssmann performs the first right heart catheterization, on himself!• 1930s – Dr. Egas Moniz performs the first neuroangiography on a live patient.© 2009 General Electric Company. All rights reserved. 5 of 20
  • 6. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and Test• 1953 – Dr. Sven Seldinger invents a method to safely introduce a catheter into a blood vessel. – A needle is placed in the blood vessel, a wire is put through the needle, the needle is removed, and a catheter is put over the wire. – With this safe, reproducible technique, angiography, angioplasty, and other procedures flourished.• 1964 – Dr. Charles Dotter performs the first angioplasty.• 1970s – American physicians develop a method for embolizing bleeding ulcers, performing coronary angiography, and angioplasty.After Dr. Dotter, in the late half of the 20th century, the field of interventional radiology flourished. Theprocedures were very effective with a favorable side effect profile. At this time, the interventional radiologistgenerally did not see the patient in advance of the procedure or in follow-up, therefore they were consideredto be a proceduralist rather than a clinical doctor. Today’s interventional radiologist is more clinical. They seepatients in consultation and follow-up, and provide services in hospitals. "The angiographic catheter can be more than a tool for passive means for diagnostic observation. Used with imagination, it can become an important surgical instrument." Dr. Charles Dotter – 1963 The Father of Interventional RadiologyNotes:© 2009 General Electric Company. All rights reserved. 6 of 20
  • 7. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestIR Equipment, Accessories, and TeamImaging Equipment Figure 1 GE InnovaTM Single Plane SystemToday’s cardiovascular imagingsystems are technologicallysophisticated and completely digital. DetectorC-arm systems are extremely flexibleand with this type of system, an x-raytube and a digital detector are mountedon opposite sides of a c-shaped arm. Asthe c-arm moves, the tube and detectormaintain the same relationship to eachother.Fluoroscopy, as well as imageacquisition, occurs with this tube anddetector. Single plane systems are X-ray tubearchitected with one c-arm, one tube,and one detector.With a bi-plane system, there are two Figure 2 GE InnovaTM Bi-Plane Systemc-arms, each equipped with an x-raytube and digital detector. Bi-planesystems are frequently used whenperforming neurovascular interventions,when it is necessary to visualize theanatomy in two different planessimultaneously, such as in frontal andlateral projections. With bi-plane units, itis also possible to obtain both the lateraland frontal image acquisitions with onecontrast injection.Another feature unique to manybi-plane systems is the ability to moveone of the arms out of the way into a"park" position, so you can operate thesystem as a single plane device.© 2009 General Electric Company. All rights reserved. 7 of 20
  • 8. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestDigital SubtractionDigital subtraction is an imaging technique designed to reduce anatomical clutter in radiographic images. It isvery commonly used in angiographic (angio) imaging to have an unobstructed view of the contrast-filledvessels. When images are acquired digitally, the subtraction process is performed automatically and directlyby a computer.Very simply, a mask image of the area containing all the anatomic detail is obtained, just prior to a contrastinjection. The mask image data is then mathematically "subtracted out" from each of the images containingcontrast, with the remainder being an image that demonstrates only the contrast-filled vessels.Subtracted fluoroscopy is a feature that may be available on more current cardiovascular imaging systems.As the name infers, a subtracted fluoroscopic image, without anatomical clutter, is available for theinterventional radiologist to view.There are several other imaging techniques that may be available on current cardiovascular systems, such asthree-dimensional (3-D) angiography and angio CT. With these techniques, the c-arm gantry of a single planesystem is capable of acquiring images as it moves rapidly in an arc around the patient. This is called spin orrotational imaging. The image data can then be formatted into either a 3-D representation or a CT-like image.Interventional ToolsNeedlesThe standard needle set is the 21-gauge micropuncture set.Wires• The diameter of the wire is measured in hundredths of an inch.