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Schaake R, Leopold I, Sandberg A, Zenk B, Shafer L, Yu D, Lu X, Theingi S, Udongwo A, Cohen GS, Maresky HS. Virtual Reality for the Management of Pain and Anxiety for IR Procedures: A Prospective, Randomized, Pilot Study on Digital Sedation. J Vasc Interv Radiol 2024; 35:825-833. [PMID: 38484911 DOI: 10.1016/j.jvir.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/10/2024] [Accepted: 03/02/2024] [Indexed: 04/23/2024] Open
Abstract
PURPOSE To assess the analgesic and anxiolytic effects of virtual reality (VR) augmentation in patients undergoing peripherally inserted central catheter (PICC) placement or fine-needle aspiration thyroid biopsy. MATERIALS AND METHODS This is a prospective, single-center randomized controlled trial with 107 patients enrolled. Patients were randomly assigned to receive standard of care (SOC) or SOC+VR during PICC or thyroid biopsy procedures. Pain and anxiety were individually measured using the visual analog scale (VAS) before and after the procedure. Vital signs including heart rate and systolic and diastolic blood pressure were recorded. One-way analysis of variance test and Games-Howell post hoc analysis were used to assess effect size and statistical significance between SOC and SOC+VR measures. RESULTS The PICC cohort consisted of 59 patients (33 in SOC+VR and 26 in SOC), with a median age of 53.1 years (interquartile range [IQR], 38.3-62.7 years). The thyroid biopsy cohort consisted of 48 patients (26 in SOC+VR and 22 in SOC), with a median age of 60.1 years (IQR, 49.0-67.2 years). One-way analysis of individuals undergoing thyroid biopsies with adjunctive VR revealed an effect size of -1.74 points (SE ± 0.71; P = .018) on VAS pain scale when compared with SOC. Analysis of individuals undergoing PICC placements revealed an effect size of -1.60 points (SE ± 0.81; P = .053) on VAS anxiety when compared with SOC. CONCLUSIONS VR as a nonpharmacologic adjunct reduced some procedure-related pain and anxiety without increasing the procedural duration.
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Affiliation(s)
- Ryan Schaake
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
| | - Ian Leopold
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alexander Sandberg
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Brianna Zenk
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - London Shafer
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Daohai Yu
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Xiaoning Lu
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Shunn Theingi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Angela Udongwo
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Gary S Cohen
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Hillel S Maresky
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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2
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Sotirchos VS, Alexander ES, Zhao K, Zhan C, Yarmohammadi H, Ziv E, Erinjeri JP. Comparison of periprocedural and procedure room times between moderate sedation and monitored anesthesia care in interventional radiology. J Clin Imaging Sci 2024; 14:11. [PMID: 38628610 PMCID: PMC11021082 DOI: 10.25259/jcis_9_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/24/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives In recent years, there has been increased utilization of monitored anesthesia care (MAC) in interventional radiology (IR) departments. The purpose of this study was to compare pre-procedure bed, procedure room, and post-procedure bed times for IR procedures performed with either nurse-administered moderate sedation (MOSED) or MAC. Material and Methods An institutional review board-approved single institution retrospective review of IR procedures between January 2010 and September 2022 was performed. Procedures performed with general anesthesia or local anesthetic only, missing time stamps, or where <50 cases were performed for both MAC and MOSED were excluded from the study. Pre-procedure bed, procedure room, post-procedure bed, and total IR encounter times were compared between MAC and MOSED using the t-test. The effect size was estimated using Cohen's d statistic. Results 97,480 cases spanning 69 procedure codes were examined. Mean time in pre-procedure bed was 27 min longer for MAC procedures (69 vs. 42 min, P < 0.001, d = 0.95). Mean procedure room time was 11 min shorter for MAC (60 vs. 71 min, P < 0.001, d = 0.48), and mean time in post-procedure bed was 10 min longer for MAC (102 vs. 92 min, P < 0.001, d = 0.22). Total IR encounter times were on average 27 min longer for MAC cases (231 vs. 204 min, P < 0.001, d = 0.41). Conclusion MAC improves the utilization of IR procedure rooms, but at the cost of increased patient time in the pre- and post-procedure areas.
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Affiliation(s)
- Vlasios S. Sotirchos
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Erica S. Alexander
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ken Zhao
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Chenyang Zhan
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Etay Ziv
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Joseph P. Erinjeri
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, United States
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Bodard S, Guinebert S, N. Petre E, Marinelli B, Sarkar D, Barral M, H Cornelis F. Percutaneous liver interventions with robotic systems: a systematic review of available clinical solutions. Br J Radiol 2023; 96:20230620. [PMID: 37873927 PMCID: PMC10646656 DOI: 10.1259/bjr.20230620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Robotic-guided interventions are emerging techniques that are gradually becoming a common tool for performing biopsies and tumor ablations in liver. This systematic review aims to evaluate their advancements, challenges, and outcomes. METHODS A systematic review was conducted using the PubMed database to identify relevant articles published between January 2000 and February 2023. Inclusion criteria focused on studies that assessed robotic systems for percutaneous liver biopsies and tumor ablations. Data extraction was performed to collect information on study characteristics; robotic systems; components and software; imaging modality; degree of freedom; and needle insertion methods. The outcome measures analyzed were procedure time, radiation dose, and accuracy. RESULTS 10 studies met the inclusion criteria. The robotic devices used included MAXIO, EPIONE, ROBIO-EX, AcuBot, and ACE robotic systems. The data set consisted of 429 percutaneous thermal ablations and 57 biopsies, both robot-guided. On average, the mean deviation of probes was reduced by 30% (from 1.6 vs 3.3 mm to 2.4 vs 3.9 mm (p < 0.001)), and 40% (p < 0.05) fewer readjustments were required during the robotic-assisted interventions. Moreover, robotic systems contributed to a reduction in operating time, ranging from 15% (18.3 vs 21.7 min, p < 0.001) to 25% (63.5 vs 87.4 min, p < 0.001). Finally, the radiation dose delivered to both the patient and the operator was decreased by an average of 50% (p < 0.05) compared to manual procedures. ADVANCES IN KNOWLEDGE Robotic systems could provide precise navigation and guidance during liver biopsies and percutaneous ablations.
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Affiliation(s)
| | - Sylvain Guinebert
- Department of Radiology, University of Paris Cité, Necker Hospital, Paris, France
| | - Elena N. Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Debkumar Sarkar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Matthias Barral
- Department of Radiology, Sorbonne University, Tenon Hospital, Paris, France
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Key BM, Callstrom MR, Filippiadis D. Musculoskeletal Interventional Oncology: A Contemporary Review. AJR Am J Roentgenol 2023; 221:503-516. [PMID: 37222277 DOI: 10.2214/ajr.23.29110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Matthew R Callstrom
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Dimitrios Filippiadis
- Department of Diagnostic and Interventional Radiology, University General Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Barral M, Chevallier O, Cornelis FH. Perspectives of Cone-beam Computed Tomography in Interventional Radiology: Techniques for Planning, Guidance, and Monitoring. Tech Vasc Interv Radiol 2023; 26:100912. [PMID: 38071025 DOI: 10.1016/j.tvir.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Cone-beam computed tomography (CBCT) has emerged as a prominent imaging modality in interventional radiology that offers real-time visualization and precise guidance in various procedures. This article aims to provide an overview of the techniques used to guide and monitor interventions that use CBCT. It discusses the advantages of CBCT, its current applications, and potential future CBCT-related developments in the field of interventional radiology.
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Affiliation(s)
- Matthias Barral
- Department of Radiology, Tenon Hospital, Paris, France; Paris Sorbonne Université, France.
| | | | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medicine Medical College, New York, NY
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Kukla P, Maciejewska K, Strojna I, Zapał M, Zwierzchowski G, Bąk B. Extended Reality in Diagnostic Imaging-A Literature Review. Tomography 2023; 9:1071-1082. [PMID: 37368540 DOI: 10.3390/tomography9030088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
The utilization of extended reality (ER) has been increasingly explored in the medical field over the past ten years. A comprehensive analysis of scientific publications was conducted to assess the applications of ER in the field of diagnostic imaging, including ultrasound, interventional radiology, and computed tomography. The study also evaluated the use of ER in patient positioning and medical education. Additionally, we explored the potential of ER as a replacement for anesthesia and sedation during examinations. The use of ER technologies in medical education has received increased attention in recent years. This technology allows for a more interactive and engaging educational experience, particularly in anatomy and patient positioning, although the question may be asked: is the technology and maintenance cost worth the investment? The results of the analyzed studies suggest that implementing augmented reality in clinical practice is a positive phenomenon that expands the diagnostic capabilities of imaging studies, education, and positioning. The results suggest that ER has significant potential to improve diagnostic imaging procedures' accuracy and efficiency and enhance the patient experience through increased visualization and understanding of medical conditions. Despite these promising advancements, further research is needed to fully realize the potential of ER in the medical field and to address the challenges and limitations associated with its integration into clinical practice.
