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To test the hypothesis of equal or even superior applicability and accuracy of a fully integrated, laser-based computed tomography (CT) navigation system compared with conventional CT guidance for percutaneous interventions.CT-guided punctures were first performed in phantoms. Four radiologists with different experience levels (2 residents (L.B., C.D.) and 2 board-certified radiologists (B.M., K.R.) performed 48 punctures using both conventional image-guided and laser-guided approaches. Subsequently, 12 punctures were performed in patients during a clinical pilot trial. Phantom targets required an in-plane or a single-/double-angulated, out-of-plane approach. Planning and intervention time, control scan number, radiation exposure, and accuracy of needle placement (measured by deviation of the needle tip to the designated target) were assessed for each guidance technique and compared (Mann-Whitney U test and t test). Patient interventions were additionally analyzed for applicability in a clinical setting.The application of laser guidance software in the phantom study and in 12 human patients in a clinical setting was both technically and clinically feasible in all cases. The mean planning time (P = .009), intervention time (P = .005), control scan number (P.001), and radiation exposure (P = .013) significantly decreased for laser-navigated punctures compared with those for conventional CT guidance and especially in punctures with out-of-plane-trajectories. The accuracy significantly increased for laser-guided interventions compared with that for conventional CT (P.001).Interventional radiologists with differing levels of experience performed faster and more accurate punctures for out-of-plane trajectories in the phantom models, using a new, fully integrated, laser-guided CT software and demonstrated excellent clinical and technical success in initial clinical experiments.

Cholangiocarcinoma (CCA) are the second most common primary liver tumors and carry a dismal prognosis. Chemosaturation with percutaneous hepatic perfusion (PHP) is a palliative, intra-arterial therapeutic approach that provides a high dose chemotherapy of the liver with reduced systemic exposure. Aim of this retrospective, monocentric study was to analyze PHP as a palliative treatment for unresectable CCA. Toxicity, adverse events and complications were classified using the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Overall response rate (ORR) and disease control rate (DCR) were evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST1.1). Median overall survival (mOS), median progression-free survival (mPFS) and hepatic mPFS (mhPFS) were computed using Kaplan–Meier estimation. In total 17 patients were treated with 42 PHP between 10/2014 and 09/2020. No significant complications occurred during the interventions. mOS was 27.6 (interquartile range (IQR) 16.5–37) months from first diagnosis and 9.9 (IQR 3.8–21) months from first PHP. mPFS was 4 (IQR 2–7) and mhPFS was 4 (IQR 3–10) months. ORR was 25% and DCR 75%. Significant, but transient hematotoxicity was frequent with grade 3/4 thrombopenia after 50%, leukopenia after 26% and anaemia after 21% of the interventions. An increase of transaminases (AST increase after 21% and ALT increase after 14% of the PHP) developed more often than a deterioration of the liver synthesis capacity. Salvage treatment with PHP has the potential to prolong life in selected patients with unresectable, refractory cholangiocarcinoma. The interventional procedure is safe. Post-interventional toxicity is frequent but manageable.

