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May BJ, Dodelzon K, Katzen J, Lamparello NA, Legasto AC, Chatterji M, Lo GC, de Leon MJ, Schweitzer AD, Min RJ. Thriving In and Out of the Reading Room: A Faculty Development Workshop. Acad Radiol 2024; 31:1141-1147. [PMID: 37863781 DOI: 10.1016/j.acra.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES Given the immense time and energy radiologists dedicate to their profession, the experience at work should be a major contributor to a meaningful and fulfilling life. In pursuit of this vision, our department launched a novel faculty development workshop entitled "Thriving In and Out of the Reading Room: What They Didn't Teach Us in Training." We report on the design, implementation and initial outcomes of this faculty development workshop. MATERIALS AND METHODS The workshop drew upon positive psychology research and the PERMA model of well-being, which encompasses five key elements: Positive emotion, Engagement, Relationships, Meaning, and Achievement. These elements have been shown to enhance work satisfaction and foster resilience. Using interactive, small group exercises, the workshop provided strategies for incorporating PERMA elements into daily life. At the conclusion of each workshop, an anonymous voluntary electronic survey was distributed to participants. RESULTS The final version of the workshop was offered to 58 faculty over eight sessions between September 2022 and May 2023. Survey results indicate that participants found the workshop to be highly valuable and practical. They also found the workshop to promote camaraderie and peer learning. Developing the workshop internally allowed us to customize it to our faculty's unique experiences and engage a large number of participants. CONCLUSION The workshop shows promise in improving job satisfaction and addressing burnout among academic radiologists.
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Affiliation(s)
- Benjamin J May
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA.
| | - Katerina Dodelzon
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Janine Katzen
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Nicole A Lamparello
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Alan C Legasto
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Manjil Chatterji
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Grace C Lo
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Mony J de Leon
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Andrew D Schweitzer
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
| | - Robert J Min
- Weill Cornell Medicine New York-Presbyterian, Department of Radiology, 520 East 70th Street, Starr 8A, New York, New York 10021, USA
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Taya M, Corines MJ, Sinha V, Schweitzer AD, Lo GK, Dodelzon K, Min RJ, Belfi L. Evaluating the Impact of Annual Resident Retreats on Radiology Resident Wellbeing. Acad Radiol 2024; 31:409-416. [PMID: 38401986 DOI: 10.1016/j.acra.2023.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 02/26/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the effect of resident-run wellness retreats on measures of stress, resilience, and cohesion amongst radiology residents. MATERIALS AND METHODS All diagnostic and interventional radiology residents in a single academic medical center were invited to participate in a wellness-focused off-campus retreat. Three retreats were held on an annual basis from 2018 to 2022 and included physical exercises, nutritional wellness, and team-building activities. Participants were surveyed pre- and post- retreat attendance focusing on the following domains: Perceived Stress Scale, higher scores indicating higher levels of perceived stress; Brief Resilience Scale, higher scores indicating greater resilience; Cohesion Scale, higher scores indicating greater cohesion. Paired t-tests and linear regression models were used to compare mean Perceived Stress, Brief Resilience, and Cohesion Scales pre- and post-retreat across covariates. RESULTS Of 78 total retreat attendances, 75 residents (96%) completed pre- and/or post-surveys. Study population was 51% female and 49% male, with mean age 29 ± 2.8 years. Comparing post- with pre-surveys, retreat attendance was associated with a significant reduction in mean Perceived Stress (12.7 vs 16.3; 95% CI 2.1-5.3) and significant increase in Brief Resilience (3.9 vs 3.7; 95% CI 0.05-0.34) and Cohesion (33 vs 27; 95% CI 4.3-6.7). First year residents experienced the greatest increase in Cohesion compared to fourth year residents (p < 0.001). Pre-retreat cohesion was significantly lower in 2022 than in 2018-2019 (26.6 vs 28.7 vs 28.6; p = 0.04), with stress and resilience not significantly different by year. CONCLUSION An annual resident retreat decreased stress, while increasing resilience and cohesion within a radiology residency, supporting retreats as a potentially viable intervention to promote physician well-being.
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Affiliation(s)
- Michio Taya
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065.
| | - Marina J Corines
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065
| | - Vishal Sinha
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065
| | - Andrew D Schweitzer
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065
| | - Grace K Lo
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065
| | - Robert J Min
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065
| | - Lily Belfi
- Department of Radiology, Weill Cornell Medicine / NewYork-Presbyterian Hospital, 525 East 68th St, New York, NY 10065
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Talenfeld AD, Min RJ. The Future of Interventional Radiology: Counterpoint-Interventional and Diagnostic Radiology Will Be Better Together. AJR Am J Roentgenol 2023; 221:734-735. [PMID: 37436035 DOI: 10.2214/ajr.23.29683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Adam D Talenfeld
- Department of Radiology, Weill Cornell Medicine, 520 E 70th St, New York, NY 10021
| | - Robert J Min
- Department of Radiology, Weill Cornell Medicine, 520 E 70th St, New York, NY 10021
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Hecht EM, Robbins JB, Desser TS, Grist TM, Min RJ, Catanzano TM, Slanetz PJ. Defining the Roles and Responsibilities for the Vice Chair for Academic Affairs/Faculty Development in Radiology. Acad Radiol 2023; 30:2728-2733. [PMID: 37059613 DOI: 10.1016/j.acra.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/16/2023]
Abstract
RATIONALE AND OBJECTIVES To inform the development of a job description for Vice-Chairs for academic affairs (VCAA), members of the Alliance of Leaders in Academic Affairs in Radiology (ALAAR) were surveyed to better understand their current job responsibilities and how they would ideally allocate their professional time. MATERIALS AND METHODS Based on a survey of 33 university-affiliated radiology departments and discussion among ALAAR members, the authors developed a detailed job description for the VCAA. The 21-question survey was composed and validated by experts in the field. It was distributed to all members of ALAAR via email with an electronic link and was open for 5 months. Results of the survey were tabulated, and a job description was crafted to represent the foundational roles of academic affairs leaders in radiology. RESULTS The response rate for institutions represented in ALAAR was 73% (33/45). All participants reported that they practiced in a university-affiliated institution. Faculty size varied from ≤49 (30.3%, 10/33), 50-99 faculty (24.2%, 8/33), and ≥100 faculty members (45.5%, 15/33). Only 24% of survey respondents had a detailed job description at the time of hire. More than 40% attested to significant oversight over faculty development programs (45%), mentorship programs (42%, and promotions (45%). Respondents ideally want increased oversight (defined as >10%) over exit interviews, faculty awards, promotions, onboarding, recruitment and hiring, and wellness programming. CONCLUSION The aspirational mission of the VCAA is to oversee components of sequential stages in the professional lifecycle of faculty members but a common job description for this role is lacking.