• Standard length is 145 centimeters (cm).Sheaths• The purpose of a sheath is to traumatize the vessel only one time. Catheters and wires are then passed through the sheath so the blood vessel will be bothered only once.• Sheath is measured in French and one French is 0.33 millimeter (mm).The French Gauge system is commonly used to measure the outer diameter of cylindrical medicalinstruments. The system was devised by Joseph-Frédéric-Benoît Charrière, a 19th century Parisian maker ofsurgical instruments. The diameter of a catheter, in millimeters, can be determined by dividing the French sizeby 3.Catheters• A variety of sizes and shapes are available.• The type used depends on the interventionalist and the vasculature.• Microcatheter is a generic term for a catheter that is less than 3 French (1 mm).© 2009 General Electric Company. All rights reserved. 8 of 20
  • 9. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestBalloons• These are used to dilate tubular structures that have narrowed. This includes, but is not limited to arteries, veins, ureters, and bile ducts.• A variety of diameters and shapes are available.StentsThese are small, flexible tubes made of plastic or wire mesh, and generally used to hold open vessels or othertubular structures that are narrowed or blocked.Embolics• These are devices or materials used to intentionally clot off blood vessels, typically in the case of unwanted bleeding.• Coils, gelfoam pledgets, or other particles can be used to embolize vessels.The Interventional Radiology TeamThe IR team generally consists of a physician who performs the procedure, a nurse who monitors bloodpressure and administers medications, and the technologist who handles all remaining functions. Dependingon the facility, a physician assistant or fellow or resident may also participate in the procedure.The IR technologist performs multiple roles during an interventional procedure.• Prepatory – Prepare and set up the interventional suite. – Patient preparation and follow-up care (close and/or dress wound).• TechnicalAssist and run the imaging equipment.• Intellectual – Problem solve. – Suggest new equipment and/or techniques.Notes:© 2009 General Electric Company. All rights reserved. 9 of 20
  • 10. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestIR ProceduresInterventions can be performed in many areas of the body and in most organ systems, with imaging being acritical component during each procedure. The following list identifies common interventional procedures.Arterial Interventions• Diagnostic angiograms – Performed less frequently given the availability of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) technology.• Angioplasty• Stenting• Atherectomy• Cryoplasty• LaserVenous Interventions• Dialysis fistula maintenance• Venous angioplasty/stenting• Thrombolysis• Inferior vena cava (IVC) filter placement and removalGastrointestinal (GI) Bleeding• Emergent procedures• Embolize a bleeding vessel to the bowel. – Bleeding ulcer, diverticulitis, etc.• Perform an intrahepatic portosystemic shunt (TIPS) to treat variceal bleeding. – A TIPS is a stent that is placed in veins in the middle of the liver to improve blood flow to and from the organ. – Patients who typically need a TIPS, are cirrhotic with portal hypertension (increased pressure in the portal vein). – Portal hypertension causes blood to flow backward from the liver into the veins of the stomach, lower esophagus, and intestines, causing enlarged vessels (varices), bleeding, and the accumulation of fluid in the chest or abdomen. – A tunnel is made through the liver to connect the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (three veins that carry blood away from the liver). A stent is then placed in this tunnel to keep the pathway open.© 2009 General Electric Company. All rights reserved. 10 of 20
