Interventional Radiology Delivers High-Value Health Care and Is an Imaging 3.0 Vanguard

The Changing Landscape of Interventional Radiology: Growth in Nonprocedural Services and Market Dynamics

OBJECTIVE

To evaluate the evolution of interventional radiology (IR) practice patterns from 2013 to 2022, focusing on longitudinal growth in evaluation and management (E&M) services among actively practicing IR physicians.

METHODS

Using the Medicare Physician and Other Supplier Public Use File, we retrospectively identified "actively practicing IR physicians" based on a minimum 10% threshold of annual procedural and clinical work relative value units derived from IR-specific procedural codes. For each calendar year, we tallied the number of actively practicing IR physicians, total E&M claims, and mean E&M claims per IR physician. A two-step decomposition was then performed to quantify how much of the change in total E&M services was attributable to fluctuations in physician count versus changes in per-physician E&M billing.

RESULTS

From 2013 to 2022, total E&M claims rose from 149,481 to 201,825 (+52,344, +35.0%, P < .05). The number of IR physicians billing ≥11 E&M claims per annum rose 12.9% from 1,347 in 2013 to 1,522 in 2022. Mean E&M claims per clinically active IR physician increased 19.8% from 111 to 133 (P < .05). The number of actively practicing IR physicians declined from 12,483 in 2013 to 11,585 in 2022 (-7.2%). Decomposition analysis revealed that, absent the drop in IR physician count, E&M claims would have been higher by 10,776. However, an additional 62,559 E&M services stemming from increased per-physician billing offset this effect, yielding a net growth of approximately 52,000 E&M claims.

CONCLUSION

IR physicians markedly expanded their E&M activities during the past decade. This growth is primarily driven by a rising fraction of "active-clinical" IRs who are growing in number and intensifying their clinical workload. These findings underscore IR's accelerating transition toward comprehensive patient care, with significant implications for training, practice management, and the specialty's role within the broader health care landscape.

Assessing interventional radiology specialty knowledge and perception amongst Tanzanian medical students before and after exposure to an immersive curriculum

AIMS

This study aims to assess the impact that delivering an introductory interventional radiology (IR) lecture series has on the knowledge and perception of the specialty among medical students in a resource-limited setting with, until recently, no IR presence.

MATERIALS AND METHODS

An introductory four-hour lecture series in IR was delivered to third-year medical students in Tanzania. Prior to and following the lecture series, participants completed a 27-item paper-based survey assessing their knowledge and perception of the specialty.

RESULTS

Out of a class of 213, the pre- and post-lecture survey was returned by 148 (69.5%) and 151 (70.9%) respondents, respectively. 94.5% of respondents indicated that they were aware of IR as a specialty. Among respondents, 97.3% expressed interest in having IR lectures integrated into their curriculum, compared to 29.0% that reported having any prior IR training. 27.3% believed their knowledge in IR compared to other specialties was either "good" or "excellent", which improved to 43.3% (p<0.001). Identification that IR physicians consult patients directly, have outpatient clinics, have inpatient beds, and do rounds improved from 55.4% to 81.1% (p<0.001), 49.7% to 60.3% (p=0.066), 48.3% to 66.7% (p=0.001), and 52.0% to 66.2% (p=0.013), respectively.

CONCLUSION

By introducing short lectures on IR-relevant topics, knowledge and perception of IR improved among Tanzanian medical students. Early education and exposure to IR should be prioritized to promote the continued growth of the specialty in this setting.

Review of robotic systems for thoracoabdominal puncture interventional surgery

Cancer, with high morbidity and high mortality, is one of the major burdens threatening human health globally. Intervention procedures via percutaneous puncture have been widely used by physicians due to its minimally invasive surgical approach. However, traditional manual puncture intervention depends on personal experience and faces challenges in terms of precisely puncture, learning-curve, safety and efficacy. The development of puncture interventional surgery robotic (PISR) systems could alleviate the aforementioned problems to a certain extent. This paper attempts to review the current status and prospective of PISR systems for thoracic and abdominal application. In this review, the key technologies related to the robotics, including spatial registration, positioning navigation, puncture guidance feedback, respiratory motion compensation, and motion control, are discussed in detail.

