ABSTRACT
The interventional radiologist uses the standard imaging techniques that best define the target organ or lesion to guide minimally invasive vascular and nonvascular procedures. These procedures are adapted from standard surgical procedures to establish a diagnosis, initiate therapeutic management, or provide palliative care for patients with cancer. Minimally invasive approaches are often safer, less traumatic, and less painful but equally therapeutic and more cost effective than the surgical alternative for the patient and the health care provider. This is particularly important in the critically ill patient in the intensive care unit (ICU), in whom all procedures carry a higher than average risk. Procedures utilized in the care of patients with neoplasms include imaging-guided biopsy and drainage (gastrostomy, nephrostomy, biliary drain, and cholecystostomy); arterial interventions (infusion, embolization, chemoembolization, balloon angioplasty, and stent=stent-graft placement); and venous interventions (insertion and repositioning of long-term central venous access devices, stents, inferior vena caval filters; foreign body retrieval; thrombolysis; transjugular liver biopsy; and insertion of a transjugular intrahepatic portosystemic shunt [TIPS]), among others. State-of-theart imaging modalities, including fluoroscopy, ultra-
sound, computed tomography (CT), and magnetic resonance imaging (MRI), are utilized to guide the placement of needles, catheters, and devices directly to the target site deep within the body through a small skin incision. These procedures often are performed under local anesthesia with intravenous sedation and typically do not require general anesthesia.