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Affiliation(s)
- Elizabeth M Hecht
- Department of Radiology, Weill Cornell Medicine, New York, New York.
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Terry S Desser
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert J Min
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Tara M Catanzano
- Department of Radiology, UMass Chan Medical School-Baystate, Springfield, Massachusetts
| | - Priscilla J Slanetz
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Colucci PG, Gao MA, Schweitzer AD, Chang EW, Riyahi S, Taya M, Lu C, Ballon D, Min RJ, Prince MR. A Novel Hands-on Approach Towards Teaching Diagnostic Radiology Residents MRI Scanning and Physics. Acad Radiol 2023; 30:998-1004. [PMID: 36642587 DOI: 10.1016/j.acra.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES Traditional approaches towards teaching magnetic resonance imaging (MRI) scanning and physics have limitations that a hands-on course may help overcome. A dedicated week of MRI instruction may help improve radiology resident confidence and competence. Additional benefits may include improved physician-technologist communication and accelerated mastery of MRI safety. MATERIALS AND METHODS Surveys and tests were approved by our Program Evaluation Committee and administered at the beginning and at the end of this one-week course. The course consisted of protected reading time as well as practice scanning with a research magnet and assisting with clinical scanning under the close supervision of a licensed MRI technologist. Eighteen senior residents (nine third-year and nine fourth-year) participated in this course during its first year. RESULTS Few residents had previous experience with MRI physics, scanning, or research prior to residency. After this course, mean resident confidence increased by 0.47 points (3.33 vs 2.86; p=0.01) on a five-point Likert scale. Understanding of MRI physics, as measured by pre- and post-tests, increased by 22% (0.72 vs 0.50; p<0.01), corresponding to a large effect size of 1.29 (p<0.001). Resident feedback reported that this course was efficacious (5/5), engaging (4.9/5), and had optimal faculty oversight. The most highly rated component of the course was the opportunity to experiment with the research MR scanner (5/5). CONCLUSION A dedicated week of MRI education was highly rated by residents and associated with improvements in confidence and understanding, suggesting a positive correlation between confidence and competence. Additional metrics, such as trends in scores on the American Board of Radiology's Core Examination over the next several years, may further support the apparent benefits of this hands-on MR course.
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Affiliation(s)
| | - Madeleine A Gao
- Hospital For Special Surgery, New York, New York; SUNY Downstate Health Sciences University, Brooklyn, New York
| | | | - Eileen W Chang
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, New York, New York
| | - Sadjad Riyahi
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, New York, New York; SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Michio Taya
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, New York, New York
| | - Connie Lu
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, New York, New York
| | - Doug Ballon
- Citigroup Biomedical Imaging Center / Weill Cornell Medicine, New York, New York
| | - Robert J Min
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, New York, New York
| | - Martin R Prince
- NewYork-Presbyterian Hospital / Weill Cornell Medicine, New York, New York
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Groner LK, Lee M, Gil HDJ, Min RJ, Babagbemi K. Hiding in plain sight: How incorporating honest discussion of racial and social (in)justice into medical education can inspire change. Clin Imaging 2022; 89:37-42. [DOI: 10.1016/j.clinimag.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
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Dodelzon K, Belfi L, Schweitzer AD, Lamparello N, Legasto AC, McGinty G, Spottswood S, Min RJ, Babagbemi K. The Design and Preliminary Experience with a Virtual Diversity Visiting Student Acting Internship in Radiology for Underrepresented Minority Medical Students. Acad Radiol 2022; 29:598-608. [PMID: 33773896 DOI: 10.1016/j.acra.2021.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Benefits of a diverse physician workforce are numerous and the impact of a lack of diversity has been highlighted with the COVID-19 pandemic. Despite the commitment of professional societies such as the American College of Radiology to diversity in Radiology, the field and its residency training programs remain the least diverse. With COVID-19 related suspension of in-person medical student rotations, our Department of Radiology redesigned and implemented a virtual radiology internship for underrepresented minority (URM) medical students. METHODS A four-week virtual radiology internship was designed to provide clinical exposure to radiology and to allow students to gain an understanding of what a career in radiology entails. Course design included videoconference patient care sessions, didactic lectures, online modules, mentoring, and extra-clinical curriculum. Feedback from students was collected using online surveys assessing pre- and postcourse attitudes and understanding of a career in radiology and the students' perceived aptitude for such a career, as well as course component evaluation. RESULTS Three participants were enrolled in the inaugural clerkship. All noted exceptional educational course content and ample opportunities to build connections with faculty and residents-with mentoring seen as the highlight of the course. All indicated a significant shift in perception of the field and in declaring interest in pursuing a career in radiology. CONCLUSION Virtual radiology internship for URM students is a feasible paradigm to address potential impediments to diversification of the specialty by both engaging interested URM medical students in a career in radiology and arming them with the tools for a successful application to radiology residency.
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Reichman M, Arleo EK, Min RJ, Hentel K, Cahill M, Ruddy T, Sullivan D, Drotman M. Adding value in the era of COVID-19: Increasing usage of a patient-centered radiology consultation service. Clin Imaging 2021; 80:211-214. [PMID: 34343836 PMCID: PMC8261130 DOI: 10.1016/j.clinimag.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the effects of COVID-19 pandemic on our department's Radiology Consultation Service (RCS) related to breast imaging, and how utilization of the provided services may have differed as compared to prior to the pandemic. MATERIALS AND METHODS A retrospective cohort study of patients and health care providers who consulted the RCS, as well as those patients who had a screening mammogram and/or ultrasound between January 1, 2019 and September 1, 2020. Consultations were performed by an RRA, RN and one of 17 breast imaging radiologists assigned to consults on daily. Descriptive statistics were performed to describe the study subject population. RESULTS Between January 1, 2020 and July 31, 2020, a total of 1623 consultations were performed, in comparison to the control period from the year prior (January 1, 2019 to July 31, 2019), when a total of 1398 consultations were performed, representing a 16% increase in one year. Between March 1, 2020 and June 30, 2020, a total of 679 consultations were performed, in comparison to the control period from the year prior (March 1, 2019 to June 30, 2019), when 583 consultations were performed, representing a 16.5% increase in a four-month period. 350 out of 679 (36.8%) consultations addressed COVID concerns. CONCLUSIONS While much of radiology experienced an unprecedented decrease in imaging studies during the initial peak of COVID-19 crisis, the RCS at our institution showed a significant increase in services provided, evolving to address pressing concerns related to COVID-19.