With the increasing need for minimally invasive procedures based on lower complication rates, higher patient acceptance, and technical developments, there is a growing focus on the sound interventional training of young radiologists. This survey aimed to analyze the current situation in interventional radiology (IR) training in Germany to detect shortcomings and identify areas for improvement.From November 1-30, 2020, an online questionnaire was distributed to representative radiological associations and societies with the request to forward it to radiology residents and radiologists 40 years. The 44 questions covered six distinct areas from personal working conditions to the characterization of the IR department, training conditions, role of women in IR, and attendance at congresses/external training.A total of 330 participants completed the questionnaire. 77 % of participants expressed a high interest in IR, and 47 % could even imagine subspecializing in interventional radiology. Most institutions provided the necessary learning conditions and infrastructure. The rate of overall satisfaction with IR training conditions was 45 % (vs. a dissatisfaction rate of 39 %). However, females showed a lower satisfaction rate with their training environment than male participants (28 % vs. 51 %; P = 0.06). Positive correlations with work satisfaction were found for the presence and duration of the IR rotation, the number of partly independently/mentored performed interventions, and structured feedback. Moreover, the need for a structured training curriculum was expressed by 67 % of participants.Radiological residents and young radiologists expressed a high interest in interventional radiology, and they rate the infrastructure of German hospitals regarding IR as sufficient. However, they expressed the need for consistent IR rotations and better-structured resident and postgraduate education (curriculainterviews).Interest in interventional radiology among radiological residents and young radiologists in Germany is high, but satisfaction with interventional radiology training leaves room for improvement. The most frequently mentioned aspects that can improve IR training were · organized rotations of at least 6 months. · structured curriculums with face-to-face feedback. · structured guidance by senior interventionists during procedures. CITATION FORMAT: · Sieren M, Katoh M, Mahnken AH et al. Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey. Fortschr Röntgenstr 2022; 194: 1346 - 1357.Die fundierte interventionelle Ausbildung junger RadiologInnen gerät durch den zunehmenden Bedarf an minimal-invasiven Prozeduren immer mehr in den Fokus. Ziel dieser Umfrage war es, die aktuelle Situation der Ausbildung in der Interventionellen Radiologie (IR) in Deutschland zu analysieren, um Defizite aufzudecken und Verbesserungsmöglichkeiten zu identifizieren.Vom 1. bis 30. November 2020 wurde ein Online-Fragebogen an repräsentative radiologische Verbände und Gesellschaften versandt mit der Bitte, ihn an AssistenzärztInnen und RadiologInnen 40 Jahre weiterzuleiten. Die 44 Fragen deckten 6 verschiedene Bereiche ab, von den persönlichen Arbeitsbedingungen bis zur Charakterisierung der IR-Abteilung, den Ausbildungsbedingungen, der Rolle der Frauen in der IR und der Teilnahme an Kongressen/externen Fortbildungen.Insgesamt haben 330 TeilnehmerInnen den Fragebogen ausgefüllt. 77 % der TeilnehmerInnen bekundeten ein hohes Interesse an der IR und 47 % konnten sich sogar eine Subspezialisierung in der interventionellen Radiologie vorstellen. Die Mehrheit der Institutionen stellten die notwendigen Rahmenbedingungen und Infrastruktur bereit. Insgesamt lag die Zufriedenheit über die interventionsradiologische Weiterbildung bei 45 % (vs. 39 % Unzufriedenheit), wobei die Zufriedenheit mit den Ausbildungsbedingungen bei Teilnehmerinnen geringer ausfiel als bei den Teilnehmern (28 % vs. 51 %; P = 0,06). Positive Korrelationen mit der Arbeitszufriedenheit wurden für das Vorhandensein und die Dauer der IR-Rotation, die Anzahl der teilweise selbstständig/supervidiert durchgeführten Eingriffe und ein institutionalisiertes, strukturiertes Feedback festgestellt. Darüber hinaus äußerten 67 % der Teilnehmer den Wunsch nach einem strukturierten Ausbildungscurriculum.AssistenzärztInnen und junge RadiologInnen zeigen ein hohes Interesse an der Interventionellen Radiologie und bewerten die Infrastruktur deutscher Krankenhäuser im Bereich der IR als ausreichend. Sie äußerten jedoch den Bedarf an konsistenten IR-Rotationen und einer besser strukturierten grundlegenden und weiterführenden Ausbildung (CurriculaInterviews).Das Interesse an der Interventionellen Radiologie ist bei Assistenzärzten und jungen Radiologen in Deutschland hoch, die Zufriedenheit mit der Ausbildung in der Interventionellen Radiologie ist geringer. Die am häufigsten genannten Aspekte, die die IR-Ausbildung verbessern können, waren · organisierte Rotationen von mindestens 6 Monaten Dauer. · strukturierte Curricula mit persönlichem Feedback. · strukturierte Anleitung durch erfahrene Interventionisten während der Eingriffe.

