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Ghosn Y, Khdhir M, Jabbour Y, Dushfunian D, Kobeissi I, Abbas N, Akkari C, Kahwaji EM, Muallem N. Factors affecting radiation dose, radiation exposure time and procedural time in arterial embolization for active hemorrhage. Emerg Radiol 2024:10.1007/s10140-024-02262-w. [PMID: 38955874 DOI: 10.1007/s10140-024-02262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To evaluate patient and procedure-related factors contributing to the radiation dose, cumulative fluoroscopy time (CFT), and procedural time (PT) of Arterial Embolization (AE) for suspected active bleeding. METHODS Data on patients who underwent AE for suspected bleeding was retrospectively gathered between January 2019 and April 2022. Data collected included the dependent variables consisting of dose-area product (DAP), CFT, PT, and independent variables consisting of demographic, bleeding-specific, and procedure-specific parameters. All statistical computations were performed in SPSS statistics. The alpha value was set at 0.05. RESULTS Data from a total of 148 AE were collected with an average patient's age of 61.06 ± 21.57 years. Higher DAP was independently associated with male sex (p < 0.002), age ranges between 46 and 65 years (p = 0.019) and > 66 years (p = 0.027), BMI above 30 (p = 0.016), attending with less than 10 years of experience (p = 0.01), and bleeding in the abdomen and pelvis (p = 0.027). Longer CFT was independently associated with attending with less than 10 years of experience (p < 0.001), having 2 (p = 0.004) or > 3 (p = 0.005) foci of bleed, and age between 46 and 65 years (p = 0.007) and ≥ 66 years (p = 0.017). Longer PT was independently associated with attending with less than 10 years of experience (p < 0.001) and having 2 (p = 0.014) or > 3 (p = 0.005) foci of bleed. CONCLUSION The interventionist experience influenced radiation dose, CFT and PT. Dose was also affected by patients' sex, age, BMI, as well as bleeding location. CFT was also affected by patients' age, and both CFT and PT were also affected by the number of bleeding foci. These findings highlight the multifaceted factors that affect radiation dose and procedural time, emphasizing the importance of interventionist expertise, patient's age, sex, BMI, location and number of bleeds.
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Affiliation(s)
- Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O.Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Mihran Khdhir
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - Yara Jabbour
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O.Box 11-0236, Beirut, 1107 2020, Lebanon
| | - David Dushfunian
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Iyad Kobeissi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nada Abbas
- American University of Beirut, Beirut, Lebanon
| | - Chantal Akkari
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O.Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Eva-Maria Kahwaji
- Faculty of Health Science, American University of Berirut, Beirut, Lebanon
| | - Nadim Muallem
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O.Box 11-0236, Beirut, 1107 2020, Lebanon.
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Appeadu M, Rosales R, Sherman AL, Irwin R, Tiozzo E, Price C. Interventional Spine Course: Improving Fluoroscopic Safety and Procedural Efficacy Among Physical Medicine and Rehabilitation Residents Using a Lecture and Model-Based Curriculum. Am J Phys Med Rehabil 2023; 102:625-629. [PMID: 36729909 DOI: 10.1097/phm.0000000000002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Therapeutic interventional techniques using fluoroscopy are often used in the management of spinal pain. Currently, there are no standardized means of instruction and assessment of fluoroscopic interventional spinal procedures for physiatry trainees. The aim of our study is to evaluate the utility of an interventional spine training course for physical medicine and rehabilitation residents in improving safety and efficacy when performing these procedures. We performed a prospective multiple cohort study analyzing interventional spine knowledge and procedural ability among physical medicine and rehabilitation residents after implementing a training course that used lectures, hands-on training, and video-recorded objective structured clinical examination self-assessments. Of the total of 28 physical medicine and rehabilitation residents over the 2-yr study period, each class saw a statistically significant improvement in mean objective structured clinical examination scores from pre-examination to postexamination ( P < 0.05). Written examination scores also had a statistically significant preimprovement to postimprovement in the postgraduate years 2 and 3 classes. Our study supports the use of an interventional spine course for physical medicine and rehabilitation residents, and by following the existing cohorts and adding more cohorts in the future, we will continue to demonstrate valuable and comprehensive results.