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Affiliation(s)
- Melissa Reichman
- Weill Cornell Medical College at New York-Presbyterian Hospital, 425 East 61st Street, 9th Floor, New York, NY 10065, United States of America.
| | - Elizabeth Kagan Arleo
- Weill Cornell Medical College at New York-Presbyterian Hospital, 425 East 61st Street, 9th Floor, New York, NY 10065, United States of America
| | - Robert J Min
- Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th Street Box 141, New York, NY 10065, United States of America
| | - Keith Hentel
- Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th Street Box 141, New York, NY 10065, United States of America
| | - Meghan Cahill
- Radiology Consultation Service, Department of Radiology, Weill Cornell Medical College, 520 E. 70th Street Star Pavilion, New York, NY 10065, United States of America
| | - Tara Ruddy
- Radiology Consultation Service, Department of Radiology, Weill Cornell Medical College, 425 E. 61th Street, New York, NY 10065, United States of America
| | - Deirdre Sullivan
- Radiology Consultation Service, Department of Radiology, Weill Cornell Medical College, 425 E. 61th Street, New York, NY 10065, United States of America
| | - Michele Drotman
- Weill Cornell Medical College at New York-Presbyterian Hospital, 425 East 61st Street, 9th Floor, New York, NY 10065, United States of America
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Belfi LM, Dean KE, Bartolotta RJ, Shih G, Min RJ. Medical student education in the time of COVID-19: A virtual solution to the introductory radiology elective. Clin Imaging 2021; 75:67-74. [PMID: 33497880 PMCID: PMC7816883 DOI: 10.1016/j.clinimag.2021.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
Rationale and objectives During the COVID-19 pandemic, medical educators and students are facing unprecedented challenges while navigating the new virtual landscape that social-distancing policies mandate. In response to these challenges, a new virtual introduction to radiology elective was established with unique online resources and curriculum. Materials and methods A previously in-person 2-week introductory radiology elective was converted into a completely virtual experience using an internally developed, open-source, peer-reviewed, web-based teaching modules combined with virtual lectures, interdisciplinary conferences, and readout sessions of de-identified cases loaded to a DICOM viewer. Students from the first four months of course enrollment completed a multiple choice pre- and post-course knowledge assessments and a 5-point Likert Scale survey as part of their educational experience. Results In total, 26 4th-year medical students participated over 4 separate 2-week sessions from July to October of 2020. This included 12 students from the home intuition and 14 visiting students. On average, students scored 62.2% on the 55-question pre-test and 89.0% on the same test upon completion of the course, a statistically significant increase (p < 0.001). All 26 students felt engaged throughout the course. All 26 agreed (23 “strongly agreed”) that they were more comfortable looking at imaging studies following the course. All 26 also agreed (21 “strongly agreed”) that the course helped them prepare for their future clinical rotations and careers. Conclusion Initial pilot program using unique web-based resources and student encounters during a two-week virtual introductory radiology elective proved to be a positive educational experience for the first 26 students enrolled.
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Affiliation(s)
- Lily M Belfi
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America.
| | - Kathryn E Dean
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America.
| | - Roger J Bartolotta
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO 80045, United States of America
| | - George Shih
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America.
| | - Robert J Min
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America.
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Xu HS, Cavaliere RM, Min RJ. Transforming the Imaging Experience While Decreasing Sedation Rates. J Am Coll Radiol 2019; 17:46-52. [PMID: 31570312 DOI: 10.1016/j.jacr.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of the MRI-am-a-Hero program on sedation utilization for outpatient pediatric MRI studies. METHODS The MRI-am-a-Hero program, which utilizes multimedia educational material and popular comic book characters to educate and support pediatric patients during MRI scan, was implemented at the radiology facility of a single tertiary care, academic medical center. The effect of the MRI-am-a-Hero program on sedation utilization for pediatric MRI was retrospectively evaluated using multivariate regressions yielding odds ratio of sedation before and after program implementation. The institutional review board approved the study with HIPAA compliancy. Effectiveness of the program was evaluated while controlling for age, neurological MRI examination, number of examinations in the case, and use of intravenous contrast. Further analysis was performed in subgroups categorized by age, neurological MRI versus nonneurological MRI, and the use of contrast. RESULTS The percent of MRI cases with sedation decreased from 22.9% to 17.3% after the MRI-am-a-Hero program was implemented. When controlling for other variables, including patient age, neurological MRI, number of examinations in a case, and use of intravenous contrast, the odds of a study being performed with sedation after program implementation are 40% less than the odds before program implementation (odds ratio [OR] 0.60, P < .001). The effect of the program was greatest for patients aged 4 to 7 (OR 0.56, P < .001), followed by patients aged 8 to 11 (OR 0.64, P = .019). It was not statistically significant for patients aged 12 to 15 (OR 0.97, P = .919). CONCLUSION MRI-am-a-Hero is a generalizable and inexpensive program for reducing sedation utilization for outpatient pediatric MRI studies, especially for patients aged 4 to 11.
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Affiliation(s)
- Helen S Xu
- Weill Cornell Imaging at NewYork-Presbyterian, New York, New York
| | | | - Robert J Min
- Weill Cornell Imaging at NewYork-Presbyterian, New York, New York.
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Behzadi AH, Khilnani NM, Zhang W, Bares AJ, Boddu SR, Min RJ, Prince MR. Pelvic cardiovascular magnetic resonance venography: venous changes with patient position and hydration status. J Cardiovasc Magn Reson 2019; 21:3. [PMID: 30602387 PMCID: PMC6317255 DOI: 10.1186/s12968-018-0503-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To determine the effect of hydration as well as prone versus supine positioning on the pelvic veins during cardiovascular magnetic resonance (CMR) venography. METHODS Under institutional review board approval, 8 healthy subjects were imaged with balanced steady state free precession, non-contrast CMR venography to measure common and external iliac vein volumes and common femoral vein cross-sectional area in the supine, prone and decubitus positions after dehydration and again following re-hydration. CMR venography from 23 patients imaged both supine and prone were retrospectively reviewed and measurements of common femoral and iliac veins areas were compared using Wilcoxon test. RESULTS Common femoral vein area on CMR venography increased with prone positioning (83 ± 35 mm2) compared to supine positioning (59 ± 21 mm2) (p = 0.02) and further increased with hydration to 123 ± 44 mm2 (p < 0.01). With right and left side down decubitus positioning, the common femoral vein area on dehydration increased from 29 ± 17 mm2 in the ante-dependent position to 134 ± 36 mm2 in the dependent position (p < 0. 001). Similarly, common and external iliac veins increased in volume with prone, 5.4 ± 1.9 cm3 and 5.8 ± 1.9 cm3 compared to supine positioning 4.6 ± 1.8 cm3 and 4.5 ± 1.9 cm3 (p = 0.01) and further increase with hydration to 6.7 ± 2.1 cm3 and 6.3 ± 1.9 cm3 (p = 0.01). CMR venography on patients also demonstrated an increase in mean common femoral vein luminal area from 103 ± 44 mm2 in supine position to 151 ± 52 mm2 with prone positioning (p < 0.001) as well as increases in common and external iliac vein volumes from 6.5 ± 2.6 cm3 and 8.0 ± 3.4 cm3 in the supine position to 7.5 ± 2.5 cm3 and 9.3 ± 3.6 cm3 with prone positioning (p < 0.01). CONCLUSIONS Common femoral and common/external iliac vein size on CMR venography may be affected by position and hydration status. Routine clinical CMR venography of the pelvis could include prone positioning and avoiding dehydration to maximize pelvic vein distension.