Radiology reports mostly contain free-text, which makes it challenging to obtain structured data. Natural language processing (NLP) techniques transform free-text reports into machine-readable document vectors that are important for creating reliable, scalable methods for data analysis. The aim of this study is to classify unstructured radiograph reports according to fractures of the distal fibula and to find the best text mining method.We established a novel German language report dataset: a designated search engine was used to identify radiographs of the ankle and the reports were manually labeled according to fractures of the distal fibula. This data was used to establish a machine learning pipeline, which implemented the text representation methods bag-of-words (BOW), term frequency-inverse document frequency (TF-IDF), principal component analysis (PCA), non-negative matrix factorization (NMF), latent Dirichlet allocation (LDA), and document embedding (doc2vec). The extracted document vectors were used to train neural networks (NN), support vector machines (SVM), and logistic regression (LR) to recognize distal fibula fractures. The results were compared via cross-tabulations of the accuracy (acc) and area under the curve (AUC).In total, 3268 radiograph reports were included, of which 1076 described a fracture of the distal fibula. Comparison of the text representation methods showed that BOW achieved the best results (AUC = 0.98; acc = 0.97), followed by TF-IDF (AUC = 0.97; acc = 0.96), NMF (AUC = 0.93; acc = 0.92), PCA (AUC = 0.92; acc = 0.9), LDA (AUC = 0.91; acc = 0.89) and doc2vec (AUC = 0.9; acc = 0.88). When comparing the different classifiers, NN (AUC = 0,91) proved to be superior to SVM (AUC = 0,87) and LR (AUC = 0,85).An automated classification of unstructured reports of radiographs of the ankle can reliably detect findings of fractures of the distal fibula. A particularly suitable feature extraction method is the BOW model. Key Points: Citation Format

Purpose To retrospectively evaluate the technical and clinical success of interventional treatments employed in three University medical centers and to develop work-flow recommendations for intra-arterial embolizations in patients with life-threatening spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH). Materials and methods Retrospective evaluation of all patients with contrast-enhanced CT and digital subtraction angiography (DSA) for SRRSH from 01/2018 to 12/2022, amounted to 91 interventions in 83 patients (45f, 38m) with a mean age of 68.1 ± 13.2 years. Analysis of the amount of bleeding and embolized vessels, choice of embolization material, technical success, and 30-day mortality was performed. Results Pre-interventional contrast-enhanced CT demonstrated active contrast extravasation in 79 cases (87%). DSA identified a mean of 1.4 ± 0.88 active bleeds in all but two interventions (98%), consisting of 60 cases with a singular and 39 cases of >1 bleeding artery, which were consecutively embolized. The majority of patients underwent embolization with either n-butyl-2-cyanoacrylate (NBCA; n=38), coils (n=21), or a combination of embolic agents (n=23). While the technical success rate was documented at 97.8%, 25 patients (30%) died within 30 days after the initial procedure, with mortality rates ranging from 25 to 86% between the centers, each following different diagnostic algorithms. Conclusion Embolotherapy is a safe therapy option with high technical success rates in patients with life-threatening SRRSH. To maximize clinical success and survival rates, we propose a standardized approach to angiography as well as a low threshold for re-angiography.

Purpose To investigate the effect of the ongoing COVID-19 pandemic on interventional radiology (IR) in Germany in 2020 and 2021. Materials und Methods This retrospective study is based on the nationwide interventional radiology procedures documented in the quality register of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR-QS-Register). The nationwide volume of interventions in the pandemic years 2020 and 2021 was compared with the pre-pandemic period (Poisson-test, Mann-Whitney test). The aggregated data were additionally evaluated by intervention type with differentiated consideration of the temporal epidemiological infection occurrence. Results During the two pandemic years 2020 and 2021, the number of interventional procedures increased by appr. 4 % compared to the same period of the previous year (n = 190 454 and 189 447 vs. n = 183 123, respectively, p Conclusion The COVID-19 pandemic in Germany led to a significant short-term decrease in interventional radiology procedures in the initial phase. A compensatory increase in the number of procedures was observed in the subsequent period. This reflects the adaptability and robustness of IR and the high demand for minimally invasive radiological procedures in medical care. Key points: Citation Format

