New technology applications: thrombolysis of acute deep vein thrombosis

Treatment of deep vein thrombosis traditionally has focused on preventing the potentially life-threatening complication of pulmonary embolism rather than on removing or reducing the thrombus. Although treatment with anticoagulants may prevent thrombus propagation, the body's intrinsic thrombolytic system is left to attempt clot dissolution. Because this natural process is generally ineffective in its ability to fully recanalize a proximal vein, the risks of recurrent thrombosis as well as the disabling complication of postthrombotic syndrome increase. Moreover, the long-term consequences of postthrombotic syndrome include pain, disability, and, for many, a significant decrease in the quality of life. Recent technology using high-frequency, low-power ultrasound, or mechanical thrombectomy with catheter-directed delivery of a thrombolytic drug directly into the clot is available and showing promise. Nurses are caring for patients who receive endovascular interventions with lytic infusions. The nursing challenge is to provide safe and effective patient care.

Less invasive cardiovascular treatments shift spotlight to catheterization labs

Less invasive techniques for treating cardiovascular problems--such as placing stents and coils inside diseased blood vessels--are shining a larger spotlight on hospitals' catheterization labs. A big challenge: Turf wars among surgeons, radiologists and other physicians. Even more troubling: dramatic payment changes proposed by CMS.

What's new in vascular interventional radiology? Aortic stent grafting

BACKGROUND

Medical therapies are moving progressively toward 'minimally invasive' techniques resulting in less physiological disruption, smaller 'entry points', reduced intra- and post-operative complications, and earlier discharge. This is exemplified by the emerging technique of abdominal aortic aneurysm treatment with percutaneous endoluminal stent grafting.

OBJECTIVE

This article aims to provide an update on aortic stent grafts.

DISCUSSION

Aortic stent grafting carries less risk to the patient, is associated with less morbidity and mortality than traditional surgical procedures, and results in earlier discharge. Care in preoperative assessment to ensure the best match between patient and graft is essential, as is attentive postoperative follow up.

Interventional radiology: a modular approach

The authors offer a modular approach to the development of new procedures in the field of pediatric interventional radiology as a conceptual model and a springboard for further discussion.

Image-guided therapy and minimally invasive surgery in children: a merging future

Minimally invasive image-guided therapy for children, also known as pediatric interventional radiology (PIR), is a new and exciting field of medicine. Two key elements that helped the rapid evolution and dissemination of this specialty were the creation of devices appropriate for the pediatric population and the development of more cost-effective and minimally invasive techniques. Despite its clear advantages to children, many questions are raised regarding who should be performing these procedures. Unfortunately, this is a gray zone with no clear answer. Surgeons fear that interventional radiologists will take over additional aspects of the surgical/procedural spectrum. Interventional radiologists, on the other hand, struggle to avoid becoming highly specialized technicians rather than physicians who are responsible for complete care of their patients. In this article, we briefly discuss some of the current aspects of minimally invasive image-guided therapy in children and innovations that are expected to be incorporated into clinical practice in the near future. Then, we approach the current interspecialty battles over the control of this field and suggest some solutions to these issues. Finally, we propose the development of a generation of physicians with both surgical and imaging skills.

Uterine artery embolisation - a treatment alternative for women with fibroids

BACKGROUND

Fibroids are a common benign tumour of the female reproductive tract. Uterine artery embolisation is a minimally invasive catheter based technique that compares favourably with surgical treatments.

OBJECTIVE

Uterine artery embolisation is an intervention that is especially suited to women who wish to preserve their uterus. This article briefly outlines the medical and surgical treatment options for fibroids with an in depth focus on fibroid embolisation.

DISCUSSION

Australian interventional radiologists have been performing uterine artery embolisation for fibroid disease successfully for a number of years. This procedure - like any intervention - is not without complication, but it does enable women a valid alternative treatment pathway for fibroids. General practitioners can discuss the procedure with their local interventional radiologist and can foster a broader understanding of the process with their female patients when considering treatment options.

Vertebroplasty - a new treatment for vertebral compression fractures

BACKGROUND

The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men. Vertebroplastyn involves the injection of artificial bone cement and an opacifier into the inter-trabecular marrow space of the fractured vertebra.

OBJECTIVE

This article describes vertebroplasty as a treatment of vertebral compression fractures.

DISCUSSION

Treatment for vertebral compression fractures regardless of aetiology has been largely conservative and directed toward pain control. Vertebroplasty has gained popularity since 1987 for treatment of vertebral compression fractures. Vertebroplasty is a safe, effective, and cost effective procedure when performed in an appropriate technical environment by adequately trained interventional radiologists.