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Affiliation(s)
- Paulina Kukla
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
| | - Karolina Maciejewska
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
| | - Iga Strojna
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
| | - Małgorzata Zapał
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
- Department of Adult Neurology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Grzegorz Zwierzchowski
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
- Department of Medical Physics, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Bartosz Bąk
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
- Department of Radiotherapy II, Greater Poland Cancer Centre, 61-866 Poznan, Poland
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Noikham A, Tivirach W, Pongraweewan O, Suphathamwit A, Puangpunngam N, Jirativanont T. Popliteal sciatic nerve block for high-risk patients undergoing lower limb angioplasty: A prospective double-blinded randomized controlled trial. Medicine (Baltimore) 2023; 102:e33690. [PMID: 37145010 PMCID: PMC10158915 DOI: 10.1097/md.0000000000033690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND To assess the rate of conversion to general anesthesia, sedative and analgesic drug-sparing effects, and complications of popliteal sciatic nerve block (PSNB) compared with a sham block during lower limb angioplasty. METHODS A randomized, controlled, double-blinded trial of patients with chronic limb-threatening ischemia (CLTI) who receive PSNB with 0.25% levobupivacaine 20 mL compared with a sham block (control) during lower limb angioplasty. Pain scores, conversion rate to general anesthesia, amount of sedoanalgesia drug usage, complications, and satisfaction with the anesthesia technique by surgeons and patients were assessed. RESULTS Forty patients were enrolled in this study. Two of 20 (10%) control group patients were converted to general anesthesia, while none of the patients in the intervention group required general anesthesia (P = .487). Pain scores before PSNB did not differ between the groups (P = .771). After the block, pain scores in the block group were lower than those in the control group: 0 (0, 1.5) (median, interquartile range) and 2.5 (0.5, 3.5), respectively (P = .024). The analgesic effect persisted until immediately after the surgery (P = .035). There was no difference in pain scores at the 24-hours follow-up visit (P = .270). The total propofol and fentanyl dosage requirements, a number of patients who required propofol and fentanyl, side effects, and satisfaction were not different between the groups. No major complications were noted. CONCLUSIONS PSNB provided effective pain relief during and immediately after lower limb angioplasty, but did not statistically affect the rate of conversion to general anesthesia, sedoanalgesia drug usage, or complications.
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Affiliation(s)
- Alif Noikham
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wannapa Tivirach
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orawan Pongraweewan
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aphichat Suphathamwit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattawut Puangpunngam
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tachawan Jirativanont
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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8
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Weynants L, Chys B, D'hulst P, Merckx L, Van Besien J, Tailly T. Virtual reality for pain control during shock wave lithotripsy: a randomized controlled study. World J Urol 2023; 41:589-594. [PMID: 36680576 DOI: 10.1007/s00345-023-04280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Although external shock wave lithotripsy (SWL) is an outpatient procedure generally not requiring anesthesia or sedation, patients may experience pain during the procedure. The aim of this study is to evaluate whether a virtual reality device is effective in reducing patient-reported pain during the procedure, consequently leading to exposure to higher energy levels and better clinical outcomes. METHODS Inclusion criteria for SWL were according to the latest EAU guidelines on urolithiasis. Patients were randomized 1:1 in two groups (SWL with VR and SWL without VR). The primary outcome of this randomized, controlled study (RCT) was an overall difference in pain levels determined by VAS-scores. Secondary outcomes were differences in comfort levels, determined by Likert-scale scores, clinical success and total delivered energy. RESULTS Between January 2019 and September 2021, we enrolled 166 patients; 84 were randomized to the control arm and 82 to the VR arm. Patients without VR experienced significantly more pain compared to the VR group (mean VAS-score = 4.94 vs 4.01; p = 0.011). The mean total delivered energy was significantly higher in the VR group compared to the control group (55.2 J vs. 48.8 J; p = 0'037). No significant differences in comfort levels and clinical success were found. CONCLUSION This study supports the use of VR as a method of pain relief during shock wave lithotripsy. Higher energy levels can be achieved during the treatment while comfort levels remained equal; this however did not lead to improved clinical success. REGISTRATION NUMBER AND NAME OF TRIAL REGISTRY Clinicaltrials.gov: NCT05183269. Virtual reality for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized study at a single institution. https://clinicaltrials.gov/ct2/show/NCT05183269?term=shock+wave+lithotripsy&cond=virtual+reality&cntry=BE&draw=2&rank=1 .
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Affiliation(s)
- Laurens Weynants
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium. .,Department of Urology, University Hospital Ghent, Ghent, Belgium.
| | - Brecht Chys
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Pieter D'hulst
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Luc Merckx
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Jeroen Van Besien
- Department of Urology, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review. J Clin Med 2023; 12:jcm12030843. [PMID: 36769490 PMCID: PMC9917582 DOI: 10.3390/jcm12030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.
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Rousseaux F, Panda R, Toussaint C, Bicego A, Niimi M, Faymonville ME, Nyssen AS, Laureys S, Gosseries O, Vanhaudenhuyse A. Virtual reality hypnosis in the management of pain: Self-reported and neurophysiological measures in healthy subjects. Eur J Pain 2023; 27:148-162. [PMID: 36196745 PMCID: PMC10091709 DOI: 10.1002/ejp.2045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/10/2022] [Accepted: 10/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Virtual reality hypnosis (VRH) has emerged as a new and promising option for pain management. Nonetheless, neural dynamics of pain modulation during VRH have not been investigated yet. The aim of this study was to measure the effects of VRH on pain, combining neurophysiological and self-reported measurements. METHODS Eighteen healthy subjects underwent noxious electrical stimulations in both normal wakefulness and VRH conditions. Dissociation, absorption, time perception, anxiety, pain intensity and unpleasantness, heart rate variability and breathing were reported for each condition. EEG signals were analysed using event-related potentials (ERP) and time-frequency response (TFR) time-locked to stimuli. Neurophysiological features were correlated with self-reported data. RESULTS VRH condition was associated with lower pain and higher dissociation. VRH significantly decreased amplitudes of N100 and P200 ERP components, reduced EEG power between 1 and 5 Hz from 100 to 560 ms, and increased EEG power from 5 to 11 Hz from 340 to 800 ms. These findings were observed at frontal, central and posterior electrodes. Heart rate variability was significantly higher and breathing frequency reduced with VRH. Correlations were found between the self-reported level of pain and ERP components. CONCLUSION VRH modulates cerebral pain processes and body physiology, leading to reduced pain levels. These findings offer a first insight on the analgesic mechanisms of VRH and suggest that VRH is an effective approach to reduce experimental pain. SIGNIFICANCE VRH decreases experimental pain perception, increases subject level of dissociation and modulates cerebral pain processing mechanisms. Pain can be managed with analgesic medication but also through complementary interventions. Among these, hypnosis and virtual reality (VR) are known to reduce pain for patients and healthy individuals. In recent years, an innovative technique combining hypnosis and VR has been proposed to help patients in managing pain. However, to our knowledge, no study has focused on the underlying mechanisms of this VR/hypnosis combination. We showed that VR combined with hypnosis decreases experimental pain, increases dissociation and influences EEG modulation.