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Affiliation(s)
- Ashkan H Behzadi
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Neil M Khilnani
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Weiguo Zhang
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Amanda J Bares
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Srikanth R Boddu
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Robert J Min
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA.
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Chazen JL, Sarva H, Stieg PE, Min RJ, Ballon DJ, Pryor KO, Riegelhaupt PM, Kaplitt MG. Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor. J Neurosurg 2018; 129:315-323. [DOI: 10.3171/2017.4.jns162803] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to evaluate the utility of diffusion tensor imaging (DTI) tractography–based targeting of the dentatorubrothalamic tract (DRT) for magnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy in patients with essential tremor (ET) and correlate postprocedural tract disruption with clinical outcomes.METHODSFour patients received preprocedural and immediate postprocedural DTI in addition to traditional anatomical MRI sequences for MRgFUS thalamotomy. Optimal ablation sites were selected based on the patient-specific location of the DRT as demonstrated by DTI (direct targeting) and correlated with traditional atlas-based measurements for thalamic ventral intermediate nucleus (Vim) lesioning (indirect targeting). Fiber tracts were displayed three-dimensionally during the procedure and used in conjunction with clinical signs of tremor control for fine correction of the ablation site. Immediately following the conclusion of the procedure, the MRgFUS head frame was removed and patients were placed in a 32-channel MRI head coil for follow-up DTI and anatomical MRI sequences.RESULTSAll patients had excellent postoperative tremor control and successful pre- and postprocedural DTI fiber tracking of the corticospinal tract, medial lemniscus, and DRT. Immediate postprocedure DTI failed to track the DRT ipsilateral to the lesion site with a preserved contralateral DRT, coincident with substantial resolution of contralateral tremor.CONCLUSIONSDTI can reliably identify the optimal ablation target and demonstrates tract disruption on immediate postprocedural imaging. A clinical improvement of ET was observed immediately following the procedure, correlating with DRT disruption and suggesting that interruption of the DRT is a consequence of clinically successful MRgFUS thalamotomy. These findings may have utility for both MRgFUS procedure planning in surgically naive patients and retreatment of patients who have previously undergone unsuccessful thalamic Vim lesioning.
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Affiliation(s)
| | | | | | | | | | - Kane O. Pryor
- 4Anesthesia, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Paul M. Riegelhaupt
- 4Anesthesia, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Salama GR, Sullivan C, Holzwanger D, Giambrone AE, Min RJ, Hentel KD. Improving Care and Education Through a Radiology Resident-driven Clinical Consultation Service. Acad Radiol 2017; 24:1175-1181. [PMID: 28392029 DOI: 10.1016/j.acra.2017.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/13/2017] [Accepted: 01/30/2017] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVE As health care moves toward bundled payment systems and merit-based incentive models, increasing awareness of the value of the radiologist is essential. A resident-driven clinical imaging rounds (CIR) program initiated at our institution allows radiologists to actively and directly participate in the team-based medical model. A retrospective review of survey data evaluated the qualitative and quantitative effects of CIR on clinical management, communication, and education of referring providers and radiology residents. MATERIALS AND METHODS The initial 10 months of a resident-organized CIR were evaluated in a retrospective study. Twenty radiology residents and 150 internal medicine physicians and medical students participated in imaging rounds. An anonymous survey of participants was performed and results were analyzed. RESULTS Eighty-five percent of radiology resident participants completed the survey (N = 17). Approximately 30% of internal medicine participants completed the survey (N = 45). There was an overwhelming positive review of imaging rounds, with a large majority of all groups agreeing that imaging rounds improve education, communication, and patient care. CONCLUSIONS Resident-driven imaging rounds provide a valuable opportunity to improve communication, education, and patient care. We have created a CIR with a sustainable workflow that allows direct and regularly scheduled imaging-medicine consultation valued by both radiologists and internal medicine physicians, improving the quality of patient care and providing education to our radiology residents in value-based care.
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Comerota AJ, Min RJ, Rathbun SW, Khilnani N, Rooke T, Wakefield TW, Carman TL, Lurie F, Vedantham S, Zimmet SE. Program requirements for fellowship education in venous and lymphatic medicine. Phlebology 2016; 32:459-473. [PMID: 27535088 DOI: 10.1177/0268355516664213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In every field of medicine, comprehensive education should be delivered at the graduate level. Currently, no single specialty routinely provides a standardized comprehensive curriculum in venous and lymphatic disease. Method The American Board of Venous & Lymphatic Medicine formed a task force, made up of experts from the specialties of dermatology, family practice, interventional radiology, interventional cardiology, phlebology, vascular medicine, and vascular surgery, to develop a consensus document describing the program requirements for fellowship medical education in venous and lymphatic medicine. Result The Program Requirements for Fellowship Education in Venous and Lymphatic Medicine identify the knowledge and skills that physicians must master through the course of fellowship training in venous and lymphatic medicine. They also specify the requirements for venous and lymphatic training programs. The document is based on the Core Content for Training in Venous and Lymphatic Medicine and follows the ACGME format that all subspecialties in the United States use to specify the requirements for training program accreditation. The American Board of Venous & Lymphatic Medicine Board of Directors approved this document in May 2016. Conclusion The pathway to a vein practice is diverse, and there is no standardized format available for physician education and training. The Program Requirements for Fellowship Education in Venous and Lymphatic Medicine establishes educational standards for teaching programs in venous and lymphatic medicine and will facilitate graduation of physicians who have had comprehensive training in the field.
