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Image-guided percutaneous biopsy is a commonly ­performed interventional radiological procedure that plays an important role in patient care and management. It is a safe and effective procedure that is less invasive than surgical biopsy and can be performed using a variety of imaging modalities available to most radiologists. Increasingly, referring physicians rely on the expertise and skill of the interventional radiologist to obtain tissue specimens from organ systems within the abdomen and pelvis. Image-guided percutaneous biopsy is associated with low morbidity and mortality, and therefore it can be applied to patients who are too ill to undergo an operation. This chapter reviews the basic principles of image-guided percutaneous biopsy.

Image-guided percutaneous abscess drainage (PAD) ­represents a major contribution by the field of ­interventional radiology to patient care [1]. Since the 1980s, it has evolved to become a well-established, minimally invasive procedure for the treatment of infected fluid collections in the abdomen and pelvis [2–6]. This chapter discusses the indications, techniques, and complications of PAD.

Percutaneous gastrostomy is a safe, low-cost method of providing essential nutrition without the discomfort of a nasogastric tube [1]. The interventional radiologist plays an increasingly important role in the creation and maintenance of enteral access. Of the three standard methods available for gastrostomy (surgical, endoscopic, radiologic), radiologic percutaneous gastrostomy is the least invasive and is associated with less morbidity and mortality when compared to surgical or endoscopic approaches [2, 3]. In many cases, radiologic percutaneous gastrostomy can be performed as an outpatient procedure and feedings can be initiated shortly after placement. For patients at risk of aspiration due to gastroesophageal reflux, percutaneous gastrostomy can be easily converted to percutaneous gastrojejunostomy. Finally, radiologic percutaneous gastrostomy placed under fluoroscopic guidance has been shown to have lower costs when compared to endoscopic and surgical approaches.

Percutaneous nephrostomy (PCN) was first described in 1955 as a means to decompress a kidney obstructed. Since then refinements in technique and advances in equipment and image-guidance have established this procedure as an essential procedure for the interventional radiologist. While relief of hydronephrosis remains the leading indication for PCN today, access to the renal collection system serves other roles beyond the relief of hydronephrosis. This chapter reviews the indications, technique of PCN and nephroureteral stent placement; PCN is a mainstay of nonvascular interventions. Tract creation for stone extraction or other endoscopic manipulation is the same as that of PCN.