September 15, 2022

Radiology History: The Birth of Interventional Radiology

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Eric Cyphers, BS, M4, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, and Columbia University Department of Bioethics, New York, NY

headshotInterventional radiology was born from diagnostic radiology over a half-century ago, when two physicians thought to bridge the radiologist’s role from diagnosis to treatment1–4. “Was it possible to use the same diagnostic imaging tools that have revolutionized the practice of medicine to guide the real-time treatment of disease?” wrote Stanley Baum, MD, FACR, one of the founders of interventional radiology.4

A glimpse into the birth of interventional radiology would not be possible without first discussing the advent of the Seldinger technique, an elegant method to gain access to the body with only a needle, wire and catheter. Sven Ivar Seldinger, MD, was a Swedish radiologist from a family of precision tool workers and developed this technique during “a severe attack of common sense” in the early 1950s.5 Safe and easy access to the vascular system led to the field of diagnostic angiography using contrast material to selectively opacify various blood vessels within the body for diagnosis and surgical planning.4

Interventional radiology was conceived on Jan. 16, 1964, when Charles Dotter, MD, percutaneously dilated a stenosed segment of the superficial femoral artery in an 82-year-old woman with gangrenous ischemia who refused leg amputation1. He successfully dilated the stenotic vessel with a guidewire and Teflon catheter, and circulation returned to her limb. This was not only evident via radiologic imaging but also when the patient left the hospital on her own two feet1,3.

While Dr. Dotter used angiographic tools to increase blood flow in occluded arteries, Dr. Baum used them to stop blood flow in patients with gastrointestinal bleeding4. In the 1950s and ‘60s, a patient with gastrointestinal bleeding faced a massive clinical dilemma. The flexible endoscope and colonoscopy had not yet been invented, so patients with such bleeds were subjected to dangerous laparotomies in hopes of locating and treating the bleed. In the early ‘60s, Drs. Baum and Moreye Nusbaum, MD, not only began infusing contrast material through angiographic catheters to locate the site of bleeding via extravasation, but also began locally infusing vasopressin to stop the bleeding site2,6.

These seminal events marked the beginning of interventional radiology as we know it today with the catheter bridges the gap between diagnosis and treatment. The use of angiographic catheters to restore blood flow in cases of occlusion and stop blood flow in cases of gastrointestinal hemorrhage are two examples of the many innovations that have pioneered this branch of radiology.

In addition to celebrating the birth of interventional radiology, please join the ACR® in 2023 for our Centennial year celebration to mark another major milestone — a century of ACR quality, integrity, leadership and innovation. Our 100th anniversary gives us an opportunity to recognize and celebrate the world-changing achievements and contributions of ACR members. The College commends the lifesaving impact our members have had on radiology, patient care and society.

ACR members, leadership, volunteers and staff are working together to bring about the next century of innovation and to advance medical care. Look for more information about the celebration in the coming months, including historical trivia, terrific stories from members, articles in the ACR Bulletin, a Gala at the 2023 ACR Annual Meeting and more.

Learn about all specialties at RadiologyInfo.org.

 

References:

  1. Dotter C.T., Judkins M.P. “Transluminal Treatment of Arteriosclerotic Obstruction: Description of a New Technic and a Preliminary Report of Its Application,” Circulation, November 1964;30(5):654–70.

  2. Baum S., Nusbaum M. “The Control of Gastrointestinal Hemorrhage by Selective Mesenteric Arterial Infusion of Vasopressin,” Radiology, March 1971;98(3):497–505.

  3. Rösch J., Keller F.S., Kaufman J.A. “The Birth, Early Years, and Future of Interventional Radiology,” Journal of Vascular and Interventional Radiology, July 2003;14(7):841–53.

  4. Baum R.A., Baum S. “Interventional Radiology: A Half Century of Innovation,” Radiology, November 2014;273(2S):S75–91.

  5. Valji K. “’A Severe Attack of Common Sense’: Sven Ivar Seldinger (1921–1998) and the Birth of Interventional Medicine,” Journal of Vascular and Interventional Radiology, September 2021;32(9):1255–7.

  6. Nusbaum M., Baum S. “Radiographic Demonstration of Unknown Sites of Gastrointestinal Bleeding,” Surgical Forum. 1963;14:374–5.