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Affiliation(s)
- Floriane Rousseaux
- Sensation & Perception Research Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Laboratory of Cognitive Ergonomics and Work Intervention, University of Liege, ULiege (B32), Quartier Agora, Liege, Belgium
| | - Rajanikant Panda
- Coma Science Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Centre du Cerveau, University Hospital of Liège, Liege, Belgium
| | | | - Aminata Bicego
- Sensation & Perception Research Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Laboratory of Cognitive Ergonomics and Work Intervention, University of Liege, ULiege (B32), Quartier Agora, Liege, Belgium
| | - Masachika Niimi
- Coma Science Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium
| | - Marie-Elisabeth Faymonville
- Sensation & Perception Research Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Algology Interdisciplinary Center, University Hospital of Liege, CHU Sart Tilman, Domaine Universitaire du Sart Tilman, Liège, Belgium
| | - Anne-Sophie Nyssen
- Sensation & Perception Research Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Laboratory of Cognitive Ergonomics and Work Intervention, University of Liege, ULiege (B32), Quartier Agora, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Centre du Cerveau, University Hospital of Liège, Liege, Belgium
| | - Olivia Gosseries
- Sensation & Perception Research Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Coma Science Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Centre du Cerveau, University Hospital of Liège, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation & Perception Research Group, GIGA Consciousness, University of Liege, GIGA (B34), Quartier Hopital, Liege, Belgium.,Algology Interdisciplinary Center, University Hospital of Liege, CHU Sart Tilman, Domaine Universitaire du Sart Tilman, Liège, Belgium
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11
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Weiss D, Wilms LM, Ivan VL, Vach M, Loberg C, Ziayee F, Kirchner J, Schimmöller L, Antoch G, Minko P. Complication Management and Prevention in Vascular and non-vascular Interventions. ROFO-FORTSCHR RONTG 2022; 194:1140-1146. [PMID: 35977554 DOI: 10.1055/a-1829-6055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE This overview summarizes key points of complication management in vascular and non-vascular interventions, particularly focusing on complication prevention and practiced safety culture. Flowcharts for intervention planning and implementation are outlined, and recording systems and conferences are explained in the context of failure analysis. In addition, troubleshooting by interventionalists on patient cases is presented. MATERIAL AND METHODS The patient cases presented are derived from our institute. Literature was researched on PubMed. RESULTS Checklists, structured intervention planning, standard operating procedures, and opportunities for error and complication discussion are important elements of complication management and essential for a practiced safety culture. CONCLUSION A systematic troubleshooting and a practiced safety culture contribute significantly to patient safety. Primarily, a rational and thorough error analysis is important for quality improvement. KEY POINTS · Establishing a safety culture is essential for high-quality interventions with few complications.. · A rational and careful troubleshooting is essential to increase quality of interventions.. · Checklists and SOPs can structure and optimize the procedure of interventions.. CITATION FORMAT · Weiss D, Wilms LM, Ivan VL et al. Complication Management and Prevention in Vascular and non-vascular Interventions. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1829-6055.
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Affiliation(s)
- Daniel Weiss
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Lena Marie Wilms
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Vivien Lorena Ivan
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Marius Vach
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Christina Loberg
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Farid Ziayee
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
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Filippiadis DK, Pua U, Georgiadi E, Quek LHH, Kelekis A, How GY, Kelekis N. Percutaneous Ablation of Metastatic Lymph Nodes: An Insight from the Comparison of Efficacy and Safety Between Cryoablation and Radiofrequency Ablation. Cardiovasc Intervent Radiol 2022; 45:1134-1140. [PMID: 35680674 DOI: 10.1007/s00270-022-03191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively compare efficacy and safety of computed tomography (CT)-guided percutaneous ablation of metastatic lymph nodes (LN) between cryoablation (CA) and radiofrequency ablation (RFA). MATERIALS AND METHODS A bi-central institutional database research identified 28 patients (42 metastatic LNs) who underwent percutaneous CT-guided ablation. RFA group included 18 patients/26 tumors; CA group included 10 patients/16 tumors. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics, technical and clinical success on a per tumor and a per patient basis and complication rates were recorded, evaluated and compared between the 2 groups. RESULTS Both RFA and CA groups had the same median tumor size (2.00 vs. 2.20 cm, p = 0.257), the same median follow-up time (20.50 vs. 20.00 months, p = 0.923) and the same median length of hospital stay (1.00 vs. 1.00 days, p = 0.283). CA group had a higher median procedure time (110.50 vs. 52.00 min, p = 0.001). On a per lesion basis, the overall complete response post-ablation was 88.46% (23/26 lesions) in the RFA and 93.75% (15/16 lesions) in the CA group; no association was revealed between local tumor control and ablation technique (p = 0.709). No complications were recorded in both Groups. On a per patient basis, CA had a longer disease-free interval (24.00 vs. 14.50, p = 0.012) which, however, did not affect the overall survival between the two techniques (26.0 vs. 22.0, p = 0.099 for CA and RFA respectively). CONCLUSION Our limited data suggest that CT-guided RFA and CA are equally effective on terms of efficacy and safety for the treatment of metastatic lymph nodes.
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Affiliation(s)
- Dimitrios K Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens,, 1 Rimini str, 12462, Haidari/Athens, Greece.
| | - Uei Pua
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Eleni Georgiadi
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens,, 1 Rimini str, 12462, Haidari/Athens, Greece
| | | | - Alexis Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens,, 1 Rimini str, 12462, Haidari/Athens, Greece
| | - Guo Yuan How
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens,, 1 Rimini str, 12462, Haidari/Athens, Greece
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The Impact of COVID-19 on Interventional Radiology Practice Worldwide: Results from a Global Survey. Cardiovasc Intervent Radiol 2022; 45:1152-1162. [PMID: 35277726 PMCID: PMC8916069 DOI: 10.1007/s00270-022-03090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/04/2022] [Indexed: 02/08/2023]
Abstract
Background The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves. Methods An anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis. Results Interventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis. Conclusion While the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03090-6.
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Filippiadis DK, Velonakis G, Mazioti A, Tsochatzis A, Vrachliotis T, Kelekis A, Kelekis N. Percutaneous Navigation under Local Anesthesia for Computed Tomography-Guided Microwave Ablation of Malignant Liver Lesions Located in the Hepatic Dome. MEDICINA-LITHUANIA 2021; 57:medicina57101056. [PMID: 34684093 PMCID: PMC8540943 DOI: 10.3390/medicina57101056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The aim of the present study was to report the safety and efficacy of percutaneous navigation under local anesthesia for computed tomography-guided microwave ablation of malignant liver lesions located in the hepatic dome. Patients with primary and secondary malignant liver lesions located in the hepatic dome who underwent percutaneous computed tomography-guided microwave ablation using a computer-assisted navigation system under local anesthesia were prospectively evaluated. The primary objective was technical success. Materials and Methods: The sample consisted of 10 participants (16 lesions) with a mean age of 60.60 years (SD = 9.25 years) and a mean size of 20.37 ± 7.29 cm, and the mean follow-up time was 3.4 months (SD = 1.41) months. Results: Primary technical success was 93.75%. Tumor remnant was noticed at one month follow-up in a single metastatic lesion, which was re-treated with an ablation session, and no tumor remnant was depicted in the subsequent imaging follow-up (secondary technical success 100%). Grade I self-limited complications (according to the CIRSE classification system) included small pleural effusion (n = 1) and minor bleeding post antenna removal (n = 1) requiring nothing but observation. Conclusions: the findings of the present study indicate that percutaneous navigation under local anesthesia is a safe and efficacious approach for computed tomography-guided microwave ablation of malignant liver lesions located in the hepatic dome. Large randomized controlled studies are warranted to observe treatment effectiveness and compare the results with those of other options.
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Percutaneous Image-Guided Vertebral Fixation in Cancer-Related Vertebral Compression Fractures: A Case Series Study. MEDICINA-LITHUANIA 2021; 57:medicina57090907. [PMID: 34577830 PMCID: PMC8472438 DOI: 10.3390/medicina57090907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
Background and objectives: Cancer-related vertebral compression fractures (VCF) may cause debilitating back pain and instability, affecting the quality of life of cancer patients. To further drive cement deposition during vertebroplasty, the aims of this restrospective case series study were to report the feasibility, safety and short term efficacy (≤6 months) of percutaneous vertebral fixation in cancer-related vertebral compression fractures using various intravertebral implants. Methods: All consecutive cancer patients treated with percutaneous vertebral fixation for VCF were retrospectively included. Various devices were inserted percutaneously under image guidance and filled by cement. Descriptive statistics were used and a matched paired analysis of pain scores was performed to assess for changes following interventions. Results: A total of 18 consecutive patients (12 women (66.6%) and 6 men (33.3%); mean age 59.7 ± 15.5 years) were included. A total of 42 devices were inserted in 8 thoracic and 16 lumbar vertebrae. Visual analogue scale measurement significantly improved from 5.6 ± 1.8 preoperatively to 1.5 ± 1.7 at 1 week (p < 0.01) and to 1.5 ± 1.3 at 6 months (p < 0.01). No severe adverse events were observed, but three adjacent fractures occurred between 1 week and 5 months after implantation. Conclusions: Percutaneous vertebral fixation of cancer-related VCF is feasible and safe and allows pain relief.
