The Germans Trias Radiodiagnosis Service its part of the Clinical Directorate of Diagnostic by Imaging. Is on the hospital's ground floor, and it is in charge of diagnostic imaging. It is divided into a general radiology area and a high technology area, where two high-performance CT scanners, two 3T and 1.5T MRI scanners (Diagnostic Imaging Institute) and five ultrasound machines are located. In addition, there is a specific radiology area in the Emergency Room.

It is in charge of diagnostic imaging of pathologies associated with the gastrointestinal system, the hepatobiliary tract and the genitourinary system, both in the adult and peadiatric population. It has a wide range of imaging tests for the study, monitoring, diagnosis and treatment of different diseases. All tests are done and interpreted by specialized medical staff.

In regular radiological practice , the area works mostly on two different imaging techniques:

• Techniques aimed at diagnosis and monitoring abdominal and pelvic disorders: ultrasound, ultrasound cystography, CT scan, and hepatic elastography, among others.
• Interventional image-guided procedures (ultrasound/CT) for diagnostic or therapeutic purposes: tumour ablation, core needle biopsy (CNB) and fine needle aspiration (FNA), abdominal collection drainage and nerve block by pulsed radiofrequency, among others.

Innovation

Lately, the abdomen area has also been working with a new interventional technique aimed at improving efficacy of kidney tumour treatment and reducing the complications of this procedure: cryoablation. This procedure consists of destroying the tumour by freezing it, through a metal probe introduced inside the tumour and through which very cold gasses are made to flow to freeze the tumour and destroy tumoural cells. In comparison with other ablation techniques, it possible to treat larger tumours.

Multidisciplinary committees

The area works together with medical professionals from other services (Medical Oncology, Radiation Oncology, General and Gastrointestinal Surgery, Urology, Paediatrics and OBGYN) for the purpose of dealing with the most complex patients from a multidisciplinary approach. This is done in the following committees that meet regularly: Oesophagean Tumour Committee, Colorectal Cancer Committee, Urological Tumour Committee, Gynecological Tumour Committee, Pelvic Floor Committee, Hepatocellular Carcinoma Committee and Liver Metastases Committee.

It operates as a cross-sectional unit made up of a multidisciplinary group of professionals and coordinated by a radiologist. The services and units that are part of it are, in addition to Radiodiagnosis: Pathological Anatomy, General and Gastrointestinal Surgery, Plastic Surgery, Genetic CounsellingCounselling, OBGYN, Nuclear Medicine, Medical Oncology, Radio-oncology, Psycho-oncology and Rehabilitation.

From the radiological point of view, the unit offers the following services:

• Breast radiology: diagnostic , monitoring and screening mammography, galactography, mammography of surgical pieces and esterotaxia
• Ultrasound: of breast, axillary staging, of surgical piece, supraclavilular and breast echo doppler
• Breast elastography
• Breast Magnetic Resonnance (MRI): of breast implant and contrast enhanced
• Interventional procedures: for example, ultrasound-guided presurgical breast lesion localisation, estereotaxia or MRI; core needle biopsy (CNB) and fine needle aspiration (FNA); ultrasound-guided lesion marker placement; esterotaxia or ultrasound-guided sentinel node injection, or mammographic-guided pre-surgical localisation of breast lesion, among others.

It manages diagnostic imaging of the locomotor system, central nervous system, head and neck associated pathologies, both in adults and paediatric population.

In regular radiological practice, the area works with the following imaging techniques:

Diagnostic imaging

• Conventional osteo-articular digital radiology
• CT scan of bone, soft parts, brain, head and neck and spine

Percutaneous interventional radiology (through the skin)

Today, it is possible to reach practically all the musculo-skeletal system through the skin, i.e., percutaneously. This makes it possible to perform biopsies with local anaesthesia or therapeutical procedures with a short hospital stay and which are minimally aggressive for the patient. The musculoskeletal diagnostic imaging and neuroradiology area performs the following:

• Diagnostic techniques: fine needle aspiration (FNA) and lesion biopsy of musculoskeletal, bone and soft parts of the head and neck.
• Therapeutic techniques: draining, joint and perijoint injection, radiofrequency nerve block, vertebrae cementing (to strengthen the vertebrae and reduce pain), other bone cementing, percutaneous radiofrequency painful tumour ablation and bone mestastases with microwave ablation.