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Affiliation(s)
- Michael Appeadu
- From the Department of Physical Medicine and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
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Braun VPB, Nunninger M, Hamm B, Scheel M, Jahnke P. Training of CT-guided Periradicular Therapy in a Realistic Simulation Environment - Evaluation and Recommendations for a Training Curriculum. Acad Radiol 2021; 28:1296-1303. [PMID: 32807605 DOI: 10.1016/j.acra.2020.07.021] [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] [Received: 05/25/2020] [Revised: 07/07/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the training of computed tomography (CT)-guided periradicular therapy in a realistic simulation environment and to derive recommendations for a training curriculum. MATERIALS AND METHODS A novel simulation environment including the use of a 3D printed, patient-mimicking phantom was used to train medical students to perform CT-guided periradicular therapy of the lumbar spine. Seventeen participants underwent three training sessions (day 0, day 7, and after day 28) with six procedures per session. Procedure duration and the number of fluoroscopy image acquisitions were recorded. Participants' performance was assessed by an independent investigator using a six-point checklist scale (0 = lowest, 6 = highest). In addition, participants self-evaluated their skills and the simulation training in questionnaires. RESULTS Procedure durations and image acquisitions decreased after one training session (p < 0.001) without further improvement thereafter (p > 0.6). They also decreased within training sessions and were lowest after five procedures in all sessions. Performance scores improved after the first session to nearly perfect scores in the second session (mean 5.7; 95%CI: 5.5-6.0; p < 0.001) and decreased again in the third session (mean 4.9; 95%CI: 4.6-5.3; p = 0.008). Participants were satisfied with their training progress and felt adequately prepared to perform CT-guided periradicular therapies on patients after the training. CONCLUSION Simulation-based training of CT-guided periradicular therapy in a realistic environment is effective and should ideally be performed with one training session consisting of five procedures shortly before treating the first patient.
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Affiliation(s)
- Victor Paul Bela Braun
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Maximilian Nunninger
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Paul Jahnke
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
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Negroni D, Cassarà A, Trisoglio A, Soligo E, Berardo S, Carriero A, Stecco A. Learning curves in radiological reporting of whole-body MRI in plasma cell disease: a retrospective study. Radiol Med 2021; 126:1451-1459. [PMID: 34309766 PMCID: PMC8558285 DOI: 10.1007/s11547-021-01391-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/25/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND The plasma cell disease is been studying by the whole-body MRI technology. However, the time requested to learn this radiological technique is unknown. PURPOSE To esteem, quantitatively and qualitatively, the essential time to learn the whole-body MRI diffusion-weighted imaging with background body signal suppression in patients with plasma cell disease. MATERIALS AND METHODS Between January 2015 and February 2017, three readers in-training with different levels of experience examined the anonymised and randomised whole-body MRI images of 52 patients with a diagnosis of plasma cell disease and analysed their morphological (T1w, T2w with and without fat suppression) and functional sequences. Reports of an expert radiologist were considered the standard of reference. Images were analysed in two sessions, during which each reader was timed. Readers reported the number of segments with lesions and staged the disease using the Durie-Salmon PLUS staging system. Weighted Cohen's ĸ and Z-test were used to compare the trainees' reports with those of the expert radiologist, and learning curves were drawn up to show changes between the two sessions. RESULTS Weighted Cohen's ĸ of number of lesioned segments increased from 0.536 ± 0.123 to 0.831 ± 0.129 (Prob > Z under 0.005), thus approaching the goal of ĸ > 0.8. Trainees reached the level of experienced radiologist in terms of time by the 33rd patient. Agreement concerning the Durie-Salmon PLUS increased from 0.536 ± 0.123 to 0.831 ± 0.129 (Prob > Z under 0.005). CONCLUSIONS The findings of this study demonstrate that whole-body MRI with DWIBS can be learned in about 80 reports and leads to a high level of inter-observer concordance when using the Durie-Salmon PLUS staging system.