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Hepatic Arterial Infusion of Chemotherapy for Advanced Hepatobiliary Cancers: State of the Art. Cancers (Basel) 2021; 13:cancers13123091. [PMID: 34205656 PMCID: PMC8234226 DOI: 10.3390/cancers13123091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Liver functional failure is one of the leading causes of cancer-related death. Systemic chemotherapy usually offers a modest benefit in terms of disease control rate, progression-free survival, and overall survival at the cost of a significant percentage of adverse events. Liver malignancies are mostly perfused by the hepatic artery while the normal liver parenchyma by the portal vein network. On these bases, the therapeutic strategy consisting of hepatic arterial infusion of chemotherapy takes place. This review aims to summarize the current knowledge on this approach from different points of view, such as techniques, drugs pharmacology and pharmacokinetics, and clinical outcomes for advanced hepatobiliary cancers. Most of the collected studies have several limitations: non-randomized retrospective design, a relatively small number of patients, the hepatic arterial administration of different chemotherapeutic agents, as well as its combination with a great heterogeneity of systemic agents. However, despite these limitations, the presented data show favorable results in terms of safety and efficacy for hepatic arterial infusion of chemotherapy, with respect or in alternative to the gold standard treatment, even when they are combined with systemic treatments. Therefore, this therapeutic strategy may be an alternative or an integrative treatment option for advanced hepatobiliary cancers. Further and larger prospective, randomized, multi-center studies, with well-defined inclusion criteria and treatment strategies, are required to confirm the presented data. Abstract Liver functional failure is one of the leading causes of cancer-related death. Primary liver tumors grow up mainly in the liver, and thus happens for liver metastases deriving from other organs having a lower burden of disease at the primary site. Systemic chemotherapy usually offers a modest benefit in terms of disease control rate, progression-free survival, and overall survival at the cost of a significant percentage of adverse events. Liver malignancies are mostly perfused by the hepatic artery while the normal liver parenchyma by the portal vein network. On these bases, the therapeutic strategy consisting of hepatic arterial infusion (HAI) of chemotherapy takes place. In literature, HAI chemotherapy was applied for the treatment of advanced hepatobiliary cancers with encouraging results. Different chemotherapeutic agents were used such as Oxaliplatin, Cisplatin, Gemcitabine, Floxuridine, 5-Fluorouracil, Epirubicin, individually or in combination. However, the efficacy of this treatment strategy remains controversial. Therefore, this review aims to summarize the current knowledge on this approach from different points of view, such as techniques, drugs pharmacology and pharmacokinetics, and clinical outcomes for advanced hepatobiliary cancers.
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CT evaluation of patent artery after percutaneous cryoablation of renal cell carcinoma. Diagn Interv Imaging 2021; 102:753-758. [PMID: 34144934 DOI: 10.1016/j.diii.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this retrospective study was to determine the incidence of persistent patent artery after percutaneous cryoablation of renal cell carcinoma (RCC) and the relationship between patent arteries one month after cryoablation and early tumor progression. MATERIALS AND METHODS One hundred and fifty-nine patients (112 men, 47 women; mean age, 63.6±14.6 [SD] years; age range: 21-91 years) who underwent percutaneous cryoablation for 186 RCCs (mean diameter, 1.9±0.6 [SD] cm; range: 0.7-4.0cm) were retrospectively included. After cryoablation, patients underwent contrast-enhanced computed tomography (CT) with ≤2-mm slice thickness within one week from cryoablation, and at one, three, and six months. The time course of patent artery in the ablated renal parenchyma after cryoablation was the primary endpoint. The relationships between patent arteries one month after cryoablation and treatment effectiveness, tumor vascularity, tumor enhancement one month after cryoablation, tumor subtype, and renal function changes were evaluated as secondary endpoints. RESULTS CT showed patent arteries in the ablated renal parenchyma within one week in 166 RCCs (89.2%), at one month in 54 RCCs (29.0%), at three months in 8 RCCs (4.3%), and at six months in 2 RCCs (1.1%). The presence of patent artery one month after cryoablation was significantly associated with tumor enhancement at the same time point (P=0.015). There was no association between patent arteries one month after cryoablation and treatment effectiveness (P=0.693). CONCLUSION Patent arteries in the ablated renal parenchyma are commonly observed on CT examination after percutaneous cryoablation of RCC. However, they gradually disappear and do not require specific treatment.
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Rana A, Nguyen TN, Siegler JE. Stroke and neurointervention in the COVID-19 pandemic: a narrative review. Expert Rev Med Devices 2021; 18:523-531. [PMID: 33966557 DOI: 10.1080/17434440.2021.1928495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: In this review, we will summarize the impact of the COVID-19 pandemic on neurointerventional care for patients with cerebrovascular disease, with a particular emphasis on epidemiology, neurointerventional processes, and lessons learned from paradigm shifts in endovascular care.Areas covered: Peer-reviewed research is summarized regarding the complications of COVID-19 as related to the pandemic's impact on hospital admissions, imaging capabilities, treatment times, and outcomes of neurointerventional cases.Expert opinion: In the first wave of the COVID-19 pandemic, there was a global decline in neuroimaging, use of intravenous thrombolysis, thrombectomy, and coil embolization for ruptured intracranial aneurysms. An early recommendation to utilize general anesthesia and intubate all patients undergoing intervention to avoid an emergent aerosolizing procedure was found to have worse outcomes. The decline in new stroke and subarachnoid hemorrhage diagnoses may be related to patient and/or family fear of seeking acute medical care. A true shift in stroke epidemiology is also possible. As several vaccines become more readily available and the world rebounds from this pandemic, we hope to transform the neurointerventional experiences discussed in this paper into strategies that may improve care delivery of neurologically ill patients during a global crisis.
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Affiliation(s)
- Ameena Rana
- Cooper Medical School of Rowan University, Camden United States
| | - Thanh N Nguyen
- Department of Neurology, Radiology, and Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, United States
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, United States
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De Marini P, Cazzato RL, Garnon J, Dalili D, Leonard-Lorant I, Leclerc L, Autrusseau PA, Auloge P, Weiss J, Tricard T, Lang H, Gangi A. Safety and oncologic efficacy of percutaneous MRI-guided cryoablation of intraparenchymal renal cancers. Diagn Interv Imaging 2021; 102:531-538. [PMID: 33931365 DOI: 10.1016/j.diii.2021.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and oncologic efficacy of percutaneous magnetic resonance imaging (MRI)-guided cryoablation of intraparenchymal renal cancer. MATERIALS AND METHODS Between February 2009 and August 2019, 31 consecutives patients with 31 entirely intraparenchymal biopsy-proven renal cancers were treated with cryoablation under MRI-guidance in our institution, and were retrospectively included. There were 20 men and 11 women with a mean age of 68.5±12.5 (SD) (range: 40-91years). Patient, tumor- and procedure-related, and follow-up data were retrospectively collected and analyzed. Local recurrence free (LRFS), metastasis free (MFS), disease free (DFS), cancer specific (CSS), and overall survivals (OS) were calculated. RESULTS Primary and secondary technical efficacy rates were 94% and 100%, respectively. Median follow-up was 27months. Seven (7/31; 23%) minor complications were noted in 7 patients. Patients showed a significant decline of the estimated glomerular filtration rate (eGFR) between baseline and nadir (mean basal eGFR 65.9±22.4 [SD] mL/min/1.73m2vs. mean nadir eGFR 52.8±26.0 [SD] mL/min/1.73m2; P<0.001), but only two showed a clinically significant renal function decline. Three-year estimates of primary and secondary LRFS, MFS, and DFS were 64% (95% confidence interval [CI]: 47-87%), 89% (95% CI: 78-99%), 83% (95% CI: 77-98%), and 45% (95% CI: 28-73%), respectively. No patients died due to renal cancer evolution (three-year CSS of 100%; 95% CI: 100-100%). One patient died 52months after the percutaneous treatment due to cryoablation-unrelated causes (three-year OS of 100%; 95% CI: 100-100%). CONCLUSION MRI-guided percutaneous cryoablation for intraparenchymal renal cancer offers good oncologic outcomes with acceptable complication rates and renal function worsening.