Changes in the American Interventional Radiology Literature: Comparison over a 10-Year Time Period

PURPOSE

To determine the changes that occurred regarding interventional radiologic research in the major American radiology journals between 1992-1993 and 2002-2003.

METHODS

Articles published in three major American radiology journals (Journal of Vascular and Interventional Radiology, American Journal of Roentgenology, and Radiology) during two distinct 24-month time periods (1992-1993 and 2002-2003) were evaluated. All articles judged to be pertinent to the interventional radiologic community were included. Investigations included in journal subheadings other than "interventional" or "vascular radiology" were included if the emphasis of the article was on a vascular imaging modality or peripheral intervention. Exclusions included: case reports, technical reports, letters to the editor, breast interventions, and primary neurointerventions. Data were collected regarding the affiliations of the primary author (nationality, hospital type, department); primary category of interest of the investigation; funding information; and study design variables. Two-by-two chi-squared statistical analyses were performed comparing the variables from the early and late data sets.

RESULTS

A total of 405 articles met the inclusion criteria for the early data set (1992-1993); 488 articles met the inclusion criteria for the late data set (2002-2003). Variables that demonstrated a statistically significant decrease from the early data set to the late data set included: articles in which the primary author was from a department of radiology (91.1% vs. 86.3%; p < 0.025); articles written by a primary author who was American (69.4% vs. 44.6%; p < 0.001); and articles with a primary category of investigation that had a nonvascular intervention focus (22.7% vs. 11.9%; p < 0.001). Variables that demonstrated a statistically significant increase from the early data set to the late data set included primary authors from Western Europe (18.0% vs. 30.1%; p < 0.001) and Asia (6.6% vs. 18.4%; p < 0.001), the primary field of investigation, with significant increases noted for primary cancer interventions (6.5% vs. 13.3%; p < 0.001), gynecologic interventions (0.2% vs. 4.5%; p < 0.001), stent-grafts (0 vs. 2.9%; p < 0.001), and spine interventions (0 vs. 1.8%; p < 0.01). Studies receiving funding also demonstrated a significant increase when comparing the early and late data sets (11.3% vs. 23.0%, respectively; p < 0.001).

CONCLUSIONS

Articles published in the American radiologic literature have changed significantly over the past 10 years. Primary authors are more likely to be nonradiologists and less likely to be American. Investigations dealing primarily with nonvascular interventions are less common; however, some forms of intervention (particularly cancer interventions) are seen more frequently in the literature. The percentage of funded projects has more than doubled in the same time frame.

Interventional Radiology in Liver Transplantation

Radiology is a key specialty within a liver transplant program. Interventional techniques not only contribute to graft and recipient survival but also allow appropriate patient selection and ensure that recipients with severe liver decompensation, hepatocellular carcinoma or portal hypertension are transplanted with the best chance of prolonged survival. Equally inappropriate selection for these techniques may adversely affect survival. Liver transplantation is a dynamic field of innovative surgical techniques with a requirement for interventional radiology to parallel these developments. This paper reviews the current practice within a major European center for adult and pediatric transplantation.

The future of radiology research

The field of radiology has grown significantly over the past 25 years. This can in large part be attributed to advances in research and, indeed, the future of the field depends on this continued tradition. Although funding to radiology research has increased substantially in the past decade, much of the research is being carried out by researchers who are not radiologists, with research funding being distributed accordingly. There are clear indications that too few radiologists are performing research for a variety of reasons, including a shortage of time, training and manpower. At the same time, there are indications that radiologists-in-training (fellows, residents and medical students) are interested in a future dual clinical-research career. We review the issues pertinent to research in radiology, with a focus on interventional radiology, at a time when the fostering of research in radiology has become of paramount importance.

Ultrasound-Guided Biopsies: Tricks, Needle Tips, and Other Fine Points

Ultrasound (US)-guided biopsy of thyroid nodules, abdominal masses, liver masses, random core liver biopsies, as well as aspiration of abdominal or pleural fluid is now routine practice. The ability of US to guide biopsy of abnormalities seen on cross-sectional imaging studies is well recognized as an efficient and effective means of achieving a tissue diagnosis. Its use requires basic knowledge of US image analysis, but clinically useful intuitive and nonintuitive methods can enhance its strengths. The purpose of this review is to provide a practical guide to some of these tricks that may be useful in everyday clinical practice.