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Pimenta A, Azevedo L, Ramos I, Santos J. Establishment of Diagnostic Reference Levels in Portuguese Interventional Radiology departments. Eur J Radiol 2024; 173:111377. [PMID: 38382425 DOI: 10.1016/j.ejrad.2024.111377] [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: 10/12/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To establish Portuguese Diagnostic Reference Levels (DRLs), for six body fluoroscopy guided interventional procedures (FGIP). METHOD A retrospective study was conducted in five interventional departments most representative of Interventional Radiology (IR) practice. Dose values, in terms of air kerma area product (PKA in Gy.cm2), air kerma at the patient entrance reference point (Ka,r in mGy), and exposure parameters (fluoroscopy time (FT) and number of cine runs) were collected. Examinations were selected per procedure (at least 20), according to the antero-posterior and lateral diameter mean value (±5 cm), measured on previous Computed Tomography (CT) examinations. RESULTS Data of 489 body FGIP show a large variation on dose values per procedure and per department. National DRLs in terms of PKA were 20.2 Gy.cm2 for Percutaneous transhepatic biliary drainage (PTBD), 98.2 Gy.cm2 for Bronchial artery embolisation (BAE), 247.7 Gy.cm2 for Transarterial chemoembolisation (TACE), 331.6 Gy.cm2 for Inferior epigastric arteries embolisation (IEAE), 312.0 Gy.cm2 for Transjugular intrahepatic portosystemic shunt (TIPS) and 19.3 Gy.cm2 for Endovascular treatment of femoral popliteal arteries (ETFPA). CONCLUSIONS This is the first study reporting Interventional Radiology DRLs in Portugal and we propose preliminary national estimates for the six more common body FGIP. The results of this study will be presented and discussed with all Portuguese IR departments, to promote procedures optimisation.
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Affiliation(s)
- Andrea Pimenta
- University Hospital of St. John (CHUSJ), Radiology Department - Porto, Portugal.
| | - Luís Azevedo
- CINTESIS@RISE Department of Community, Information and Health Decision Sciences- MEDCIDS, Faculty of Medicine University of Porto, Porto, Portugal.
| | | | - Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Portugal.
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Haldeman PB, Ghani MA, Rubio P, Pineda M, Califano J, Sacco AG, Minocha J, Berman ZT. Interdisciplinary Approach to Expedited Outpatient Gastrostomy Tube Placement in Head and Neck Cancer Patients: A Single Center Retrospective Study. Acad Radiol 2024:S1076-6332(24)00149-1. [PMID: 38521613 DOI: 10.1016/j.acra.2024.03.008] [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: 01/09/2024] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
RATIONALE AND OBJECTIVE Treatment for head and neck cancer (HNC) can lead to decreased oral intake which often requires gastrostomy tube (g-tube) placement to provide nutritional support. A multidisciplinary team (MDT) consisting of interventional radiology (IR), HNC oncology and surgery, nutrition, and speech language pathology departments implemented an expedited outpatient g-tube placement pathway to reduce hospital stays and associated costs, initiate feeds sooner, and improve communication between care teams. This single center study investigates differences in complications, time to procedure and costs savings with implementing this pathway. METHODS 142 patients with HNC who underwent elective image guided g-tube placement by IR from 2015 to 2022 were identified retrospectively. 52 patients underwent the traditional pathway, and 90 patients underwent the expedited pathway. Patient demographics, procedure characteristics, periprocedural costs and 90-day complication rates were collected and compared statistically. RESULTS The 90-day complication rate was comparable between groups (traditional=32.7%; expedited=22.2%; p-value=0.17). The expedited pathway decreased the time from consult to procedure by 11.1 days (95% CI 7.6 - 14.6; p < 0.001) and decreased charge per procedure by $2940 (95% CI $989-$4891; p < 0.001). CONCLUSION A MDT for the treatment of patients with HNC successfully provided enteral nutrition support faster, with fewer associated costs, and in a more patient centered approach than previously done at this institution.
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Affiliation(s)
- Pearce B Haldeman
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA
| | - Mansur A Ghani
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA
| | - Patricia Rubio
- Moores Cancer Center, UC San Diego, La Jolla, California, USA
| | - Minette Pineda
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA
| | - Joseph Califano
- Moores Cancer Center, UC San Diego, La Jolla, California, USA; Department of Otolaryngology, UC San Diego, La Jolla, California, USA
| | | | - Jeet Minocha
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA; Moores Cancer Center, UC San Diego, La Jolla, California, USA
| | - Zachary T Berman
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA; Moores Cancer Center, UC San Diego, La Jolla, California, USA.
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Geevarghese R, Bodard S, Razakamanantsoa L, Marcelin C, Petre EN, Dohan A, Kastler A, Frandon J, Barral M, Soyer P, Cornelis FH. Interventional Oncology: 2024 Update. Can Assoc Radiol J 2024:8465371241236152. [PMID: 38444144 DOI: 10.1177/08465371241236152] [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] [Indexed: 03/07/2024] Open
Abstract
Interventional Oncology (IO) stands at the forefront of transformative cancer care, leveraging advanced imaging technologies and innovative interventions. This narrative review explores recent developments within IO, highlighting its potential impact facilitated by artificial intelligence (AI), personalized medicine and imaging innovations. The integration of AI in IO holds promise for accelerating tumour detection and characterization, guiding treatment strategies and refining predictive models. Imaging modalities, including functional MRI, PET and cone beam CT are reshaping imaging and precision. Navigation, fusion imaging, augmented reality and robotics have the potential to revolutionize procedural guidance and offer unparalleled accuracy. New developments are observed in embolization and ablative therapies. The pivotal role of genomics in treatment planning, targeted therapies and biomarkers for treatment response prediction underscore the personalization of IO. Quality of life assessment, minimizing side effects and long-term survivorship care emphasize patient-centred outcomes after IO treatment. The evolving landscape of IO training programs, simulation technologies and workforce competence ensures the field's adaptability. Despite barriers to adoption, synergy between interventional radiologists' proficiency and technological advancements hold promise in cancer care.
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Affiliation(s)
- Ruben Geevarghese
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Clement Marcelin
- Department of Radiology, Bordeaux University, Hopital Pellegrin, Bordeaux, France
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Adrian Kastler
- Department of Radiology, Grenoble University Hospital, Grenoble, France
| | - Julien Frandon
- Department of Radiology, Nimes University Hospital, Nimes, France
| | - Matthias Barral
- Department of Radiology, Sorbonne University, Hopital Tenon, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Sorbonne University, Hopital Tenon, Paris, France
- Weill Cornell Medical College, New York, NY, USA
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Torres TP, Costa P, Moreira H, Dionísio T, Sousa P. Treatment Of Post-Operative Chylothorax: The Role Of Intranodal Lymphangiography And Thoracic Duct Disruption. Port J Card Thorac Vasc Surg 2024; 30:67-70. [PMID: 38345884 DOI: 10.48729/pjctvs.343] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/23/2023] [Indexed: 02/15/2024]
Abstract
Thoracic duct embolization has been increasingly adopted as a first-line therapy of chylothorax and this procedure includes lipiodol lymphangiography, thoracic duct access and embolization. Lymphangiography itself has a therapeutic role, with volume-dependent success rates of 37%-97% and even a reported 100% success rate in outputs of < 500 mL/day. We present a clinical case of a 48-years-old man diagnosed with esophageal squamous cell carcinoma, who underwent esophagectomy and presented with post-operative high-output (> 1L/day) chylothorax; thoracic duct embolization was proposed. Even though thoracic duct access and embolization were not achieved due to technical and anatomical factors, lipiodol lymphangiography and possibly thoracic duct maceration (after several punctures/attempts) contributed to the clinical success of the procedure, and this chylothorax with output values superior to those reported in the literature resolved within three days. As such, the therapeutic role of intranodal lymphangiography and thoracic duct disruption should be taken into account.