  • 11. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestVenous AccessCentral venous access catheters (CVAC) are inserted into the body so patients can receive medication ornutrients directly into the bloodstream or gastrointestinal system, or so blood can be drawn, sparing thepatient from repeated needle sticks. Physicians often recommend CVACs for patients who require regularchemotherapy treatments, antibiotic or medication infusions, nutritional supplements, or hemodialysis.Examples of CVACs include:• Peripherally inserted central catheters (PICCs). Sometimes called long lines. – Long, thin lines designed for placement in one of the larger veins near the heart. Used when a person needs intravenous medication, chemotherapy, or fluids for an extended period of time. Typically, these types of medications quickly cause smaller veins to clot off, so they must be delivered into the larger veins closer to the heart. May also be used when someone requires frequent blood sampling.• Ports (implantable)• Dialysis catheters• Total parenteral nutrition (TPN) lines• OthersDrainages• Abscess drains• Chest tubes• Percutaneous nephrostomies/stents• Biliary drains/stents• Gastrostomy tubesWith some medical conditions, it is necessary to place a catheter into an organ or body cavity to removeunwanted fluids such as blood or urine. If it is required that the drainage occurs over an extended period oftime, such as days, weeks, or even months, it is necessary to properly secure the catheter in the drainage site.This is accomplished by using a Cope loop or lockable pig-tail catheter. With this type of catheter, theinterventional radiologist is capable of forming a curl at its distal end, thereby creating an efficient means toprevent the catheter from being dislodged.BiopsiesDepending upon the facility, biopsies may be performed by either an interventional radiologist or a bodyradiologist.Interventional Oncology• Many new minimally-invasive techniques.• Directly target cancer in the lung, liver, and kidneys.© 2009 General Electric Company. All rights reserved. 11 of 20
  • 12. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and Test• Local ablation – Less invasive, shorter recovery time. – Imaging is used to confirm treatment zone. – Radio frequency ablation (RFA) = burn it. – Cryoablation = freeze it.• Arterial treatments – Chemoembolization – Radioembolization – Allows high dose chemotherapy (or radiation) directly into the tumor, without the systemic side effects.Uterine Fibroid Embolization (UFE)• Benign tumors of uterus• Very common in 30- to 50-year-old women.• Symptoms: – Heavy bleeding – Bulk symptoms (urinary, constipation) – Pain and cramping – InfertilityPain Management• Vertebroplasty• Kyphoplasty• Epidural steroid injections• Nerve blocks• Facet blocks• Numerous other pain proceduresVaricose Vein Treatments• Endovenous laser ablation, sometimes called endovenous laser therapy (EVLT). – Modern alternative to “stripping.” – Destroy refluxing veins with heat.• Ambulatory phlebectomy – Removal of bulging varicose veins. – Microincisions (1 to 2 mm)• Sclerotherapy – Injecting veins with a detergent to occlude them.© 2009 General Electric Company. All rights reserved. 12 of 20
  • 13. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestCase StudiesCase One• Seventy-five-year-old woman.• Progressive abdominal pain, especially post-prandial.• Fifteen pound weight loss over six months.• Pertinent medical history: coronary artery disease, hypertension.• Long history of smoking. Quit five years ago.• Colonoscopy: ischemic colitis of cecum.• One month follow-up: – Resolved abdominal pain. – Gained weight.• Mesenteric ischemia MRA/CTA – Confirm diagnosis. – Determine measurements (diameter/length stent needed). – Evaluate all three mesenteric vessels. – Evaluate for other causes of pain.Case Two• Fifty-five-year-old man.• CT scan for abdominal pain. Cause not seen.• Incidental 2.5 cm right upper pole solid renal mass.• No other significant findings.• Presumed renal cell carcinoma. – Options: Partial nephrectomy. Nephrectomy. Local ablation (cryoablation/RFA). Watchful waiting.• Pertinent medical history: coronary artery disease, coronary artery bypass graft surgery, low ejection fraction (i.e., not a surgical candidate).• Referred for cryoablation.• When performing interventional oncology: – Obtain pre- and post-contrast enhanced CT / MRI. Response based on the degree of enhancement. Size of lesion is secondary (i.e., the treatment zone is intentionally larger than the tumor). Distinguish calcification/blood from tumor.© 2009 General Electric Company. All rights reserved. 13 of 20
