1.介入放射学总论1【PPT】 .ppt
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1、介入放射学定义,是以影像诊断为基础,在医学影像诊断设备的引导下,利用穿刺针、导管及其他介入器材,对疾病进行治疗或采集组织学、细菌学及生理、生化资料进行诊断的学科 在影像设备导引下,利用微创的手段对疾病进行诊断和治疗的学科。是继内科学、外科学之后的第三医学,The history of interventional radiology,The history of interventional radiology is a fascinating迷人的 look at innovative 创新的 pioneers who changed the delivery of medicine and
2、 greatly improved the quality of patients lives.The improved ability of radiologists to see inside the body gave rise to 引起,使发生,导致interventional radiology(IR)-minimally invasive targeted treatments performed under guided imaging-in the mid-1970s.Interventional radiology procedures are a major advanc
3、e in medicine that do not require large incision 切口 and offer less risk,less pain and shorter recovery times compared to surgery.,The history of interventional radiology,Interventional radiologists invented angioplasty and the first catheter-delivered stent,state of the art treatments that are commo
4、n place in medicine today.Interventional radiology is a medical specialty recognized by the American Board of Medical Specialties and the American Medical Association.,介入放射学发展史,20世纪上半叶科学家的探索创新为今后的介入放射学发展奠定了良好坚实的基础1928年Santos等完成第一例经皮直接穿刺主动脉造影1929 Werner Forsmann:自体右心导管插管1931年Dos Stantos首先用针穿刺腹主动脉完成了最
5、早的动脉造影1940年古巴放射学家Farinas用股动脉切开的方法将导管送入主动脉,但是此方法由于操作繁杂并未被推广,Werner Forssman catheterized his own heart in 1929 to prove catheterization could be done 自体右心导管插管,Dr.Werner Forssman,He placed a ureteral catheter into a vein in his arm,advanced it to the right atrium of his heart,and walked upstairs to th
6、e x-ray department where he took the confirmatory x-ray film.In 1956,Dr.Werner Forssman was awarded The Nobel Prize,Dr.Werner Forssman,介入放射学发展史,20世纪40年代根据Cournand及Richards的经验开展了右心房、室及肺动脉的导管技术,The Nobel Prize in Physiology or Medicine 1956,Andr Frdric Cournand Columbia University Division,Cardio-Pulm
7、onary Laboratory,Bellevue Hospital New York,NY,USA.1/3 of the prize Werner Forssmann Mainz University Mainz,Federal Republic of Germany;Bad Kreuznach,Federal Republic of Germany.1/3 of the prize Dickinson W.Richards Columbia University New York,NY,USA.1/3 of the prize for their discoveries concernin
8、g heart catheterization and pathological changes in the circulatory system,20世纪40年代后期,瑞典学者Jonsson首先用经皮穿刺颈总动脉后,将细针芯抽出,通过外套管送入细银线,通过细银线作引导将外套针向下送至主动脉弓,行血管造影,Seldinger Technique,Seldinger技术的出现,血管造影术这一介入放射学的基本操作才由缓慢的步伐转向迅速的发展1953年瑞典Sven-Ivar Seldinger医师首创了用套管针、导丝和导管经皮股动脉插管作血管造影的方法,大大简化并提高了介入放射学操作的安全性,为当
9、代介入放射学奠定了基础应用初期,因为一些临床医师对其可行性持怀疑态度两发展缓慢20世纪50年代中期至60年代,Seldinger技术开始被应用于许多器官,如:经皮、经肝胆管造影、经皮肾盂、输尿管造影等北美放射学会因此而授予Seldinger荣誉会员称号,Sven Ivar Seldinger Catheter Replacement of the Needle in Percutanous Angiography,Sven Ivar Seldinger(1921-1999),radiologist,was born in Mora,Sweden.Graduating in medicine f
10、rom the Karolinska Institute in 1948,he began his training in radiology in 1950.In 1953,Dr.Seldinger published the description of a percutaneous entry technique in the journal,Acta Radiologica.,Sven Ivar Seldinger,The equipment required to perform the basic technique includes only(1)a thin wall intr
11、oducer needle,(2)a wire guide and(3)a plastic preformed catheter.Through a simple puncture,access is gained to any part of the body via the cardiovascular system,using a series of x-ray films as a guide,Sven Ivar Seldinger,Dr.Seldinger pioneered in applying his technique to the localization of tumor
12、s by arteriography,selective renal angiography,percutaneous transhepatic cholangiography,and portal venography.The simplicity of the Seldinger technique which continues to revolutionize cardiology and radiology has provided the catalyst 催化剂 for innovative application in the areas of interventional r
