Interventional Procedures

The biliary system is a tree-like network of tubes draining bile, a greenish fluid that helps you digest food, from the liver into the small bowel. When this system becomes blocked, it can lead to life threatening infection, liver failure, and potentially death. Gallstones, tumors, and infections can all block the biliary system. Sometimes, the system becomes blocked and the only symptoms are a yellowish tinge to your skin or the white part of your eye. Regardless of the symptoms, an accurate diagnosis is essential and can be made with ultrasound, CT, or MRI. Our board certified radiologists are experts in finding the cause of the obstruction so that you can proceed to definitive treatment!

Once the blockage is identified, a gastroenterologist using a scope from inside the digestive tract can typically manage these obstructions. However, when safe access to the biliary system is not possible from inside the small bowel, surgery or a minimally invasive procedure are indicated. Minimally invasive procedures involving the biliary tree can focus on the gallbladder (cholecystostomy tube), the bile ducts themselves (internal / external biliary drain), or the main trunk of the biliary tree, the common bile duct (drain placement or stenting). The right option for you will require a multidisciplinary approach potentially including your primary care physician, a gastroenterologist, a surgeon, and an interventional radiologist.

Many medical and post-surgical conditions can take time to heal, which can be frustrating for the patient. Long-term intravenous access is mandatory when dealing with renal failure, cancer, infection, caustic medications, or necessary treatment effect/high doses. The repeat trauma of multiple needle pokes and blood draws can be exhausting, only adding to the difficulty of dealing with an illness.

Our board certified interventional radiologists are experts at placing small catheters into the peripheral veins to overcome the repetitive needle sticks, to support medication administration, and give patients a longer duration option of access to the central circulatory system. Whether you require a small peripherally placed catheter that leads to the central venous system (a PICC line), a port (a portable central venous access device implanted under the skin), or central access for hemodialysis, our board certified interventional radiologists are here to help you meet your needs.

The aforementioned catheters are all placed under sterile technique with local anesthesia and are performed as outpatient procedures. If you need long term central venous access and have questions or concerns, you have come to the right place. Our team of interventional radiologists are happy to assist you in understanding the process, the procedures, and the outcomes revolving around central venous access.

We work closely with the local medical community and look forward to being part of your medical team. Call us today to schedule your consultation at 307-232-5054.

Patients receiving hemodialysis and peritoneal dialysis are commonly seen, evaluated, and treated by our board certified interventional radiology physicians. Whether you have a fistula, graft, hemodialysis catheter, or need a new peritoneal dialysis catheter, we are here to serve you. While we do not perform open surgical procedures, our minimally invasive techniques can prolong the life of your current access. Please click below or call 307-232-5054 to make an appointment with one of our board certified interventional radiologists.

Acute Ischemic Stroke is the fifth leading cause of death in the USA and is the leading cause of disability. Up to 22% of patients presenting with ischemic stroke are eligible candidates for clot retrieval. Larger clots portend worse outcomes.  The faster the clot is removed, the more brain is saved, and the better the patient outcome. Recent trials have proven that Mechanical Thrombectomy (removing the clot) is superior to medical therapy alone (tPA) in anterior circulation (the front of the brain) large vessel occlusion ischemic strokes.

How do strokes happen?

Ischemic strokes are identical to heart attacks in that the arteries (the blood vessels that carry oxygen from the heart to your body) become blocked and the downstream organ (the brain) is starved of oxygen. 

Time is brain. 1.9 Million neurons are lost from the brain each minute that the brain is starved of oxygen. Every delay the patient encounters on the way to an emergency department within a stroke ready hospital results in less favorable outcomes.

How do you fix it?

The short story is, get to Wyoming Medical Center.

The first step is recognizing a stroke when it happens. It is easy to remember FAST. Just think, “I need to get grandma to the hospital FAST!” FAST is an acronym, Facial Droop: Does grandma have a droopy face on one side or the other? Arm Weakness: Is one of grandma’s arms weaker than the other? Speech Difficulties: Can grandma repeat a short sentence or sing her favorite song? It is Time to call 911.  Facial Droop, Arm Weakness, Speech / Singing Difficulties, Time to call 911.

The second step is to ask the Emergency Medical Service team, whether it is the Fire Department, the Police, or the Ambulance, “Are you taking grandma to a stroke center that can perform Thrombectomy?” and “Does the hospital you’re taking me to treat the condition of Stroke?”

The third step is to bypass lab tests, chest radiographs, and further time delays and obtain high end imaging; CAT scans of the brain will help evaluate for bleeding, how old the stroke is, and if there is a large vessel occlusion. 