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Affiliation(s)
- Tiago Paulino Torres
- Radiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Pedro Costa
- General Surgery Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Herculano Moreira
- General Surgery Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Teresa Dionísio
- Radiology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
| | - Pedro Sousa
- Radiology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
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Quealy JB. Mechanical Thrombectomy for Aseptic, Atraumatic, Medically Refractory Cerebral Venous Sinus Thrombosis: a Systematic Review. Clin Neuroradiol 2024:10.1007/s00062-023-01373-0. [PMID: 38329489 DOI: 10.1007/s00062-023-01373-0] [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: 10/02/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) follows a severe clinical course in 13.5% of cases. Practice guidelines recommend endovascular therapy (EVT); no randomised control trials (RCTs) exist comparing EVTs. PURPOSE To determine whether specific EVTs are superior to alternatives. DATA SOURCES CENTRAL, Medline, Embase, five other databases and four clinical trials registers. Grey literature searches, reference checking, citation searching, and author contact. STUDY SELECTION All CVST cases treated with mechanical thrombectomy (MT) were includible. Paediatric, and trauma-related or infection-related thromboses were excluded. DATA ANALYSIS Standard Cochrane review procedures. Primary outcome measures; clinical efficacy (modified Rankin Score, mRS), technical efficacy (recanalisation), and clinical safety (procedure-related complications and death). Subgroup analyses were performed, comparing outcome measures between demographic groups, clinico-radiological severity, interventional strategies, and degrees of recanalisation. DATA SYNTHESIS In this study 124 papers were included (n = 486). All patients underwent MT, with 69.5% of patients receiving concomitant chemolysis. New/expanding intracerebral haemorrhage (ICH) occurred in 5.1%; non-haemorrhagic complications in 1.4%; 10.7% died. Predictors of poor efficacy included age ≥ 55 years, altered mental status (AMS), Glasgow Coma Scale (GCS) < 8. Predictive of poor safety outcomes included pre-existing ICH, deep system thrombosis, and AMS. Complete recanalisation was associated with improved clinical efficacy and safety outcomes. LIMITATIONS The review is based on case reports/series, increasing bias-risk. Myriad of potentially includible studies were necessarily excluded due to lack of requisite details. CONCLUSION Predictors of poor outcomes with medical therapy predict poor outcomes with MT; these measures should not dictate candidacy. Complete recanalisation predicts favorable clinical and safety outcomes. Local chemolysis is safe, improves recanalisation, and should be recommended, provided there is no contraindication. Clot maceration strategies and stent-retriever thrombectomy are associated with superior clinical efficacy and safety endpoints, as compared with balloon angioplasty and rheolysis.
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Affiliation(s)
- John B Quealy
- Department of Internal Medicine, UPMC Aut Even Hospital, Freshford Road, R95D370, Kilkenny, Ireland.
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Parikh R, Khatri S. Bridging the Divide: Strengthening Medical Education on Interventional Radiology. Can Assoc Radiol J 2024; 75:200. [PMID: 37470520 DOI: 10.1177/08465371231191450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Affiliation(s)
- Rooshi Parikh
- CUNY School of Medicine at the City College of New York, New York, NY, USA
| | - Shivam Khatri
- CUNY School of Medicine at the City College of New York, New York, NY, USA
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Janardhana A, Daryanto B, Kustono A, Aslam ABN. Successful Management of Recurrent High-Flow Priapism Treated with Selective Arterial Embolization: A Case Report. J Radiol Case Rep 2023; 17:18-26. [PMID: 38638553 PMCID: PMC11022753 DOI: 10.3941/jrcr.v17i11.5230] [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] [Indexed: 04/20/2024] Open
Abstract
Introduction High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow priapism, i.e., conservative management, the use of ice packs, mechanical decompression, surgery, and super-selective arterial embolization. Embolization is currently widely accepted in patients who fail from conservative management. This study aimed to report the use of Gelfoam and microcoil embolization in recurrent high-flow priapism compared to PVA embolization. Case Study A 36-year-old man complained of prolonged erection. The erection occurred three days before admission while waking up in the morning, not accompanied by either sexual stimulation or pain. There was a history of fall four days ago in the afternoon, with the patient's groin hitting a rocky ground. Physical examination revealed an erect penis, which felt warm, with an EHS of 4. Blood gas analysis of the corpus cavernosum showed bright red blood with a pH of 7.47, pCO2 of 23.6, pO2 of 145, HCO3 of 17.3, BE of -6, and SaO2 of 99%. Doppler ultrasound examination of the penis showed high-flow priapism. Embolization with PVA was performed, and there were decreased complaints. A few hours later, the erection occurred. Reevaluation was then performed and continued with embolization using Gelfoam and microcoil. There were immediate successful results (EHS of 3) accompanied by a decrease in symptoms. Long-term follow-up has shown a return to normal erectile function six months following the injury. Conclusion Priapism may happen due to various etiologies. Differentiating high-flow and low-flow is paramount during the acute phase because of different treatment strategies. Conservative management may be applied to high-flow priapism. If conservative management fails, embolization may be attempted. The choice of embolization agent must be taken into account.
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Affiliation(s)
- Alfryan Janardhana
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Indonesia
| | - Besut Daryanto
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Indonesia
| | - Andri Kustono
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Indonesia
| | - A. Bayhaqi Nasir Aslam
- Department of Radiology, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Indonesia
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Motaghed Z, Chegeni H, Mosadeghkhah A, Azimi Aval M, Gerami R, Ebrahiminik H. Effect of ultrasound parameters of benign thyroid nodules on radiofrequency ablation efficacy. BMC Med Imaging 2023; 23:85. [PMID: 37337132 DOI: 10.1186/s12880-023-01044-z] [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: 12/29/2022] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND AND AIM Ultrasound-guided radiofrequency ablation (RFA) is a minimally invasive therapy for thyroid nodules (TNs). Understanding the determinants of RFA efficacy can improve treatment and prognosis. This study aims to investigate the relationship between ultrasound parameters of benign TNs and the efficacy of RFA. METHODS A pretest-posttest interventional study was conducted in 2021 on 250 randomly sampled patients with benign TNs, receiving RFA. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. The technical success rate (TSR) of this procedure was then categorized into four states, including low (VRR < 25%), moderate (VRR = 25-49%), high (VRR = 50-74%), and very high (VRR ≥ 75). Ordered logistic regression (OLR) was further utilized to investigate the effect of the ultrasound parameters of TNs on the TSR. The analyses were notably performed using Stata 14.2. RESULTS The VRR at the 1-, 3-, 6-, and 12-month follow-up periods were 38.7%, 53.6%, 59.3%, and 59.9%, respectively. The mean VR was also statistically significant at all follow-ups (p < 0.001). At the 1-, 3-, and 6-month follow-up periods, the VR of over 50% was observed in 28.2%, 52.1%, and 65.2% of the nodules, respectively. The odds ratios (ORs) of the RFA success were found to be 4.3 times higher for the nodules in the left lobe compared to the right lobe (OR: 4.31, p = 0.002), 6.3 times greater for isoechoic nodules compared to hyperechoic nodules (OR: 6.39, p < 0.001), 6.2 times higher for hyper-vascular nodules compared to hypo-vascular nodules (OR: 6.25, p = 0.005), and 2.3 times greater for mixed nodules compared to solid ones (OR: 2.37, p = 0.049). CONCLUSION The ultrasound parameters of TNs had a statistically significant effect on the efficacy of RFA. Small-sized, isoechoic, and hyper-vascular nodules, as well as those with mixed tissue, were observed to respond better to RFA, leading to a better prognosis in terms of VR after treatment.
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Affiliation(s)
- Zahra Motaghed
- Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | | | - Ali Mosadeghkhah
- Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azimi Aval
- Department of Interventional Radiology and Radiation Sciences Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Gerami
- Department of Radiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation Sciences Research Center, AJA University of Medical Sciences, Tehran, Iran.
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Jegaden M, Bleas C, Debras E, Couet D, Pourcelot AG, Capmas P, Fernandez H. Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes. J Minim Invasive Gynecol 2023; 30:494-501. [PMID: 36813132 DOI: 10.1016/j.jmig.2023.02.012] [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: 01/22/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
STUDY OBJECTIVE To study the severity of intrauterine adhesions (IUA) after uterine arterial embolization and to evaluate fertility, pregnancy, and obstetrical outcomes after hysteroscopic treatment. DESIGN Retrospective cohort. SETTING French University Hospital. PATIENTS Thirty-three patients under the age of 40 years who were treated by uterine artery embolization with nonabsorbable microparticles between 2010 and 2020 for symptomatic fibroids or adenomyosis, or postpartum hemorrhage. INTERVENTIONS All patients had a diagnosis of IUA after embolization. All patients desired future fertility. IUA was treated with operative hysteroscopy. MEASUREMENTS AND MAIN RESULTS Severity of IUA, number of operative hysteroscopies performed to obtain a normal cavity shape, pregnancy rate, and obstetrical outcomes. Of our 33 patients, 81.8% had severe IUA (state IV et V according to the European Society of Gynecological Endoscopy or state III according to the American fertility society classification). To restore fertility potential, an average of 3.4 operative hysteroscopies had to be performed [CI 95% (2.56-4.16)]. We reported a very low rate of pregnancy (8/33, 24%). Obstetrical outcomes reported are 50% of premature birth and 62.5% of delivery hemorrhage partly due to 37.5% of placenta accreta. We also reported 2 neonatal deaths. CONCLUSION IUA after uterine embolization is severe, and more difficult to treat than other synechiae, probably related to endometrial necrosis. Pregnancy and obstetrical outcomes have shown a low pregnancy rate, an increased risk of preterm delivery, a high risk of placental disorders, and very severe postpartum hemorrhage. Those results have to alert gynecologists and radiologists to the use of uterine arterial embolization in women who desire future fertility.