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Affiliation(s)
- Davide Negroni
- AOU Maggiore Hospital, Via 2 Giugno 12, Galliate, 28066, Novara, Italy.
| | | | | | | | - Sara Berardo
- AOU Maggiore Hospital, Via 2 Giugno 12, Galliate, 28066, Novara, Italy
| | | | - Alessandro Stecco
- AOU Maggiore Hospital, Via 2 Giugno 12, Galliate, 28066, Novara, Italy
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Jibri ZA, Hibbert RM, Rakhra KS. Cadaveric Simulation Training Improves Residents' Knowledge and Confidence in Performing Fluoroscopic Guided Joint Injections. Acad Radiol 2021; 28:877-882. [PMID: 32739075 DOI: 10.1016/j.acra.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVE Simulation training has been strongly encouraged to enhance radiology trainees' procedural competency. We aimed to assess whether a cadaveric simulation training session was effective in improving radiology residents' subjective technical ability, knowledge and confidence in performing fluoroscopic-guided joint injections. METHODS As part of the residency program's procedural training curriculum, first year radiology resident participated in a cadaveric, musculoskeletal injection training session including a didactic lecture followed by a practical hands-on component. Trainees performed fluoroscopic guided hip and shoulder injections on fresh cadavers, supervised by two fellowship-trained musculoskeletal radiologists. Trainees' knowledge on indications, contraindications, preprocedural care, complications, and technical ability in performing the procedures, as well as their rating of overall session experience were evaluated with pre- and post-session questionnaires (5 point Likert-scale). The mean residents' scores for pre- and post-session questionnaire items were calculated and compared using paired t-test. The magnitude of difference between mean pre- and post-session scores was compared between the items using analysis of variance. RESULTS Results Over a 5-year period, 27 trainees participated in the joint injection simulation session. The mean pre- and post-session scores were significantly higher in the post session questionnaire for all five items pertaining to knowledge of indications, contraindications, preprocedural care, complications, and technical ability (all p < 0.0001). The magnitude of improvement was not different between the items (p = 0.45). Most of the participants rated the training facilities, contents, hands-on experience, teaching quality, and session organization as very good or excellent. CONCLUSIONS Cadaveric joint injection simulation training significantly improved trainees' subjective knowledge, confidence, and technical ability in performing joint injections.
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Silva V, Martínez L, Santiago M, López A, Sánchez J, Vázquez-Garza E, Cantú F, García B, Chora D, Guerra M, Franco-Cabrera M. Interventional pain training using phantom model during COVID-19 pandemic. Pain Pract 2021; 21:984-990. [PMID: 33934501 PMCID: PMC8236913 DOI: 10.1111/papr.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
Background Fluoroscopic‐guided lumbar procedures have increased in daily pain practice because the lumbar spine is one of the most common sources of pain. Interventional pain fellows must develop a minimum number of skills during their training in order to achieve the competences without neglecting radiological safety. However, medical training in fluoroscopic‐guided interventions is being affected by the current coronavirus disease 2019 (COVID‐19) situation. Methods The objective of this study was to evaluate the use of a phantom model for lumbar injection as a training strategy during the COVID‐19 pandemic in fellows of interventional pain. The study was divided into theoretical and practical modules. The hands‐on practice was performed in a lumbar model phantom where fellows were evaluated in four fluoroscopically guided approaches: intra‐articular facet block (IAFB), medial branch block (MBB), transforaminal block (TFB), and interlaminar block (ILB) divided in 5 sessions. The aim was to make as many punctures as possible in every session. We measured total procedural performance (TPP), total needle hand time (TNH), and total radiation dose generated by the fluoroscopic machine (TRD) during each procedure. Additionally, a survey was applied to evaluate confidence and satisfaction before and after training. Results A total of 320 lumbar punctures were completed. The results were statistically significant in all approaches attempted (p < 0.01). The fellow’s survey for satisfaction and confidence demonstrated a significant difference between pre and post‐test (p < 0.01). Conclusions The results of this study highlight the importance of adaptations and adoption of new educational models. The use of the phantom model for simulation could be a strategy for other emerging situations, like the COVID‐19 pandemic. Including this practice in the interventional pain programs could lead to better results for the patient and operator radiology safety.