Once imaging is performed, a neurologist and an interventional radiologist will determine if the patient is a candidate for clot retrieval.

What does this mean for you and your family?

The interventional radiologists at Casper Medical Imaging are available 24 hours a day, 7 days a week, 365 days a year for you and your family. We are the leaders in Mechanical Thrombectomy in Wyoming and look forward to answering your questions, helping you make informed decisions, and standing by your side during your time of need.

Please email or call with Casper Medical Now.

Increased availability and utilization of cross sectional imaging in our society has greatly improved the opportunity to detect masses, tumors, and findings of unclear significance. Commonly, these lesions are present on CT or MRI scans as incidental findings – such as a small lung tumor detected when undergoing imaging evaluation for a cough or a fever.

The subspecialty field of interventional radiology has followed in lock step with advanced imaging by offering minimally invasive sampling of masses, tumors, infections, and incidental findings. These types of procedures were once impossible and in order to obtain tissue, patients would need to undergo major open surgical procedures. Thankfully, that has all changed.

The interventional radiology team at Casper Medical Imaging offers minimally invasive image guided biopsy and sampling of every major organ system. We can use ultrasound, CT, MRI, and even special mammographic techniques to obtain tissue – offering you a correct pathological diagnosis, which is the first step in determining your treatment path.

Our procedures are performed under sterile technique with local anesthesia and may not even require an incision. If necessary, medications can be given to relieve anxiety or to take away discomfort during the procedure. The recovery is virtually immediate and the vast majority of patients leave the same day of their procedure to rest and recover safely at home.

If you or a loved one has recently received a report similar to what is described above and requires a tissue diagnosis, feel free to contact us directly for a consultation. Our board certified interventional radiologists work closely with the local medical community and look forward to being part of your medical team. Call us today to schedule your consultation at 307-232-5054.

Trauma, internal bleeding, cancer, and a host of other medical conditions may prevent using blood thinners to prevent deep venous thrombosis and pulmonary embolism. When a patient has a contraindication to anticoagulation, placement of an inferior vena cava filter (IVCF) may be appropriate.

IVCF placement is performed with sterile technique with local anesthesia through a small incision in the neck or groin. A small tube, called a catheter, is placed into the large vein in the abdomen, the inferior vena cava (IVC), and images of the vessels are obtained using X-rays and contrast (the dye that allows you to see the veins). Once it is determined that the anatomy is appropriate, a small triangular shaped filter is placed through the catheter into the IVC. This filter will prevent any large blood clots that form in the lower extremities from travelling to the heart and lungs. Clot in the lungs is a pulmonary embolism, which could be rapidly fatal.

Many filters are FDA approved to remain in the body for the life of the patient, however not all patients require lifelong protection. If it is determined by your primary care provider that you no longer need protection in this fashion and can resume blood thinners you may be eligible to have your filter removed. Again, with sterile technique the large vein in the neck is accessed and a similar procedure is performed with a guidewire and catheter. However, the filter is captured using a small lasso device, collapsed into the tube/catheter in the vein, and removed from the body.

If you or a loved one has an IVC filter and needs to have it removed or might be a candidate for receiving a filter, one of our board certified interventional radiologists would be happy to see you in consultation. We work closely with the local medical community and look forward to being a part of your medical team. Call us today to schedule your consultation at 307-232-5054.

Cancer. The word alone evokes a hollow feeling in your gut. The CDC states that cancer is the second leading cause of death in the United States, exceeded only by heart disease and that one of every four deaths in the United States is due to cancer. With the rise of cross sectional imaging, many cancers are detected earlier than in the past; a great example is outlined by lung cancer screening, which has proven to detect lung cancers earlier in high risk populations. Unfortunately interventional radiologists are largely unknown to the population outside of medicine and yet have many techniques that play a vital role in the diagnosis and treatment of cancer. Read below to better understand just a few…..

A correct tissue diagnosis is an absolute necessity when you are facing cancer. Our board certified interventional radiologists are experts in obtaining tissue for our pathology and oncology colleagues with minimally invasive image guided techniques. The question then arises, after an imaging and tissue diagnosis, what are my options for treatment?

Most cancers are treated by a multidisciplinary group of physicians, all lending their expertise to improve patient outcomes. Traditional models typically included open surgery and systemic chemotherapy.

The treatment landscape is evolving and patients now have new therapeutic avenues to pursue, two of which fall into the array of procedures that our board certified interventional radiologists offer here in Casper, WY: Image guided thermal ablation and Transhepatic arterial embolization.

These two therapies are best described as local-regional therapies since they target one tumor or a small group of tumors.