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Affiliation(s)
- Margaux Jegaden
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France.
| | - Cécile Bleas
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Elodie Debras
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France
| | - Déborah Couet
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Anne-Gaëlle Pourcelot
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP (Drs. Capmas, Fernandez), Villejuif, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP (Drs. Capmas, Fernandez), Villejuif, France
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Indovina L, Moretti R, Breschi L, Cusumano D, Meffe G, Placidi L, Nardini M, Reale R, Quici A, Placidi E, Stimato G, Capotosti A. Use of secondary air kerma from dose area product and fluoroscopy time for preventive effective dose estimation to interventional radiology procedures staff. J Radiol Prot 2023. [PMID: 37224797 DOI: 10.1088/1361-6498/acd858] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Interventional radiology workers are potentially exposed to high levels of ionizing radiations, therefore preventive dose estimation is mandatory for a correct risk classification of staff. Effective Dose (ED) is a radiation protection quantity strictly related to the secondary air kerma (KS), by using appropriate multiplicative conversion factors (ICRP 106). The aim of this work was to evaluate the accuracy of KSestimated from a physical measurable quantity such as Dose-Area Product (DAP) or Fluoroscopy Time (FT). METHODS Radiological units (n=4) were characterized in terms of primary beam air kerma and DAP-meter response consequently defining a DAP-meter Correction Factor (CF) for each unit. Then KS, scattered from an anthropomorphic phantom and measured by a digital multimeter, was compared with the one estimated from DAP and FT. Different combinations of tube voltages, field sizes, current and scatter angles were used to simulate the variation of working conditions. Further measures were performed to estimate the couch transmission factor for different phantom placements on operational couch defining a CF as the mean transmission factor. RESULTS When no CFs were applied, measured KSshowed a median percentage difference between 33.8% and 115.7% with respect to KSevaluated from DAP, while between -46.3% and 101.8% for KSevaluated from FT. Instead when previously defined CFs were applied on evaluated KS, the median percentage difference between measured KSand the one evaluated from DAP ranged between -7.94 % and 15.0%, while between -66.2% and 17.2% for that evaluated from FT. CONCLUSION When appropriate CF are applied, the preventive ED estimation from median DAP value seems to be more conservative and easier to obtain with respect to the one from FT value. Further measures should be performed with personal dosimeter in routine activities to assess the proper KSto ED conversion factor.
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Affiliation(s)
- Luca Indovina
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Roberto Moretti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Laura Breschi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Davide Cusumano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Guenda Meffe
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Matteo Nardini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Roberta Reale
- Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Lazio, ITALY
| | - Arturo Quici
- Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Lazio, ITALY
| | - Elisa Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Gerardina Stimato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
| | - Amedeo Capotosti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, ITALY
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Saraiva RO, Loureiro RV, Glória Coimbra JM. An Uncommon Cause of Recurrent Upper Gastrointestinal Bleeding. Gastroenterology 2023; 164:e8-e9. [PMID: 36155197 DOI: 10.1053/j.gastro.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Rita Ornelas Saraiva
- Gastroenterology Unit, Centro Hospitalar e Universitário Lisboa Central, Lisboa, Portugal.
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12
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Becker LS, Dewald CLA, von Falck C, Werncke T, Maschke SK, Kloeckner R, Wacker FK, Meyer BC, Hinrichs JB. Effectuality study of a 3D motion correction algorithm in C-arm CTs of severely impaired image quality during transarterial chemoembolization. Cancer Imaging 2022; 22:37. [PMID: 35908026 PMCID: PMC9338620 DOI: 10.1186/s40644-022-00473-3] [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: 12/07/2021] [Accepted: 06/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate effectivity of a 3D-motion correction algorithm in C-Arm CTs (CACT) with limited image quality (IQ) during transarterial chemoembolization (TACE). Methods From 1/2015–5/2021, 644 CACTs were performed in patients during TACE. Of these, 27 CACTs in 26 patients (18 m, 8f; 69.7 years ± 10.7 SD) of limited IQ were included. Post-processing of the original raw-data sets (CACTOrg) included application of a 3D-motion correction algorithm and bone segmentation (CACTMC_no_bone). Four radiologists (R1-4) compared the images by choosing their preferred dataset and recommending repeat acquisition in case of severe IQ-impairment. R1,2 performed additional grading of intrahepatic vessel visualization, presence/extent of movement artifacts, and overall IQ. Results R1,2 demonstrated excellent interobserver agreement for overall IQ (ICC 0.79,p < 0.01) and the five-point vessel visualization scale before and after post-processing of the datasets (ICC 0.78,p < 0.01). Post-processing caused significant improvement, with overall IQ improving from 2.63 (CACTOrg) to 1.39 (CACTMC_no_bone;p < 0.01) and a decrease in the mean distance of identifiable, subcapsular vessels to the liver capsule by 4 mm (p < 0.01). This proved especially true for datasets with low parenchymal and high hepatic artery contrast. A good interobserver agreement (ICC = 0.73) was recorded concerning the presence of motion artifacts, with significantly less discernible motion after post-processing (CACTOrg:1.31 ± 1.67, CACTMC_no_bone:1.00 ± 1.34, p < 0.01). Of the 27 datasets, ≥ 23 CACTMC_no_bone were preferred, with identical datasets chosen by the readers to show benefit from the algorithm. Conclusion Application of a 3D-motion correction algorithm significantly improved IQ in diagnostically limited CACTs during TACE, with the potential to decrease repeat acquisitions.
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Affiliation(s)
- Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Cornelia L A Dewald
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE8220 Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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13
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Emelianova D, Prikis M, Morris CS, Gibson PC, Solomon R, Scriver G, Smith ZT, Bhave A, Shields J, DeSarno M, Kumar A. The evolution of performing a kidney biopsy: a single center experience comparing native and transplant kidney biopsies performed by interventional radiologists and nephrologists. BMC Nephrol 2022; 23:226. [PMID: 35752759 PMCID: PMC9233823 DOI: 10.1186/s12882-022-02860-1] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney biopsy is the most vital tool guiding a nephrologist in diagnosis and treatment of kidney disease. Over the last few years, we have seen an increasing number of kidney biopsies being performed by interventional radiologists. The goal of our study was to compare the adequacy and complication rates between kidney biopsies performed by interventional radiology versus nephrology. METHODS : We performed a single center retrospective analysis of a total of all kidney biopsies performed at our Institution between 2015 and 2021. All biopsies were performed using real-time ultrasound. Patients were monitored for four hours post biopsy and repeat ultrasound or hemoglobin checks were done if clinically indicated. The entire cohort was divided into two groups (Interventional radiology (IR) vs nephrology) based on who performed the biopsy. Baseline characteristics, comorbidities, blood counts, blood pressure, adequacy of the biopsy specimen and complication rates were recorded. Multivariable logistic regression was used to compare complication rates (microscopic hematuria, gross hematuria and need for blood transfusion combined) between these two groups, controlling for covariates of interest. ANCOVA (analysis of variance, controlling for covariates) was used to compare differences in biopsy adequacy (number of glomeruli per biopsy procedure) between the groups. RESULTS 446 kidney biopsies were performed in the study period (229 native and 147 transplant kidney biopsies) of which 324 were performed by IR and 122 by nephrologist. There was a significantly greater number of core samples obtained by IR (mean = 3.59, std.dev. = 1.49) compared to nephrology (mean = 2.47, std.dev = 0.79), p < 0.0001. IR used 18-gauge biopsy needles while nephrologist exclusively used 16-gauge needles. IR used moderate sedation (95.99%) or general anesthesia (1.85%) for the procedures more often than nephrology, which used them only in 0.82% and 0.82% of cases respectively (p < 0.0001). Trainees (residents or fellows) participated in the biopsy procedures more often in nephrology compared to IR (97.4% versus 69.04%, p < 0.0001). The most frequent complication identified was microscopic hematuria which occurred in 6.8% of biopsies. For native biopsies only, there was no significant difference in likelihood of complication between groups, after adjustment for covariates of interest (OR = 1.01, C.I. = (0.42, 2.41), p = 0.99). For native biopsies only, there was no significant difference in mean number of glomeruli obtained per biopsy procedure between groups, after adjustment for covariates of interest (F(1,251) = 0.40, p = 0.53). CONCLUSION Our results suggest that there is no significant difference in the adequacy or complication rates between kidney biopsies performed by IR or nephrology. This conclusion may indicate that kidney biopsies can be performed safely with adequate results either by IR or nephrologists depending on each institution's resources and expertise.
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Affiliation(s)
- Daria Emelianova
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA.
| | - Marios Prikis
- Division of Nephrology and Transplantation, Department of Medicine, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Christopher S Morris
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Pamela C Gibson
- Department of Pathology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Richard Solomon
- Department of Medicine, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Geoffrey Scriver
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Zachary T Smith
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Anant Bhave
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Joseph Shields
- Department of Radiology, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Michael DeSarno
- Department of Medical Biostatistics, Robert Larner MD College of Medicine, Burlington, VT, USA
| | - Abhishek Kumar
- Yale School of Medicine, Section of Nephrology, New Haven, CT, USA
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14
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Youssef EW, Aly A, Brahmbhatt A, Moussa A, Santos E. Lymphatic Interventions in the Cancer Patient. Curr Oncol Rep 2022. [PMID: 35639331 DOI: 10.1007/s11912-022-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The incidence of lymphatic leakage (iatrogenic and non-iatrogenic) is growing in cancer population due to the increased complexity of the surgical procedures and improved overall survival in cancer patients. The purpose of this article is to review the contemporary approach in the field of percutaneous lymphatic embolization in cancer patients with lymphatic leaks. RECENT FINDINGS Since the advent of intranodal lymphangiography in 2011 alongside with the MR and CT lymphangiography, the accuracy of diagnosis of the lymphatic diseases has significantly improved significantly. These advancements have triggered a revival of minimally invasive lymphatic interventions. Lymphatic embolization is expanding from the classic indication, thoracic duct embolization, to other lymphatic disorders (chylous ascites, lymphoceles, liver lymphorrhea, protein-losing enteropathy). The growth of lymphatic research and the standardization of the lymphatic interventions require a multidisciplinary and collaborative approach between physicians and researchers.
