Interventional angiography utilization for adult trauma patients in Trauma Centers across the United States: An observational study using the National Trauma Data Bank

Angiography and embolization are part of trauma management protocols for various injuries. This study examines the use of angiography and embolization use in trauma care across Trauma Centers in the United States. We used the National Trauma Data Bank (NTDB) 2017 dataset in this retrospective observational study. Adult trauma patients (≥16 years) who underwent conventional angiography with or without embolization were included. A univariate analysis was carried out to describe patients' demographic and injury characteristics as well as the time to angiography, angiography details, complications, and outcome (survival to hospital discharge: yes/no). One-year period prevalence proportion of angiography procedure was determined. A total of 4242 patients were included. The 1-year period prevalence proportion of angiography procedure with or without embolization was 0.53% (95% confidence intervals: 0.527-0.529). The median age was 41 years (interquartile range: 27-58) with most patients being in the age group 16 to 64 (83.8%) and males (72.6%). Over half of the patients, 55.4% had an embolization procedure performed in addition to angiography. The mean time to angiography was 263.77 ± 750.19 minutes. The most common embolization sites were the pelvis (24.9%), spleen (11.8%), and liver (9%). This study described angiography and embolization utilization in adult trauma patients in Trauma Centers in the US. Its findings provide the basis for future studies to examine more closely angiography/embolization utilization in specific subpopulations, and to create standardized risk stratification tools for trauma patients who are candidates for this procedure.

Occupational doses in interventional angiography after radiological protection training and use of a real-time direct display dosimeter

Vascular x-ray guided interventions are complex and may result in high occupational doses to ionising radiation if staff do not take appropriate actions to minimise their exposure. In this prospective intervention study, ten staff members wore an extra personal dosimeter on the upper body above their regular protective clothing during four consecutive periods. Between each period either additional practical radiological protection training was given or a real-time direct display dosimeter were provided to the staff. Each staff's personal dose equivalent, Hp(10) normalised to the total air kerma-area product for the procedures where each staff were involved, KAPt, was used as the dependent variable. A focus-group interview with the staff were performed about the usefulness of the training and real-time dose rate display system. Our aim was to investigate if the interventions (practical training or real-time dose rate display) did affect the staff doses in the short and long term (five months later). Significant (p < 0.05) reductions of staff doses Hp(10)/KAPt were found after practical radiological protection training, but not after using real-time dose rate displays. Significant reductions were maintained after five months without additional interventions. The results from the focus-group interview indicated that making radiation 'visible', during practical training and usage of real-time direct display dosimeter, made it easier to understand how to act to lower occupational doses.

Report of AAPM Task Group 272: Comprehensive acceptance testing and evaluation of fluoroscopy imaging systems

Modern fluoroscopes used for image guidance have become quite complex. Adding to this complexity are the many regulatory and accreditation requirements that must be fulfilled during acceptance testing of a new unit. Further, some of these acceptance tests have pass/fail criteria, while others do not, making acceptance testing a subjective and time consuming task. The AAPM Task Group 272 Report spells out the details of tests that are required and gives visibility to some of the tests that while not yet required, are recommended as good practice. The organization of the report begins with the most complicated fluoroscopes used in interventional radiology or cardiology, continues with general fluoroscopy and mobile C-arms. Finally, the Appendices of the report provide useful information, an example report form and topics that needed their own section due to the level of detail. This article is protected by copyright. All rights reserved.

Bronchial Artery Embolization, an Increasingly Used Method for Hemoptysis; Treatment and Avoidance

Objectives

Hemoptysis is an alarming symptom. It may cause some severe life-threatening complications. Hypertrophic and fragile bronchial artery causes hemoptysis and occurs mostly in bronchiectasis, sarcoidosis, active or sequelae tuberculosis, aspergilloma, lung cancer or cystic fibrosis. Bronchial artery embolization is one of the angiographic methods used in diagnosis and treatment for years performed by radiologists. Hemoptysis is used mostly in patients with hemoptysis. Using this method, surgical management with high mortality and morbidity rates can be avoided or better conditions for surgery can be provided via stopping hemorrhage before surgery. We aim to share the experiences of our hospital about patients who underwent bronchial artery embolization and compare our results with the literature.

Methods

Thirty-nine patients (29 male, 10 female) underwent angiography-aiming embolization. Pathologies were hemoptysis in 37 patients, Castleman disease in two patients. Embolization was performed in 33 patients; 31 for hemoptysis, two for Castleman disease. Bilateral embolization was performed in six patients.

Results

Computed tomography (CT) was helpful in diagnosing the side of bleeding in 91.8% of the patients with hemoptysis. Bronchoscopy was diagnostic in 53% of patients. Polyvinyl alcohol (n=27) was mostly used for embolization. Hemoptysis recurred in six patients (19.3%). All were managed successfully, of four with re-embolization. One major complication, transient blindness, was observed.

Conclusion

Bronchial artery embolization is minimally invasive, more tolerable compared to surgery can be managed with high success and lower complication rates, especially hemoptysis and in some other situations. It provides time for evaluating the underlying disease and delaying surgery for elective conditions. That is why this method has been used increasingly.