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Affiliation(s)
- Victor Silva
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Luis Martínez
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Margarita Santiago
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Anna López
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Juan Sánchez
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Eduardo Vázquez-Garza
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Fernando Cantú
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Baltazar García
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Daniel Chora
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - Miguel Guerra
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
| | - María Franco-Cabrera
- Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México
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Tenewitz C, Le RT, Hernandez M, Baig S, Meyer TE. Systematic review of three-dimensional printing for simulation training of interventional radiology trainees. 3D Print Med 2021; 7:10. [PMID: 33881672 PMCID: PMC8059217 DOI: 10.1186/s41205-021-00102-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
RATIONALE AND OBJECTIVES Three-dimensional (3D) printing has been utilized as a means of producing high-quality simulation models for trainees in procedure-intensive or surgical subspecialties. However, less is known about its role for trainee education within interventional radiology (IR). Thus, the purpose of this review was to assess the state of current literature regarding the use of 3D printed simulation models in IR procedural simulation experiences. MATERIALS AND METHODS A literature query was conducted through April 2020 for articles discussing three-dimensional printing for simulations in PubMed, Embase, CINAHL, Web of Science, and the Cochrane library databases using key terms relating to 3D printing, radiology, simulation, training, and interventional radiology. RESULTS We identified a scarcity of published sources, 4 total articles, that appraised the use of three-dimensional printing for simulation training in IR. While trainee feedback is generally supportive of the use of three-dimensional printing within the field, current applications utilizing 3D printed models are heterogeneous, reflecting a lack of best practices standards in the realm of medical education. CONCLUSIONS Presently available literature endorses the use of three-dimensional printing within interventional radiology as a teaching tool. Literature documenting the benefits of 3D printed models for IR simulation has the potential to expand within the field, as it offers a straightforward, sustainable, and reproducible means for hands-on training that ought to be standardized.
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Affiliation(s)
- Chase Tenewitz
- Mercer University School of Medicine, Savannah, GA, USA.
| | - Rebecca T Le
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Saif Baig
- UF Health Jacksonville, Jacksonville, FL, USA
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Antas JDS, de Holanda AKG, Andrade ADS, de Araujo AMS, Costa IGDC, Dantas LR, de Lima SKM, Sarmento PLDFA. Arteriovenous anastomosis learning curve using low cost simulator. J Vasc Bras 2020; 19:e20190144. [PMID: 34211509 PMCID: PMC8218093 DOI: 10.1590/1677-5449.190144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background In order to reduce difficulties with learning surgical techniques, supplementary tools for training were developed. This paper describes the learning curve followed by student volunteer research subjects who used an alternative model for practicing vascular anastomosis. Objectives To evaluate the vascular anastomosis technique learning curve and development of manual skills using a low-cost experimental model. Methods Experimental and prospective study using end-to-side vascular anastomosis in latex balloons over five successive phases, initiated after theoretical and practical guidance given by experienced vascular surgeon. The study subjects were six undergraduate medical students from Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil, in their third to fifth years of the course. Cluster analysis was used to interpret the data collected on the quality of anastomoses and the time taken. Results The time taken to perform anastomosis reduced for all students, with statistical differences from phase 1 compared to phases 4 and 5. There was also a trend to increasing scores on the quality index as the phases progressed. However, no statistical differences were detected using the Friedman test, which is appropriate for data measured with ordinal levels (quality was assessed on a scale of 1 to 5). Conclusions It was found that the training model used was effective for increasing learning of this technique. It is believed that future studies with larger samples or a higher number of phases could demonstrate both reduced time and improved quality of the anastomoses performed with statistical significance.
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Affiliation(s)
- Jéssika da Silva Antas
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
| | - Ana Karolina Gama de Holanda
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
| | - Achilles de Sousa Andrade
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
| | | | | | - Luciano Ribeiro Dantas
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
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Maudgil DD. Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology. Clin Radiol 2020; 76:185-192. [PMID: 33081990 PMCID: PMC7568486 DOI: 10.1016/j.crad.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
Healthcare expenditure is continually increasing and projected to accelerate in the future, with an increasing proportion being spent on interventional radiology. The role of cost effectiveness studies in ensuring the best allocation of resources is discussed, and the role of National Institute of Health and Care Excellence (NICE) in determining this. Issues with demonstrating cost effectiveness have been discussed, and it has been found that there is significant scope for improving cost effectiveness, with suggestions made for how this can be achieved. In this way, more patients can benefit from better treatment given limited healthcare budgets.