Impact of Work Environment on Job Satisfaction among Interventional Radiologists in Japan: A Cross-sectional Study

Purpose

This study aims to measure job satisfaction among interventional radiology physicians in Japan and analyze the factors affecting job satisfaction.

Material and Methods

A web-based survey was conducted among the members of the Japanese Society of Interventional Radiology between October and December 2021. Participants were questioned regarding their job satisfaction, workplace, work status, and demographic information. Principal component analysis was applied to 15 reasons related to job satisfaction, and the factors affecting job satisfaction were analyzed.

Results

Valid responses were obtained from 901 (31.9%) of the 2,824 interventional radiology physicians invited to participate. Job satisfaction was reported as "very satisfied" in 79 (8.8%), "moderately satisfied" in 426 (47.3%), "neither satisfied nor dissatisfied" in 230 (25.5%), "moderately dissatisfied" in 133 (14.8%), and "very dissatisfied" in 33 (3.7%) respondents. Thus, there were 505 (56.0%) satisfied physicians. Three principal components were extracted from the reasons for job satisfaction. Job satisfaction tended to be higher among those who reported performing a higher number of interventional radiology procedures and was positively associated with a higher rate of work time dedicated to interventional radiology and the first principal component (the environment of clinical practice, research, and interventional radiology education). The third principal component (salary and work environment) and the absence of an "IkuBoss" [a boss who takes initiative in creating a work environment supportive of the work-life balance of colleagues] were associated with lower job satisfaction.

Conclusions

More than half the participants reported high job satisfaction. Job satisfaction of interventional radiology physicians in Japan was positively associated with a favorable clinical, research, and educational environment and negatively associated with the absence of an "IkuBoss," noninterventional radiology work, overtime work, and salary.

Implications of IR Being a Primary Specialty on the Professional Organizational Relationship between Interventional and Diagnostic Radiology

The recent awarding of primary specialty status to interventional radiology (IR) invites a re-examination of the long-standing relationship between IR and diagnostic radiology (DR). In this new era, it is important to evaluate how the organizations that represent these 2 specialties can best contribute to strengthening a growth in collaborations and partnerships that will benefit their members and patients. Areas of organizational focus with the potential to enhance the future for both groups include combining efforts directed toward advocacy and government relations, developing practice models to create successful IR and DR working relationships, and providing more data to demonstrate the value of IR above and beyond the work relative value units and professional revenues that IR generates.

A History and Modern Framework for Quality Improvement in Interventional Radiology

Quality improvement (QI) initiatives have benefited patients as well as the broader practice of medicine. Large-scale QI has been facilitated by multi-institutional data registries, many of which were formed out of national or international medical society initiatives. With broad participation, QI registries have provided benefits that include but are not limited to establishing treatment guidelines, facilitating research related to uncommon procedures and conditions, and demonstrating the fiscal and clinical value of procedures for both medical providers and health systems. Because of the benefits offered by these databases, Society of Interventional Radiology (SIR) and SIR Foundation have committed to the development of an interventional radiology (IR) clinical data registry known as VIRTEX. A large IR database with participation from a multitude of practice environments has the potential to have a significant positive impact on the specialty through data-driven advances in patient safety and outcomes, clinical research, and reimbursement. This article reviews the current landscape of societal QI programs, presents a vision for a large-scale IR clinical data registry supported by SIR, and discusses the anticipated results that such a framework can produce.

Demonstrating the Value of Interventional Radiology

While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services. Recognizing the shift in reimbursement to high-value care, it is imperative that interventional radiology (IR) develop the evidence needed to articulate to all relevant stakeholders how IR contributes value to the system.

Establishing a pediatric interventional radiology inpatient consult service

OBJECTIVE

To delineate pediatric interventional radiology (IR) inpatient consult growth and resulting collections after implementation of a pediatric IR consult service.