13、adiology,urology,anesthesiology and critical care medicine.,介入放射学发展史,1956年Oedman、Morino与Tillander等分别提出用导管作选择性插管术,使插管造影术逐渐成熟20世纪70年代至80年代期间:介入放射学使用的器材得到了迅速的发展和极大的改善、从而大大促进了经皮穿刺技术的应用和发展高分辨率影像增强器和DSA技术的普及,全身各部位的血管造影以及血管腔内介入疗法,因其侵袭程度小,治疗效果显著,而在世界各国广泛迅速地开展起来,Charles Theodore Dotter:The Father of Interven
14、tional Radiology,1964年美国放射学家Dotter开发了使用同轴导管系统的血管成形术,是介入放射学的新的亚专业-成形术实践和理论的奠基石在此基础上,才有球囊导管扩张术和金属支架置入术的出现,1964.1.16 1st PTA on a women of 83,Charles Theodore Dotter(1920-1985),was born in Boston,Massachusetts.He studied medicine and radiology at Cornell University,where he served in a staff position f
15、rom 1950 to 1952.He then served as Professor and Chairman of Radiology at the University of Oregon Medical School for 33 years until his death.Dr.Dotter altered the course of cardiovascular radiology and is considered the father of interventional radiology.He began modifying the Seldinger technique
16、for therapeutic purposes.,This first therapeutic use of the Seldinger technique quietly started a medical revolution:simultaneous diagnostic and therapeutic procedures reduced the number of surgical beds needed,patient risk and the length of patient stay.Costly and traumatic surgical procedures were
17、 eliminated in many cases.These benefits proliferated 增生扩散as the technique extended into other areas of medicine.,Dr.Dotter first described transluminal angioplasty in 1964.While skepticism 怀疑论 reigned 统治 in the United States,European radiologists institutionalized使制度化,习俗化 the term,“Dottering”of pat
18、ients.Dotters pioneering work and vision 想象力are reflected in four gold medals in radiology and,in 1978,a nomination任命 for the Nobel Prize in Medicine.,介入放射学发展史,1967年Margulis在美国放射学杂志AJR上最早提出“Interventional diagnostic radiology-a new subspeciality”Alexander R.Margulis.“Interventional diagnostic radiol
19、ogy-a new subspeciality”,Am.J.Roentgenol.Mar 1967;99:763-765.,Curriculum vitaeAlexander R.Margulis,Professor of Radiology AffiliationWeill Medical College,Cornell University,New York Date of birth31 March 1921 CountryUSA PositionClinical Professor of Radiology EducationHarvard Medical School,MD 1950
20、:Internship:Henry Ford HospitalDetroit,MI;Residency Radiology:Univ.Of Michigan,Ann ArborSeven Honorary Doctorates:Med.College Wisconsin,Marseilles,Toulouse,Montpellier,Louvain,Ludwig-Max.Univ.Muenchen,Karolinska Post graduate positionsAssistant Prof.Univ.of Minnesota,Assoc.Prof then Professor Washin
21、gton U.,St.Louis MO,1959-1963Professor and Chairman Univ.of Calif.SanFrancisco 1963-1989,Associate Chancellor and Founding DirectorMagnetic Res.Science Center UCSF Publicationsover 230 articles on GI radiology,Books on MRI Alimentary Tract Radiology Areas of researchGI Radiology,CT virtual colonosco
22、py,介入放射学被学术界广泛认可,是在l976年Wallace在“Cancer”杂志上以“Interventional Radiology”为题系统地阐述了介入放射学的概念以后,并于1979年欧洲放射学会第一次介入放射学学术会议上作了专题介绍,此命名方逐步在国际学术界达成共识,介入放射学的发展史,介入放射学的发展过程中,许多技术都来自外科手术,被放射学家采用并逐步改良以适应介入放射学的使用,并将一些原仅用于诊段的手段发展为介入治疗方法包括:经皮管腔成形术、血管栓塞术、经动脉灌注术等、经皮活检、抽吸与引流,介入放射学发展史:血管成形术与支架术,介入放射学发展史:血管成形术与支架术,1964年1月
23、16日Charles Dotter首次应用经皮穿刺插管,用不同直径的聚四氟乙烯同轴导管扩张技术治疗外周动脉粥样硬化获得初步成功。1973年Andreas Gruntzig 年发明了球囊导管(balloon catheter)后,使经皮腔内血管成形术得以在临床上普遍应用1977年Eurich首先把经皮血管成形术应用于冠状动脉,继而在欧美普遍开展,Andreas Gruentzig 1939-1985.1974.2.12 PTA with Gruentzig single lumen balloon catheter.1977.4 PTCA with balloon,Andreas Gruentz
24、ig,After employing Dotters techniques of transluminal angioplasty,which he had learned from Eberhart Zeitler in Nuremberg,Andreas Gruentzig,a young German physician working at University Hospital in Zurich,Switzerland,began toying with the idea of 不认真的考虑adding a balloon to the Dotter catheters,Andre
25、as Gruentzig,He started fashioning精加工 prototypes 原型in his own kitchen,searching for a viable可行的 material and design.In 1975 he developed a double-lumen catheter fitted with a polyvinylchloride氯化聚乙烯 balloon that would set in motion 发动,引起 a revolution in medicine.He presented the results of animal stu
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