Innovative Angiography Suite

We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Well, hello and welcome to our show. I am Deborah Howell and today's guest is Dr. Amir Ronaghi, Interventional Radiologist at Orange Coast Memorial. Dr. Ronaghi is board certified in diagnostic radiology and specializes in vascular and interventional radiology. The angiography suite is a unique innovation which takes minimally invasive capabilities to a higher level with advanced imaging technology supporting a wide variety of interventional vascular procedures. Dr. Ronaghi is here to tell us about the various types of procedures performed in the suite, from diagnosis to treatment, and how this technology benefits patients. Welcome, Dr. Ronaghi.

Amir Ronaghi, MD: Good morning. Thank you for inviting me to this podcast.

Deborah Howell (Host): It is definitely our pleasure, and we're glad you're here. Can you tell us a little bit about what interventional radiology is?

Amir Ronaghi, MD: Great. Thank you for asking that question. Because this is a relatively new field and is not well known beyond the medical community. Most of your listeners are probably familiar with the field of diagnostic radiology, where an x-ray, a CAT scan or ultrasound or MRI are used to find out what's going on with the patient. For example, if you have a broken bone, you may take an x-ray to find out whether your bone is in fact broken or not. In the field of interventional radiology, we used imaging guidance to perform minimally invasive procedures. For example, in the old times, if you had an abscess in your abdomen, the surgeon had to open you up and drain the abscess. Now with the imaging guidance, using either ultrasound or CT, one can place a small tube into the abscess and drain the abscess. This is much quicker without need for general anesthesia with pinpoint accuracy and without needing to open up the patient with much faster recovery for the patient.

Deborah Howell (Host): Did you say without anesthesiology?

Amir Ronaghi, MD: Yeah, absolutely. Yes, we basically give what we called conscious sedation, which we give some medication to make you a little sleepy. It's called moderate sedation, but there's no anesthesiology involved.

Deborah Howell (Host): Yes. That's impressive.

Amir Ronaghi, MD: Yeah.

Deborah Howell (Host): All right, let's move on a little bit. What is an angiography suite?

Amir Ronaghi, MD: Well, Angiography Suite is the place where all the fascinating things that the interventional radiologist can do take place. It is basically a room that has a table where the patient lies, a C-arm, which is basically a C-shaped instrument that produces and captures the images. It has a TV monitor that allows the practitioner to see the images, and often it also has an ultrasound unit. In a highly advanced lab, such as the one at Orange Coast Memorial, there are also powerful computers that process the images in a few different ways and deliver the data in a form that is most useful to the interventional radiologist in seconds. The room is usually staffed by one or two nurses, two x-ray technologists, and a physician who performs the procedure.

Deborah Howell (Host): It sounds very futuristic.

Amir Ronaghi, MD: Yes, it is. You should see our room. It looks completely futuristic.

Deborah Howell (Host): I love it. I'm sure it's very shiny. Now, what types of procedures can be performed in this angiography suite?

Amir Ronaghi, MD: Well, there are a wide variety of procedures that can be performed. With the minimally invasive techniques, we can treat abscesses, perform biopsies, treat cancers, detect abnormalities of vessels and treat all sorts of conditions that previously required extensive surgery and prolonged hospitalization. For example, we can study vessels and see if they're narrowed or not, and we can treat them by performing balloon angioplasty, where we put a balloon and open up the vessel, or putting a stent, which is basically a metallic tube, to keep things open. Sometime we perform life-saving procedures. For example, for those patients who, let's say, have an accident and have internal bleeding, we can stop the blood vessels that are causing the bleeding and therefore save the patient from a major internal injury.

Deborah Howell (Host): Right. So it appears to me as you're talking that this technology allows physicians to both diagnose and treat patients. Is that right?

Amir Ronaghi, MD: That's correct. It is basically a one-stop shop when you come in and we can diagnose the patient and also perform procedures that could be life-saving or improve the quality of life significantly.

Deborah Howell (Host): Unbelievable. I'm so glad we're in the year 2015, aren't you?

Amir Ronaghi, MD: Oh, yes, definitely.