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15
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Lohmann S, Öztürk G, Junger D, Hoffmann R, Burgert O. Assessment of the Body Posture of Interventional Radiologists. Stud Health Technol Inform 2022; 294:809-810. [PMID: 35612211 DOI: 10.3233/shti220591] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physicians in interventional radiology are exposed to high physical stress. To avoid negative long-term effects resulting from unergonomic working conditions, we demonstrated the feasibility of a system that gives feedback about unergonomic situations arising during the intervention based on the Azure Kinect camera. The overall feasibility of the approach could be shown.
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Affiliation(s)
- Saskia Lohmann
- School of Informatics, Reutlingen University, Reutlingen, Germany
| | - Gürkan Öztürk
- School of Informatics, Reutlingen University, Reutlingen, Germany
| | - Denise Junger
- School of Informatics, Reutlingen University, Reutlingen, Germany
| | - Rüdiger Hoffmann
- Department of Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Oliver Burgert
- School of Informatics, Reutlingen University, Reutlingen, Germany
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16
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Shields A, Williams K, Veeturi SS, Tutino V, Ionita C, Bednarek DR, Rudin S. Initial evaluation of 2D and 3D simulated high-speed 1000 fps vascular contrast-flow image sequences using computational fluid dynamics (CFD). Proc SPIE Int Soc Opt Eng 2022; 12036:120360F. [PMID: 35983493 PMCID: PMC9385176 DOI: 10.1117/12.2611170] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Digital subtraction angiography (DSA) remains the clinical standard for detailed visualization of the neurovasculature due to its high-spatial resolution; however, detailed blood-flow quantification is impaired by its low-temporal resolution. Advances in photon-counting detector technology have led us to develop High-Speed Angiography (HSA), where x-ray images are acquired at 1000 fps for more accurate visualization and quantification of blood flow. We have implemented a physics-based optical flow method to extract such information from HSA, but validation of the angiography-derived velocity distributions is not straightforward. Computational fluid dynamics (CFD) is widely regarded as the benchmark for hemodynamic analysis, as it provides a multitude of quantitative flow parameters throughout the volume of interest. However, there are several limitations with this method related to over-simplification of boundary conditions and suboptimal meshing (spatial resolution), that make CFD simulation results an inexact criterion for validation. To overcome this issue for HSA validation, CFD was used to generate both simulated high-speed angiograms and the corresponding ground-truth 3D flow fields to better understand the relationship between the 3D volumetric-flow distribution and the 2D projected-flow distribution as is obtained with angiography, and the subsequent 2D approximation of flow velocity. Several geometries were investigated, ranging from simple pipe models to complex patient-specific aneurysms. Simulated datasets were analyzed with the optical flow algorithm, and the effects of flow divergence, quantum mottle, and intensity gradient on the calculation were evaluated. From these simulations, we can evaluate whether flow fields reconstructed from HSA are representative of significant flow patterns in the 3D vasculature.
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Affiliation(s)
- A Shields
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - K Williams
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - S S Veeturi
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - V Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - C Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - D R Bednarek
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
| | - S Rudin
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY
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17
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van der Reijd DJ, Baetens TR, Gomez Munoz F, Aarts BM, Lahaye MJ, Graafland NM, Lok CAR, Aalbers AGJ, Kok NFM, Beets-Tan RGH, Maas M, Klompenhouwer EG. Percutaneous cryoablation: a novel treatment option in non-visceral metastases of the abdominal cavity after prior surgery. Abdom Radiol (NY) 2022; 47:3345-3352. [PMID: 35779093 PMCID: PMC9388473 DOI: 10.1007/s00261-022-03598-y] [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: 03/23/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess the primary safety and oncological outcome of percutaneous cryoablation in patients with non-visceral metastases of the abdominal cavity after prior surgery. METHODS All patients with non-visceral metastases after prior abdominal surgery, treated with percutaneous cryoablation, and at least one year of follow-up were retrospectively identified. Technical success was achieved if the ice-ball had a minimum margin of 10 mm in three dimensions on the per-procedural CT images. Complications were recorded using the Society of Interventional Radiology (SIR) classification system. Time until disease progression was monitored with follow-up CT and/or MRI. Local control was defined as absence of recurrence at the site of ablation. RESULTS Eleven patients underwent cryoablation for 14 non-visceral metastases (mean diameter 20 ± 9 mm). Primary tumor origin was renal cell (n = 4), colorectal (n = 3), granulosa cell (n = 2), endometrium (n = 1) and appendix (n = 1) carcinoma. Treated metastases were localized retroperitoneal (n = 8), intraperitoneal (n = 2), or in the abdominal wall (n = 4). Technical success was achieved in all procedures. After a median follow-up of 27 months (12-38 months), all patients were alive. Local control was observed in 10/14 non-visceral metastases, and the earliest local progression was detected after ten months. No major adverse events occurred. One patient suffered a minor asymptomatic adverse event. CONCLUSION This proof-of-concept study suggests that cryoablation can be a minimal invasive treatment option in a selected group of patients with non-visceral metastases in the abdominal cavity after prior surgery.
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Affiliation(s)
- D. J. van der Reijd
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T. R. Baetens
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F. Gomez Munoz
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,Department of Interventional Radiology, Hospital Clinic Universitari, Barcelona, Spain
| | - B. M. Aarts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M. J. Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N. M. Graafland
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C. A. R. Lok
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A. G. J. Aalbers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N. F. M. Kok
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R. G. H. Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands ,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M. Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E. G. Klompenhouwer
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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18
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Justaniah AI, Felemban BA, Garad F, Safar BO. Interventional Radiology Board Examination Experience in Saudi Arabia During COVID-19. J Vasc Interv Radiol 2021; 33:201-202. [PMID: 34718098 PMCID: PMC8639163 DOI: 10.1016/j.jvir.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Almamoon I Justaniah
- Vascular & Interventional Radiologist, Deputy Chair, Department of Radiology, King Faisal Specialist Hospital & Research Centre (Gen. Org.) - Jeddah, P.O. Box 40047, Jeddah 21499, Saudi Arabia.
| | - Basim A Felemban
- Consultant Radiologist - Vascular & Interventional Radiology, Body Imaging Director of Radiology Services, Makkah Healthcare Cluster Head of Interventional Radiology Department Radiology Residency Director, Alnoor Specialist Hospital Makkah, Saudi Arabia Work
| | - Fares Garad
- Consultant Interventional Radiologist, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Bandar O Safar
- Consultant Interventional, Abdominal and Cardiovascular Radiology Section Head, Vascular and International Radiology Quality Director, Radiology Department King Faisal Specialist Hospital & Research Centre - Riyadh MBC - 28, P.O.Box 3354, Riyadh 11211, Saudi Arabia
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Sekino H, Ishii S, Sato H, Nomoto M, Kawana S, Suenaga H, Kuroiwa D, Ito H. Three cases of organized hematoma of the maxillary sinus in patients who underwent preoperative arterial embolization. Radiol Case Rep 2021; 16:3945-3949. [PMID: 34712374 PMCID: PMC8529391 DOI: 10.1016/j.radcr.2021.09.039] [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: 08/10/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023] Open
Abstract
Organized hematoma (OH) is benign tumor in the maxillary sinus. The standard treatment for OH is complete surgical resection, however massive bleeding can occur during the procedure, albeit rarely. Some reports have suggested preoperative embolization is useful for reducing the volume of intraoperative bleeding. We report 3 cases of OH in the maxillary performed preoperative embolization. We identified the feeding arteries by angiography or IVR-CT, and we embolized them using Gelatin sponge particles. The embolized artery was the maxillary artery or both the maxillary and the facial artery. There were no major complications as a result of embolization. The mean fluoroscopy time was 35.8 minutes, and the mean fluoroscopy dose was 329.3 mGy. Tumor resection was performed the next day after arterial embolization. The mean bleeding volume for surgery was 383.3 ml, and the mean operative time was 194 minutes. No recurrence was observed in any of the cases over a 4-year follow-up period. We considered that it is possible that preoperative artery embolization is useful for decreasing intraoperative bleeding volume. Although the methods and usefulness of embolization await future reports, it is a technique that should be considered preoperatively because of its potential to prevent massive bleeding.
