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SJHH / Health Services/ Diagnostic Services/ Diagnostic Imaging/ Centre for Interventional Radiology and Oncology (CiRO)

Centre for Interventional Radiology and Oncology (CiRO)

What this program does...

Interventional Radiology

Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments. Interventional Radiology includes a vast range of procedures ranging from angioplasty to embolisation to radiofrequency ablation of tumours. Most of the procedures are performed using percutaneous approaches, which are image guided. These procedures can replace traditional surgical techniques with lower complication rates than conventional techniques and shorter hospital stays.

Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery. Many of the procedures require patient preparation and some diagnostic lab tests prior to Intervention. The section on patient preparation describes both the general preparation and specific preparation required for individual procedures. We have also included a section with all the patient information leaflets available for download.

Interventional Oncology

Interventional Oncology (IO) is a subspecialty of IR that uses imaging guidance to deliver minimally invasive therapies to patients with cancer. It is considered the "4th pillar" of cancer therapy alongside medical, surgical, and radiation oncology worldwide.

Scope of Services

The St. Joseph's Healthcare Interventional Radiology Service delivers high quality, innovative, patient focused clinical services supported by an active research environment.

The Interventional Service is founded on a team of specialist technologists, nurses and Interventional radiologists working in close collaboration with clinical colleagues; particularly nephrology, urology, vascular surgery, general surgery, thoracic surgery, ENT, obstetrics and gynecology and other medical specialties.

Interventional Radiology can have a life saving role for the acutely ill patient, particularly for the treatment of hemorrhagic emergencies. The Interventional service has a dedicated on call service to ensure continuous access to emergency treatment.

Interventional Radiology Outpatient Clinic

There is a formal radiology outpatient clinic to follow up with patients who have undergone certain IR procedures. This assists in the continuing care of the patient. The IR clinic helps to optimize patient care by providing the interventional radiologist with the opportunity to meet the patient prior to the procedure and to obtain a pertinent history and physical examination. The procedure can be explained to the patient in full and treatment options are discussed.

Addressing the need for pre-procedural labs, radiographs, or referral prior to any intervention reduces the chance of delay on the day of the procedure. Post-procedure follow-up is coordinated through the clinic.

Patient Preparation

Documentation

All patients attending the interventional suite require the following documentation:

  • X- ray requisition form with all the relevant clinical information 
  • Case notes 
  • Patient drug chart (CMAR)
  • Fluid prescription and fluid balance sheets if on IV fluids/output assessment 
  • Baseline recordings including blood glucose if relevant 
  • Name band

Blood Tests

A coagulation screen should be done based on the departmental guidelines.

Summary for US Guided Intervention

  • INR required in all procedures
  • PTT only in patients with heparin
  • Platelet count routinely required only for liver, renal biopsy, and RFA
  • Withhold Plavix only for 5 days - Liver biopsy and drainages
  • Withhold Aspirin/Plavix ONLY for Renal biopsy and RFA for 5 days
  • Warfarin should be stopped as per current practice (5 days) and INR rechecked
  • Fractionated heparin: withhold 24 hours or up to two doses for Renal biopsy/RFA

Summary for CT Guided Intervention

  • INR required in all procedures
  • PTT only in patients with heparin
  • Platelet count routinely required only for Renal Biopsy and RFA withholdPlavix only for 5 days
    • Lung Biopsy
    • Chest/Abdominal drainages
  • Withhold Aspirin/Plavix for Renal biopsy and RFA for 5 days
  • Warfarin should be stopped as per current practice (5 days) and INR rechecked
  • Fractionated heparin: withhold 24 hours or up to two doses for Renal biopsy/RFA 

Summary for Angio Intervention

  • INR required in all procedures
  • PTT only in patients with heparin
  • Platelet count routinely required for:
    • New Nephrostomy
    • New PTC/Cholecystomy insertion
  • Withhold Plavix only for 5 days
    • Arterial angioplasty/stenting
    • G, GJ tubes
    • Dialysis line insertion
    • Embolisation
  • Withhold Aspirin/Plavix only
    • Nephrostomy/PTC for 5 days
  • Platelet count routinely for Nephrostomy, PTC
  • Warfarin should be stopped as per current practice and INR rechecked
  • Fractionated heparin: withhold 24 hours or up to two doses for renal biopsy/RFA

Consent

Patients will be asked for consent in the department by the Interventional Radiologist carrying out the procedure.

Fasting

Patients should fast for approximately 4 hours. If patients are having gastroduenal procedures, they should fast for 8 hours and hydrate accordingly.

Specific Preparations

Biliary Drainage

  • I.V fluids to hydrate pre-procedure
  • 1.0g Ancef about 1 hour pre-procedure (unless allergy noted)

Gastrostomy/Jejunostomy

  • Ideally patients should have a nasogastric tube in situ (not always possible)

Pelvic Angiography/Procedures

  • Observation of the 10 day rule for women between 13 and 55.

We ask that you do not bring any valuables with you as the hospital cannot be responsible for lost or stolen personal items. 