METHODS

An inpatient IR consult process was created at a single academic children's hospital in October 2019. IR consult note templates were created in Epic (Epic Systems Corporation, Verona, Wisconsin) and utilized by 4 IR physicians. Automatic charge generation was linked to differing levels of evaluation and management (E&M) service relating to current procedural terminology (CPT) inpatient consult codes 99251-99255. The children's hospital informatics division identified IR consult notes entered from the implementation of the consult service: October 2019 to January 2022. The university radiology department billing office provided IR service E&M charge, payment, and relative value units (RVU) information during this study period. A chart review was performed to determine the IR procedure conversion rate. Mann-Whitney and a two-sample t-test statistical analyses compared use of the 25-modifier, monthly consult growth and monthly payment growth. P-value < 0.05 was considered statistically significant.  RESULTS: Within this 27-month period, a total of 2153 inpatient IR consults were performed during 1757 Epic hospital encounters; monthly consult peak was reached 5 months into the study period. Consult level breakdown by CPT codes: 99251-8.7%, 99252-81.7%, and 99253-8.8%. 69.7% of IR consults had consult-specific billing with payments in 96.4% resulting in $143,976 new revenue. From 2020 to 2021, IR consult volume trended upward by 13.4% (P =0.069), and consult-specific payments increased by 84.1% (P<0.001). IR consult procedure conversion rate was 96.5%.

CONCLUSION

An inpatient pediatric IR consult service was quickly established and maintained by four physicians over a 27-month study period. Annual IR consult volume trended upward and consult-specific payments increased, resulting in previously uncaptured IR service revenue.

Systematic Review of Use of Patient-Reported Outcomes in Interventional Radiology

INTRODUCTION

A patient-reported outcome (PRO) is any outcome reported directly by the patient, in contradistinction to a clinician-reported outcomes, which have dominated clinical research. This systematic review evaluates the ways in which PROs have been used in the interventional radiology literature.

METHODS

Systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was designed and conducted by a medical librarian. Studies were screened for inclusion by two independent members, with a third member as a conflict resolver. The data were extracted from each study in a consistent and structured manner.

RESULTS

In all, 354 studies met criteria for full-text analysis; 218 of 354 (62%) used a prospective design and most frequently provided level III (249 of 354, 70%) or level I (68 of 354, 19%) evidence. The manner in which PROs were obtained was reported in 125 of 354 (35%) of studies. Questionnaire response rate was documented in 51 of 354 (14%) studies, and questionnaire completion rate was documented in 49 of 354 (14%) studies. Of 354 studies, 281 (79%) studies used at least one independently validated questionnaire. The disease domains most commonly assessed via PRO were women's health (62 of 354, 18%) and men's health (60 of 354, 17%).

DISCUSSION

Wider development, validation, and systematic use of PROs in IR would enable more informed patient-centered decision making. A greater focus on PROs in clinical trials would elucidate expected outcomes from the patient's perspective, simplifying comparisons with therapeutic alternatives. To produce more convincing evidence, trials must apply validated PROs rigorously and report possible confounding factors consistently.

Bridging the simulation-to-real gap for AI-based needle and target detection in robot-assisted ultrasound-guided interventions

BACKGROUND

Artificial intelligence (AI)-powered, robot-assisted, and ultrasound (US)-guided interventional radiology has the potential to increase the efficacy and cost-efficiency of interventional procedures while improving postsurgical outcomes and reducing the burden for medical personnel.

METHODS

To overcome the lack of available clinical data needed to train state-of-the-art AI models, we propose a novel approach for generating synthetic ultrasound data from real, clinical preoperative three-dimensional (3D) data of different imaging modalities. With the synthetic data, we trained a deep learning-based detection algorithm for the localization of needle tip and target anatomy in US images. We validated our models on real, in vitro US data.

RESULTS

The resulting models generalize well to unseen synthetic data and experimental in vitro data making the proposed approach a promising method to create AI-based models for applications of needle and target detection in minimally invasive US-guided procedures. Moreover, we show that by one-time calibration of the US and robot coordinate frames, our tracking algorithm can be used to accurately fine-position the robot in reach of the target based on 2D US images alone.

CONCLUSIONS

The proposed data generation approach is sufficient to bridge the simulation-to-real gap and has the potential to overcome data paucity challenges in interventional radiology. The proposed AI-based detection algorithm shows very promising results in terms of accuracy and frame rate.

RELEVANCE STATEMENT

This approach can facilitate the development of next-generation AI algorithms for patient anatomy detection and needle tracking in US and their application to robotics.

KEY POINTS

• AI-based methods show promise for needle and target detection in US-guided interventions. • Publicly available, annotated datasets for training AI models are limited. • Synthetic, clinical-like US data can be generated from magnetic resonance or computed tomography data. • Models trained with synthetic US data generalize well to real in vitro US data. • Target detection with an AI model can be used for fine positioning of the robot.