  • 14. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestCase Three• Eighty-three-year-old woman.• Chief complaint: progressive low back pain.• Refractory to narcotics.• Pertinent medical history: osteoporosis, atherosclerosis.• Lumbar spine films obtained, no films available for comparison.• Requested to perform kyphoplasty at eleventh thoracic (T11) and first lumbar (L1) vertebral segments.• Physical exam findings: – Diffuse spinal and paraspinal tenderness. – Negative straight leg raise. – No weakness.• Next step: – Imaging to determine chronicity of fractures. MRI. Bone scan.• Follow-up: – Significant improvement in pain. – Off narcotics.• Before performing vertebral augmentation: – Advanced imaging is essential (especially MRI). – Avoid unnecessary procedures. – Increase success rates. – MRI: Stir/T2 fat saturation; post gadolinium.Notes:© 2009 General Electric Company. All rights reserved. 14 of 20
  • 15. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestAppendix A: PresentersKit Czarnecki, B.A., R.T. (R)X-ray TiP-TV Program ManagerGE HealthcareJames M. Walker, M.D.Interventional RadiologistMilwaukee Radiologists, Ltd.Milwaukee, WisconsinAppendix B: ResourcesResource used by Dr. WalkerRosch, J., Keller, F., and Kaufman, J., "The Birth, Early Years, and Future of Interventional Radiology," Journal ofVascular and Interventional Radiology, 2003, 14: 841-853.Electronic ResourcesAmerican College of Radiology: http://www.acr.orgAngioDynamics® Incorporated: http://www.angiodynamics.comMedcyclopaedia: http://www.medcyclopaedia.comMerriam-Webster OnLine: http://www.merriam-webster.com/dictionary/Society of Interventional Radiology: http://www.sirweb.orgNOTE: The Internet is an ever-evolving environment and links are subject to change without notice.© 2009 General Electric Company. All rights reserved. 15 of 20
  • 16. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestAppendix C: Glossaryangioplasty: a technique to mechanically widen a blood vessel that is narrowed or totally obstructed.anomaly: deviation from the average or norm; anything structurally unusual or irregular or contrary to a general rule.atherosclerosis: arteriosclerosis characterized by irregularly distributed lipid deposits in the intima of large and medium-sized arteries. Such deposits are associated with fibrosis and calcification.CABG: coronary artery bypass graftCAD: coronary artery diseasecannulate: to insert a cannula (catheter) into a cavity, duct, or vessel for the drainage of fluid or the administration of medication (contrast).cirrhosis: a consequence of chronic liver disease characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated) leading to progressive loss of liver function.claudication (intermittent): cramping pain and weakness in the legs and especially the calves on walking that disappears after rest and is usually associated with inadequate blood supply to the muscles.cryoplasty: a type of therapy for vascular disease that both cools and dilates a stenosed vessel at the same time.CT: computed tomographyCTA: computed tomography angiographyembolization: therapeutic introduction of various substances into the circulation to occlude vessels, either to arrest or prevent hemorrhaging or to devitalize a structure or organ by occluding its blood supply.empyema: the presence of pus in a bodily cavity (as the pleural cavity).ethiodol: brand of ethiodized oil that is a sterile injectable radiopaque diagnostic agent, typically used in hysterosalpingography and lymphography.ischemia: deficient supply of blood to a body part (as the heart or brain) that is due to obstruction of the inflow of arterial blood (as by the narrowing of arteries by spasm or disease)methacrylate: polymethyl methacrylate (PMMA); bone cement.MRA: magnetic resonance angiographyphlebectomy: excision of a segment of a vein, performed sometimes as a cure for varicose veins.PMH: pertinent medical historypostprandial: after a meal.PTFE: polytetrafluorethylene; a synthetic material used in the production of arterial prostheses (grafts).RFA: radio frequency ablation© 2009 General Electric Company. All rights reserved. 16 of 20
  • 17. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and Testsclerotherapy: a technique where a vein is injected with a chemical solution which causes the vessel to sticktogether. As a result, the treated vessel can no longer hold blood. It shrivels and is eventually reabsorbed bythe body. Sclerotherapy is used to treat spider veins and small varicose veins.splenomegaly: enlarged spleen.stenosis: a constriction or narrowing of a duct or passage; a stricture.thrombolysis: destruction of a thrombus or blood clot.TIPS: transjugular intrahepatic portosystemic shuntUFE: uterine fibroid embolizationvarices: abnormally dilated and lengthened veins, arteries, or lymph vessels; especially varicose veins.© 2009 General Electric Company. All rights reserved. 17 of 20