Patient Safety Checklist

IRPaSS Interventional Radiology Patient Safety Screening

The protocol and concept was adapted from the World Health Organization (WHO) Surgical Safety Checklist to reflect the nature of Interventional Radiology (IR). It is designed as a collaborative process and is currently in use by the entire IR team: Interventional Radiologists, Nurses and Technologists involved in all image guided interventional procedures. The checklist involves a safety checklist, “pause” prior to commencing the procedure, and involves a number of components that must be met prior to and after the procedure. In addition to the checklist, the protocol was implemented with a team brief at the beginning of the list of cases, and a debriefing at the end, as is the case in most surgical procedures. The checklist is divided into three main sections: patient information, pre-procedure information, and procedure related events. The patient information section includes initially identifying the “vitals” as per WHO recommendations – patient identification information. Other components of the pre-procedure section include: allergies/asthma, coagulation status, renal and liver function, cardiac history and in the case of radiological procedures, pregnancy. In addition, a procedure related section involves vital components of the procedure itself: consent, side marking, administration of procedural medications and vital parameters. The checklist is organized in such a way that the person completing it can tick one checkbox for “yes”, or “N/A”, initial, and include comments, if necessary. Initialing in each section of the checklist ensures accountability if different components of the checklist are performed by different members of the team. The simplicity of the process ensures consistency throughout the checklist, as well as between one procedure and the next. ??The procedure section includes the total fluoroscopy time and dose, as well as the total volume of contrast media administered. This allows for monitoring and future auditing to assure that patient safety is not compromised. This section also involves ensuring that the ward to which the patient is to be transferred has been informed and that aftercare instructions are communicated to the patient. The former represents a novel component to routine checklists, and is part of the attempt to ensure efficient and safe patient transfer, while reducing turnover time between one procedure and the next. After the procedure is completed, the checklist is scanned into the central Picture Archiving and Communication System (PACS).

Please click here to download the Safety Checklists & Protocols at St. Joseph's Healthcare.

Procedures Performed

Arterial Interventions

  • Diagnostic peripheral angiography, angioplasty and stent placement
  • Thrombolysis
  • Renal angiography, angioplasty and stent placement
  • Mesenteric angiography, stent insertion and embolisation
  • Tumour embolisation 
  • Postpartum hemorrhage management 
  • Bronchial artery embolizations
  • Vascular malformation management
  • Uterine Artery Embolization

Venous Interventions

  • Venography 
  • Dialysis catheter placement 
  • Venoplasty and stent placement 
  • Haemodialysis access interventions including mechanical thrombectomy 
  • Varicocoele embolisation 
  • IVC filter placement and retrieval 
  • Venous stenting 
  • Venous sampling 
  • Ovarian and pelvic vein embolisation 
  • Removal of intravascular foreign bodies

CT Guided Intervention

  • Lung Biopsy
  • Renal Mass Biopsy 
  • Abdominal Lesion Biopsy
  • Drainage of Fluid Collections
  • Renal Tumor ablation

US Guided Intervention

  • Liver Biopsy
  • Kidney Biopsy
  • Lymph Node Biopsy
  • Fluid Drainage

Gastrointestinal Interventions

  • Percutaneous gastromy and gastrojejunostomy insertions
  • Biliary drainage
  • Transjugular liver biopsy

Musculoskeletal Interventions

  • Bone Biopsy
  • Facet joint injection

Tumour Ablation

  • Renal Tumour Ablation

Urological Interventions

  • Percutaneous nephrostomy insertion and change
  • Antegrade ureteric stent placement
  • Retrograde ureteric stent exchange.
  • Renal artery embolisation

Post Procedure Care

Vascular Procedures

Arterial Procedures

  • Vitals observation for two hours

Puncture Site related advice

  • 4-8 Fr access -  3 hrs flat and  1 hrs bed rest 

Venous Procedures

  • Flush catheters at the end of the procedure 
  • Sodium citrate lock for dialysis catheters 
  • Routine observations for two hours 
  • Puncture site(neck) and line exit site for bleeding

Gastro-Intestinal Procedures

Gastrostomy/Jejunostomy

  • Vitals observation for two hours 
  • NBM for 6 hours 
  • Clear Fluids introduced at 4 hours 
  • Feeding commenced after 6  hours
  • Flush the tube after every usage

Biliary Procedures

  • Vitals observation for two hours 
  • Drain on free drainage 
  • Signs of perforation- Biliary peritonitis

Genito-Urinary Procedures

  • Vitals observation for two hours 
  • Drain on free drainage

Patient Information

What You Need to Know About Angiograms

What You Need to Know About Angioplasty and Vascular Stenting

Contact us

CiRO (Reception)
Telephone: 905-522-1155 ext. 35387
Fax: 905-540-6576

Angio Interventional Booking
Telephone: 905-522-1155 ext. 35387
Fax: 905-540-6576

US guided biopsy
Telephone: 905-522-1155 ext. 35387 
Fax: 905-540-6576

CT guided biopsy booking
Telephone: 905-522-1155 ext. 35278
Fax: 905-521-6166

CiRO Recovery Area
Telephone: 905-522-1155 ext. 33836

Useful Links

Canadian Interventional Radiology Association

Society of Interventional Radiology (SIR)

British Society of Interventional Radiology (BSIR)

Cardiovascular and Interventional Radiology Society of Europe (CIRSE)

Interventional Radiology Society of Australia and New Zealand

RadiologyInfo.org