Episode 16: Interventional radiology with Bobby Chiong (part 1)

An overview of interventional radiology with Dr. Bobby Chiong, board-certified interventional radiologist and chair of radiology at SBH Health System, with a focused look at what IR’s all about, coordination between care teams, vascular access, and troubleshooting.

Takeaway lessons

  1. Interventional radiologists can’t do everything, but they potentially can do almost anything, and you usually won’t know what’s possible unless you ask. They have the potential to play a role in many situations which we never realize. Even if just a consultation to discuss a case (particularly in complex, multi-disciplinary situations), a good IR will be happy to have a conversation.
  2. Quote of the episode: “There’s all kind of procedures that I can do that you’ve never heard of… but I can’t tell you about them all, because there’s a lot of them.”
  3. Bridging the gap between primary teams and IR is best accomplished by building relationships. Get to know your interventional radiologists, speak to them in person, and make an effort to reach out to them rather than just typing in an order and awaiting magic.
  4. For nearly every vascular access attempt: ultrasound guidance, short-axis view, micropuncture needle.
  5. Fluoroscopy helps vascular access by ensuring correct depth of the wire and catheter and the correct vessel each step of the way. You can live without it, but it’s a big help.
  6. Can’t advance a wire? You’re not intravascular (dissecting the vessel, in the subcutaneous, or through the backwall), or you’re against a valve (try spinning the wire), or you’re hitting some stenosis or thrombosis.
  7. One reason IR gets lines you can’t is by setting up their ultrasound properly. Spend some time with a radiologist or ultrasound tech to learn to really optimize your view. They also have a whole lot of options for needles and wires you probably don’t, and subtle differences in wire stiffness, needle bevels, etc may make the difference.

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