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Affiliation(s)
| | - Robert J Min
- 2 The Department of Radiology, Weill Cornell Medicine, New York, USA
| | - Suman W Rathbun
- 3 Vascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Neil Khilnani
- 2 The Department of Radiology, Weill Cornell Medicine, New York, USA
| | - Thom Rooke
- 4 Gonda Vascular Center, Mayo Clinic, Rochester, USA
| | - Thomas W Wakefield
- 5 Department of Surgery, Section of Vascular Surgery, University of Michigan Health System, Ann Arbor, USA
| | - Teresa L Carman
- 6 Cardiovascular Medicine, University Hospitals Case Medical Center, Cleveland, USA
| | | | - Suresh Vedantham
- 7 Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, USA
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Abstract
Introduction The patterns of recurrent varicose veins after endovascular ablation of the saphenous veins are not well described. Methods The current study describes the ultrasound defined recurrence patterns seen in 58 patients (79 limbs) who returned for evaluation of recurrent varicose veins from a cohort of 802 patients treated with endovenous laser ablation and subsequent sclerotherapy from March 2000 to March 2007 with clinical follow-up until May 2014. Findings The most common ultrasound defined recurrence patterns leading to the varicose veins were new reflux in the anterior accessory saphenous and small saphenous veins as well as recanalization of the treated saphenous segment. Neovascularization at the saphenofemoral junction and incompetent perforating veins as the source of the recurrent veins were not seen. Conclusions The patterns of recurrence following thermal ablation of saphenous veins are different to those seen after surgery. Specifically, new reflux in other saphenous veins is responsible for most recurrent varicose veins and neovascularity seems to be unusual following endovenous laser ablation.
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Affiliation(s)
- Ronald S Winokur
- Division of Interventional Radiology, Department of Radiology, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Neil M Khilnani
- Division of Interventional Radiology, Department of Radiology, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Robert J Min
- Division of Interventional Radiology, Department of Radiology, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Starikov A, Drotman M, Hentel K, Katzen J, Min RJ, Arleo EK. 2D mammography, digital breast tomosynthesis, and ultrasound: which should be used for the different breast densities in breast cancer screening? Clin Imaging 2015; 40:68-71. [PMID: 26549432 DOI: 10.1016/j.clinimag.2015.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/21/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine which modalities [2D mammography (2D), digital breast tomosynthesis (DBT), whole breast sonography (WBS)] are optimal for screening depending on breast density. METHODS Institutional retrospective cohort study of 2013 screening mammograms (16,789), sorted by modalities and density. RESULTS Cancer detection is increased by adding WBS to 2D (P=.02) for the overall study population. Recall rate was lowest with 2D+DBT (10.2%, P<.001) and highest with 2D+DBT+WBS (23.6%, P<.001) for the overall study population as well. CONCLUSION Women with dense and nondense breasts benefit from reduced recall rate with the addition of DBT; however, this benefit is negated with the addition of WBS.
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Affiliation(s)
- Anna Starikov
- New York-Presbyterian/Weill Cornell, Department of Radiology, 425 East 61st Street, 9th floor, New York, NY 10065
| | - Michele Drotman
- New York-Presbyterian/Weill Cornell, Department of Radiology, 425 East 61st Street, 9th floor, New York, NY 10065
| | - Keith Hentel
- New York-Presbyterian/Weill Cornell, Department of Radiology, 425 East 61st Street, 9th floor, New York, NY 10065
| | - Janine Katzen
- New York-Presbyterian/Weill Cornell, Department of Radiology, 425 East 61st Street, 9th floor, New York, NY 10065
| | - Robert J Min
- New York-Presbyterian/Weill Cornell, Department of Radiology, 425 East 61st Street, 9th floor, New York, NY 10065
| | - Elizabeth Kagan Arleo
- New York-Presbyterian/Weill Cornell, Department of Radiology, 425 East 61st Street, 9th floor, New York, NY 10065.
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Weidman EK, Dean KE, Rivera W, Loftus ML, Stokes TW, Min RJ. MRI safety: a report of current practice and advancements in patient preparation and screening. Clin Imaging 2015; 39:935-7. [PMID: 26422769 DOI: 10.1016/j.clinimag.2015.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022]
Abstract
MRI offers detailed diagnostic images without ionizing radiation; however, there are considerable safety concerns associated with high electromagnetic field strength. With increasing use of high and ultra high (7T) magnetic field strength, adequate patient preparation and screening for ferrous material is increasingly important. We review current safety standards for patient screening and preparation and how they are implemented at our institution. In addition, we describe a novel supplemental screening technique wherein the lights are dimmed in response to detected ferrous metal at the threshold of Zone IV.
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Affiliation(s)
- Elizabeth K Weidman
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065
| | - Kathryn E Dean
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065
| | - William Rivera
- Weill Cornell Imaging at NewYork-Presbyterian, 520 East 70th Street, New York, NY 10021
| | - Michael L Loftus
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065
| | - Thomas W Stokes
- Weill Cornell Imaging at NewYork-Presbyterian, 520 East 70th Street, New York, NY 10021
| | - Robert J Min
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065; Weill Cornell Imaging at NewYork-Presbyterian, 520 East 70th Street, New York, NY 10021.
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Belfi LM, Bartolotta RJ, Giambrone AE, Davi C, Min RJ. "Flipping" the introductory clerkship in radiology: impact on medical student performance and perceptions. Acad Radiol 2015; 22:794-801. [PMID: 25592027 DOI: 10.1016/j.acra.2014.11.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Among methods of "blended learning" (ie, combining online modules with in-class instruction), the "flipped classroom" involves student preclass review of material while reserving class time for interactive knowledge application. We integrated blended learning methodology in a "flipped" introductory clerkship in radiology, and assessed the impact of this approach on the student educational experience (performance and perception). MATERIALS AND METHODS In preparation for the "flipped clerkship," radiology faculty and residents created e-learning modules that were uploaded to an open-source website. The clerkship's 101 rising third-year medical students were exposed to different teaching methods during the course, such as blended learning, traditional lecture learning, and independent learning. Students completed precourse and postcourse knowledge assessments and surveys. RESULTS Student knowledge improved overall as a result of taking the course. Blended learning achieved greater pretest to post-test improvement of high statistical significance (P value, .0060) compared to lecture learning alone. Blended learning also achieved greater pretest to post-test improvement of borderline statistical significance (P value, .0855) in comparison to independent learning alone. The difference in effectiveness of independent learning versus lecture learning was not statistically significant (P value, .2730). Student perceptions of the online modules used in blended learning portions of the course were very positive. They specifically enjoyed the self-paced interactivity and the ability to return to the modules in the future. CONCLUSIONS Blended learning can be successfully applied to the introductory clerkship in radiology. This teaching method offers educators an innovative and efficient approach to medical student education in radiology.