To analyze the impact of the COVID-19 pandemic in 2020 on the radiological imaging volume in Germany.In this retrospective multicenter study, we analyzed CT and MRI examinations of 7 radiology institutes across Germany from January to December 2020. The imaging volume was compared to 2019 (Wilcoxon-Mann-Whitney test). Modality, patient service locations, and examined body parts were assessed in consideration of time periods of the pandemic. In addition, correlation with the incidence of SARS-CoV-2 cases and associated death was performed (Spearman-test).In total, in 2020, imaging volume declined by 4 % (n = 8314) compared with 2019 (p 0.05). The hard lockdown during the first pandemic wave (calendar week 12-16, March 22 - April 19) revealed the highest decrease with 29 % (n = 894, p 0.01), with the greatest decrease in CT (36 % vs. MRI 26 %), outpatients (38 %, p 0.01), and imaging of the spine and extremities (51-72 %, 0.05 - p 0.01). Examinations referred from the emergency department (-13 %, p 0.05) and CT of the chest (-16 %, p 0.05) were least affected. With the end of the first wave, gradual normalization of the imaging volume was observed and persisted until the end of the observation period. A reduction of imaging volume negatively correlated with the incidence of SARS-CoV-2-positive cases and associated deaths (r = 0.28 and 0.49, p 0.05 and p 0.001).The COVID-19 pandemic was associated with a significant temporary decline in imaging volume. After the first lockdown period, a quick recovery was observed with radiologic imaging examinations steadily approaching prior-year figures.· This study assesses the impact of dynamic pandemic activity on radiological imaging in a multicenter analysis in Germany.. · The COVID-19 pandemic was associated with a temporary decline in CT and MRI scans.. · Relaxation of restrictions was associated with fast normalization of imaging volumes to prior-year levels, which persisted until the end of the year.. · Significant catch-up effects were not observed..· Schmidbauer M, Grenacher L, Juchems MS et al. Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. Fortschr Röntgenstr 2022; 194: 625 - 633.ZIEL: Untersuchung der Auswirkungen der COVID-19-Pandemie auf die Durchführung radiologischer Bildgebung in Deutschland.In dieser retrospektiven multizentrischen Studie wurden die durchgeführten CT- und MRT-Bildgebungen 7 deutschlandweiter radiologischer Zentren von Januar bis Dezember 2020 analysiert. Das Untersuchungsvolumen wurde mit dem Vorjahreszeitraum verglichen (Wilcoxon-Mann-Whitney-Test). Die Auswertung der aggregierten Daten erfolgte differenziert nach Modalität, Zuweiser, Körperregion und unter besonderer Berücksichtigung der zeitlichen Pandemieentwicklung. Die Untersuchungszahlen wurden zudem mit der Inzidenz von SARS-CoV-2-positiven Fällen und assoziierten Todesfällen korreliert (Spearman-Test).Im Pandemiejahr 2020 wurden insg. 4 % (n = 8314) weniger CT- und MRT-Untersuchungen durchgeführt als im Vorjahr (p 0,05). Die Differenz ist vornehmlich auf den Zeitraum des harten Lockdowns (Kalenderwoche 12–16, 22. März bis 19. April 2020) zurückzuführen, welcher im Vergleich zum Vorjahreszeitraum zu einem Rückgang der Untersuchungen um 29 % geführt hat (n = 894, p 0,01). MRT-Untersuchungen waren dabei stärker betroffen als CT-Untersuchungen (36 % vs. 26 %). Der größte Rückgang war mit –38 % (p 0,01) bei ambulanten Patienten zu verzeichnen und bei Untersuchungen von Wirbelsäule und Extremitäten (–51 % bis –72 %, p 0,05 bis p 0,01). Am geringsten tangiert waren Untersuchungen aus den Zentralen Notaufnahmen (–13 %, p 0,05) sowie CT-Untersuchungen des Thorax (–16 %, p 0,05). Das Ende des harten Lockdowns ging mit einer sukzessiven Normalisierung des Untersuchungsvolumens auf das Vorjahresniveau einher, die auch mit Beginn der zweiten Pandemiewelle und des milderen Lockdowns am Jahresende anhielt. Der Rückgang der Untersuchungen 2020 korrelierte dabei negativ mit der Inzidenz an SARS-CoV-2-positiven Fällen und assoziierten Todesfällen (r = 0,28 und 0,49; p 0,05 und p 0,001).Die COVID-19-Pandemie in Deutschland führte 2020 temporär zu einem signifikanten Rückgang radiologischer CT- und MRT-Untersuchungen. Nach Ende des ersten Lockdowns im Frühjahr zeigte sich eine rasche Erholung der Untersuchungszahlen mit weitgehender Stabilisierung des Untersuchungsvolumens auf das Vorjahresniveau.· Die Studie zeigt die pandemiebedingten Veränderungen radiologischer Bildgebung in einer multizentrischen, deutschlandweiten Analyse.. · Im Jahr 2020 kam es während des ersten Lockdowns zu einem temporären quantitativen Rückgang an CT- und MRT-Untersuchungen.. · Mit Beginn der ersten Lockerungen trat eine zügige Normalisierung der Untersuchungsvolumina auf Vorjahresniveau ein, die bis zum Jahresende anhielt.. · Signifikante Nachholeffekte wurden nicht beobachtet..· Schmidbauer M, Grenacher L, Juchems MS et al. Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. Fortschr Röntgenstr 2022; 194: 625 – 633.