Multidisciplinary committee

The area works together with medical professionals from other services (Medical Oncology, Radiation Oncology, Neurosurgery, Neurology, Otorhynolaringology, Maxilofacial Surgery, Orthopaedic and Traumatology Surgery, Intensive Care Medicine, Nuclear Medicine, Pathological Anatomy and Paedriatics) for the purpose of dealing with the most complex patients from a multidisciplinary approach. This is done in the following committees that meet regularly: Locomotor System Tumour Committee, Head and Neck Tumour Committee, Nervous System Tumour Committee, Vascular Malformations Committee, Diabetic Foot Committee, Vertebroplasty/Kiphoplasty Committee and Polytrauma Patient Committee.

This area performs diagnostic and therapeutic vascular interventions with minimally invasive state-of-the-art, image-guided techniques. The area collaborates with other multidisciplinary services and units, including Vascular Surgery, General and Gastrointestinal Surgery, Hepatology, Medical and Radio Oncology, Dermatology, Urology and Nephrology, among others.

The interventional procedures carried out daily are:

• Angiography: this is an X-ray test of the veins (fleblography) and arteries (arteriograph) of the body and the extremities to diagnose obstructions, bleeding and other blood vessel problems. An interventional radiologis carries out this procedure. During angiography, the doctor inserts a thin tube (catheter) in an artery or vein through a small hole in the skin, the size of a pencil tip. A liquid substance know as "contrast" is injected to make blood vessels visible for the X-ray machine. One of the most common reasons to perform an angiograpy is to see if there is blockage or stenosis in a blood vessel that may interfere with the normal blood flow through the body. In many cases, the interventional radiologist can treat a blocked blood vessel without surgery while doing the angiography. The interventional radiologist treats obstructions by means of techniques known as angioplasty and thrombolysis.
• Balloon angioplasty and stent: many times, the interventional radiologist can open up blocked or narrowed blood vessels. For example, in some patients, arterial hypertension, known as renal vascular hypertension, is caused by obstructed renal arteries. The interventional radiologist can treat the obstruction without surgery by dilating it with an arterial balloon or by means of an intrarterial device known as stent.
• Transjugular hepatic biopsy: this is a procedure that consists of taking as small liver sample to analyse it under the microscope, in cases of patients with a difficult to diagnose liver disease who would not tolerate a percutaneous biopsy because of coagulation problems or abdominal fluid (ascites). The interventional radiologist introduces a small catheter in the jugular vein in the neck and advances the catheter towards the hepatic vein by using X-rays. The biopsy is done directly from the hepatic vein.
• Central venous access catheter: catheters are small tubes inserted under the skin to take a sample painlessly, to extract blood or to administer medication. When a central venous catheter is placed, irritation and discomfort caused by repeated injections are eliminated. There are different types of central venous access catheters available, and they are used in chemotherapy, drug infusion, nutrition and hemodialysis.
• TIPS placement: its name comes from the acronym TIPS (Transjugular Intrahepatic Portosystemic Shunt). It is a treatment employed in some patients with advanced portal hypertension. The procedure consists of connecting the porta vein (the vein carrying the blood from the intestines to the liver) with the hepatic veins (veins that carry the blood from the liver to the heart). It is done by puncturing the jugular vein in the neck and then a stent is placed in the porta vein communicating with the hepatic vein. That way, direct communication of the blood flow between the two venous system is achieved.
• Urinary tract stenosis dialation: in some cases, patients who have had urinary tract surgery can have obstruction or stenosis (narrowing) due to post surgery scarring. The interventional radiologist can fix that by using a balloon.
• Aneurysm embolization: Aneurysms are abnormal artery bag or balloon-like dilations that can appear in many arteries in the body. The interventional radiologist can treat an aneurysm through a puncture in a leg artery (femoral) and by means of a catheter, placing different medical devices in the aneurysm, causing thrombosis (the blood coagulates), and thus eliminating the risk of bleeding.
• Gastrointestinal bleeding embolization: the interventional radiologist inserts a catheter in the femoral leg artery and moves it through the body by using X-rays towards the point of gastrointestinal bleeding. Next, metal devices or particles are inserted in the artery through the catheter to stop the bleeding.
• Pelvic varicocele and varius embolization: it is a procedure done to treat patients with pelvis varicole (dialation of spermatic veins) and varius (ovarian and periuterine veins) without surgery. It consists of a small puncture in an arm vein and, by using X-rays, introducing a catheter towards the spermatic or pelvic veins, where a sclerosing agent is administered. This sclerosing agent causes thrombosis of the varicose veins, preventing them from filling up with blood, which makes it impossible to dilate again.
• Cava vein filters: in some cases, patients with deep venous thrombosis of the extremities can show pulmonary thromboembolism (PTE) caused by a thrombus in the extremity travelling to the heart and later the lung, o obstructing pulmonary circulation. In certain patients, the interventional radiologist can place a metallic filter in the cava vein by means of a a small puncture in the vein, to keep a thrombus from moving to the heart and the pulmonary circulation.
• Percutaneous biliary interventionism: it consists of inserting small catheters through the skin to reach the liver's biliary tract. This procedure is used to treat biliary tract stenosis (narrowing), obstructive jaundice (yellow skin colouring due to biliary obstruction) and biliary tract lithiasis. Biopsies can be obtained by means of this technique.
• Interventionist emergency procedures: 24 hours, 365 days of the year.
• Chemoembolization of hepatic tumours: it is a leading technique used to treat patients with malignant liver tumours when surgery is not recommended. It is performed by puncturing the leg artery (femoral) and introducing a catheter in the hepatic artery. The interventional radiologist will do an liver arteriography to locate the tumour and then inject a combination of chemotherapy and small sand-like particles. Chemotherapy kills tumoural cells, while the particles block the flow of blood that feeds the tumour, and its reduces its size. This technique avoids having to use systemic intravenous chemotherapy and significantly improves the patient's quality of life. Although this treatment is not a cancer cure, it has shown that it can extend the life of some liver cancer patients.
• Hemodialysis arteriovenous fistulas intravascular repair: many patients with chronic kidney disease who require hemodyalisis treatment undergo a surgical procedure to create an arteriovenous fistula (direct communication of an artery with a vein in the arm or leg) for dialysis. Ocasionally, these fistula become obstructed or narrowed. The interventional radiologist can repair fistula by means of a direct arterial or venous puncture using balls or other devises to achieve the correct functioning of the fistula.
• Thrombolytic therapy: it is a treatment used in cases of artery obstruction caused by a blood clot or thrombus. Thrombolitic drugs that dissolve the thrombus are injected through a catheter to eliminate the thrombus and reestablish normal blood flow.
• Vascular anomalies and malformations treatment: it consists of administering sclerosing agents or embolization particles by percutaneous or intraarterial means to treat vascular anomalies such as child hemangiomas, venous malformations, arteriovenus malformations and lymphagiomas, among others.
• Hemoptysis treatment by means of embolization: some patients with pulmonary diseases may have airway bleeding that conventional drug treatment is sometimes unable to stop. The interventional radiologist can treat pulmonary bleeding (hemoptysis) by means of puncturing the leg artery (femoral) and introducing a catheter up to the bronchial arteries by using X-rays. The doctor administers particles in the arteries with the purpose of stopping pulmonary bleeding.

