Interventional Radiology and the Dotter Institute
The most brilliant advances in medical technology and research are only as useful as our ability to apply them in the clinical setting. In keeping with this philosophy, the Dotter Institute serves as a beacon of both internationally recognized research and locally delivered advanced clinical care.
Patients throughout Oregon and the northwestern United States are regularly sent to the Institute for management of complex vascular and nonvascular diseases. Although physically located on the campus of Oregon Health & Science University, the Institute also provides exclusive full-time service to Doernbecher Children’s Hospital and the Portland Veterans Affairs Medical Center. In addition, the Institute works closely with the Shriner’s Hospital of Portland to provide interventional services on a case-by-case basis. Through these interactions, the Institute makes high-level care available to patients from a broad range of backgrounds and financial circumstances.
The Institute’s clinical facilities include six dedicated angio-interventional suites, two of which have been certified to function as an operating room under the Institute’s domain. They are fitted with the newest, most technologically advanced angiographic equipment available anywhere in the world. When computed tomography (CT) is required for aspiration and/or drainage procedures, six separate machines are available through the departments of diagnostic radiology at both OHSU and Veterans hospitals.
Embolization of three arteriovenous malformations in the right lung. A) Before, and B) after embolization
In addition to traditional catheter-directed angiography, the Dotter Institute is responsible for magnetic resonance angiography (MRA) and CT angiography (CTA) of the aorta, pelvis, and peripheral vasculature. The decision to pursue MRA or CTA rather than conventional angiography is made on a case-by-case basis in consultation with the referring clinical staff. Two 1.5 Tesla and two 3.0 Tesla MR suites are available for these studies. This equipment provides the latest advances in non-invasive imaging – digital subtraction gadolinium bolus chase MRA – to be applied immediately to clinical practice. Four multidetector CT machines are available at OHSU Hospital for CTA. In addition, a 256 detector CT is located at OHSU Center for Health & Healing.
Among the highly specialized clinical programs at the Institute are: an integrated, multispecialty clinic for treatment of hereditary hemorrhagic telangiectasia; an emergency response team for stroke thrombolysis; and the region’s most active practices in transjugular intrahepatic portosystemic shunt (TIPS) placement, carotid and intracranial artery angioplasty/stenting, and uterine artery embolization for fibroids. As a result of these activities, the Institute has experienced a significant increase in its annual caseload since its founding.
Embolization of large uterine fibroid done on outpatient basis. A) pelvic angiogram shows highly vascular fibroid. B) embolization occluded the fibroid vasculature
Aside from its ongoing programs, the Dotter Institute establishes new protocols for clinical research. Ongoing studies include a modification of the access for TIPS, called DIPS, and the development of a new imaging coil and new imaging protocols for MRA. Multi institutional clinical research projects include participation in multi-center trials of an endovasacular stent graft, a new MRA contrast agent, and uterine artery embolization versus hysterectomy in the treatment of uterine fibroids.
Even using the newest and most complex techniques, more than 50 percent of patients treated at the Institute are managed on an outpatient basis. The result is decreased health-care costs and increased convenience for these individuals. An Interventional Recovery Unit (IRU) makes outpatient management possible with 21 private beds and a team of skilled nurses who provide routine post-procedure monitoring. Should an individual patient require a longer period of observation, the Dotter staff has had admitting privileges at OHSU Hospital since the late 1960’s.
The key to the Institute’s tremendous success in the clinical arena is the strong sense of collegiality and trust among the Dotter staff, the referring clinicians, and allied care specialists. Fostered by a common goal of providing exceptional care, this mutual respect is supported by ongoing dialogue and bilateral participation in patient management. Each member of the healthcare team is thus able to combine his or her expertise with that of other practitioners. For the patient, there can be no better situation.