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Charalel RA, McGinty G, Brant-Zawadzki M, Goodwin SC, Khilnani NM, Matsumoto AH, Min RJ, Soares GM, Cook PS. Interventional Radiology Delivers High-Value Health Care and Is an Imaging 3.0 Vanguard. J Am Coll Radiol 2015; 12:501-6. [DOI: 10.1016/j.jacr.2014.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/29/2014] [Indexed: 02/01/2023]
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Zimmet SE, Min RJ, Comerota AJ, Meissner MH, Carman TL, Rathbun SW, Jaff MR, Wakefield TW, Feied CF. Core content for training in venous and lymphatic medicine. Phlebology 2014; 29:587-93. [PMID: 25059735 PMCID: PMC4230537 DOI: 10.1177/0268355514545120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content.
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Affiliation(s)
| | - Robert J Min
- The Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | - Mark H Meissner
- The Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa L Carman
- Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Suman W Rathbun
- Vascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael R Jaff
- The Vascular Center, Massachusetts General Hospital, Boston, MA
| | - Thomas W Wakefield
- Department of Surgery, Section of Vascular Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Craig F Feied
- The Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, USA
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Affiliation(s)
- R A Charalel
- From the Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - K D Hentel
- From the Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - R J Min
- From the Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - P C Sanelli
- From the Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
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Arleo EK, Saleh M, Ionescu D, Drotman M, Min RJ, Hentel K. Recall rate of screening ultrasound with automated breast volumetric scanning (ABVS) in women with dense breasts: a first quarter experience. Clin Imaging 2014; 38:439-444. [DOI: 10.1016/j.clinimag.2014.03.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/03/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
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Min RJ, Almeida JI, McLean DJ, Madsen M, Raabe R. Novel vein closure procedure using a proprietary cyanoacrylate adhesive: 30-day swine model results. Phlebology 2012; 27:398-403. [PMID: 22262871 DOI: 10.1258/phleb.2011.011084] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To conduct a pilot study to demonstrate a novel method of using a proprietary cyanoacrylate (CA) for closure of superficial veins. MATERIALS AND METHODS Right and left superficial epigastric veins from two swine models were utilized due to the vein's similarities with the human great saphenous vein. Under ultrasound guidance, access was gained and a 5-F delivery catheter was advanced to the junction of the superficial epigastric and abdominus rectus veins. A dispenser gun was then utilized to inject 0.16 mL of CA while compression was applied cephalad to the end of the catheter. Immediately after delivery, the catheter was pulled back 3 cm and manual compression was employed for 30 seconds. After this first injection, the ultrasound probe was repositioned caudad to the injection and cephalad to the catheter tip and another 0.16 mL injection was delivered with immediate 3 cm pullback of the delivery system. Manual compression was applied at the caudad end of the treated vein for 30 seconds. This process was repeated until the entire target segment was treated. RESULTS At 30 days postimplantation, the treated veins were occluded with no evidence of recanalization or migration. Histological findings revealed that the lumen was dilated by coalescing, arborizing clear spaces with entrapped lytic erythrocytes, demarcated by a thin band of granular eosinophilic material. Spindle cells with dense eosinophilic matrix replaced the tunica intima and disrupted the tunica media. CONCLUSION Results of this initial study demonstrated that intravascular injection of CA is feasible for closure of superficial veins in animal models. These findings warrant further animal studies of this proprietary CA to assess efficacy, safety and its effects on perivenous structures.
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Affiliation(s)
- Robert J Min
- Department of Radiology, Weill Cornell Medical College, 525 East 68th Street, Starr 8a-37 New York, NY 10065, USA.
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Almeida JI, Min RJ, Raabe R, McLean DJ, Madsen M. Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results. Vasc Endovascular Surg 2011; 45:631-5. [PMID: 21757495 DOI: 10.1177/1538574411413938] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The introduction of cyanoacrylate (CA) within a blood vessel triggers polymerization, followed by an inflammatory reaction. METHODS A sheath was positioned 2.0 cm caudad to the junction of the superficial epigastric and abdominus rectus veins in 2 swine, followed by ultrasound-guided injection of 0.16 mL of CA glue. After glue delivery, the catheter was pulled back 3 cm, compression was applied to the treatment site, and the process was repeated for the entire length. At 60 days postimplantation, the veins were harvested surgically and examined histologically. RESULTS The histologic changes were consistent with a chronic foreign-body-type inflammatory response. Venous closure, segmental wall thickening, and fibrosis were observed. CONCLUSION Injection of CA is feasible for closure of superficial veins in animal models. Vein closure is achieved via an inflammatory process which ultimately leads to fibrosis.
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Affiliation(s)
- Jose I Almeida
- Miami Vein Center, 1501 South Miami Avenue, Miami, FL 33129, USA.
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Abstract
Duplex ultrasonography (DUS) is an essential part of the evaluation of patients with most forms of superficial venous insufficiency. DUS has also become an important tool in directing and assessing the results of a variety of minimally invasive treatments of this disease. In this article, we review the salient aspects of performing an adequate DUS evaluation and the utility of this technique in guiding treatment.