Image guided thermal ablation is a well described and potential therapeutic approach in appropriately selected patients with solitary or a few localized cancerous lesions. While we can treat any organ system, two excellent patient examples are: 1) A solitary lung mass in a patient who is unable to undergo surgery and 2) A solitary kidney mass. Both of these scenarios are very reasonable candidates for image guided thermal ablation. Whether the thermal nature of the treatment is heat or ice, the intended result is to kill the tumor and a small amount of its local surroundings to prevent recurrence. These procedures are performed on an outpatient basis under imaging guidance with ultrasound or CT. Through a safe access point in the sterile skin with a small ~1 centimeter incision, local anesthesia is administered to surround the treatment area and prevent damage to local organs. Once the applicator is appropriately positioned within the tumor(s), heating or freezing is initiated and monitored with real time imaging. Once the tumor is treated and the applicator is removed a bandage is placed at the skin site and the patient is recovered over a 2-4 hour period. The vast majority of patients are discharged that same day to recover in the comfort of their home.

Liver directed therapies we offer include bland bead and chemotherapeutic laced bead treatments for primary and metastatic disease. Through a small sterile incision in the wrist or groin, access to the arterial system is performed with ultrasound guidance. Over a small guidewire a tube, called a catheter, is advanced into the liver arterial system and the small beads are injected directly into the blood vessels supplying the tumors. Patients typically receive intravenous medications to relieve anxiety and control discomfort and are then closely monitored overnight in the hospital. The vast majority of patients are discharged the following morning to recover fully in the comfort of their home.

The greatest challenge for patients when dealing with a cancer diagnosis is that they are unaware of the options available to treat their disease.

One of our board certified interventional radiologists specializing in interventional oncology would be happy to meet with you, discuss your options, and determine if a minimally invasive approach is right for you. We work closely with the local medical community and look forward to being part of your medical team. Call us today to schedule your consultation at 307-232-5054.

Your kidneys produce and drain urine into your bladder for elimination through very small tubes called the ureters. These tubes can sometimes become blocked by kidney stones, blood clots, or cancer which can lead to pain, blood in your urine, infection, and poor renal function. These conditions are managed by a urologist, a subspecialist surgeon focusing on the kidneys, ureters, bladder, and reproductive organs.

Often, when a ureter becomes blocked and can not be safely accessed from the urinary bladder, your urologist will involve an interventional radiologist to relieve the obstruction. Placing a tube through the skin, into the kidney, and placing a small catheter into the kidney collecting system (either the renal pelvis or the bladder directly) is called nephrostomy tube placement.

Once a nephrostomy tube is placed, it will be clinically managed by your urologist. When the tube needs to be changed (typically every 4-6 weeks) you will be taken care of by one of our board certified interventional radiologists. If you have questions or concerns about tube placement, management, or ongoing care please do not hesitate to contact us directly at 307-232-5054.

80% of adults will experience back pain at some point in their lives. This fact and the growth of non-invasive treatment options has led to patients seeking a multitude of different injections to help with their pain.

Our board certified interventional radiologists are experts in image guidance and using minimally invasive techniques to help ease pain. Whether you require a nerve root block (NRB), epidural steroid injection (ESI), rhizotomy (thermal destruction of the sensory nerves of the facets, or facet injection – we can help!

While we do not provide prescription medication or surgical techniques, we would be happy to be a part of your minimally invasive team. Feel free to call 307-232-5054 for more information on how we can help you get back to your best life!

Chronic Pelvic Pain (CPP) in women is extremely common. So common that it accounts for up to 40% of visits to Gynecologists and 15% of Family Practitioners. CPP is defined as non-cyclic pain lasting more than six months in duration. The list of medical conditions associated with CPP is long, typically requiring a team of physicians to correctly determine which part of the body requires a more detailed evaluation and treatment. Many women have undergone medical and surgical treatment with little or no relief. One of the more commonly overlooked diagnoses is called Pelvic Venous Insufficiency (PVI) or Pelvic Congestion Syndrome.

Pelvic Venous Insufficiency, Symptoms:

Heavy cramping pelvic pain that increases after intercourse and towards the end of the day.
Lying down flat or elevating the pelvis with pillows improves the sensation of heaviness; the pain is virtually gone upon awakening in the morning following a night of restful restorative sleep.
Some women experience bowel and bladder symptoms due to venous congestion.
Some women will have venous varices in the upper thighs, genital region, or buttocks.

What Causes Pelvic Venous Insufficiency?