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Affiliation(s)
- Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
| | - Ian Leonard-Lorant
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Loïc Leclerc
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Pierre-Alexis Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Thibault Tricard
- Department of Urology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
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Tsochatzis A, Mazioti A, Iliadis G, Velonakis G, Efthymiou E, Kelekis A, Kelekis N, Filippiadis D. Percutaneous Microwave Ablation of Liver Lesions: Differences on the Sphericity Index of the Ablation Zone between Cirrhotic and Healthy Liver Parenchyma. Diagnostics (Basel) 2021; 11:diagnostics11040655. [PMID: 33916400 PMCID: PMC8066372 DOI: 10.3390/diagnostics11040655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022] Open
Abstract
To compare different parameters of the sphericity index of the ablation zone following microwave ablation (MWA) on cirrhotic- and healthy-liver parenchyma in a series of patients treated with the same MWA system. Institutional database research identified 46 patients (77 lesions) who underwent MWA. “Cirrhotic liver group” (CLG) included 35 hepatocellular carcinoma lesions; “healthy liver group” (HLG) included 42 metastatic lesions. The long axis (LAD), short axis 1 (SAD-1) and 2 (SAD-2), the mean SAD-1 and SAD-2 (mSAD) diameter (in mm) and the mean sphericity (mSPH) index of the ablation zones were evaluated for each treated lesion in both groups from baseline to follow-up. A mixed model analysis of variance reported significant main effect of group on SAD-1 (p = 0.023), SAD-2 (p = 0.010) and mSAD (p = 0.010), with HLG showing lower values compared to CLG. No differences were detected on the LAD (pFDR = 0.089; d = 0.45), and mSPH (pFDR = 0.148, d = 0.40) between the two groups. However, a significant main effect of time was found on LAD (p < 0.001), SAD-1 (p < 0.001), SAD-2 (p < 0.001) and mSAD (p < 0.001), with decreased values in all indices at follow-up compared to baseline. A significant group by time interaction was observed on mSPH (p = 0.044); HLG had significantly lower mSPH at follow-up where CLG did not show any significant change. Our findings indicate that although in cirrhotic liver short axis diameter of the MWA zone seems to be significantly longer, this has no effect on the sphericity index which showed no significant difference between cirrhotic vs. healthy liver lesions. On the contrary, on one month follow-up ablation zones tend to become significant more ellipsoid in healthy whilst remains stable in cirrhotic liver.
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Beydoun N, Brunner P, De La Torre Y, Herpe G, Guillevin R, Ingrand P, Tasu JP. Effectiveness of CT-guided epidural infiltration of steroids and local anesthetics for acute and chronic herpes zoster neuralgia. Diagn Interv Imaging 2021; 102:525-530. [PMID: 33785313 DOI: 10.1016/j.diii.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness and complication rate of computed tomography (CT)-guided epidural injection of steroids and local anesthetics for pain relief in patients with neuralgia due to acute or chronic herpes zoster (HZ). MATERIALS AND METHODS A prospective study was conducted from April 2017 to February 2019 including patients with HZ neuralgia (HZN) at any stage (acute or chronic, the latter being defined as pain lasting more than 3 months and also called post herpetic neuralgia [PHN]). The sensory ganglion of the affected dermatome and/or the affected sensory nerve was targeted under CT-guidance and local injection of a mixture of two vials of methylprednisolone 40mg/mL and 2mL of Lidocaine 1% was performed. Using a visual analogue scale (VAS, 0 to 10), pain was assessed prior to the procedure, and at day 7, 1 month, 3 months and 6 months. Adverse effects were graded according to the Society of Interventional Radiology classification. RESULTS Twenty patients were included. There were 9 men and 11 women with a mean age of 67±13.9 (SD) years (range: 27-83 years). Of these, 14 patients had acute HZN and 6 had PHN. Mean VAS at baseline was 8.1±1.2 (SD) (range: 6-10) with significant decrease (P<0.0001) at day 7 (3.4±3.2 [SD]; range: 0-10), day 30 (3.4±3.2 [SD]; range: 0-9), day 90 (2.9±3.2 [SD]; range: 0-9), and day 180 (2.5±3.1 [SD]; range: 0-9). Infiltrations were significantly more effective on acute HZN than on PHN (P<0.001) and required significantly fewer infiltrations for pain relef (P=0.002). Only one grade A adverse event was reported. CONCLUSION Epidural injection of a mixture of steroids and local anesthetics under CT-guidance is effective on HZN with a persisting effect over 6 months.
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Affiliation(s)
- Nadeem Beydoun
- University Hospital of Poitiers, Department of Radiology, 86021, Poitiers, France
| | | | - Yannick De La Torre
- University Hospital of Poitiers, Department of Radiology, 86021, Poitiers, France
| | - Guillaume Herpe
- University Hospital of Poitiers, Department of Radiology, 86021, Poitiers, France
| | - Remy Guillevin
- University Hospital of Poitiers, Department of Radiology, 86021, Poitiers, France
| | - Pierre Ingrand
- University of Poitiers, Clinical research center, CIC 1402, 86021, Poitiers, France
| | - Jean-Pierre Tasu
- University Hospital of Poitiers, Department of Radiology, 86021, Poitiers, France; LATim, Laboratory of Medical Information Processing-inserm UMR 1101, 29609 Brest cedex, France.
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22
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Filippiadis D, Charalampopoulos G, Tsochatzis A, Reppas L, Mazioti A, Kelekis A, Kelekis N. Feasibility and safety of percutaneous computed tomography guided radiofrequency ablation of lymph nodes in oligometastatic patients: a single center's experience. Br J Radiol 2021; 94:20200445. [PMID: 33756082 DOI: 10.1259/bjr.20200445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. METHODS Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40-87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded. RESULTS Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure. CONCLUSION CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy. ADVANCES IN KNOWLEDGE With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.
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Affiliation(s)
- Dimitrios Filippiadis
- Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens 1 Rimini str, 12462, Haidari/Athens, Greece
| | - George Charalampopoulos
- Consultant of Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Athanasios Tsochatzis
- Residentof Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Lazaros Reppas
- Consultant of Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Argyro Mazioti
- Consultant of Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Alexis Kelekis
- Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens 1 Rimini str, 12462, Haidari/Athens, Greece
| | - Nikolaos Kelekis
- Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens 1 Rimini str, 12462, Haidari/Athens, Greece
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Grigoriadis S, Tsitskari M, Ioannidi M, Zavridis P, Kotsantis I, Kelekis A, Filippiadis D. Computed Tomography-Guided Percutaneous Radiofrequency Ablation of the Splanchnic Nerves as a Single Treatment for Pain Reduction in Patients with Pancreatic Cancer. Diagnostics (Basel) 2021; 11:diagnostics11020303. [PMID: 33668667 PMCID: PMC7917944 DOI: 10.3390/diagnostics11020303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this paper is to prospectively evaluate the efficacy and safety of percutaneous computed tomography (CT)-guided radiofrequency (RF) neurolysis of splanchnic nerves as a single treatment for pain reduction in patients with pancreatic cancer. Patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication who underwent CT-guided neurolysis of splanchnic nerves by means of continuous radiofrequency were prospectively evaluated for pain and analgesics reduction as well as for survival. In all patients, percutaneous neurolysis was performed with a bilateral retrocrural paravertebral approach at T12 level using a 20 Gauge RF blunt curved cannula with a 1cm active tip electrode. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with numeric visual scale (NVS) units. The mean patient age was 65.4 ± 10.8 years (male-female: 19-11). The mean pain score prior to RF neurolysis of splanchnic nerves was 9.0 NVS units; this score was reduced to 2.9, 3.1, 3.6, 3.8, and 3.9 NVS units at 1 week, 1, 3, 6, and 12 months respectively (p < 0.001). Significantly reduced analgesic usage was reported in 28/30 patients. Two grade I complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. According to the results of the present study, solely performed computed tomography-guided radiofrequency neurolysis of splanchnic nerves can be considered a safe and efficacious single-session technique for pain palliation in patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication. Although effective in pain reduction the technique seems to have no effect upon survival improvement.
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Affiliation(s)
- Stavros Grigoriadis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece; (M.I.); (A.K.); (D.F.)
- Correspondence: ; Tel.: +30-210-5831832; Fax: +30-210-5326418
| | - Maria Tsitskari
- Interventional Radiology Department, George Papanikolaou General Hospital, 57010 Thessaloniki, Greece; (M.T.); (P.Z.)
| | - Maria Ioannidi
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece; (M.I.); (A.K.); (D.F.)
| | - Periklis Zavridis
- Interventional Radiology Department, George Papanikolaou General Hospital, 57010 Thessaloniki, Greece; (M.T.); (P.Z.)
| | - Ioannis Kotsantis
- Section of Medical Oncology, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece;
| | - Alexis Kelekis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece; (M.I.); (A.K.); (D.F.)