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Affiliation(s)
- Hirofumi Sekino
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan,Corresponding author. Hirofumi Sekino.
| | - Shiro Ishii
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hirohito Sato
- Department of Otorhinolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Mika Nomoto
- Department of Otorhinolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Satoshi Kawana
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, Japan
| | - Hiroki Suenaga
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Daichi Kuroiwa
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
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Lee CM, Jeon CH, Lee R, Kwon H, Kim CW, Kim JH, Kim JH, Kim H, Kim SH, Lee CK, Park CY, Bae M. Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries: Clinical Outcomes of Transcatheter Systemic Artery Embolization. Taehan Yongsang Uihakhoe Chi 2021; 82:923-935. [PMID: 36238056 PMCID: PMC9514418 DOI: 10.3348/jksr.2020.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022]
Abstract
Purpose We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.
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21
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Eden C, Clifford H, Wang A, Mohammed A, Yim P. Carotid approach to anterior circulation thromboembolectomy in an adult with failing fontan physiology: a case report. BMC Anesthesiol 2021; 21:151. [PMID: 34006242 PMCID: PMC8128684 DOI: 10.1186/s12871-021-01364-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background Anesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion. Case Presentation We describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. She was admitted to the hospital almost 29 years after her initial surgeries to undergo workup for a dual heart and liver transplant in the context of a failing Fontan with elevated end diastolic pressures, NYHA III heart failure symptoms, and liver cirrhosis from congestive hepatopathy. During the workup in the context of holding anticoagulation for invasive procedures, she developed a middle cerebral artery (MCA) stroke requiring a thromboembolectomy via left carotid artery approach. Discussion and Conclusions This case posed many challenges to the anesthesiologist including airway control, hemodynamic and cardiopulmonary monitoring, evaluation of perfusion, vascular access, and management of anticoagulation in an adult patient in heart and liver failure with Fontan physiology undergoing thromboembolectomy for MCA embolic stroke.
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Affiliation(s)
- Caroline Eden
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, NY, New York, USA. .,Department of Anesthesiology, New York-Presbyterian, Columbia University Medical Center, 622 W 168th St, NY, 10032, New York, USA.
| | - Hugo Clifford
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, NY, New York, USA
| | - Arthur Wang
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, NY, New York, USA
| | - Asif Mohammed
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Florida, Miami, USA
| | - Peter Yim
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, NY, New York, USA
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22
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Chae SY, Park C, Kim JK, Kim HO, Lee BC. Ultrasound-Guided Percutaneous Thrombin Injection of Femoral Artery Pseudoaneurysms Caused by Vascular Access. Taehan Yongsang Uihakhoe Chi 2021; 82:589-599. [PMID: 36238797 PMCID: PMC9432433 DOI: 10.3348/jksr.2020.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 11/17/2022]
Abstract
Purpose To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. Materials and Methods Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed. The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. Results The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5-40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/µL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. Conclusion The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.
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23
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Hanrahan TP, Goodwin M, Testro A. An Extraordinary Cause of Dyspnea and Weight Loss. Gastroenterology 2021; 160:e19-e20. [PMID: 32673693 DOI: 10.1053/j.gastro.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Timothy P Hanrahan
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
| | - Mark Goodwin
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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O'Reilly MK, Chick JFB, Lee MJ, Geoghegan T. Endometrial assessment of premenopausal women prior to uterine artery embolization: A cross sectional survey of Interventional Radiologists. Clin Imaging 2021; 76:42-45. [PMID: 33549918 DOI: 10.1016/j.clinimag.2021.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/28/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Michael K O'Reilly
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.
| | | | - Michael J Lee
- Department of Interventional Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Tony Geoghegan
- Department of Interventional Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Busch C, Fehr A, Rohr A, Custe B, Collins Z. Do Video Games Predict an Early Advanced Capacity to Learn Interventional Radiology Skills? J Med Educ Curric Dev 2021; 8:2382120521992334. [PMID: 33614969 PMCID: PMC7871050 DOI: 10.1177/2382120521992334] [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] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To elucidate the relationship between video game (VG) play and interventional radiology (IR) technical skills in medical students. MATERIALS AND METHODS Twenty medical students recruited at our institution's IR symposium completed a survey to ascertain demographics and prior VG experience, then participated in a 3-part trial of skills assessing IR and VG skill and visuospatial aptitude (VSA). IR skill was evaluated via an endovascular simulation task, VG skill by performance on three separate VGs, and VSA using the Cube Comparison test. Regression analysis was tested the strength of relationship between IR skill and VG experience, VG skill, and VSA, respectively, and participants were stratified by IR skill to top and bottom halves for survey-response comparison. RESULTS There was no correlation between either VG skill or visuospatial aptitude and IR skill (r = -0.22, p = 0.35; and r = 0.14, p = 0.57). Greater number of years playing VGs correlated with superior IR skill (Spearman's rho=-0.45, p<0.05). Students who selected IR as their specialty of interest had extensive VG experience, playing for > 15 years (n = 4, 80%), at least 10 hours per week at their peak (n = 3, 60%), and reported being either "skilled" or "highly skilled" at VGs (n = 3, 60%). CONCLUSIONS In our study, though limited by power, number of years playing VGs correlated positively with IR skills in medical students. Prior VG experience may predict an early advanced capacity to learn IR skills and an interest in the specialty.
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Affiliation(s)
- Caleb Busch
- Interventional Radiology Department, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Austin Fehr
- Interventional Radiology Department, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Aaron Rohr
- Interventional Radiology Department, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Brandon Custe
- Interventional Radiology Department, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Zachary Collins
- Interventional Radiology Department, University of Kansas School of Medicine, Kansas City, KS, USA
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Carraro do Nascimento V, De Villiers L, Chia GS, Rice H. Aspiration technique for percutaneous endovascular retrieval of contraceptive device embolized to the pulmonary vasculature. Radiol Case Rep 2020; 16:571-574. [PMID: 33384758 PMCID: PMC7772520 DOI: 10.1016/j.radcr.2020.12.049] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
Contraceptive implant migration into the pulmonary circulation is an uncommon, but potentially serious complication. We describe an "aspiration" technique for percutaneous retrieval of a contraceptive implant from a subsegmental pulmonary artery, using a Penumbra Neuron MAX 088 guiding catheter and a Merit Medical VacLok Vacuum Pressure Syringe, as an alternative to the previously described snare technique. Our patient had an uneventful recovery and was discharged home on the same day.
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Javor D, Moyses J, Loewe C, Schernthaner RE. Radiation dose reduction capabilities of a new C-arm system with optimized hard- and software. Eur J Radiol 2020; 134:109367. [PMID: 33221618 DOI: 10.1016/j.ejrad.2020.109367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/27/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the radiation dose reduction capabilities and the image quality of a new C-arm system in comparison to a standard C-arm system. METHOD Prospective, randomized, IRB approved two-arm trial design. 49 consecutive patients with primary or secondary liver cancer were treated with transarterial chemoembolization (TACE) on two different angiography units. 28 patients were treated on a conventional angiography unit B, 21 patients on unit A which provides improved hardware and optimized image processing algorithms. Dose area product (DAP) and fluoroscopy time were recorded. DSA image quality of all procedures was assessed on a four-rank-scale by two independent and blinded readers. RESULTS Both cohorts showed no significant differences with regard to patient characteristics, tumor burden and fluoroscopy time. The new system resulted in a statistically significant reduction of cumulative DAP of 72% compared to the old platform (median 76 vs. 269 Gy*cm2). Individually, Fluoro-DAP and DSA-DAP decreased by 48% and 77% (p = 0.012 and p < 0.01), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms. CONCLUSIONS The new C-arm system significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality. The combination of optimized hardware and software yields the highest radiation dose reduction and is of utmost importance for patients and interventionalists.
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Affiliation(s)
- Domagoj Javor
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Johanna Moyses
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ruediger E Schernthaner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Anand V, Maybody M, Fischer GW, Dabo-Trubelja A. Acute Hemodynamic Compromise following Superior Vena Cava Stent Placement: A Case Report. ACTA ACUST UNITED AC 2020; 2:2953-2956. [PMID: 33458570 DOI: 10.1007/s42399-020-00629-x] [Citation(s) in RCA: 1] [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: 11/30/2022]
Abstract
Symptomatic relief of Superior Vena Cava (SVC) syndrome caused by tumor obstruction is achieved by the placement of a percutaneous superior vena cava stent. Complications are rare. Even more uncommon is acute hemodynamic compromise from acute hemopericardium during placement of an SVC stent. Point of Care Ultrasound (POCUS) in the Interventional Radiology Suite (IR) suite allows for rapid diagnosis and guidance of pericardial drainage and hemodynamic management.