  • 18. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and TestAppendix D: Post-Test XR: Introduction to Interventional Radiology LMS Course Number: 3374To be eligible for CE credit, you MUST view the video presentation first. Then complete the post-test on the GEHealthcare Learning System (hls.gehealthcare.com) by the due date listed online.1. In 1953, Dr. _____ invented a method to safely introduce a catheter into a blood vessel. a. Seldinger b. Dotter c. Forssmann d. Egas-Moniz2. Dr. _____ is often referred to as the father of interventional radiology. a. Seldinger b. Dotter c. Gruntzig d. Lindenthal3. The diameter of wires used during interventional radiology procedures is measured in _____. a. French b. millimeters c. hundredths of an inch d. centimeters4. A _____ is used so that the blood vessel is traumatized only once during an interventional procedure. a. balloon b. catheter c. wire d. sheath5. One French is equal to _____ mm. a. 0.33 b. 0.50 c. 1 d. 26. Microcatheter is a generic term for a catheter that is less than _____ French. a. 1 b. 2 c. 3 d. 47. _____ are small, flexible tubes made of plastic or wire mesh, used to hold open vessels or other tubular structures that are narrowed or blocked. a. Balloons b. Stents c. Embolics d. Cryonics© 2009 General Electric Company. All rights reserved. 18 of 20
  • 19. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and Test8. _____ are devices or materials used to intentionally clot off blood vessels, typically in the case of unwanted bleeding. a. Stents b. Catheters c. Balloons d. Embolics9. According to Dr. Walker, the interventional imaging technologist has three roles: prepatory, technical, and intellectual. a. True b. False10. _____ is an interventional procedure that removes hard plaque in the blood vessels by passing it through a catheter and out of the body. a. UFE b. Atherectomy c. Thrombolysis d. Angioplasty11. During a/an _____ procedure, a shunt is placed between the portal and hepatic veins to decrease the pressure in the portal venous system. a. UFE b. PICC c. TIPS d. IVC filter12. _____ is/are a common symptom of portal hypertension. a. Claudication b. Non-healing foot ulcers c. Ureteral fibroids d. Variceal bleeding13. All of the following are considered venous access devices, EXCEPT a/an _____. a. chest tube b. PICC line c. dialysis catheter d. implantable port14. _____ are long lines placed near the heart and commonly used to deliver antibiotics or chemotherapy, or when frequent blood sampling is required. a. Stents b. PICC lines c. IVC filters d. Chest tubes15. Once a _____ catheter has been positioned, the distal end of the catheter can be curled so that it remains in place. a. Seldinger b. Dotter c. Cope loop d. PICC© 2009 General Electric Company. All rights reserved. 19 of 20
  • 20. GE Healthcare XR: Introduction to Interventional RadiologyREV 0 Program Supplement and Test16. When performing an arterial chemoembolization, _____ is added to the chemotherapy agent in order to demonstrate radiographically that the tumor has been effectively targeted. a. polyvinyl alcohol b. methacrylate c. detergent d. ethiodol17. Radio frequency ablation destroys a tumor by freezing it. a. True b. False18. Which of the following statements is NOT representative of the UFE procedure? a. Uterine fibroids are hypovascular. b. Blood vessels that feed uterine fibroids are embolized with PVA particles or microspheres. c. This procedure is an alternative to hysterectomy or myomectomy. d. Magnetic resonance imaging is obtained before and several months after the procedure.19. _____ is a procedure that uses heat from a laser to destroy the inner lining of a varicose vein so that it is no longer a conduit for blood. a. Sclerotherapy b. Phlebectomy c. EVLT d. Kyphoplasty20. _____ may occur when the blood supply is acutely returned to previously ischemic tissues. a. Pulmonary embolus b. Hypertension c. Atherosclerosis d. Reperfusion edema© 2009 General Electric Company. All rights reserved. 20 of 20