Date of Award

January 2021

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Julius Chapiro

Second Advisor

Darko Pucar

Abstract

Interventional Radiology (IR) has become an integral component of modern, developed healthcare systems. The minimally invasive, image-guided procedures that the field offers are highly effective and often lead to significantly less morbidity than alternative surgical options. The growth of IR globally is in an early phase; however, patients and healthcare systems stand to benefit from its rapid expansion and integration around the world.

Globally, billions of people are without access to safe surgery and diagnostic imaging. However, the democratization of radiology resources such as portable ultrasound and low-cost medical devices is making IR more accessible than ever before. Global healthcare trends have seen governments investing more in hospital infrastructure, and in the development of local residency programs to train future practitioners in the specialty.

This thesis examines multiple aspects of the future of IR in a global setting, which represent an amalgamation of different, simultaneous approaches to advancing IR practice in these settings. A review of locoregional catheter directed therapies demonstrates the value of developing an interventional oncology (IO) program, a branch of IR that has become standard of care in multiple indications in the US. Further explored are the results of a retrospective single-institution study of response to a specific IO therapy, TACE. This is one of the most common and effective interventional approaches to treating primary liver cancer as well as liver metastases. The value of specific imaging metrics to assess treatment response and viability for retreatment are discussed. These IO techniques are extremely exciting for their potential in low- and medium-income countries that are implementing IR programs. Additionally, this thesis reviews the creation of a simulation device to be used by IR trainees in resource limited areas.

Also demonstrated is a method for designing new medical devices through ideation and prototyping phases, and lastly discussed, is a venture working to create frugally designed medical devices that can be rapidly deployed into developing IR and IO programs. IR is a specialty that is driven by innovation, which necessitates the use of often expensive medical devices. Low-cost innovation and redesign of these devices can make them more accessible and more useful in lower resource settings. Innovation using these frugal methods can be helpful in accelerating the growth of IR globally, and treating more patients effectively and safely.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 10/12/2023

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