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Affiliation(s)
- Vaibhav Anand
- Dept of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Majid Maybody
- Interventional Radiology Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Gregory W Fischer
- Dept of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Anahita Dabo-Trubelja
- Perioperative Echocardiography and Ultrasound; Director, Onco-Anesthesia Anesthesia Fellowship, Memorial Sloan Kettering Cancer Center, New York, NY 10065, 1275 York Ave., C-330
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Yagi N, Nakagami T, Yamaguchi S, Hamaoka T, Fukai K. Novel method for endovascular fenestration using radiofrequency transseptal needle for aortic dissection with malperfusion syndrome. Radiol Case Rep 2020; 15:1437-1441. [PMID: 32642013 PMCID: PMC7334550 DOI: 10.1016/j.radcr.2020.06.015] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Malperfusion syndrome is considered one of the most significant adverse events in aortic dissection disease and often requires invasive strategies to improve ischemia. We report the case of a patient who was presented with worsening claudication and leg rest pain due to malperfusion syndrome of type B aortic dissection. We successfully performed endovascular fenestration therapy to relieve the symptom by using a NRG radiofrequency transseptal needle (Baylis Medical, Montreal, Canada). We suggest that this novel method would be available for the patients with malperfusion syndrome of aortic dissection
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Affiliation(s)
- N Yagi
- Department of Cardiovascular Medicine, University Hospital, Kyoto Prefectural University of Medicine, 465 Kaji-cho, Kamigyo-ku, Kyoto-shi, Kyoto, 602-8566, Japan.,Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - T Nakagami
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - S Yamaguchi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - T Hamaoka
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - K Fukai
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
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Warhadpande S, Khaja MS, Sabri SS. The Impact of COVID-19 on Interventional Radiology Training Programs: What You Need to Know. Acad Radiol 2020; 27:868-71. [PMID: 32359819 DOI: 10.1016/j.acra.2020.04.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has affected medical education in unprecedented ways. Herein, we briefly describe the affects of COVID-19 on Interventional Radiology residency training and summarize up to date guidance by governing bodies and key stakeholders.
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Abstract
Image-guided percutaneous thermal ablation is a widely acceptable local therapy for patients with colorectal liver metastases who are noneligible for surgery or present with recurrence after hepatectomy. The increasing knowledge of factors that affect oncologic outcomes has allowed selected patients with resectable small volume colorectal liver metastases to be treated by thermal ablation with curative intent. The continuous technological evolutions in imaging and image-guidance and the wide implementation of microwave ablation that overcomes most of the limitations of radiofrequency ablation have contributed to this paradigm shift. The importance of patient selection, ablation margin evaluation, and confirmation of complete tumor ablation (A0) are discussed in this article.
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Clements W, Chow J, Corish C, Tang VD, Houlihan C. Assessing the Burden of Packaging and Recyclability of Single-Use Products in Interventional Radiology. Cardiovasc Intervent Radiol 2020; 43:910-5. [PMID: 32034434 DOI: 10.1007/s00270-020-02427-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE With a shift to single-use products in interventional radiology (IR) centres for sterility and cost reasons, it is prudent to consider the burden of packaging and employ efforts to assess and reduce waste, as well as promote recycling wherever possible. This study aimed to quantify the amount of waste in IR packaging and what proportion is recyclable. MATERIALS AND METHODS A range of IR products were weighed using mass scales. Products were assessed for total weight, overall waste, and potentially recyclable waste. Waste was defined as any packaging which was not considered vital to the product to perform its duty and thus was for packaging or shipping purposes. Products were pooled into one of the following categories: catheters and sheaths, wires, needles, devices, coils, and packs/ancillary. RESULTS Seventy-two different products were collected from 26 manufacturers to represent a range of items. The weight of all products was 12,466 g (median 51, range 2-1600), and weight of waste was 6830.7 g (median 34, range 1.1-732). The weight of recyclable waste was 5202.2 g (median 11.5, range 0-701). There were median 2 waste packages per item (range 1-5). The proportion of waste of the overall weight was 54.8% and of this, 76% of all waste was potentially recyclable. CONCLUSION There is a significant burden of waste in manufactured IR products, and while a high proportion is recyclable, we encourage manufacturers of IR products and devices to consider alternative means of transport and packaging of products which will reduce the overall waste burden. LEVEL OF EVIDENCE Level 3.
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Morrison G, Collins A, McCorry R. COLLATERAL THINKING. Ulster Med J 2020; 89:40-41. [PMID: 32218629 PMCID: PMC7027175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gary Morrison
- Liver Unit, RVH Belfast,Correspondence to: Dr Gary Morrison. E-mail:
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Dabrowiecki A, Newsome J, Bercu ZL, Martin JG. Postpartum haemorrhage requiring embolisation of a hypertrophied round ligament artery. BMJ Case Rep 2019; 12:12/8/e230071. [PMID: 31473635 DOI: 10.1136/bcr-2019-230071] [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] [Indexed: 11/04/2022] Open
Abstract
A gravida 4 para 1021, 41-year-old woman postcaesarean section at 39 weeks and 1 day with clinically significant haemorrhage required embolisation of unique uterine arterial collaterals. She had persistent haemorrhage after initial bilateral uterine artery embolisation, and on further investigation she was found to have a hypertrophied right round ligament artery. Once successful embolisation of this abnormal right round ligament artery was completed using a combination of Gelfoam and coils, haemostasis was achieved. She had rapid clinical improvement, no complications and no further admissions on postprocedural follow-up over a year and a half later.
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Affiliation(s)
- Alexander Dabrowiecki
- Interventional Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Janice Newsome
- Interventional Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zachary L Bercu
- Interventional Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan G Martin
- Interventional Radiology, Duke University School of Medicine, Durham, North Carolina, USA
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Ahmed SA, Hyman C, Eltorai AEM, Ahn SH. Evaluation of Integrated Interventional Radiology Residency Websites. R I Med J (2013) 2019; 102:19-23. [PMID: 31398963] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
RATIONALE AND OBJECTIVES In the transition to the integrated interventional radiology residency model, residency websites are important resources of program information for prospective applicants. The objective of this investigation was to evaluate the availability and comprehensiveness of integrated interventional radiology residency websites. MATERIALS AND METHODS A complete list of programs participating in the 2018 integrated interventional radiology match was collected using the online Fellowship and Residency Electronic Interactive Database and Electronic Residency Application Service. Residency program websites were evaluated for the presence of 19 variables related to resident education and recruitment, and the percent comprehensiveness of each website was calculated based on the number of variables present. The effect of program size and geographic region on website availability and comprehensiveness was assessed. RESULTS Of the 69 programs participating in the 2018 match, 18 (26%) programs did not have any locatable website. Of the 51 programs with websites, 30 (59%) had stand-alone interventional radiology websites distinct from the associated diagnostic radiology website. Large programs were more likely to have a residency website than small programs (91% versus 54%, p=0.001). Across all categories, the mean website comprehensiveness was 33%. Mean website comprehensiveness of programs in the Midwest (43%) and Northeast (37%) was significantly greater than mean website comprehensiveness of programs in the West (19%) (p=0.005). CONCLUSION Overall, 1 in 4 integrated interventional radiology residency programs did not have locatable websites. Many integrated interventional radiology residency websites lack important content variables. Efforts should be made to improve the residency websites and digital training resources for prospective interventional radiology applicants and to help showcase programs in the best light.
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Affiliation(s)
| | | | | | - Sun H Ahn
- Vascular and Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University
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Abdullah HMA, Atiq M, Yeager T. Percutaneous removal of a retained appendicolith causing recurrent perihepatic abscesses between the liver and diaphragm. BMJ Case Rep 2019; 12:12/7/e230176. [PMID: 31324669 DOI: 10.1136/bcr-2019-230176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/03/2022] Open
Abstract
Many cases of appendicitis can be associated with appendicoliths. These may sometimes be lost during appendectomies and may be lodged in the body. Most of these cases lead to recurrent abscess formation, and these appendicoliths invariably need removal. Typically, this used to be done as an open surgery or laparoscopically. Here we describe the case of a transcutaneous removal of an appendicolith that was lodged between the liver and diaphragm that led to recurrent perihepatic abscess formation in a 24-year-old otherwise healthy man. The patient made a successful recovery without any recurrence. A transcutaneous approach to remove a retained appendicolith may be a feasible, a safe and an easy method to extract appendicoliths that are accessible for transcutaneous removal.
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Affiliation(s)
- Hafez Mohammad Ammar Abdullah
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Muslim Atiq
- Department of Gastroenterology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Terry Yeager
- Department of Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
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Kelley M, Spieler B, Rouse C, Karl B, Marshall R, Carbonella G. Urinothorax: A rare complication of percutaneous nephrostomy. Radiol Case Rep 2019; 14:729-733. [PMID: 30988865 PMCID: PMC6447739 DOI: 10.1016/j.radcr.2019.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/17/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022] Open
Abstract
We present a case of a urinothorax resulting from treatment of genitourinary pathology. The presentation, diagnosis, and management of a 46-year-old female with an urinothorax are discussed. Urinothorax is a rare cause of a pleural effusion, most commonly arising from a traumatic etiology. Imaging can be crucial in the diagnosis, particularly computerized tomography (CT), which can help characterize any associated causative genitourinary abnormalities such as anatomical defects or a urinoma. A urinothorax is often posttraumatic in etiology, associated with the treatment of genitourinary pathology, as in this case. Treatment of the source of the urine leak is required to properly manage an urinothorax and often requires a multi-disciplinary approach.