Interventional Radiology Workforce Shortages Affecting Small and Rural Practices: A Report of the SIR/ACR Joint Task Force on Recruitment and Retention of Interventional Radiologists to Small and Rural Practices

Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists. Lack of access to interventional radiologic services results in a failure to meet the needs of patients, hospitals, and other community stakeholders. Acknowledging this challenge, the ACR's Commission on General, Small, Emergency and/or Rural Practice and Commission on Interventional and Cardiovascular Imaging and the Society of Interventional Radiology partnered to establish a joint task force to study this issue and identify strategies the ACR and the Society of Interventional Radiology should take to improve small and rural practice recruitment and retention of interventional radiologists. This report describes the deliberations and recommendations of the task force.

Current Controversies in Radiology on Cost, Reimbursement, and Price Transparency: AJR Expert Panel Narrative Review

Many believe that fundamental reform of the U.S. healthcare system is overdue and necessary given rising national healthcare expenditures, poor performance on key population health metrics, meaningful health disparities, concerns about potential financial toxicity of care, inadequate price transparency, pending insolvency of Medicare Part A, increasing commercial insurance premiums, and significant uninsured and underinsured populations. The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency, believes that part of this reform includes redistribution of reimbursements away from specialties such as radiology. Thus, despite an increase in the Medicare population and spending, Medicare payments for medical imaging have been decreasing for years. Further, the No Surprises Act, a federal law intended to curb the problem of surprise medical billing, was re-purposed in federal rule-making to reduce reimbursement from commercial payers to certain specialties including radiology. In this article, we examine challenges facing the U.S. healthcare system, focusing on cost, reimbursement, and price transparency, and the role of radiology in addressing such challenges. Medical imaging is a minor contributor to national healthcare expenditures, but provides an outsized impact on patient care. The radiology community should work together to demonstrate the value of medical imaging and reduce inappropriate utilization of low-value care.

Defining the Value of Interventional Radiology to Healthcare Stakeholders: Proceedings from a Society of Interventional Radiology Research Consensus Panel

Interventional radiology (IR) has collectively struggled to articulate and prove its value to several external stakeholders. The goal of this research consensus panel was to provide a summary of the existing knowledge, identify current gaps in knowledge, identify the strengths and weaknesses in existing data, and prioritize research needs related to the value of IR. Panelists were asked to identify the critical relationships/alliances that should be fostered to advance the prioritized research and determine how the Society of Interventional Radiology and the Society of Interventional Radiology Foundation can further support these initiatives. Following presentations and discussions, it was determined that proving and quantifying how IR decreases the length of stay and prevents hospital admissions are the most salient, value-related research topics to pursue for the specialty.

Pediatric interventional radiology - does it add value?

Although attempts have been made to show that pediatric interventional radiology adds value in children's hospitals, none has been particularly persuasive. An analysis of individual procedures would seem to be the most scientific approach, but there are numerous problems, including the effects that different health care systems have on clinical practice and the difficulty of generalizing the results of a single-center study to other hospitals, even within the same type of health care system. It is unsurprising that there are no published randomized controlled trials comparing both the costs and outcomes of specific pediatric interventional radiology procedures with surgical alternatives, and in fact these may not be feasible. There is only anecdotal evidence of the value of pediatric interventional radiology in multidisciplinary teams in children's hospitals. Currently, the best justification may be the counterfactual: demonstrating what can go wrong if pediatric interventional radiology expertise is not available.

The Role of Physician-Driven Device Preference in the Cost Variation of Common Interventional Radiology Procedures

PURPOSE

To analyze the impact of physician-specific equipment preference on cost variation for procedures typically performed by interventional radiologists at a tertiary care academic hospital.

MATERIALS AND METHODS

From October 2017 to October 2019, data on all expendable items used by 9 interventional radiologists for 11 common interventional radiology procedure categories were compiled from the hospital analytics system. This search yielded a final dataset of 44,654 items used in 2,121 procedures of 11 different categories. The mean cost per case for each physician as well as the mean, standard deviation, and coefficient of variation (CV) of the mean cost per case across physicians were calculated. The proportion of spending by item type was compared across physicians for 2 high-variation, high-volume procedures. The relationship between the mean cost per case and case volume was examined using linear regression.