PVI results when the veins that drains the ovaries begins to flow in the wrong direction. This type of venous insufficiency is common, affecting 10% of women. Up to sixty percent of women with these broken veins will experience the classic symptoms including, but not limited to: a dull pelvic ache, constant pelvic pain that worsens with standing, a heaviness or fullness in the pelvis that progressively worsens throughout the day, and deep pelvic pain following intercourse. Urinary urgency and bowel symptoms may also be associated with these findings.

A common question asked is, “Why do these veins break?” Unfortunately, there is no one simple answer. It is likely a combination of the ovarian vein being exposed to high concentrations of estrogen and progesterone over multiple menstrual cycles, dilation of the vein in response to pregnancy, and dysfunction of the venous valves – the support structure that makes the vein a one-way street.

We Can Diagnose or Rule Out PVI

Fortunately, the diagnosis can be verified by painless and non-invasive imaging such as Magnetic Resonance Venography, a very specific type of MRI, and ultrasound. Once this diagnosis is confirmed, these veins can be treated with small metal coils (imagine the spring on the inside of a pen) that prevent the blood from flowing in the wrong direction. The procedure is performed in an outpatient setting with a rapid recovery.

As described on this page, Pelvic Venous Insufficiency (PVI) represents a fundamental problem with the valves in the gonadal or ovarian veins. This condition was described a long time ago and was previously known as Pelvic Congestion Syndrome. Due to the emotional overlay ascribed to the latter term, we currently refer to this condition as Pelvic Venous Insufficiency. Either term can be used to describe the same fundamental flaw in the venous valves, and there can certainly be a resultant emotional component to living with daily pelvic pain. However, the term Pelvic Venous Insufficiency accurately describes the condition without associating the term negatively with anxiety, depression, or both. Therefore, we use the term Pelvic Venous Insufficiency to avoid the potential labeling of a patient’s experience with this disease process.
Pelvic Venous Insufficiency, Medical Imaging:

Magnetic Resonance Venography is a painless type of MRI that can help visualize the physiologic aspects of arterial and venous blood flow with a small amount of contrast injected through an intravenous line.
Transabdominal and transvaginal ultrasound can detect enlarged and dilated veins in the pelvis, giving insight to whether or not venous disease should be included in the workup for chronic pelvic pain

Pelvic Venous Insufficiency, Treatment, Technical Aspects:

The goal of eliminating gonadal venous reflux is aimed at re-routing the flow of venous blood away from the pelvis and eradicating the incompetent veins.

A small sterile catheter (imagine a very fine drinking straw) is inserted into the incompetent gonadal veins using X-ray guidance from a tiny incision in the groin or neck. Contrast dye is injected into the veins to document that the blood is indeed flowing in the wrong direction. Once confirmed, small coils (imagine the tiny spring in a ballpoint pen) are deployed into the vein, again using X-ray guidance to block the flow of blood.

Once the appropriate veins are blocked, the blood is re-routed to the central venous drainage.

This process stops the blood from flowing through the broken veins, thus alleviating the venous pooling in the pelvis thereby decreasing pain and discomfort.

Dr. Charles Bowkley has been treating this condition in Wyoming since 2010. If you have experienced the symptoms above or would like more information, please do not hesitate to contact Casper Medical Imaging.

Benign prostatic hyperplasia is an extremely common finding in elderly males, which contributes to significant alterations in quality of life due to lower urinary tract symptoms. Most modest symptoms are managed with medications, however these medications can produce other symptoms or side effects that lower patient compliance. When medication has failed and urinary symptoms continue, many patients are offered surgery – typically transurethral resection of the prostate (TURP). Minimally invasive surgical techniques have been developed; however these offer less symptom relief than TURP alone.

A newer and less invasive technique offered by interventional radiologists like ours, is called prostate artery embolization. Like many of our procedures, there is no surgical downtime, there is no surgical scar, and patients experience markedly improved (67%) quality of life. Since the first report of prostate arterial embolization in 2000, numerous studies have been performed demonstrating its safety, efficacy, and quality of life improvement outcomes. In comparative studies, prostate artery embolization performs well against TURP and minimally invasive surgical procedures, with less morbidity.

We work closely with our colleagues in Urology and one of our board certified interventional radiologists would be happy to see you in consultation to determine if prostate artery embolization is the right choice for you. Please call 307-232-5054 to schedule your consultation.

The most common benign tumors of the uterus are known as uterine fibroids, or uterine leiomyomata. These tumors can grow rather large and are associated with a spectrum of symptoms, most notably vaginal bleeding and heaviness or bulk symptomatology. Medical treatment is largely unsuccessful in long term management and therefore the traditional or classic treatment of uterine fibroids was hysterectomy, which is a major abdominal-pelvic invasive surgical procedure.


