Question 26 from the second paper of 2012 and the identical Question 6 from the second paper of 2006 ask the trainee to discuss the role of interventional radiology. They may be at least as vague as the questions that asked about the role of ultrasound in critical care. The questions favoured a trainee who can come up with a structure for this question quickly, and spout a bunch of indications. The answer offered below divides the issue into therapeutic and diagnostic roles, and then discusses the limitations of interventional radiology as a whole. This sort of structure lends itself well to a tabulated format, which should be memorable and easily reproduced should such a question ever appear again.

The Role of Interventional Radiology in Critical Care
Application Role Advantages and Limitations
Generally
  • Exposure to IV contrast
  • Risks of vascular access
  • Risks of transport ("hostile" environment of the interventional radiology suite)
  • Demand for skilled operators
Diagnostic Diagnosis of cerebral vasculitis
Localisation of intestinal haemorrhage
  • Opportinuty to embolise within the same procedure
Gold standard for confirmation of brain death
  • Preferred strategy
  • More invasive than Tc99 HMPAO
Therapeutic Radiologically guided drainage
  • Less invasive than surgical approach
Coiling of aneurysms
  • Equivalent to surgery in efficacy
Vasospasm vasodilation
  • Preferred strategy
TIPS procedures
  • Safer than surgical shunt
Embolisation of bleeding vessels
  • Available when surgical control fails
Coronary intervention
  • Preferred strategy
IVC filter insertion
  • Preferred strategy
Vascular access
  • Available when all other approaches fail

References

Harris, K. G., et al. "Diagnosing intracranial vasculitis: the roles of MR and angiography." American journal of neuroradiology 15.2 (1994): 317-330.

Hunnam, G. R., and C. D. R. Flower. "Radiologically-guided percutaneous catheter drainage of empyemas." Clinical radiology 39.2 (1988): 121-126.

Nicolaou, Savvas, et al. "Ultrasound-guided interventional radiology in critical care." Critical care medicine 35.5 (2007): S186-S197.