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Harbron RW. Review of IAEA Human Health Series report 42: Establishing and Improving Interventional Radiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:017002. [PMID: 38329017 DOI: 10.1088/1361-6498/ad2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Richard W Harbron
- Newcastle University, Newcastle upon Tyne, United Kingdom
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
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Sharma P, Shah R, Zavaletta V, Bertino F, Sankhla T, Kim JM, Leshen M, Shah J. Pediatric Transplant Interventions. Tech Vasc Interv Radiol 2023; 26:100930. [PMID: 38123288 DOI: 10.1016/j.tvir.2023.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The field of pediatric organ transplantation has grown significantly in recent decades, with interventional radiology (IR) playing an essential role in managing pre and post-transplant complications. Pediatric transplant patients face unique challenges compared to adults, including donor-recipient size mismatch, and complications of a growing child with changing physiology. Interventional radiologists play a major role in pediatric renal and liver transplant. IR interventions begin early in the child's pretransplant journey, with diagnostic procedures such as biopsies, angiograms, and cholangiograms. These procedures are essential for understanding the etiology of organ failure and identifying potential transplant candidates. Minimally invasive therapeutic procedures may serve as bridges to transplant and may include vascular access optimization for hemodialysis, transjugular intrahepatic portosystemic shunts (TIPS) creation, and tumor embolization or ablation. After transplant, image-guided biopsies for the surveillance of graft rejection and treatment of vascular or luminal stenoses, pseudoaneurysms, and anastomotic leaks can maintain the function and longevity of the transplant organ. Careful consideration must be given to patient size and evolving anatomy, radiation exposure, and the need for deeper sedation for pediatric patients. Despite these challenges, the integration of IR in pediatric transplant care has proven beneficial, offering minimally invasive alternatives to surgery, faster recovery times, and improved outcomes.
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Affiliation(s)
- Pareena Sharma
- Medical College of Georgia, Augusta University, Augusta, GA
| | - Ritu Shah
- Seth G.S Medical College and K.E.M Hospital, Mumbai, Maharashtra, India
| | - Vaz Zavaletta
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Frederic Bertino
- Department of Radiology, Interventional Radiology Section, NYU Langone Health/NYU Grossman School of Medicine, New York, NY
| | - Tina Sankhla
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jun Man Kim
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Leshen
- Department of Radiology, Division of Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Jay Shah
- Department of Radiology, Division of Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, GA; Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA.
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Morcillo AB, Huerga C, Bayón J, López A, Corredoira E, Hernández T, Novo JR, Ponce MD, Fernández L, Rodríguez R, Garzón G, Vañó E, Guibelalde E, Alejo L. ASSESSMENT OF OCCUPATIONAL EXPOSURE IN THE MAIN PAEDIATRIC INTERVENTIONAL RADIOLOGY PROCEDURES. RADIATION PROTECTION DOSIMETRY 2022; 198:386-392. [PMID: 35512690 DOI: 10.1093/rpd/ncac064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/07/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
The aim of this study is to evaluate the personal dose equivalent Hp(10) in the most frequent (non-cardiac) paediatric interventional radiology (PIR) procedures: central venous catheters (CVC), hepatic/biliary and sclerotherapy interventions. i2 active solid-state dosemeters placed over the lead apron were used to monitor the exposure of three interventional radiologists over 18 months. A database was created to register all procedures performed by each radiologist (including the type of procedure and the kerma-area product, PKA). The mean Hp(10) per procedure for CVC, sclerotherapy and hepatic/biliary interventions was respectively 0.01 ± 0.01 mSv, 0.18 ± 0.13 mSv and 0.12 ± 0.06 mSv (k = 2). A similar value of Hp(10)/PKA was found despite the type of procedure or the patient weight (~10 μSv/Gy·cm2). There was high variability among individual interventions, probably due to the variable level of complexity, which led to uncertainties in the measurements' mean higher than those associated with the dosemeter's angular and energy dependence. i2 therefore proved suitable for monitoring Hp(10) in PIR procedures.