  • Heavy or prolonged menstrual bleeding;
  • Severe menstrual cramping;
  • Pelvic pressure, discomfort, excessive bloating or fullness, particularly peri-menstrual, and bothersome abdominal wall distortion caused by the enlarged uterus;
  • Pelvic pain related to identified leiomyomas, including dyspareunia (painful intercourse);
  • Urinary urgency, frequency, nocturia (frequent urination at night), or urine retention related to the enlarged leiomyomatous uterus; and
  • Hydronephrosis (swelling of the kidney) caused by the enlarged uterus.

The first report of using minimally invasive image guided catheter directed treatment to treat uterine fibroids was published in 1995. The FIBROID registry was created and analyzed demonstrating that uterine artery embolization for symptomatic uterine fibroids is a safe and effective alternative to hysterectomy.
Based on the long term clinical outcomes from rapid adoption by the interventional radiology community, supported by randomized clinical trial data, it is clear that uterine artery embolization is appropriate for consideration in all patients with symptomatic uterine fibroids and therefore should be presented to all patients seeking treatment for symptomatic uterine fibroids and adenomyosis.

We work closely with our local Gynecologists and one of our board certified interventional radiologists would be happy to see you in consultation at your convenience. Please call 307-232-5054 to schedule your appointment today.

Do you have tired, heavy, aching, swollen and painful legs?

At least 25% of women and 15% of men suffer from these symptoms.

Dr. Charles Bowkley III M.D. and Dr. Geoffrey Smith M.D., FACR are Interventional Radiologists who specialize in the diagnosis and treatment of varicose veins. A consultation with one of our physicians and a simple ultrasound can diagnose venous insufficiency.


A little background on how the veins work, well how they’re supposed to work. In normal veins, valves open and close to get blood back to your heart. Venous insufficiency, the cause of varicose veins, happens when the valves inside the veins fail and let blood flow in the wrong direction.

There are several factors that increase your chances of developing varicose veins:

  • Heredity
  • Gender
  • Pregnancy
  • Age
  • Prolonged Standing
  • Obesity
  • Physical Trauma

Those who have had a deep vein thrombosis (DVT) are also at risk for a similar problem known as deep venous reflux.

If left untreated, varicose veins can lead to skin ulcerations. These are wounds in the area of the calf and ankle that do not heal without treating the underlying vein. Often, these wounds can become infected, warranting immediate intervention.


The ultrasound test takes about an hour. The technologist will squeeze your legs while documenting the direction of blood flow in the veins. Once we have the results of the ultrasound you and your physician will work together to choose the best plan of care.

Diagnosis of venous insufficiency and its treatment are considered medical conditions, and they are covered by most insurance companies. Our billing office takes care of the pre-certification process for you.

Our success rate is nearly flawless. With proper post procedure care, recurrence rates in the treated veins are almost zero.

Spinal compression fractures are common, especially in the elderly. Softening of the bones, known as osteopenia, is common as we age, particularly in women, and can be a significant predisposing factor. They can be the result of a fall or minor trauma and result in central back pain overlying the fracture with an associated “band-like” discomfort that wraps around the sides and front. Conservative management typically involves physical therapy and bracing, focusing on strengthening the supportive musculature and allowing bone healing to take place. The acute period following the fracture is typically managed with anti inflammatory medications and pain medication ranging from Tylenol to strong narcotics.

When conservative methods fail, a minimally invasive approach may be warranted to restore the stability of the broken vertebrae. While “vertebral augmentation” is a term frequently used, the descriptive term “vertebroplasty” is also commonly used.

It’s important to understand that pain relief is likely more closely related to fixation of the fracture fragments rather than actual height restoration. Two different minimally invasive procedures exist for fracture fixation; vertebroplasty and kyohoplasty.

Vertebroplasty consists of placing a small needle through the numbed skin into the broken vertebral body using X-Ray guidance. Once the needle is safely in place a type of cement is injected into the broken vertebral body to assist in fracture fixation.

Kyphoplasty is performed in a similar fashion, however two needles are placed into the broken vertebral body, small balloons are placed into the broken vertebral body in an attempt to restore some height to the broken vertebral body, and cement is injected through the needles to fill the newly created space.

Spinal intervention requires a multidisciplinary approach to ensure the safest options have been considered for your treatment. Further, not every compression fracture is amenable to a percutaneous approach. Please call today to arrange a consultation with one of our board certified interventional radiologists at 307-232-5054

Interventional Procedures

For more information or to schedule an appointment to discuss any of these procedures please follow the link below