RESULTS

There was a high variability within each procedure, with the highest and the lowest CV for radioembolization administration (56.6%) and transjugular liver biopsy (4.9%), respectively. Variation in transarterial chemoembolization cost was mainly driven by microcatheters/microwires, while for nephrostomy, the main drivers were catheters/wires and access sets. Mean spending by physician was not significantly correlated with case volume (P =.584).

CONCLUSIONS

Physicians vary in their item selection even for standard procedures. While the financial impact of these differences vary across procedures, these findings suggest that standardization may offer an opportunity for cost savings.

The Operational and Financial Value of an Interventional Radiology Clinic at a Large, Academic, Tertiary Public Hospital System

Purpose To evaluate the operational and financial impact of an interventional radiology (IR) clinic at a tertiary county hospital system.

Methods The IR clinic, which opened in January 2017, evaluates outpatient referrals and completes preprocedure workups, nonimage-guided procedures, and postprocedure follow-up visits. Procedural volumes, locations, start times, and end times were analyzed from September 2015 to June 2018, with comparison of pre- and postclinic values by t-tests.

Results Relative to the preclinic period, the number of IR cases completed each quarter has increased by an average of 12% (pre: 953 ± 63, post: 1063 ± 34, p = 0.01). Procedures that saw the largest quarterly growth included port placements (44% increase; pre: 82 ± 8, post: 118 ± 17, p = 0.002), inferior vena cava (IVC) filter placements (24% increase; pre: 33 ± 12, post: 41 ± 8, p = 0.20), IVC filter removals (72% increase; pre: 18 ± 7, post: 31 ± 8, p = 0.02), and treatments of lower extremity venous disease (100% increase; pre: 7 ± 2, post: 14 ± 6, p = 0.04). Completion of 119 cases/quarter in clinic (removal of tunneled catheters and infusion ports), as well as a reduction of emergent nephrostomy exchanges, reduced quarterly facility charges for these procedures by $350,000. Since the opening of the IR clinic, the first outpatient case started 36 minutes earlier (p < 0.001) and the last case finished 19 minutes earlier (p = 0.004).

Conclusion Opening an IR clinic resulted in a significant increase in case volume while reducing avoidable costs and improving efficiency of the angiography suite.

Outbreak of Vancomycin-resistant Enterococcus faecium in Interventional Radiology: Detection Through Whole-genome Sequencing-based Surveillance

BACKGROUND

Vancomycin-resistant enterococci (VRE) are a major cause of hospital-acquired infections. The risk of infection from interventional radiology (IR) procedures is not well documented. Whole-genome sequencing (WGS) surveillance of clinical bacterial isolates among hospitalized patients can identify previously unrecognized outbreaks.

METHODS

We analyzed WGS surveillance data from November 2016 to November 2017 for evidence of VRE transmission. A previously unrecognized cluster of 10 genetically related VRE (Enterococcus faecium) infections was discovered. Electronic health record review identified IR procedures as a potential source. An outbreak investigation was conducted.

RESULTS

Of the 10 outbreak patients, 9 had undergone an IR procedure with intravenous (IV) contrast ≤22 days before infection. In a matched case-control study, preceding IR procedure and IR procedure with contrast were associated with VRE infection (matched odds ratio [MOR], 16.72; 95% confidence interval [CI], 2.01 to 138.73; P = .009 and MOR, 39.35; 95% CI, 7.85 to infinity; P < .001, respectively). Investigation of IR practices and review of the manufacturer's training video revealed sterility breaches in contrast preparation. Our investigation also supported possible transmission from an IR technician. Infection prevention interventions were implemented, and no further IR-associated VRE transmissions have been observed.

CONCLUSIONS

A prolonged outbreak of VRE infections related to IR procedures with IV contrast resulted from nonsterile preparation of injectable contrast. The fact that our VRE outbreak was discovered through WGS surveillance and the manufacturer's training video that demonstrated nonsterile technique raise the possibility that infections following invasive IR procedures may be more common than previously recognized.