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece; (M.I.); (A.K.); (D.F.)
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Prestat AJ, Gondim Teixeira PA, Rauch A, Loeuille D, Pretat PH, Louis M, Blum A. First intention vertebroplasty in fractures within an ankylosed thoracolumbar spinal segment. Diagn Interv Imaging 2021; 102:421-430. [PMID: 33549510 DOI: 10.1016/j.diii.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the outcome of percutaneous vertebral cementoplasty (PVC) as the first-line treatment for traumatic thoracolumbar fractures within an ankylosed spinal segment. MATERIALS AND METHODS Thirty-one patients (15 men, 16 women; mean age: 79.2±11 [SD] years; age range: 66-95 years) with thoracolumbar fractures within an ankylosed spine segment without neurological impairment treated with PVC were retrospectively evaluated. All patients were controlled at six weeks and one year after PVC. Ankylosing conditions, fractures sites and types, radiological consolidation, spinal complications were assessed. Anterior/posterior vertebral height ratios were measured before and after PVC. Postoperative pain relief and treatment success (radiological fracture consolidation) rates were considered. RESULTS The 31 patients had a total of 39 fractures (19 stable [49%], 20 unstable [51%]) treated with PVC. Primary success rate of PVC (initial fracture consolidation without complication) was 61% (19/31). Seven patients (7/31; 23%) exhibited new fractures, and the secondary success rate of PVC (global fracture consolidation one year after repeat PVC) was 87% (34/39). Global consolidation rates of unstable fractures were 85% (17/20) of treated levels. Pain score was null in 84% patients (26/31) one year after PVC. There were no significant differences between pre-PVC (0.62±0.18 [SD]; range: 0.22-0.88) and post-PVC (0.60±0.18 [SD]; range: 0.35-0.88) vertebral height ratios (P=0.94). CONCLUSION PVC conveys a high overall success rate and effectively controls pain in patients with vertebral fractures within ankylosed spine segments.
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Affiliation(s)
- Alexandre J Prestat
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France; Department of Musculoskeletal Radiology, Hôpital Pasteur 2, CHU de Nice, 06000 Nice, France.
| | | | - Aymeric Rauch
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Damien Loeuille
- Department of Rheumatology, Central Hospital, University Hospital Center of Nancy (CHRU-Nancy), 54511 Vandoeuvre-Lès-Nancy, France
| | - Pierre-Henri Pretat
- Department of Neurosurgery, Central Hospital, University Hospital Center of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Matthias Louis
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
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Autrusseau PA, Garnon J, Bertucci G, Dalili D, De Marini P, Auloge P, Koch G, Caudrelier J, Weiss J, Cazzato RL, Gangi A. Complications of percutaneous image-guided screw fixation: An analysis of 94 consecutive patients. Diagn Interv Imaging 2021; 102:347-353. [PMID: 33516740 DOI: 10.1016/j.diii.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively assess the safety profile of percutaneous image-guided screw fixation (PIGSF) for insufficiency, impending or pathological fractures. MATERIALS AND METHODS From July 2012 to April 2020, all consecutive patients who underwent PIGSF were retrospectively included in the study. Patient characteristics, fracture type, procedural data and complications were analyzed. Complications were divided into per-procedural, early (<24hours) and delayed (>24hours) and classified into minor (grade 1-2) and major complications (grade 3-5) according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS A total of 110 fractures (40 insufficiency [36%], 53 pathological [48.5%] and 17 impending [15.5%] fractures) in 94 patients (48 women, 46 men; mean age, 62.7±12.7 [SD] years; age range: 32-88 years) were treated with PIGSF during 95 procedures. Twenty-four-hours follow-up was available for all patients, and>24-hours follow-up was available for 79 (79/110; 71.8%) fractures in 69 (69/94; 73.4%) patients. Per-procedural complications occurred in 3/110 fractures (2.7%, all minor). Early complications were reported in 4/110 fractures (3.6%, 1 major and 3 minor) and delayed ones in 14/79 fractures (17.7%, 5 major and 9 minor). The most frequent major delayed complication was infection (3/79; 3.8%). CONCLUSION The rate of per-procedural and early (within 24hours) complications following PIGSF is extremely low with most complications being minor, with major complications being delayed ones (>24hours).
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Affiliation(s)
- Pierre-A Autrusseau
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Grégory Bertucci
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, OX3 7LD Oxford, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, WC2R 2LS London, United Kingdom
| | - Pierre De Marini
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Julia Weiss
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Roberto L Cazzato
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Imaging, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
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Cazzato RL, De Marini P, Leonard-Lorant I, Dalili D, Koch G, Autrusseau PA, Mayer T, Weiss J, Auloge P, Garnon J, Gangi A. Percutaneous thermal ablation of sacral metastases: Assessment of pain relief and local tumor control. Diagn Interv Imaging 2021; 102:355-361. [PMID: 33487588 DOI: 10.1016/j.diii.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To retrospectively report on safety, pain relief and local tumor control achieved with percutaneous ablation of sacral bone metastases. MATERIALS AND METHODS From February 2009 to June 2020, 23 consecutive patients (12 women and 11 men; mean age, 60±8 [SD] years; median, 60; range: 48-80 years) with 23 sacral metastases underwent radiofrequency (RFA) or cryo-ablation (CA), with palliative or curative intent at our institution. Patients' demographics and data pertaining to treated metastases, procedure-related variables, safety, and clinical evolution following ablation were collected and analyzed. Pain was assessed with numerical pain rating scale (NPRS). RESULTS Sixteen (70%) patients were treated with palliative and 7 (30%) with curative intent. Mean tumor diameter was 38±19 (SD) mm (median, 36; range: 11-76). External radiation therapy had been performed on five metastases (5/23; 22%) prior to ablation. RFA was used in 9 (39%) metastases and CA in the remaining 14 (61%). Thermo-protective measures and adjuvant bone consolidation were used whilst treating 20 (87%) and 8 (35%) metastases, respectively. Five (22%) minor complications were recorded. At mean 31±21 (SD) (median, 32; range: 2-70) months follow-up mean NPRS was 2±2 (SD) (median, 1; range: 0-6) vs. 5±1 (median, 5; range: 4-8; P<0.001) at the baseline. Three metastases out of 7 (43%) undergoing curative ablation showed local progression at mean 4±4 (SD) (median, 2; range: 1-8) months follow-up. CONCLUSION Percutaneous ablation of sacral metastases is safe and results in significant long-lasting pain relief. Local tumor control seems sub-optimal; however, further investigations are needed to confirm these findings due to paucity of data.
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Affiliation(s)
- Roberto L Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Ian Leonard-Lorant
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, OX37LD Oxford, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre A Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Theo Mayer
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
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Barat M, Dohan A, Dautry R, Amat L, Soyer P, Morel O. A simple and safe technique for endoluminal extraction of migrated Nexplanon. Diagn Interv Imaging 2021; 102:265-267. [PMID: 33454233 DOI: 10.1016/j.diii.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France.
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - Raphaël Dautry
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Louise Amat
- Department of Obstetrics and Gynecology, Université de Lorraine, CHRU-Nancy, 54000 Nancy, France; INSERM, IADI, Université de Lorraine, 54000 Nancy, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - Olivier Morel
- Department of Obstetrics and Gynecology, Université de Lorraine, CHRU-Nancy, 54000 Nancy, France; INSERM, IADI, Université de Lorraine, 54000 Nancy, France
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Filippiadis D, Mazioti A, Velonakis G, Tsochantzis A, Tosoratti N, Kelekis A, Kelekis N. Continuous versus pulsed microwave ablation in the liver: any difference in intraoperative pain scores? Ann Gastroenterol 2021; 34:80-84. [PMID: 33414626 PMCID: PMC7774668 DOI: 10.20524/aog.2020.0557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022] Open
Abstract
Background This study prospectively compared intraoperative pain scores during percutaneous microwave ablation of the liver in patients randomized between continuous and pulsed energy delivery algorithms. Methods During a 12-month period, 20 patients who underwent microwave liver ablation were prospectively randomized between 2 different energy delivery modes: “continuous mode” (CM, n=10) and “pulsed mode” (PM, n=10). All ablation sessions were performed using the same microwave ablation platform under computed tomographic guidance and intravenous analgesia. Within 30 min post ablation, all patients completed a questionnaire assigning a numeric pain intensity score from 0 (no pain) to 10. Results Mean pain scores were 8.17±1.850 in the CM group and 4.50±1.567 in the PM group, with a statistically significant difference of 3.667±2.807 pain units (P=0.001). The mean procedure time was 53.5±20.90 min in the PM group vs. 58.5±17.44 min in the CM group (P=0.279). The mean size of the lesions was 2.81±0.95 cm in the PM group and 2.81±0.85 cm in the CM group (P=0.984). On a per-lesion basis, technical success was achieved in all evaluable tumors in both groups. No difference was noted in the local tumor control on the 6-month imaging evaluation. No complications were observed in the CM arm, while small perihepatic hemorrhagic fluid collections were reported in the PM group. Conclusions Both algorithms for microwave energy delivery have comparable treatment effects in terms of 6-month local tumor control for liver lesions <3 cm in diameter. PM treatments compared to CM appear to induce significantly less pain in patients undergoing percutaneous liver ablation under intravenous analgesia.