The tests performed include:

• Conventional digital radiology
• Computerized tomography (CT)
• Thoracic ultrasound
• CT or ultrasound-guided biopsies and aspirations
• Radio-guided hidden pulmonary lesion localization (ROLL technique).
• Percutaneous tumour lesion ablation by means of microwave, radiofrequecy or cryotherapy

The area aims to treat the patient from a multidisciplinary approach, and it collaborates closely, through specialized committees, with other services and units, such as: Medical Oncology, Pulmonology, Thoracic Surgery, Radiotherapy, Nuclear Medicine, Reumathology, Cardiology and Intensive Medicine. It also actively participates in regular meetings with thoracic radiologists from other hospitals in the metropolitan area of Barcelona, where highly complex cases are discussed.

Procedures for diagnosis and monitoring thoracic disorders:

These disorders are mainly: infectious pulmonary disease, chronic obstructive pulmonary disease (COPD), intersticial pulmonary diseases (pulmonary fibrosis and other diffuse pulmonary disorders) and neoplasia (pulmonary tumours, pleural and mediastinal).

To diagnose and monitor them, CT scans with 3D reconstruction studies are done to schedule surgeries, and vascular studies by arterial mapping for caridovascular interventionism.

Image-guided interventional procedures for diagnostic or therapeutic purposes:

The area does lung, mediastinum, pleural and thoracic wall fine needle percutaneous (through the skin) aspirations (FNPA) and CT-guided core needle aspirations (CNA) for diagnosis and molecular studies.

In those cases where the lung's tumoral lesion is small and difficult to find during surgery, the area can do it with the help of the CT, radioisotope marking prior to surgery (ROLL technique) that makes intraoperative localisation possible.

From the therapeutic point of view, the area does microwave or radiosurgery ablation of primary or metastasic lung tumours, following the Thoracic Tumour Committee's decision.

As an innovative and promising technique, the area also has cryoablation available for specifically selected cases.