Impact of COVID-19 Pandemic on Interventional Radiology Practice—A Multicenter Observational Study

Background The COVID-19 pandemic has brought unprecedented challenges to health care services including interventional radiology (IR). Treating COVID-19 infected patients became a priority; furthermore, government policies of differing elective procedures and the public’s fear of contacting COVID-19 have impacted IR workload worldwide. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the workflow in six vascular IR centers located across India.

Methods The data were collected retrospectively from April 1 to June 30, 2020. All the six centers were staffed by the alumni of a single parent center located in India. Data was also collected from the same time period in 2019 for comparison.

Results A total of 893 patients were treated from April 1 to June 30, 2019, and 419 were treated during the same period in 2020 during the pandemic, a 53% case volume reduction (95% CI:28. 56–129.44; p < 0.001). The month of April had the largest case volume reduction (66%, 95% CI: 13.57–50.43; p < 0.001). Elective procedures showed an 85% reduction (95% CI: 9.62–91.71; p < 0.001). Venous interventions showed the highest reduction of 76% (95% CI: 0.75–67.75; p < 0.001). Neurological emergencies, dialysis-related interventions, and nonvascular procedures did not show a significant change. No patient tested positive for COVID-19 prior to the procedure; however, one patient who was treated emergently was found to be positive later.

Conclusion COVID-19 pandemic has severely impacted IR practice across India. Workload reduction was more profound at the beginning of the COVID-19 pandemic with a gradual improvement over time.

Analysis of patients receiving ≥ 100 mSv during a computed tomography intervention

OBJECTIVE

To identify a patient cohort who received ≥ 100 mSv during a single computed tomography (CT)-guided intervention and analyze clinical information.

MATERIALS AND METHODS

Using the dose-tracking platform Radimetrics that collects data from all CT scanners in a single hospital, a patient-level search was performed retrospectively by setting a threshold effective dose (E) of 100 mSv for the period from January 2013 to December 2017. Patients who received ≥ 100 mSv in a single day during a single CT-guided intervention were then identified. Procedure types were identified, and medical records were reviewed up to January 2020 to identify patients who developed short- and/or medium-term (up to 8 years) medical consequences.

RESULTS

Of 8952 patients with 100 mSv+, there were 33 patients who underwent 37 CT-guided interventions each resulting in ≥ 100 mSv. Procedures included ablations (15), myelograms (8), drainages (7), biopsies (6), and other (1). The dose for individual procedures was 100.2 to 235.5 mSv with mean and median of 125.7 mSv and 111.8 mSv, respectively. Six patients (18 %) were less than 50 years of age. During the study period of 0.2 to 7 years, there were no deterministic or stochastic consequences identified in this study cohort.

CONCLUSIONS

While infrequent, CT-guided interventions may result in a single procedure dose of ≥ 100 mSv. Awareness of the possibility of such high doses and potential for long-term deleterious effects, especially in younger patients, and consideration of alternative imaging guidance and/or further dose optimization should be strongly considered whenever feasible.

KEY POINTS

• Although not so frequent, CT-guided interventions may result in a single procedure dose of ≥ 100 mSv • Procedures with potential for high dose includes ablations, myelograms, drainages, and biopsies.

Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis

PURPOSE

To characterize perceptions of palliative versus futile care in interventional radiology (IR) as a roadmap for quality improvement.

METHODS

Interventional radiologists (IRs) and referring physicians were recruited for anonymous interviews and/or focus groups to discuss their perceptions and experiences related to palliative verse futile care in IR. Sessions were recorded, transcribed, and systematically analyzed using dedicated software, content analysis, and grounded theory. Data collection and analysis continued simultaneously until additional interviews stopped revealing new themes: 24 IRs (21 males, 3 females, 1-39 years of experience) and 7 referring physicians (3 males, 4 females, 6-14 years of experience) were analyzed.

RESULTS

Many IRs (75%) perceived futility as an important issue. Years of experience (r = 0.60, p = 0.03) and being in academics (r = 0.62, p = 0.04) correlated with greater perceived importance. Perceptions of futility and whether a potentially inappropriate procedure was performed involved a balance between four sets of factors (patient, clinician, procedural, and cultural). These assessments tended to be qualitative in nature and are challenged by a lack of data, education, and consistent workflows. Referring clinicians were unaware of this issue and assumed IR had guidelines for differentiating between palliation and futility.