Background To assess the technical feasibility, success rate, puncture complications and procedural characteristics of transjugular intrahepatic portosystemic shunt (TIPS) placement using a three-dimensional vascular map (3D-VM) overlay based on image registration of pre-procedural contrast-enhanced (CE) multi-detector computed tomography (MDCT) for portal vein puncture guidance. Materials and methods Overall, 27 consecutive patients (59 ± 9 years, 18male) with portal hypertension undergoing elective TIPS procedure were included. TIPS was guided by CE-MDCT overlay after image registration based on fluoroscopic images. A 3D-VM of the hepatic veins and the portal vein was created based on the pre-procedural CE-MDCT and superimposed on fluoroscopy in real-time. Procedural characteristics as well as hepatic vein catheterization time (HVCT), puncture time (PT), overall procedural time (OPT), fluoroscopy time (FT) and the dose area product (DAP) were evaluated. Thereafter, HVCT, PT, OPT and FT using 3D-VM (61 ± 9 years, 14male) were compared to a previous using classical fluoroscopic guidance (53 ± 9 years, 21male) for two interventional radiologist with less than 3 years of experience in TIPS placement. Results All TIPS procedure using of 3D/2D image registered 3D-VM were successful with a significant reduction of the PSG (p 2. HVCT, OPT and FT of the interventionalist with less TIPS experience using 3D/2D image registered 3D-VM were statistically different to an interventionalist with similar experience using fluoroscopic guidance (pHVCT = 0.0022; pOPT = 0.0097; pFT = 0.0009). PT between these interventionalists was not significantly different (pPT = 0.2905). Conclusion TIPS placement applying registration-based CE-MDCT vessel information for puncture guidance is feasible and safe. It has the potential to improve hepatic vein catherization, portal vein puncture and radiation exposure.

The aim of this animal study was to compare the fluoroscopic image quality (IQ) and radiation dose between a tantalum (Ta)-specific contrast-to-noise ratio-driven exposure control (Ta-CEC) and a detector dose-driven exposure control (DEC) in abdominal angiography.Nine angiography scenarios were created in seven anaesthetised pigs using Ta-based embolisation material during percutaneous liver and kidney intervention. Fluoroscopic images were acquired using three DEC protocols with different dose levels and Ta-CEC protocols with different IQ levels, sampled in small steps. Polymethyl-methacrylate and aluminium plates were used to simulate attenuation of three water equivalent thicknesses (WET). Three blinded readers evaluated the IQ of DEC and dose equivalent Ta images and selected the Ta-IQ equivalent image corresponding to the DEC image.Interobserver agreement for the IQ assessment was 0.43 for DEC, 0.56 for Ta-CEC and for the assessment of incident air kerma at the interventional reference point (KCompared to DEC, Ta-CEC significantly improved the fluoroscopic depiction of Ta, while maintaining the K

Background To evaluate effectivity of a 3D-motion correction algorithm in C-Arm CTs (CACT) with limited image quality (IQ) during transarterial chemoembolization (TACE). Methods From 1/2015–5/2021, 644 CACTs were performed in patients during TACE. Of these, 27 CACTs in 26 patients (18 m, 8f; 69.7 years ± 10.7 SD) of limited IQ were included. Post-processing of the original raw-data sets (CACTOrg) included application of a 3D-motion correction algorithm and bone segmentation (CACTMC_no_bone). Four radiologists (R1-4) compared the images by choosing their preferred dataset and recommending repeat acquisition in case of severe IQ-impairment. R1,2 performed additional grading of intrahepatic vessel visualization, presence/extent of movement artifacts, and overall IQ. Results R1,2 demonstrated excellent interobserver agreement for overall IQ (ICC 0.79,p p Org) to 1.39 (CACTMC_no_bone;p p Org:1.31 ± 1.67, CACTMC_no_bone:1.00 ± 1.34, p MC_no_bone were preferred, with identical datasets chosen by the readers to show benefit from the algorithm. Conclusion Application of a 3D-motion correction algorithm significantly improved IQ in diagnostically limited CACTs during TACE, with the potential to decrease repeat acquisitions.