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Affiliation(s)
- Ana B Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Antonio López
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Joan R Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María D Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucía Fernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ricardo Rodríguez
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
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Harilal S, Mangray H, Madziba S, Ghimenton F. Isolated vascularized gastric tube biliary enteric drainage: a paediatric case series experience. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00122-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite the enormous surgical advancements in the last century, access to the biliary system is lost when a Roux-en-Y (RY) biliary drainage procedure is performed. Attempts have been made to overcome this inconvenient sequel using variations in the RY anastomosis, small bowel grafts and vascular grafts. These have been predominantly unsuccessful. An isolated vascularized gastric tube (IVGT) graft has been reported in the literature, which was successfully used for adult patients with common bile duct injuries. We have adopted the technique of using an IVGT graft for bile duct reconstruction in the paediatric patients at our institution. We reviewed our experience at our institution between January 2015 and October 2019. This was a retrospective review of all paediatric patients undergoing an IVGT graft procedure for biliary tract anatomical obstruction in the past 5 years. We looked at the indications for surgery, the demographic profile of the patients and outcomes following surgery and outlined the surgical technique used.
Results
IVGT bile duct reconstruction was performed on eight patients. Patients ranged from 2 months to 7 years, and there was an equal number of males and females. The diagnosis was made on clinical suspicion and confirmed with ultrasound (U/S) and magnetic resonance cholangiopancreatography (MRCP). There was an 87.5% resolution of biliary obstruction, and two patients who had bile leaks postoperatively were managed conservatively. Unfortunately, one patient died in the early postoperative period from sepsis due to pneumonia. Follow-up was for a minimum of 6 months and up to 5 years.
Conclusion
IVGT biliary enteric drainage is a safe, reproducible procedure that allows access to the biliary tree if required in the future. Thus, this procedure serves as an alternative, especially in limited-resource areas where interventional radiology is not available for future interventions.
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Morcillo AB, Alejo L, Huerga C, Bayón J, Obesso A, Corredoira E, Novo JR, Hernández T, Ponce MD, Fernández L, Rodríguez R, Garzón G, Vañó E, Guibelalde E. Local diagnostic reference levels for paediatric non-cardiac interventional radiology procedures. Phys Med 2020; 72:1-6. [PMID: 32179406 DOI: 10.1016/j.ejmp.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/08/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To establish local diagnostic reference levels (DRLs) for non-cardiac interventional procedures in paediatrics. METHODS The type of procedure, the patient's weight and age and dose-related data from 279 interventions was recorded in a database completed by interventional radiologists, radiographers and technicians of the Medical Physics department. These procedures were classified into 14 categories and 6 weight ranges. Local DRLs were proposed for those ranges in which a sample of at least 15 patients could be gathered and were calculated as the third quartile (Q3) of the air kerma-area product (PKA) values. The Q3 of the fluoroscopy time (FT) and number of digital subtraction angiography (DSA) images were also obtained. Finally, the correlation between PKA and weight was analysed. RESULTS Local DRLs are proposed for three types of procedures: hepatic/biliary interventions (5-15 kg, 1304 cGy·cm2; 15-30 kg, 2121 cGy·cm2), sclerotherapy procedures (15-30 kg, 704 cGy·cm2; 30-50 kg, 4049 cGy·cm2; 50-80 kg, 3734 cGy·cm2) and central venous catheter (CVC) procedures (5-15 kg, 84 cGy·cm2). Hepatic/biliary interventions showed a moderate correlation (r = 0.61), while sclerotherapy procedures presented a poor correlation (r = 0.34) between PKA and weight, possibly due to the PKA dependence on the complexity level. Regarding CVC procedures, a clearly higher correlation was found when the fluoroscopy PKA value was normalised to the FT (r = 0.85 vs r = 0.35). CONCLUSIONS The results support the feasibility of establishing DRLs for the most common procedures (sclerotherapy, hepatic/biliary and CVC interventions) despite the small number of paediatric interventions.
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Affiliation(s)
- Ana Belén Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Alba Obesso
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Joan Ricardo Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Dolores Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucía Fernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ricardo Rodríguez
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
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Thorpe NK, Cutajar D, Lian C, Pitney M, Friedman D, Perevertaylo V, Rosenfeld A. A comparison of entrance skin dose delivered by clinical angiographic c-arms using the real-time dosimeter: the MOSkin. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:423-30. [DOI: 10.1007/s13246-016-0435-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/06/2016] [Indexed: 10/21/2022]
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