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Affiliation(s)
- Dimitrios Filippiadis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Argyro Mazioti
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - George Velonakis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Athanasios Tsochantzis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Nevio Tosoratti
- R&D Manager, HS Hospital Service SpA, Aprilia (LT), Italy (Nevio Tosoratti)
| | - Alexis Kelekis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Nikolaos Kelekis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
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Tselikas L, Champiat S, Sheth RA, Yevich S, Ammari S, Deschamps F, Farhane S, Roux C, Susini S, Mouraud S, Delpla A, Raoult T, Robert C, Massard C, Barlesi F, Soria JC, Marabelle A, de Baere T. Interventional Radiology for Local Immunotherapy in Oncology. Clin Cancer Res 2021; 27:2698-2705. [PMID: 33419781 DOI: 10.1158/1078-0432.ccr-19-4073] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/24/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
Human intratumoral immunotherapy (HIT-IT) is under rapid development, with promising preliminary results and high expectations for current phase III trials. While outcomes remain paramount for patients and the referring oncologists, the technical aspects of drug injection are critical to the interventional radiologist to ensure optimal and reproducible outcomes. The technical considerations for HIT-IT affect the safety, efficacy, and further development of this treatment option. Image-guided access to the tumor allows the therapeutic index of a treatment to be enhanced by increasing the intratumoral drug concentration while minimizing its systemic exposure and associated on-target off-tumor adverse events. Direct access to the tumor also enables the acquisition of cancer tissue for sequential sampling to better understand the pharmacodynamics of the injected immunotherapy and its efficacy through correlation of immune responses, pathologic responses, and imaging tumor response. The aim of this article is to share the technical insights of HIT-IT, with particular consideration for patient selection, lesion assessment, image guidance, and technical injection options. In addition, the organization of a standard patient workflow is discussed, so as to optimize HIT-IT outcome and the patient experience.
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Affiliation(s)
- Lambros Tselikas
- Département d'Anesthésie, Chirurgie et Interventionnel (DACI), Gustave Roussy, Villejuif, France. .,Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, Gustave Roussy, Villejuif, France
| | - Stephane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Rahul A Sheth
- Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steve Yevich
- Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samy Ammari
- Radiology Department, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Frederic Deschamps
- Département d'Anesthésie, Chirurgie et Interventionnel (DACI), Gustave Roussy, Villejuif, France
| | - Siham Farhane
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Charles Roux
- Département d'Anesthésie, Chirurgie et Interventionnel (DACI), Gustave Roussy, Villejuif, France
| | - Sandrine Susini
- Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, Gustave Roussy, Villejuif, France
| | - Severine Mouraud
- Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, Gustave Roussy, Villejuif, France
| | - Alexandre Delpla
- Département d'Anesthésie, Chirurgie et Interventionnel (DACI), Gustave Roussy, Villejuif, France
| | - Thibault Raoult
- Service de Promotion des Etudes Cliniques (SPEC), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Caroline Robert
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France.,Gustave Roussy Cancer Campus, Université Paris Saclay, Saint-Aubin, France
| | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France.,Gustave Roussy Cancer Campus, Université Paris Saclay, Saint-Aubin, France
| | - Fabrice Barlesi
- Gustave Roussy Cancer Campus, Université Paris Saclay, Saint-Aubin, France
| | - Jean-Charles Soria
- Gustave Roussy Cancer Campus, Université Paris Saclay, Saint-Aubin, France
| | - Aurélien Marabelle
- Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, Gustave Roussy, Villejuif, France.,Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Thierry de Baere
- Département d'Anesthésie, Chirurgie et Interventionnel (DACI), Gustave Roussy, Villejuif, France.,Gustave Roussy Cancer Campus, Université Paris Saclay, Saint-Aubin, France
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Boeken T, Di Gaeta A, Moussa N, Del Giudice C, Dean C, Pellerin O, Sapoval M. Association between intravesical prostatic protrusion and clinical outcomes in prostatic artery embolization. Diagn Interv Imaging 2021; 102:141-145. [PMID: 33423975 DOI: 10.1016/j.diii.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the influence of intravesical prostatic protrusion (IPP) on clinical outcomes after prostatic artery embolization (PAE) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS All consecutive patients who underwent PAE for lower urinary tract symptoms between January 2017 and January 2019 were retrospectively included. IPP was evaluated on pre-treatment magnetic resonance imaging examination and symptoms were assessed at follow-up consultations using the international prostate symptom score (IPSS) and quality of life (QOL) questionnaire. IPPs were classified as grade 1 (<5mm), grade 2 (5-10mm), or grade 3 (>10mm). RESULTS A total of 160 consecutive men (mean age 65±7.8 [SD] years; range: 45-89 years), underwent PAE. The mean IPSS was 21±7.3 (SD) (range: 5-35) and prostate volume 87±38 (SD) mL (range: 30-200mL). The IPP grade was 1 for 28 (28/160; 18%), 2 for 52 (52/160; 33%), and 3 for 80 (80/160; 50%) patients. There were no significant differences in IPSS at baseline between the three IPP grades. Patients with severe (grade 3) IPP had a significantly higher reduction in IPSS than those with non-severe IPP (grade 1 or 2), with estimated mean reductions of 12±2.5 (SD) (range: -4-28) and 8.3±1.9 (SD) (range: -8-21) (P=0.02), respectively. The mean reduction in the QOL score was 3.0 for grade 3 and 2.0 for grade 1 or 2 IPP (P=0.02). CONCLUSIONS The degree of IPP does not limit the efficacy of PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia.
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Affiliation(s)
- Tom Boeken
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France.
| | - Alessandro Di Gaeta
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Nadia Moussa
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Constantino Del Giudice
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Carole Dean
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Olivier Pellerin
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France; INSERM URM 970 équipe 2 Imagerie de l'Angiogenèse, 75015 Paris, France
| | - Marc Sapoval
- Department of Vascular and Oncological Interventional Radiology, AP-HP, centre, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Université de Paris, 75006 Paris, France; INSERM URM 970 équipe 2 Imagerie de l'Angiogenèse, 75015 Paris, France
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31
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Filippiadis D, Efthymiou E, Tsochatzis A, Kelekis A, Prologo JD. Percutaneous cryoanalgesia for pain palliation: Current status and future trends. Diagn Interv Imaging 2020; 102:273-278. [PMID: 33281081 DOI: 10.1016/j.diii.2020.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
Cryoanalgesia, otherwise termed cryoneurolysis, refers to application of extreme cold upon peripheral nerves for palliation of pain associated to nerve lesions or biomechanical syndromes of neoplastic and non-neoplastic substrate. Application of cryoanalgesia initiates a cascade of pathophysiologic events interrupting nerve conduction of painful stimuli without irreversible nerve damage. Cryoanalgesia is considered a safe procedure with minimal risk of complications when performed with percutaneous approaches under imaging guidance. In the era of an opioid overdose crisis, cryoanalgesia can be proposed as an alternative aiming at controlling pain and improving life quality. Imaging guidance has substituted open surgical and nerve stimulation approaches in nerve identification, significantly contributing to the minimally invasive character of percutaneous approaches. Ultrasound or computed tomography can serve as low cost, ideal guiding techniques due to their abilities for precise anatomic delineation, high spatial resolution and good tissue contrast. The purpose of this review is to become familiar with the most common imaging guided percutaneous cryoanalgesia indications, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed.
