Not long ago, radiologists just diagnosed and watched their colleagues perform. Today, rapid technical advances have made them ever more coveted co-players in the treatment process.

Today, technical progress allows us to remedy damage that was once virtually or completely inoperable. This can be done quite quickly and without undesirable side effects.

"One of the biggest domains of interventional radiology is the treatment of osteoporosis and back pain," explained Professor Dr. Afshin Gangi, head of the Radiological Department at the University Hospital of Strasbourg, France. "Today, technical progress allows us to remedy damage that was once virtually or completely inoperable. This can be done quite quickly and without undesirable side effects."

Computer and magnetic resonance tomography give us high resolution insights into practically all structures of the human body. They are highly superior to conventional x-ray images, and increasingly enable us to conduct minimally invasive surgery (key-hole procedures).

Below are the top three in the current hit list:

Osteoporosis: Special cement for new support

One of the most frequent consequences of osteoporosis is the partial fracture of the body of a vertebra. Conservatively, most of the older people affected by this disease simply obtain pain treatment and are told to stay in bed for three to six weeks. During this period muscles atrophy and it becomes hard for patients to get back on their feet.

In percutaneous vertebroplasty, special cement is injected into the patient through an insertion hole a millimetre in size. The procedure is MR-guided right to the spot where the vertebra needs support. Pain disappears with the flick of a wrist and the patient can leave after 48 hours. The superiority of this method was recently proven quite impressively in a large-scale study conducted by Dutch and Belgian scientists, led by Professor Dr. Maurits Voormolen at the University Hospital in Antwerp.

A study by Professor Giovanni Carlo Anselmetti and his colleagues at the Cancer Research Institute in Italy showed that the procedure practically always succeeds and has scarcely any side-effects if carried out correctly.

Accident-induced spinal fractures: cement instead of bones

Balloon cyphoplasty is not used to treat osteoporosis, but specifically for younger people with accident-related vertebral fractures entailing no nerve damage. In this procedure, a specially shaped balloon is inserted into a tiny hole at the spot where the vertebra collapsed. The balloon is slowly inflated over a period of 30 to 45 minutes until it matches the natural height of the vertebra. Special cement, with a calcium-phosphate base, is then injected into the cavity. Mechanically, it behaves like bone. It is reabsorbed by the body over time and replaced by real bone. The vertebra can be subjected to supporting weight after three days and patients save themselves weeks in bed in a cast.

Burning bone lesions or bone metastases with radio frequency ablation.

Radio frequency ablation (RFA) is a blessing for people with osteoid osteomas (benign bone lesions) or bone metastases. "Bone lesions are usually extremely painful, and until a few years ago there was nothing you could do about them," Professor Gangi noted. Today, a small key-hole is put in the skin and a probe with an electrode on the end is inserted. The metastases and lesions are literally burned out of the bone. This is done so thoroughly that the removed material cannot attach itself elsewhere in the body and form new metastases. After about 12 hours, the patient is virtually free of discomfort.

Professor Gangi explained, "In RFA, you have to be able to estimate how much you can remove during the procedure without overburdening the organism with burnt proteins. At the same time, my view is clear-cut: nowadays, you should never operate on a tumour, whether in a bone or in the liver, if you can use radio frequency ablation instead."

Radiologists are increasingly exchanging their traditional place at the diagnostic screen with a place at the operating table. That trend is more than evident at the European Congress of Radiology 2007. Professor Gangi remarked, "Will we even still be called radiologists in ten years or will there be new specialties by then, radio surgeon, for example?