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Affiliation(s)
- Neil M Khilnani
- Cornell Vascular, Weill Medical College of Cornell University, New York, New York
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Khilnani NM, Grassi CJ, Kundu S, D'Agostino HR, Khan AA, McGraw JK, Miller DL, Millward SF, Osnis RB, Postoak D, Saiter CK, Schwartzberg MS, Swan TL, Vedantham S, Wiechmann BN, Crocetti L, Cardella JF, Min RJ. Multi-society Consensus Quality Improvement Guidelines for the Treatment of Lower-extremity Superficial Venous Insufficiency with Endovenous Thermal Ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:14-31. [DOI: 10.1016/j.jvir.2009.01.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 10/20/2022] Open
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Andrews RT, Spies JB, Sacks D, Worthington-Kirsch RL, Niedzwiecki GA, Marx MV, Hovsepian DM, Miller DL, Siskin GP, Raabe RD, Goodwin SC, Min RJ, Bonn J, Cardella JF, Patel NH. Patient Care and Uterine Artery Embolization for Leiomyomata. J Vasc Interv Radiol 2009; 20:S307-11. [DOI: 10.1016/j.jvir.2009.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Vedantham S, Grassi CJ, Ferral H, Patel NH, Thorpe PE, Antonacci VP, Janne d'Othée BM, Hofmann LV, Cardella JF, Kundu S, Lewis CA, Schwartzberg MS, Min RJ, Sacks D. Reporting Standards for Endovascular Treatment of Lower Extremity Deep Vein Thrombosis. J Vasc Interv Radiol 2009; 20:S391-408. [DOI: 10.1016/j.jvir.2009.04.034] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 11/12/2005] [Indexed: 11/25/2022] Open
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Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, Hofmann LV, Janne d'Othée BM, Antonaci VP, Brountzos EN, Brown DB, Martin LG, Matsumoto AH, Meranze SG, Miller DL, Millward SF, Min RJ, Neithamer CD, Rajan DK, Rholl KS, Schwartzberg MS, Swan TL, Towbin RB, Wiechmann BN, Sacks D. Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. J Vasc Interv Radiol 2009; 20:S227-39. [DOI: 10.1016/j.jvir.2009.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Accepted: 11/12/2005] [Indexed: 10/20/2022] Open
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Gao J, Li JC, Xiao MS, Ng A, Trost D, Goldstein M, Kapur S, Wang J, Serur D, Dai Q, Jiang YX, Min RJ. Color duplex sonography in severe transplant renal artery stenosis: a comparison of end-to-end and end-to-side arterial anastomoses. Clin Imaging 2009; 33:116-22. [PMID: 19237054 DOI: 10.1016/j.clinimag.2008.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 08/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate differences in Doppler parameters between severe transplant renal artery stenosis (TRAS, arterial lumen reduction >80%) with end-to-end (EE) arterial anastomosis and that with end-to-side (ES) arterial anastomosis. METHODS We retrospectively reviewed color duplex sonography (CDUS) and digital subtraction angiography (DSA) images in 38 patients with severe TRAS (19 cases with EE and 19 cases with ES) between January 1, 2000, and December 31, 2006. Doppler parameters were analyzed, including peak systolic velocity (PSV) in the iliac artery, PSV at the arterial anastomosis, PSV in the transplant renal artery, PSV ratio of the stenotic artery/artery proximal to the stenosis, and acceleration time (AT) in the artery distal to the stenosis (in the intrarenal artery). All 38 cases with severe TRAS were initially diagnosed with CDUS and confirmed by DSA. RESULTS There were significant differences in PSV in the stenotic artery (P<.01), PSV in the iliac artery (P<.001), and PSV ratios of stenotic artery/artery proximal to the stenosis (P<.001) between arterial anastomosis of EE and that of ES. There was no statistically significant difference in AT in the intrarenal artery between the two types of anastomosis (P>.05). CONCLUSION Significantly different PSVs in the stenotic artery, the iliac artery, and the PSV ratio between EE and ES arterial anastomoses should be considered in the interpretation of CDUS when screening for severe TRAS. Different criteria of CDUS need to be established depending on the type of arterial anastomosis in order to improve the accuracy in diagnosing severe TRAS.
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Affiliation(s)
- Jing Gao
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA.
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Gao J, Ng A, Shih G, Goldstein M, Kapur S, Wang J, Min RJ. Intrarenal color duplex ultrasonography: a window to vascular complications of renal transplants. J Ultrasound Med 2007; 26:1403-18. [PMID: 17901143 DOI: 10.7863/jum.2007.26.10.1403] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE We analyze and discuss the importance of intrarenal color duplex ultrasonography (CDUS) in the diagnosis and differential diagnosis of vascular complications in renal transplants. METHODS We retrospectively reviewed results of CDUS, especially intrarenal CDUS, in 102 consecutive inpatients with vascular complications of renal transplants from January 1, 2000, to December 31, 2006. Correlations between CDUS and magnetic resonance angiography, digital subtraction angiography, surgical findings, and clinical diagnoses were studied. RESULTS Abnormal findings on intrarenal CDUS clearly represent vascular complications primarily located at the main renal vessels and intrarenal vessels. In our study, there were 5 cases of false-negative intrarenal arteriovenous fistulas, 1 case of false-positive transplant renal vein thrombosis, and 2 cases of false-negative transplant renal artery stenosis. The accuracy of detecting vascular complications of renal transplants with CDUS was 92% (94/102). CONCLUSIONS Intrarenal CDUS is a noninvasive, accurate diagnostic tool that can be administrated portably and is easily repeatable, thereby making it not only a highly valuable imaging technique but also the method of choice in screening and diagnosing vascular complications of renal transplants.
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Affiliation(s)
- Jing Gao
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, Starr 8A 27, New York, NY 10021, USA.
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Kundu S, Lurie F, Millward SF, Padberg F, Vedantham S, Elias S, Khilnani NM, Marston W, Cardella JF, Meissner MH, Dalsing MC, Clark TWI, Min RJ. Recommended Reporting Standards for Endovenous Ablation for the Treatment of Venous Insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Interv Radiol 2007; 18:1073-80. [PMID: 17804767 DOI: 10.1016/j.jvir.2007.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Sanjoy Kundu
- The Vein Institute of Toronto, Toronto, Ontario, Canada
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Kundu S, Lurie F, Millward SF, Padberg F, Vedantham S, Elias S, Khilnani NM, Marston W, Cardella JF, Meissner MH, Dalsing MC, Clark TWI, Min RJ. Recommended reporting standards for endovenous ablation for the treatment of venous insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Surg 2007; 46:582-9. [PMID: 17826252 DOI: 10.1016/j.jvs.2007.05.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 05/14/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Sanjoy Kundu
- The Vein Institute of Toronto, Toronto, Ontario, Canada
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Timperman PE, Khilnani NM, Min RJ, Sichlau M, Ryu RK. Re: Endovenous Laser Ablation of the Great Saphenous Vein with a 980-nm Diode Laser in Continuous Mode: Early Treatment Failures and Successful Repeat Treatments. J Vasc Interv Radiol 2007; 18:811; author reply 812-3. [PMID: 17538149 DOI: 10.1016/j.jvir.2006.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Arleo EK, Khilnani NM, Ng A, Min RJ. Features Influencing Patient Selection for Fibroid Treatment with Magnetic Resonance–guided Focused Ultrasound. J Vasc Interv Radiol 2007; 18:681-5. [PMID: 17494853 DOI: 10.1016/j.jvir.2007.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Of 333 women inquiring about minimally invasive image-guided treatments for fibroids, 209 (63%) were clinically eligible for magnetic resonance-guided focused ultrasound (MRgFUS) according to criteria specified by the Food and Drug Administration and our institution's institutional review board. One hundred three clinically eligible patients had pelvic MR imaging, and 26 (25%) were anatomically eligible for MRgFUS. A substantial proportion were anatomically ineligible for more than one reason, including too much fibroid volume (19%), presence of bowel in the ultrasound beam path (13%), and significant adenomyosis (12%). Overall, 14% of women inquiring about minimally invasive image-guided treatments for fibroids were eligible for MRgFUS, a percentage that increased when additional institutional review board restrictions were lifted.