CONCLUSION

This study characterized the complexity and qualitative nature of assessments of palliative verses futile care in IR while highlighting potential means of improving current practices. This is important given the number of critically ill patients referred to IR and costs of potentially inappropriate interventions.

The Economic Footprint of Interventional Radiology in the United States: Implications for Systems Development

PURPOSE

Despite the growing presence of interventional radiology (IR) in inpatient care, its global impact on the health care system remains uncharacterized. The aim of this study was to quantitate the use of IR services rendered to hospitalized patients in the United States and the impact on cost.

METHODS

The National Inpatient Sample 2016 was queried. Using the International Classification of Diseases, 10th revision, Clinical Modification/Procedure Classification System, adult inpatients who underwent routine IR procedures were identified. Unadjusted and adjusted analyses were performed. Weighted patient data are presented to provide national estimates.

RESULTS

Of the 29.7 million inpatient admissions in 2016, 2.3 million (7.8%) had at least one IR procedure. Patients who needed IR were older (62.8 versus 57.1 years, P < .001), were sicker on the basis of the All Patient Refined Diagnosis Related Groups (27% major or extreme versus 14% for non-IR, P < .001), and had higher inpatient mortality (8.2% versus 1.7%, P < .001). While representing 7.8% of all admissions, this cohort accounted for 18.4% ($68.4 billion) of adult inpatient health care costs and about 3 times higher mean hospitalization cost compared with other inpatients ($29,402 versus $11,062, P < .001), which remained significant even after controlling for age and All Patient Refined Diagnosis Related Group.

CONCLUSIONS

Approximately 1 in 10 US inpatients are treated by IR during their hospitalizations. These patients are sicker, with about 4 times higher mortality and 2.5 times greater length of stay, accounting for almost one-fifth of all health care costs. These findings suggest that IR should have a voice in discussions of means to save costs and improve patient outcomes in the United States.

Longitudinal study of interventional radiology activity in a large metropolitan Italian tertiary care hospital: how the COVID-19 pandemic emergency has changed our activity

Objectives

To retrospectively analyze interventional radiology (IR) activity changes in the COVID-19 era and to describe how to safely and effectively reorganize IR activity.

Methods

All IR procedures performed between January 30 and April 8, 2020 (COVID-era group) and the same 2019 period (non-COVID-era group) were retrospectively included and compared. A sub-analysis for the lockdown period (LDP: 11 March–8 April) was also conducted. Demographic, hospitalization, clinical, and procedural data were obtained for both groups and statistically compared with univariable analysis.

Results

A total of 1496 procedures (non-COVID era, 825; COVID era, 671) performed in 1226 patients (64.9 ± 15.1 years, 618 women) were included. The number of procedures decreased by 18.6% between 2019 and 2020 (825 vs 671, p < .001), with a reduction by 48.2% in LDP (188 vs 363, p < .0001). In the LDP COVID era, bedside procedures were preferred (p = .013), with an increase in procedures from the intensive care unit compared with the emergency department and outpatients (p = .048), and an increased activity for oncological patients (p = .003). No incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of healthcare workers in the IR service was registered.

Conclusions

Coronavirus disease outbreak changed the interventional radiology activity with an overall reduction in the number of procedures. However, this study confirms that interventional radiology continuum of care can be safely performed also during the pandemic, following defined measures and protocols, taking care of all patients.

Key Points

• Coronavirus disease pandemic determined a reduction of interventional radiology activity as compared to the same period of the previous year.

• Interventional radiology procedures for life-threatening conditions and non-deferrable oncologic treatments were prioritized as opposed to elective procedures.

• Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service.

Effects of a reimbursement change and travel times on the delivery of private and public radiology services in Norway: a register-based longitudinal study of Norwegian claims data

BACKGROUND

The variation in the impact of the 2008 reimbursement change for Norwegian radiology providers, depending on the travel times to private and public providers in different municipalities, was examined. The activity-based fund allocation for radiology providers was reduced from approximately 50% to 40%, which was compensated by an increased basic grant. The hypothesis was that the Norwegian population would be affected by the reimbursement change unevenly depending on their distances to different types of the providers.

METHODS

The study of the effect of the reimbursement change and travel time difference between private and public radiology providers in Norway (Time_difference) on the number of the services was performed using fixed-effects regressions applied to panel data at the municipality level with monthly observations for the period 2007-2010.