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Idachaba S, Dada O, Abimbola O, Olayinka O, Uma A, Olunu E, Fakoya AOJ. A Review of Pancreatic Cancer: Epidemiology, Genetics, Screening, and Management. Open Access Maced J Med Sci 2019; 7:663-671. [PMID: 30894932 PMCID: PMC6420955 DOI: 10.3889/oamjms.2019.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/07/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/15/2022] Open
Abstract
Pancreatic cancer ranks among the causes of cancer-related deaths. The average size of pancreatic cancer during diagnosis is about 31 mm and has not changed significantly over the past 30 years. Poor early diagnosis of a tumour has been attributed to the late-presenting symptoms. Over the years, improvement in the diagnosis of pancreatic cancer has been observed, and this can be linked to advancement in imaging techniques as well as the increasing knowledge of cancer history and genetics. Magnetic Resonance Imaging, Endoscopic Ultrasound, and Computer Topography are the approved imaging modalities utilised in the diagnosing of pancreatic cancer. Over the years, the management of patients with pancreatic cancer has seen remarkable improvement as reliable techniques can now be harnessed and implemented in determining the resectability of cancer. However, only about 10% of pancreatic adenocarcinomas are resectable at the time of diagnosis and will highly benefit from a microscopic margin-negative surgical resection. Overall, the failure of early tumour identification will result in considerable morbidity and mortality.
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Affiliation(s)
| | - Oluwafemi Dada
- All Saints University, School of Medicine, Roseau, Dominica
| | | | | | - Akunnaya Uma
- All Saints University, School of Medicine, Roseau, Dominica
| | - Esther Olunu
- All Saints University, School of Medicine, Roseau, Dominica
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Midulla M, Pescatori L, Chevallier O, Nakai M, Ikoma A, Gehin S, Berthod PE, Ne R, Loffroy R, Dake M. Future of IR: Emerging Techniques, Looking to the Future…and Learning from the Past. J Belg Soc Radiol 2019; 103:12. [PMID: 30828696 DOI: 10.5334/jbsr.1727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Innovation has been the cornerstone of interventional radiology since the early years of the founders, with a multitude of new therapeutic approaches developed over the last 50 years. What is the future holding for us? This article presents an overview of the in-coming developments that are catching on at this moment, particularly focusing on three items: the new applications of existing techniques, particularly embolotherapy and interventional oncology; the cutting-edge devices; the imaging technologies at the forefront of the image-guidance. Besides this, clinical vision and patient relation remain crucial for the future of the discipline.
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Abstract
E. N was a 48-year-old man referred from a peripheral hospital to the Maxillofacial unit of Ahmadu Bello University Teaching Hospital, Zaria, on account of 1-year history of left-sided jaw pain and swelling, particularly after meal. The conventional plain radiograph of the jaws appeared normal as there was no opacity of soft tissue or calcific density visualized. Sialography revealed an oval-shaped filling defect in the dilated left Wharton's duct, which could suggest radiolucent calculus. Ultrasound scan showed the lesion as a brightly echogenic mass surrounded by anechoic clear fluid (saliva), casting posterior acoustic shadow. A diagnosis of left submandibular sialolithiasis was made. The maxillofacial surgeons decided to remove the calculus surgically, but the patient refused surgery and then defaulted from subsequent follow-up visits.
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Affiliation(s)
- Joshua Oluwafemi Aiyekomogbon
- Department of Radiology, College of Health Sciences, University of Abuja, Abuja; Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Abdul J Salam
- Department of Radiology, Jos University Teaching Hospital, Jos, Nigeria
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Chang D, Tummala S, Sotero D, Tong E, Mustafa L, Mustafa M, Browne WF, Winokur RS. Three-Dimensional Printing for Procedure Rehearsal/Simulation/Planning in Interventional Radiology. Tech Vasc Interv Radiol 2018; 22:14-20. [PMID: 30765070 DOI: 10.1053/j.tvir.2018.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/21/2022]
Abstract
With the advances in affordable three-dimensional (3D) printing technology, 3D reconstruction and patient-specific 3D printed models are establishing a crucial role in the field of medicine for both educational purposes and procedural planning. 3D printed models provide physicians with increased 3D perception and tactile feedback, and enable a team-based approach to operational planning. However, performing an effective 3D reconstruction requires an in-depth understanding of the software features to accurately segment and reconstruct the human anatomy of interest from preacquired image data from multiple modalities such as computer tomography, 3D angiography and magnetic resonance imaging, and the different 3D printers/materials available in the market today. Increased understanding of this technology may benefit radiologists by developing techniques and tricks specific to interventional radiology and establishing a criterion to determine when to use these. Thus, the purpose of this manuscript is to provide physicians with an update on currently available 3D reconstruction software as well as printers and materials. Our initial experience using this technology is introduced based on a specific case of developing a 3D printed aorta for a patient with severe stenosis of the abdominal aorta.
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Affiliation(s)
- Doyoung Chang
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL.
| | - Srini Tummala
- Chief Vascular Interventional Services, Department of Interventional Radiology, University of Miami Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Dax Sotero
- Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Eric Tong
- Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Luai Mustafa
- Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Moawiah Mustafa
- Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - William F Browne
- Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York, NY
| | - Ronald S Winokur
- Skills Acquisition Innovation Lab, Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York, NY
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Abstract
Interventional Radiology (IR) incorporates a unique set of technical skills such as ultrasound-guided needle placement, inferior vena cava filter placement, and wire/catheter exchange, which are not easily attained in other aspects of medical training. Simple, low cost models can allow medical students and residents to attain these skills in a low risk setting. These simulated tasks will ultimately combine to improve preparedness of trainees during patient procedures allowing them to advance more quickly through the training paradigm without patient risk. Many commercially available devices may be cost prohibitive, so low cost solutions are presented.
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Affiliation(s)
- Benjamin J May
- Department of Radiology, Division of Interventional Radiology, Weill Cornell Medicine, New York, NY.
| | - Joe K Khoury
- NYIT College of Osteopathic Medicine, Serota Academic Center, Old Westbury, NY
| | - Ronald S Winokur
- Department of Radiology, Division of Interventional Radiology, Weill Cornell Medicine, New York, NY
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44
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Clements W, Goh GS, Nguyen J, Vrazas J, Rogan C, Lau G, Joseph T. Establishing a Platform for Interest and Education in Interventional Radiology Amongst Radiology Trainees. Cardiovasc Intervent Radiol 2018; 42:95-100. [PMID: 30238333 DOI: 10.1007/s00270-018-2080-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Over recent times, procedural Radiologists have begun to establish themselves as the distinct subspecialty of Interventional Radiology (IR). The Interventional Radiology Society of Australasia (IRSA) was established in 1982 to share collaborative ideas, encourage research, and promote education. IRSA developed a weekend registrar workshop attended by Radiology Registrars from Australia and New Zealand. In the 2018 event, we surveyed the Registrars to identify their interest in IR training before and after the workshop. MATERIALS AND METHODS The event was held over a weekend and consisted of both lectures and hands-on workshops. A survey was handed to all 67 registrants of the workshop and there was a 55% response rate including 78% of females in attendance. RESULTS Before the workshop, trainees rated their interest in IR training at a mean of 3.7 out of 5. After the workshop, trainees rated their interest in IR training as an average of 4.4 out of 5 (p < 0.001). The difference in interest between males and females before the workshop (4.0 vs. 3.1) was significant (p = 0.003), however after the workshop (4.5 vs. 4.1) was not significant (p = 0.07). The change in interest from attending the workshop was significant between genders, p = 0.03 (male interest increased mean 0.5, female increased mean 1.0). CONCLUSION We show that a program of lectures and workshops designed to generate interest in IR leads to a significant increase in training interest, particularly amongst females. Other subspecialty groups should consider this type of intervention and promote ongoing education and inspiration. LEVEL OF EVIDENCE Cross-sectional study, Level IV.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Clayton, VIC, Australia.
| | - Gerard S Goh
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Julian Nguyen
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Radiology, Western Health, St Albans, VIC, Australia
| | - John Vrazas
- Melbourne Institute of Vascular and Interventional Radiology, Collingwood, VIC, Australia
| | - Chris Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gabriel Lau
- Pacific Radiology, Otago/Southland, Dunedin, New Zealand.,Department of Radiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Tim Joseph
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
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45
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de Gregorio MA, Guirola JA, Sierre S, Serrano-Casorran C, Gimeno MJ, Urbano J. Interventional Radiology and Spanish Medical Students: A Survey of Knowledge and Interests in Preclinical and Clinical Courses. Cardiovasc Intervent Radiol 2018; 41:1590-1598. [PMID: 29872895 DOI: 10.1007/s00270-018-1995-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/20/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Interventional Radiology (IR) is a medical activity that has experienced an extraordinary growth in the medical field in Spain in recent years. However, there is a lack of visibility in the Spanish Health Administration and the University community, especially among medical students. PURPOSE The purpose of this study is to determine IR knowledge among medical students, preclinical and clinical, in a single University in Spain. MATERIAL AND METHODS An electronic survey was uploaded (November-December 2017) to an online learning platform (Moodle) and sent to 414 students from second (183 PCs) and fourth (231 Cs) year of medical school. A total of 313 students of 414 (75.6%) answered the survey 142/45.4% PCs and 171/54.6% Cs. RESULTS Students quantified their knowledge between adequate (41% PCs/80.7% Cs) and poor levels (50.7% PCs/14% Cs). Most of the students suggested that interventional radiologists (IRs) should have a mixed training, surgical and radiological (95% PCs/88.8% Cs). Majority of students indicated that the professionals in charge of carrying out angioplasty were the IRs (95% PCs/83.6% Cs) and only 20.4% PCs/12.8% Cs (P = 0.165) of students chose cardiologists. Almost all of the medical students in both groups said they wanted to know more about IR (99.3% PCs/100.0% Cs), and the majority of students (100.0% PCs/98.8% Cs) said they agree or strongly agree that IR should be taught as an undergraduate medical subject. CONCLUSION This study demonstrates that medical students in our University have poor knowledge of IR; however, they are overwhelmingly positive in their desire to have this subject taught as distinct curriculum in medical school.