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Affiliation(s)
- Dimitrios Filippiadis
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Efthymiou
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Tsochatzis
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Kelekis
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - J D Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364, Clifton road NE, 30322 Atlanta, GA, USA
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Ricquart Wandaele A, Kastler A, Comte A, Hadjidekov G, Kechidi R, Helenon O, Kastler B. CT-guided infiltration of greater occipital nerve for refractory craniofacial pain syndromes other than occipital neuralgia. Diagn Interv Imaging 2020; 101:643-648. [DOI: 10.1016/j.diii.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 12/30/2022]
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Seager M, Kumar S, Lim E, Munneke G, Bandula S, Walkden M. Renal cryoablation - a practical guide for interventional radiologists. Br J Radiol 2020; 94:20200854. [PMID: 32960674 DOI: 10.1259/bjr.20200854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Renal cryoablation is a treatment option for early stage renal cell carcinomas with excellent oncological outcomes and low morbidity. This review outlines the technique of renal cryoablation and provides a guide for interventional radiologists on setting up an integrated service within a renal cancer network multidisciplinary setting. Patient selection and preparation, together with the technical aspects which ensure optimal oncological outcomes and avoid collateral damage to adjacent organs are highlighted.
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Affiliation(s)
- Matthew Seager
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Shankar Kumar
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Emma Lim
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Graham Munneke
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Steve Bandula
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Miles Walkden
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
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34
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Elsamragy S, Vats T, Osborn I. Airway Management in out of the Operating Room Environments. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review. J Clin Med 2020; 9:jcm9072302. [PMID: 32698459 PMCID: PMC7408651 DOI: 10.3390/jcm9072302] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023] Open
Abstract
Interventional radiology plays an important role in the management of patients with neuroendocrine tumor liver metastasis (NELM). Transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiation therapy (SIRT) are intra-arterial therapies available for these patients in order to improve symptoms and overall survival. These treatment options are proposed in patients with NELM not responding to systemic therapies and without extrahepatic progression. Currently, available data suggest that TAE should be preferred to TACE in patients with NELM from extrapancreatic origin because of similar efficacy and better patient tolerance. TACE is more effective in patients with pancreatic NELM and SIRT has shown promising results along with good tolerance. However, large randomized controlled trials are still lacking in this setting. Available literature mainly consists in small sample size and retrospective studies with important technical heterogeneity. The purpose of this review is to provide an updated overview of the currently reported endovascular interventional radiology procedures that are used for the treatment of NELM.
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Filippiadis D, Bolotis D, Mazioti A, Tsitskari M, Charalampopoulos G, Vrachliotis T, Kelekis N, Kelekis A. Percutaneous imaging-guided techniques for the treatment of benign neuropathic pain. Diagn Interv Imaging 2020; 102:11-18. [PMID: 32439315 DOI: 10.1016/j.diii.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/22/2020] [Accepted: 05/02/2020] [Indexed: 11/17/2022]
Abstract
To date, conservative management including physical and/or systemic pharmacologic therapy is considered as the first line approach for the management of neuropathic pain syndromes. In the era of an opioid overdose crisis with an increased concern upon the risks and harms arising from the misuse of medicines for pain management, percutaneous minimally invasive techniques such as nerve infiltrations as well as neurolysis or neuromodulation techniques can be proposed to control pain and improve life quality. Computed tomography can serve as an ideal guiding technique due to its specific characteristics including precise anatomic delineation, high spatial resolution and good tissue contrast. The purpose of this review is to make the reader familiar with the most common indications for minimally invasive imaging-guided techniques in patients with neuralgia and provide current evidence regarding technical considerations.
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Affiliation(s)
- D Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini street, 12462 Haidari, Athens, Greece.
| | - D Bolotis
- Department of Radiology, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - A Mazioti
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini street, 12462 Haidari, Athens, Greece
| | - M Tsitskari
- Department of Radiology, Apollonio Private Hospital, 20 Lefkotheou street, 2054 Strovolos, Nicosia, Cyprus
| | - G Charalampopoulos
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini street, 12462 Haidari, Athens, Greece
| | - T Vrachliotis
- Department of Radiology, Henry Dunant Hospital Center, 107 Mesogion Avenue 11525 Athens, Greece
| | - N Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini street, 12462 Haidari, Athens, Greece
| | - A Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini street, 12462 Haidari, Athens, Greece
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Barral M, Dohan A, Marcelin C, Carteret T, Zurlinden O, Pialat JB, Kastler A, Cornelis FH. COVID-19 pandemic: A stress test for interventional radiology. Diagn Interv Imaging 2020; 101:333-334. [PMID: 32359930 PMCID: PMC7183289 DOI: 10.1016/j.diii.2020.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Affiliation(s)
- M Barral
- Sorbonne Université, Department of Interventional Radiology and Oncology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France
| | - A Dohan
- Université de Paris, Department of Radiology, Hopital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - C Marcelin
- Department of Radiology, CHU Bordeaux, Pellegrin Hospital, 33076 Bordeaux, France
| | - T Carteret
- Department of Radiology, Nouvelle Clinique Bordeaux Tondu, 33272 Floirac, France
| | - O Zurlinden
- Department of Radiology, Centre Hospitalier Gaston Bourret, 98835 Dumbéa Sur Mer, Nouvelle-Calédonie
| | - J-B Pialat
- Department of Radiology, Hospices Civils de Lyon, Groupement Hospitalier Sud, 69310 Pierre-Bénite, France
| | - A Kastler
- Department of Radiology, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - F H Cornelis
- Sorbonne Université, Department of Interventional Radiology and Oncology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France.
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Denys A, Guiu B, Chevallier P, Digklia A, de Kerviler E, de Baere T. Interventional oncology at the time of COVID-19 pandemic: Problems and solutions. Diagn Interv Imaging 2020; 101:347-353. [PMID: 32360351 PMCID: PMC7177103 DOI: 10.1016/j.diii.2020.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic modifies in-depth interventional oncology practice. Identification of aerosol-generating procedures is crucial for safety. Curative treatment of cancers should not be delayed during the COVID-19 pandemic. Solutions to overcome shortage in anesthesiology resources are described.
The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.
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MESH Headings
- Aerosols
- Age Factors
- Anesthesia, General
- Anesthesiology/statistics & numerical data
- Betacoronavirus
- Biopsy/adverse effects
- Biopsy/methods
- COVID-19
- COVID-19 Testing
- Cancer Care Facilities/organization & administration
- Carcinoma, Hepatocellular/therapy
- Carcinoma, Renal Cell/therapy
- Chemoembolization, Therapeutic/methods
- Clinical Laboratory Techniques/methods
- Colonic Neoplasms/pathology
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/transmission
- Databases, Factual
- Health Personnel/statistics & numerical data
- Health Resources/organization & administration
- Health Resources/supply & distribution
- Hospital Bed Capacity/statistics & numerical data
- Hospitalization/statistics & numerical data
- Humans
- Hyperthermia, Induced/methods
- Kidney Neoplasms/therapy
- Liver Neoplasms/therapy
- Lung Neoplasms/secondary
- Lung Neoplasms/therapy
- Neoplasms/complications
- Neoplasms/therapy
- Palliative Care/methods
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/transmission
- SARS-CoV-2
- Triage
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Affiliation(s)
- A Denys
- Department of Radiology, CHUV UNIL, rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - B Guiu
- Department of Radiology, Hôpital Saint ELOI, CHU Montpellier, 34000 Montpellier, France
| | - P Chevallier
- Department of Radiology, Hôpital ARCHET 2, CHU Nice, 06000 Nice, France
| | - A Digklia
- Department of Oncology, CHUV UNIL, 1011 Lausanne, Switzerland
| | - E de Kerviler
- Department of Radiology, Assistance Publique-Hopitaux de Paris, Hôpital Saint-Louis, 75010 Paris, France; Université de Paris, 75006 Paris, France
| | - T de Baere
- Department of Interventional Radiology, Institut Gustave Roussy, 94800 Villejuif, France
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Integrative Medicine in Interventional Oncology: A Virtuous Alliance. ACTA ACUST UNITED AC 2020; 56:medicina56010035. [PMID: 31963617 PMCID: PMC7022725 DOI: 10.3390/medicina56010035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 12/16/2022]
Abstract
This review aimed to identify the potential role of integrative medicine in interventional oncology. The music therapy; stress management techniques; guided imagery, including virtual reality; clinical hypnosis; and digital sedation may all be efficient on anxiety and pain during procedures performed in interventional oncology. Beyond pharmacological sedation, the implementation of integrative medicine to interventional oncology may, therefore, improve the support and care of cancer patients, which may further create a virtuous alliance.
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