RESULTS

After the reimbursement change, the number of private services decreased more than the number of public services. Private services declined after 2008, but the absolute value of the effect was smaller as the Time_difference became greater. The number of public services increased as the Time_difference grew. The total number of services decreased until the Time_difference was equal to 40 min and increased for time differences greater than 40 min.

CONCLUSIONS

The messages for policymakers are as follows. Populations that only had private providers nearby were more affected by the reimbursement change in terms of a reduced number of services. The reimbursement change contributed to the reallocation of patients from private to public providers. The difference between the centralities of municipalities in their consumption patterns was reduced and the difference between different Regional Health Authorities was increased due to the reimbursement change.

The Challenges of Providing Interventional Radiology Services to Rural and Smaller Community Hospitals

OBJECTIVE

Recruitment and retention of interventional radiologists for rural and smaller community hospital practices is a serious physician staffing issue. This article explores rural interventional radiology and perspectives of various stakeholders, such as rural radiology group practices, rural hospitals, interventional radiologists, public and private academic institutions, and urban health care providers, and considers the unique health care needs of rural patients.

CONCLUSION

Some early solutions are evident. Collaboration among all stakeholders will be necessary to properly address the challenges.

Design and properties of a novel radiopaque injectable apatitic calcium phosphate cement, suitable for image-guided implantation

An injectable purely apatitic calcium phosphate cement (CPC) was successfully combined to a water-soluble radiopaque agent (i.e., Xenetix^® ), to result in an optimized composition that was found to be as satisfactory as poly(methyl methacrylate) (PMMA) formulations used for vertebroplasty, in terms of radiopacity, texture and injectability. For that purpose, the Xenetix dosage in the cement paste was optimized by injection of the radiopaque CPC in human cadaveric vertebrae under classical PMMA vertebroplasty conditions, performed by interventional radiologists familiar with this surgical procedure. When present in the cement paste up to 70 mg I mL^-1 , Xenetix did not influence the injectability, cohesion, and setting time of the resulting composite. After hardening of the material, the same observation was made regarding the microstructure, mechanical strength and alpha-tricalcium phosphate to calcium deficient apatite transformation rate. Upon implantation in bone in a small animal model (rat), the biocompatibility of the Xenetix-containing CPC was evidenced. Moreover, an almost quantitative release of the contrast agent was found to occur rapidly, on the basis of in vitro static and dynamic quantitative studies simulating in vivo implantation. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2786-2795, 2018.

The effects of expanding outpatient and inpatient evaluation and management services in a pediatric interventional radiology practice

BACKGROUND

Despite a continuing emphasis on evaluation and management clinical services in adult interventional radiology (IR) practice, the peer-reviewed literature addressing these services - and their potential economic benefits - is lacking in pediatric IR practice.

OBJECTIVE

To measure the effects of expanding evaluation and management (E&M) services through the establishment of a dedicated pediatric interventional radiology outpatient clinic and inpatient E&M reporting system.

MATERIALS AND METHODS

We collected and analyzed E&M current procedural terminology (CPT) codes from all patients seen in a pediatric interventional radiology outpatient clinic between November 2014 and August 2015. We also calculated the number of new patients seen in the clinic who had a subsequent procedure (procedural conversion rate). For comparison, we used historical data comprising pediatric patients seen in a general interventional radiology (IR) clinic for the 2 years immediately prior. An inpatient E&M reporting system was implemented and all inpatient E&M (and subsequent procedural) services between July 2015 and September 2015 were collected and analyzed. We estimated revenue for both outpatient and inpatient services using the Medicare Physician Fee Schedule global non-facility price as a surrogate.

RESULTS

Following inception of a pediatric IR clinic, the number of new outpatients (5.5/month; +112%), procedural conversion rate (74.5%; +19%), estimated E&M revenue (+158%), and estimated procedural revenue from new outpatients (+228%) all increased. Following implementation of an inpatient clinic reporting system, there were 8.3 consults and 7.3 subsequent hospital encounters per month, with a procedural conversion rate of 88%.

CONCLUSION

Growth was observed in all meaningful metrics following expansion of outpatient and inpatient pediatric IR E&M services.