The Past and Future of Interventional Radiology

Interventional radiology (IR) faces major challenges, as it has throughout its relatively brief history.This opinion piece will subjectively review the evolution of IR and address some of the major opportunities and challenges it faces.The exact starting point of IR, or image-guided interventional procedures, is not clear, but the field evolved from and is based on several specific advances.Access to the vascular system, for diagnostic purposes, was a widespread goal in medicine from the early 20th century, one that became clear not very many years after the first description of X-rays and their use by W.C. Roentgen in 1895.In the 1920s and 1930s, various individuals attempted, with varying degrees of success, to image the heart and the vessels of the brain, and to derive physiologic information from the cardiovascular system.These attempts were limited by complex vascular access, limited imaging capability, and relatively toxic contrast agents.Access to the arteries and veins was difficult and limited until Sven Ivor Seldinger, then a resident physician in radiology in Sweden, developed a method of accessing the femoral artery without a cut-down by using a hollow-bore needle with a removable trocar and a threadable guiding wire.This was published in 1953. 1 Interestingly, Dr. Seldinger did not try to patent his technique and made no money from it.He spent his entire subsequent career as a general radiologist in a relatively rural practice in Sweden.Like many but not all major advances in IR, Seldinger's invention was based on the work of several prior investigators-it was a major step forward, but not a leap.Due to this technical advance, angiography became widely available and widely utilized, but for diagnostic purposes, but soon investigators began using angiography for information beyond the anatomical.In the 1960s, Herbert L. Abrams, at Stanford University in California, following Fellowship training in cardiovascular angiography in Sweden, described the use of epinephrine intra-arterially during renal angiography.He demonstrated that normal blood vessels contracted following epinephrine infusion, but the arteries in renal cell carcinomas (RCCs) did not, allowing preoperative identification of RCC. 2