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Affiliation(s)
- Elizabeth Kagan Arleo
- New York Presbyterian Hospital-Weill Medical College of Cornell University, 525 East 79th Street, New York, NY 10021, USA.
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Vedantham S, Grassi CJ, Ferral H, Patel NH, Thorpe PE, Antonacci VP, Janne d'Othée BM, Hofmann LV, Cardella JF, Kundu S, Lewis CA, Schwartzberg MS, Min RJ, Sacks D. Reporting Standards for Endovascular Treatment of Lower Extremity Deep Vein Thrombosis. J Vasc Interv Radiol 2006; 17:417-34. [PMID: 16567667 DOI: 10.1097/01.rvi.0000197359.26571.c2] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Suresh Vedantham
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
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Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, Hofmann LV, Janne d'Othée BM, Antonaci VP, Brountzos EN, Brown DB, Martin LG, Matsumoto AH, Meranze SG, Miller DL, Millward SF, Min RJ, Neithamer CD, Rajan DK, Rholl KS, Schwartzberg MS, Swan TL, Towbin RB, Wiechmann BN, Sacks D. Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. J Vasc Interv Radiol 2006; 17:435-47; quiz 448. [PMID: 16567668 DOI: 10.1097/01.rvi.0000197348.57762.15] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Suresh Vedantham
- Department of Radiology, Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
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Vedantham S, Rundback JH, Comerota AJ, Hunter DW, Meissner MH, Hofmann LV, Horne M, Gloviczki P, Andrews RT, Fan CM, Hume KM, Goldhaber SK, Tapson VF, Razavi MK, Min RJ. Development of a Research Agenda for Endovascular Treatment of Venous Thromboembolism: Proceedings from a Multidisciplinary Consensus Panel. J Vasc Interv Radiol 2005; 16:1567-73. [PMID: 16371519 DOI: 10.1097/01.rvi.0000183868.45154.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University of School of Medicine, St. Louis, Missouri 63110, USA.
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Vedantham S, Rundback JH, Khilnani NM, Gloviczki P, Andrews RT, Sadick NS, Fan CM, Meissner MH, Comerota AJ, Hume KM, Chrisman HB, Pavcnik D, Kaufman JA, Min RJ. Development of a Research Agenda for Endovenous Treatment of Lower-extremity Venous Reflux: Proceedings from a Multidisciplinary Consensus Panel. J Vasc Interv Radiol 2005; 16:1575-9. [PMID: 16371520 DOI: 10.1097/01.rvi.0000183869.53626.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Min RJ, Khilnani NM. Endovenous laser ablation of varicose veins. J Cardiovasc Surg (Torino) 2005; 46:395-405. [PMID: 16160686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
UNLABELLED Readily available non-invasive diagnostic tests now allow physicians to accurately map out abnormal venous pathways and identify all sources of reflux. Minimally invasive alternatives to surgical removal of incompetent truncal veins have been developed with impressive RESULTS Endovenous laser treatment can be performed in the office under local anesthesia and is associated with virtually no recovery period. Better understanding of the primary mechanism of energy transfer by direct contact between the laser fiber tip and vein wall has underscored the importance of vein emptying. Improved utilization of tumescent anesthesia has helped facilitate circumferential laser fiber to vein wall contact and virtually eliminated the incidence of heat-related complications. Further refinements in the technique and optimization of laser energy parameters have improved success rates of vein closure from 90% to nearly 100%. Compared to surgery, endovenous laser has also demonstrated lower rates of recurrence largely due to the absence of neovascularity. This review of endovenous laser treatment should validate this exciting technique as a scientifically acceptable option for eliminating truncal vein reflux. If measured by patient acceptance and satisfaction, endovenous laser and other minimally invasive methods have already supplanted traditional surgery as the treatment of choice for superficial venous insufficiency.
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Affiliation(s)
- R J Min
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA.
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Min RJ. Common Clinical Patterns and Duplex Evaluation of Venous Insufficiency. J Vasc Interv Radiol 2005. [DOI: 10.1016/s1051-0443(05)70128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Min RJ. Endovenous Laser Ablation: Outcomes. J Vasc Interv Radiol 2005. [DOI: 10.1016/s1051-0443(05)70205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Min RJ. Venous Ablation (CC). J Vasc Interv Radiol 2005. [DOI: 10.1016/s1051-0443(05)70122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Physicians unfamiliar with venous insufficiency, particularly disorders of the superficial venous system, often underestimate the complexity of the problem and the importance of proper evaluation before initiating treatment. In addition to a directed history evaluation and physical examination, additional evaluation with use of a variety of noninvasive diagnostic instruments, including duplex ultrasound, may be necessary when determining the cause, severity, and best treatment options available for a particular patient. After such evaluation, the treating physician should have a precise map of the patient's pathways of venous insufficiency, including sources of reflux (eg, saphenofemoral junction, saphenopopliteal junction, perforators), tributaries, vein size, and vein morphology.
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Affiliation(s)
- Robert J Min
- Cornell Vascular, Weill Medical College of Cornell University, 416 East 55th Street, New York, New York 10022, USA.
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Min RJ. Where to Set Up Your Center and Who Staffs It. J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Andrews RT, Spies JB, Sacks D, Worthington-Kirsch RL, Niedzwiecki GA, Marx MV, Hovsepian DM, Miller DL, Siskin GP, Raabe RD, Goodwin SC, Min RJ, Bonn J, Cardella JF, Patel NH. Patient Care and Uterine Artery Embolization for Leiomyomata. J Vasc Interv Radiol 2004; 15:115-20. [PMID: 14963177 DOI: 10.1097/01.rvi.0000109408.52762.35] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- R Torrance Andrews
- Department of Vascular and Interventional Radiology, University of Washington Medical Center, Seattle, USA
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Altman SD, Arnold WP, Blackburn BA, Julien WH, Krol KL, Mietling SW, Min RJ, Smith S. My Experience/My Center. J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Readily available noninvasive diagnostic tests now allow physicians to accurately map out abnormal venous pathways and identify sources of reflux. In recent years, minimally invasive alternatives to surgical treatment of saphenous vein reflux, the main contributor to most cases of symptomatic varicose veins, have been developed with promising results.(1-8) The latest percutaneous technique developed to treat incompetent saphenous veins is endovenous laser, which allows delivery of laser energy directly into the vein lumen to cause collagen contraction and denudation of endothelium. This stimulates vein-wall thickening with eventual fibrosis of the vein. These modern percutaneous techniques now provide patients with alternatives to ligation and stripping for treatment of significant sources of venous reflux without many of the potential complications associated with surgery.
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Affiliation(s)
- Robert J Min
- Weill Cornell Vascular, Weill Medical College of Cornell University, New York, NY 10022, USA
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