Fast and reliable monitoring of volumetric heat distribution during MRI-guided tumor ablation is an urgent clinical need. In this work, we introduce a method for generating 2.5D thermometry maps from uniformly distributed 2D MRI phase images rotated around the applicator’s main axis. The images canbe fetched directly from the MR device, reducing the delay between image acquisition and visualization. For reconstruction, we use a weighted interpolation on a cylindric coordinate representation to calculate the heat value of voxels in a region of interest. A pilot study on 13 ex vivo bio protein phantoms with flexible tubes to simulate a heat sink effect was conducted to evaluate our method. After thermal ablation, we compared the measured coagulation zone extracted from the post-treatment MR data set with the output of the 2.5D thermometry map. The results show a mean Dice score of \(0.75\pm 0.07\), a sensitivity of \(0.77\pm 0.03\), and a reconstruction time within 18.02 ms ± 5.91 ms. Future steps should address improving temporal resolution and accuracy, e.g., incorporating advanced bioheat transfer simulations.

Patients with substantially impaired kidney function and peripheral arterial disease (PAD) underwent comparative COTo evaluate the feasibility and diagnostic performance of COFifteen patients (10 men, mean age 70 ± 11 years) with PAD received COOf 135 segments, 117 showed sufficient IQ, excluding 18 segments (10 CACT, 8 DSA). Inter-observer agreement for IQ and consecutive SG demonstrated good to excellent agreement: IQCO

To compare two different types of drug-eluting microspheres with regard to impact on HRQoL after first TACE, tumour response, peri-procedural complications, adverse events and 1-year survival in patients suffering from unresectable hepatocellular carcinoma (HCC).HRQoL was prospectively assessed with validated questionnaires (EORTC QLQ-C30 and -HCC18) before and 2 weeks after treatment with their first drug-eluting beads (DEB-)TACE with either acrylamido-polyvinylalcohol-AMPS hydrogel microspheres (groupAt baseline, there were no significant differences between the treated microsphere groups. No significant differences were found in absolute HRQoL changes after first DEB-TACE between the different types of microspheres. Response rates and survival were comparable between the investigated microsphere groups. For groupDEB-TACE is generally well tolerated and effective, with comparable changes in HRQoL for both types of drug-eluting microspheres. Tumour response is better with small microspheres. A relevant deterioration of physical function underlines that an aggressive TACE using small beads should be well deliberated.

Background MRI is attractive for guiding and monitoring interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure flow and cardiac function. Methods Technical solutions have been developed for all procedural steps including imaging guidance, MR-safe catheters and instruments and patient monitoring. This has led to widening of the clinical applications. Interventional MRI is becoming increasingly important for the treatment of patients suffering from malignant diseases. The detectability of masses and consequently their accessibility for biopsy is higher, compared to other modalities, due to the high intrinsic soft tissue contrast of MRI. Temperature-dependent sequences allow for minimally invasive and tissue-sparing ablation (A-0 ablation). Conclusion Interventional MRI has become established in the clinical routine for a variety of indications, including biopsies and tumor ablation. Since the economic requirement of covering costs by reimbursement is met and interventional MRI decreases the mortality and morbidity of interventional procedures, broader application of interventional MRI can be expected in the clinical routine in the future. Key points Citation Format

Background MRI is attractive for the guiding and monitoring of interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure physiologic parameters like flow and cardiac function. Method The current status of interventional MRI for the clinical routine was analyzed. Results The effort needed for the development of MR-safe monitoring systems and instruments initially resulted in the application of interventional MRI only for procedures that could not be performed by other means. Accordingly, biopsy of lesions in the breast, which are not detectable by other modalities, has been performed under MRI guidance for decades. Currently, biopsies of the prostate under MRI guidance are established in a similar fashion. At many sites blind biopsy has already been replaced by MR-guided biopsy or at least by the fusion of MR images with ultrasound. Cardiovascular interventions are performed at several centers for ablation as a treatment for atrial fibrillation. Conclusion Interventional MRI has been established in the clinical routine for a variety of indications. Broader application can be expected in the clinical routine in the future owing to the multiple advantages compared to other techniques. Key points Citation format