Deborah Howell (Host): So how is this technology both beneficial to patients and to you as physicians?

Amir Ronaghi, MD: Well, the technology is beneficial to both because it's great. For example, one of the things that we do in the interventional radiology lab is what we call the liver chemoembolization, and this is for treatment of cancer in the liver. Now, what we do is basically we put a small tube or catheter, and we go into the blood vessel that supplies the tumor in the liver, and usually the... to deliver the therapeutic material to the tumor for the therapy, it is essential to identify the liver vessels very accurately.

Deborah Howell (Host): Right.

Amir Ronaghi, MD: But the liver has a very complex vasculature, making the precise identification of the tumor-feeding vessels somewhat challenging. It often requires significant time, radiation, and contrast. Now we have software, talking to you about the powerful computers that we have, we have software that helps us plan this embolization procedure. It basically highlights the vessels traveling from the catheter tip to the vicinity of the liver growth or liver cancer, and it effectively acts as like a GPS and guides us where we need to go to be most effective.

Deborah Howell (Host): That's sincerely incredible. Really amazing. Wow. All right. What should a patient look for, doctor, when looking for an interventional radiologist?

Amir Ronaghi, MD: Well, I think in order to have a good outcome, you basically need to have skilled interventional radiologists. But in addition, you also have to have the latest tools that are available to help the patient to maximize the benefit of the treatments while minimizing the risk to the patient. At the Orange Coast Memorial, we have five very skilled interventional radiologists who have lots of experience. And as I mentioned, we have the latest and greatest tools to help our patients have a favorable outcome.

Deborah Howell (Host): Right. I was just going to say I bet outcome is all, and that's why it's so important for a patient to utilize a hospital that offers this new technology.

Amir Ronaghi, MD: Absolutely. I definitely agree with you.

Deborah Howell (Host): Give yourself the best possible chance for a very full and happy recovery, right?

Amir Ronaghi, MD: Absolutely, and in the shortest amount of time. Most of the recovery in our lab from the procedures that we do is only a few hours, and most procedures are done as outpatient for patients and can go home. Even a procedure as complex as what I mentioned to you about the liver chemoembolization where we deliver chemotherapy to the tumor cells, you know, the patients usually go home the next day because the side effect is so minimal because the chemotherapy agent is just delivered to the tumor and the rest of the body does not see the chemotherapy agent, and therefore the side effects are much, much less.

Deborah Howell (Host): That is fantastic. Now, I suppose patients are wildly happy about this for their physical outcome, but also in their wallets they're a little bit happier because, you know, a one-night stay is far cheaper than staying for a week like patients used to have to.

Amir Ronaghi, MD: Oh, absolutely. It's great care for the patient, and the patients are obviously most comfortable at home, and they get to go home soon after the procedure.

Deborah Howell (Host): What's on the horizon, Dr. Ronaghi, in the future?

Amir Ronaghi, MD: Well, there are a lot of the different procedures, minimally invasive procedures that are coming up. For example, people are experimenting with what's called the prostate artery embolization to shrink the prostate. And instead of having to have surgery, it's possible to perform this procedure and shrink the prostate gland and therefore decrease the risk of impotence. Currently, we use uterine artery embolization for uterine fibroids in women who don't want to have hysterectomy. And this is definitely a viable option, which helps shrink the fibroid and decrease their bleeding. There is even talk of maybe instead of having weight loss surgery, maybe embolizing the blood vessel that goes to the stomach and possibly help in reducing the weight that way without having major surgery. Of course, some of these are on the horizon and they need to be studied further to determine whether they're going to be effective or not.

Deborah Howell (Host): Absolutely. Well, we have a lot of things to look forward to. Thank you so much for taking time out of your busy, busy day to be on the show, Dr. Ronaghi.

Amir Ronaghi, MD: Thank you so much for inviting me, and I hope that the information is useful to your listeners.

Deborah Howell (Host): Extremely useful. Thank you again. For more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. We will see you soon for another weekly dose of wellness brought to you by MemorialCare Health Systems. Have yourself a fantastic day.