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Musculoskeletal Interventional Radiology: What Every Doctor Should Know - Dr Rajesh Botchu

Dr Rajesh BotchuWritten by Dr Rajesh Botchu Published On 2024-10-28T18:08:15+05:30  |  Updated On 29 Oct 2024 12:53 PM IST
Musculoskeletal Interventional Radiology: What Every Doctor Should Know - Dr Rajesh Botchu
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Interventional radiology (IR) is a cornerstone of modern medicine, touching upon virtually every medical and surgical speciality. It plays a key role in the diagnosis and management of conditions across the breadth of clinical medicine.

Within this wider field, musculoskeletal intervention utilises image-guided techniques to perform minimally invasive procedures diagnosing and treating a range of conditions such as tumours, rheumatological conditions, trauma, degenerative disease, and more.

There are numerous procedures, this article will provide a taste of the most pertinent procedures to illustrate how musculoskeletal IR can contribute to patient care across a range of applications.

The overarching principle of most musculoskeletal IR procedures is to use imaging to guide a needle to a given area. This can be done for diagnosis, most commonly with percutaneous imaging-guided biopsy (IGB) where a needle is introduced through the skin into a lesion under ultrasound or CT (Computed Tomography) guidance, thereby obtaining tissue samples from suspicious bone or soft tissue lesions.

Alternatives are either a non-guided biopsy (suitable only for superficial lesions) or open surgical biopsies (which are far more invasive). Percutaneous IGB is used mainly for tumours, but also for infections and inflammatory conditions. Accurate tissue diagnosis is essential for guiding further management, including surgery or oncologic treatment.

Therapeutic uses employ the same principles. For example, image-guided injections of corticosteroids, local anaesthetics, hyaluronic acid, biologics, and blood products amongst others help pain relief and inflammation control in chronic conditions like osteoarthritis, tendinitis, or bursitis.

To do so, the injection is directed towards joints (intra-articular), tendons, or soft tissue spaces. Ultrasound, fluoroscopy, and CT are all methods which can be used to guide the needle to the correct site with each modality having its own strengths.

Although procedures can and are also performed without imaging by using landmark techniques, deeper sites of injection or those near vulnerable structures (e.g. nerves and vessels) necessitate imaging to ensure safe and accurate delivery.

Other curative treatments include the destruction of tumours (ablation) using needle tips which generate ice balls (cryotherapy) or heat (radiofrequency ablation).

Symptomatic relief can also provide great patient benefit by enabling mobilisation, such as introducing cement into spinal fractures via a needle (vertebroplasty) or blocking pain sensation from nerves (nerve block).

These are only some examples of the wide range of procedures seen in musculoskeletal IR. Almost every clinician will encounter patients who benefit from such procedures and will benefit from an awareness of the basic principles of using imaging to perform minimally-invasive procedures to facilitate treatment and diagnosis across a range of conditions.

Image showing CT guided bone biopsy of tumour

Images showing radiofrequency ablation of osteoid osteoma of tibia

Images showing radiofrequency ablation of osteoid osteoma of cervical spine

Images showing cryotherapy of fibromatosis

Images showing three level vertebroplasty for osteoporotic fractures

Image showing sacroplasty for osteoporotic fractures

Image showing cementoplasty for spinal metastasis

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article

musculoskeletal interventional radiologydr rajesh botchumusculoskeletal interventionmusculoskeletal
Dr Rajesh Botchu
Dr Rajesh Botchu

    Dr Rajesh Botchu is a Consultant Musculoskeletal Radiologist at Royal Orthopedic Hospital, Birmingham, UK. He did his radiology training from Leicester and subspeciality musculoskeletal training from ROH, Birmingham, NOC, Oxford and CIM, Geneva, Switzerland. He was the clinician of the year in 2020. He regularly lectures at regional, national and international meetings. He has a strong research portfolio with over 354 publications and 39 book chapters in addition being co editor of two Springer diagnostic imaging series. Several signs are named after him including Aamer-botchu sign, Iyengar-Botchu confluence, Haleem-Botchu classification. He is member for several musculoskeletal radiology societies. He is cofounder of free teaching MSK Radiology4U app and website.

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