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Affiliation(s)
- Miguel A de Gregorio
- GITMI (Group of Research in Minimally Invasive Techniques), University of Zaragoza, Domingo Miral s/n, 50009, Saragossa, Spain. .,Interventional Radiology Hospital Clinico Universitario Lozano Blesa, Gómez Laguna 18, 50009, Saragossa, Spain.
| | - Jose A Guirola
- GITMI (Group of Research in Minimally Invasive Techniques), University of Zaragoza, Domingo Miral s/n, 50009, Saragossa, Spain.,Interventional Radiology Hospital Clinico Universitario Lozano Blesa, Gómez Laguna 18, 50009, Saragossa, Spain
| | - Sergio Sierre
- GITMI (Group of Research in Minimally Invasive Techniques), University of Zaragoza, Domingo Miral s/n, 50009, Saragossa, Spain.,Interventional Radiology, Pediatric Hospital Universitario Austral, Juan Domingo Peron 1500, Pilar Centro, Buenos Aires, Argentina
| | - Carolina Serrano-Casorran
- GITMI (Group of Research in Minimally Invasive Techniques), University of Zaragoza, Domingo Miral s/n, 50009, Saragossa, Spain
| | - Maria J Gimeno
- GITMI (Group of Research in Minimally Invasive Techniques), University of Zaragoza, Domingo Miral s/n, 50009, Saragossa, Spain.,Interventional Radiology Hospital Clinico Universitario Lozano Blesa, Gómez Laguna 18, 50009, Saragossa, Spain
| | - Jose Urbano
- GITMI (Group of Research in Minimally Invasive Techniques), University of Zaragoza, Domingo Miral s/n, 50009, Saragossa, Spain.,Hospital Nisa Vithas, Pardo de Aravaca, La Salle 12, 28023, Madrid, Spain
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46
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Goldman DT, Peters GL, Fischman AM, Vatakencherry GG, Bream PR, Martin JG, Newsome JM, Bercu ZL, Schacht MA, Johnson KS, Milburn JM, Ong S, Kalia V, England E, Heitkamp DE. Best Practices From the APDR: Improving Medical Student Exposure to Interventional Radiology. Acad Radiol 2018; 25:789-791. [PMID: 30691774 DOI: 10.1016/j.acra.2017.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/24/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Daryl T Goldman
- University of Queensland-Ochsner Clinical School, New Orleans, Louisiana
| | - Gail L Peters
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Aaron M Fischman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Peter R Bream
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan G Martin
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice M Newsome
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L Bercu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Michael A Schacht
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Karen S Johnson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - James M Milburn
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Seng Ong
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Vivek Kalia
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Eric England
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Darel E Heitkamp
- Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indiana University Hospital, 550 N. University Blvd., Room 0641, Indianapolis, IN 46202.
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47
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Yuan CM, Nee R, Little DJ, Narayan R, Childs JM, Prince LK, Raghavan R, Oliver JD. Survey of Kidney Biopsy Clinical Practice and Training in the United States. Clin J Am Soc Nephrol 2018; 13:718-725. [PMID: 29669819 PMCID: PMC5968891 DOI: 10.2215/cjn.13471217] [Citation(s) in RCA: 17] [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: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS An anonymous, on-line survey of all Walter Reed training program graduates (n=82; 1985-2017) and all United States nephrology program directors (n=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. RESULTS Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers (P=0.02), or whose fellows performed ≥50 biopsies (P<0.01). CONCLUSIONS Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.
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Affiliation(s)
| | | | | | - Rajeev Narayan
- San Antonio Kidney Disease Center, San Antonio, Texas; and
| | - John M. Childs
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Rajeev Raghavan
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
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48
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Ikeda O, Inoue S, Tamura Y, Yamashita YI, Baba H, Inomata Y, Yamashita Y. Shunt-preserving disconnection of the portal to systemic circulation in patients with hepatic encephalopathy. Acta Radiol 2018; 59:441-447. [PMID: 28791885 DOI: 10.1177/0284185117722810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/05/2023]
Abstract
Background Portosystemic shunt obliteration by surgical or interventional radiological techniques can be effective for patients with hepatic encephalopathy (HE) although this approach is often associated with accumulation of ascites and/or formation of esophageal varices. Purpose To evaluate the clinical efficacy and safety of shunt-preserving disconnection of the portosystemic circulation (SPDPS) in patients with HE. Material and Methods Nine patients with HE and a splenorenal shunt were treated by SPDPS: eight underwent selective coil embolization of the splenic vein and one underwent stent-graft closure of the shunt. The primary endpoint was change in HE severity based on the West-Haven criteria. The secondary endpoints were changes in serum ammonia levels, hepatic function, HE recurrence during the follow-up period, and post-treatment HE recurrence based on the West-Haven diagnostic criteria. Results The technical success rate was 100% with no severe complications. After the procedure, the mean portal blood pressure increased from 18 mmHg to 22 mmHg ( P = 0.02), the mean HE grades fell from 2.1 to 1.1 ( P < 0.01), and one month after the procedure, the mean serum ammonia level decreased from 177 µg/dL to 87 µg/dL ( P = 0.03) and the mean total Child-Pugh score from 8 to 7 ( P = 0.07). Conclusion SPDPS using selective coil embolization and stent-graft closure of the shunt can be an effective and safe treatment for patients with HE.
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Affiliation(s)
- Osamu Ikeda
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seijiro Inoue
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshitaka Tamura
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yo-ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukihiro Inomata
- Department of Pediatric Surgery and Transplantation, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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49
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Shabani F, Hasanzadeh H, Emadi A, Mirmohammadkhani M, Bitarafan-Rajabi A, Abedelahi A, Bokharaeian M, Masoumi H, Seifi D, Khani T, Sanchooli M, Moshfegh S, Ziari A. Radiation Protection Knowledge, Attitude, and Practice (KAP) in Interventional Radiology. Oman Med J 2018; 33:141-147. [PMID: 29657683 DOI: 10.5001/omj.2018.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/03/2022] Open
Abstract
Objectives Due to increasing cardiac disease and its mortality rate, the frequency of cardiac imaging has grown and, as a result, interventional cardiologists potentially receive high radiation doses in cardiac examinations. This study aimed to assess the knowledge, attitude, and practice (KAP) level of radiation protection (RP) among interventional radiology staff in Iranian health care centers across the country. Methods We used a validated questionnaire survey consisting of 30 multiple-choice questions to perform a cross-sectional study. Participants were healthcare personnel working professionally with radiation at different levels (i.e., secretary, radiology technologists, nurse, and physician). The questionnaire was divided into three sections to assess KAP regarding RP. Results Significant differences exist in RP KAP mean scores based on educational age (p < 0.050). There was no significant difference in RP KAP mean scores when looking at sex, practice age, and hospital type (p > 0.050). We found a significant difference between RP KAP mean scores and different regions (p < 0.050). Conclusions Educational and practice age, sex, type of hospital, and geographical region affect he KAP of interventional radiology staff regarding RP. Since many of the subjective radiation harms for both medical team and patients, this can be easily controlled and prevented; a checkup for personnel of interventional radiology departments, considering samples from different parts of the country with different levels of education, continuous training, and practical courses may help map the status of KAP. The results of this study may also help authorized health physics officers design strategic plans to enhance the quality of such services in radiation departments.
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Affiliation(s)
- Fatemeh Shabani
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Hadi Hasanzadeh
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Emadi
- Deputy of Research and Technology, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Ahmad Bitarafan-Rajabi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Ali Abedelahi
- Department of Anatomical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mitra Bokharaeian
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamed Masoumi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Danial Seifi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Tahereh Khani
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohamad Sanchooli
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Shima Moshfegh
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas Ziari
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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50
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Abstract
Rigid inflatable gastrostomy (RIG) tubes are widely used in contemporary clinical practice for a variety of indications. Insertion of RIG tubes is associated with a high technical success rate and low incidence of mortality. In this case report, a procedural pitfall associated with intraperitoneal-extragastric malposition is described. Rigorous assessment of abdominal radiographs, as well as awareness of the expected appearance of the RIG tube and gastropexy T-fasteners, allows the abdominal radiologist to detect early RIG position in the early postprocedural period. Abdominal radiography is a widely available and inexpensive technique. The high spatial resolution it provides makes it a valuable tool in determining hardware position.
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Affiliation(s)
- Timothy E Murray
- Department of Radiology, Beaumont Hospital, P.O. Box 1297, Beaumont Road, Dublin 9, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, P.O. Box 1297, Beaumont Road, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland
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