The Comfort Component in Interventional Radiology

20/10. 20/10. 20/10. By that I am referring to the gauge and the length of the needle I usually use to start many of the procedures that I perform. It is a comfortable sound to me; I don't know if it is the length of the needle, the size, or the feel. All I know is that it makes me comfortable to feel it or see it.

All 20-gauge needles are essentially the same. Many years ago, companies produced different types of these needles in an attempt to market these differences as "better or able to produce bigger samples." The needles were basically produced for biopsies. They had different bevels; they were thin- or thick-walled and had different needle styles.

If you don't perform many nonvascular interventions, perhaps you are not as comfortable with this type of needle. I have loved this needle for 25 years. (Maybe if you are an angiographer, you have the same feeling for a guidewire or a "sidewinder" catheter.) The needle makes me feel as if have "the force." Once I have that 20-gauge where I want, I feel as if I can put a catheter anywhere. I don't say this to sound cocky, but this needle gives me confidence and makes me comfortable.

If you have ever played sports, you may have felt this with a baseball glove, a bat, a pair of skates, a certain golf glove, a special pair of running shoes. For me the only thing that compares with the feel of the 20-gauge is my old hockey skates. I could put them on almost without untying them. They fit every nook and cranny on my feet. When I was wearing them, I felt I could do anything. It wasn't really a cocky feeling; it was just a "warm" feeling. I am not trying to turn an interventional procedure into a "Zen" experience, but familiar tools can make you comfortable.

Inanimate objects such as needles and skates can give you that feeling, and so can people. I remember playing hockey and definitely feeling more comfortable when certain people were on the ice with me. It must be the same on a football or soccer team. These people just make you feel better when they are there.

This is also the same feeling when certain people are around the department or doing procedures with you. When I first started out doing procedures I remember feeling "better," more confident, more certain, if my chief was in the building. I didn't need him to help with the procedures; I didn't need him even to go over my plan for the patient. I just felt more comfortable with him there.

I don't need that person now, but I still feel happier and more comfortable when certain people are around. Maybe I give off that feeling to other people. I don't know. I think I do. You probably know too. Another physician, a technologist, a nurse, somehow they show you that they are happier and more comfortable when "you" are in the room It is only natural.

Confidence, experience, skill, and comfort are all formidable components of a successful interventional program. Everybody acknowledges the first three words, but very few people discuss "comfort." We often discuss the experience and the skill of the person doing the procedure, but rarely the "comfort" level.

Over the years we radiologists have been obsessed with our technique, our results, our complications, our turf. We don't focus on the psychological aspects of what we are doing. Surgeons do, you know. Many have very "specific" music that they play when they perform certain operations. I don't like music when I do a procedure, but some people might. It is all about comfort.

Companies that sell equipment surely know about comfort. Do you really think there is that much difference between various guidewires and catheters that we use? For example, there must be 10 different abscess drainage catheters for sale. Yet there are a number of similar catheters out there for various vascular procedures. Sales people, marketing, packaging, advertisement, even free lunches are all part of "comfort." It is just a matter of how you as an individual define "comfort." You might be more at ease with a particular sales representative than another. Maybe it is the color of the "blue max" which you like. In any case, it is comfort.

And when you are comfortable, you feel better about what you are doing and you are more confident.

What really makes one radiologist a better interventionalist than another? Is it basic knowledge of the pathological process? Is it experience? Is it training? Is it aggressiveness? Is it concentration? I would say it is all of this, but when they all come together, it is "comfort." You may be familiar with the sports term "in the zone." This is a phrase often used by athletes to try to explain what happens when they perform some incredibly successful feat such as four home runs in a baseball game, or shooting a 61 on a tough golf course. Everything seems to come together to make things work. Well, a large part of that success is due to the comfort the player feels.

As I stated, I like to start many of my procedures with a 20-gauge needle. This at least gets me going in the right direction in terms of comfort. Think about it. What makes you feel confident during a procedure? It might be helpful to think openly of the steps you take when setting up and performing an intervention. Find out what is recurring, what is consistent, and try to repeat it. You probably will find that it helps to do the same things when dealing with an extremely difficult situation.

There are a myriad of examples in the sports world where an athlete has mentioned his or her "token" of comfort. A golfer will want a particular putter, a batter, a particular bat. Hockey players are notorious for their superstitions. Many will wear the same undergarments if they are doing well. Few will change their pads, even though they are dirty and torn. (Now you know where the famous "hockey rash" comes from.) If you have ever watched the hockey playoffs, you notice that many players will not shave during the whole series.

I have many quirks when it comes to sports. If you analyzed them, you might suggest that I should have both psychotherapy and shock therapy. I can't play golf with anything but "white" tees. When I played tennis, I had to hold my racket a certain way. Do I have the same quirks when I do procedures? To a certain degree, yes.

But, I do love my 20-gauge needle. It makes me comfortable and confident. At times I think I don't even need imaging to guide me.

Feel the force; let the force guide the 20-gauge needle. Of course, this is a little extreme, but there certainly is something valuable about comfort and feel.