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Affiliation(s)
- D D Maudgil
- Radiology Department, Wexham Park Hospital, Frimley Health Foundation Trust, Wexham Street, Slough, Berks, SL2 4HL, UK.
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Theilig D, Mayerhofer A, Petschelt D, Elkilany A, Hamm B, Gebauer B, Geisel D. Impact of interventionalist's experience and gender on radiation dose and procedural time in CT-guided interventions-a retrospective analysis of 4380 cases over 10 years. Eur Radiol 2020; 31:569-579. [PMID: 32851446 PMCID: PMC8263432 DOI: 10.1007/s00330-020-07185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/30/2020] [Accepted: 08/12/2020] [Indexed: 11/09/2022]
Abstract
Objectives To investigate the impact of the interventionalist’s experience and gender on radiation dose and procedural time in CT-guided interventions. Methods We retrospectively analyzed 4380 CT-guided interventions performed at our institution with the same CT scanner from 2009 until 2018, 1287 (29%) by female and 3093 (71%) by male interventionalists. Radiation dose, number of CT fluoroscopy images taken per intervention, total procedural time, type of intervention, and degree of difficulty were derived from the saved dose reports and images. All 16 interventionalists included in this analysis performed their first CT-guided interventions during the study period, and interventions performed by each interventionalist were counted to assess the level of experience for each intervention in terms of the number of prior interventions performed by her or him. The Mann-Whitney U test (MWU test), multivariate regression, and linear mixed model analysis were performed. Results Assessment of the impact of gender with the MWU test revealed that female interventionalists took a significantly smaller number of images (p < 0.0001) and achieved a lower dose-length product per intervention (p < 0.0001) while taking more time per intervention (p = 0.0001). This finding was confirmed for most types of interventions when additionally accounting for other possible impact factors in multivariate regression analysis. In linear mixed model analysis, we found that radiation dose, number of images taken per intervention, and procedural time decreased statistically significantly with interventionalist’s experience. Conclusions Radiation doses of CT-guided interventions are reduced by interventionalist’s experience and, for most types of interventions, when performed by female interventionalists. Key Points • Radiation doses in CT-guided interventions are lower when performed by female interventionalists. • Procedural times of CT-guided interventions are longer when performed by female interventionalists. • Radiation doses of CT-guided interventions decrease with the interventionalist’s experience. Electronic supplementary material The online version of this article (10.1007/s00330-020-07185-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorothea Theilig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Anna Mayerhofer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Petschelt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aboelyazid Elkilany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
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Díez N, Pacheco S, Llorente M, Fernández S. Validation of a Sensor-Fitted Simulator for Upper Airway Examination. Otolaryngol Head Neck Surg 2020; 164:339-345. [PMID: 32689875 DOI: 10.1177/0194599820941017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To validate a simulator for upper airway examination, fitted with sensors, for use as an academic tool for learning how to conduct examination of the upper airway and for evaluation of that learning. STUDY DESIGN Validation study. SETTING Undergraduate medical education. SUBJECTS AND METHODS A group of 18 fifth-year medical students and another of 6 otorhinolaryngology specialists conducted 6 examinations each with the simulator. To investigate concurrent validity, we calculated the correlation between damage scores provided by the simulator and damage assessment by a specialist. To evaluate construct validity, we compared both groups with regard to damage scores, technical procedure, and time spent. To examine content and face validity, we used questionnaires based on a 5-point Likert scale. RESULTS For concurrent validity, the correlation between the simulator's damage scores and the specialist's damage assessment was high: Spearman's ρ was 0.828 (P < .001). For construct validity, the group of students differed from the group of specialists in damage scores (P = .027) and in technical procedures (P < .001) but not in time spent. For content validity, all questionnaire statements were scored highly, and both groups had similar average scores. For face validity, the group of specialists considered the simulator to be realistic, and all statements on the questionnaire were rated with at least 4/5. CONCLUSION Concurrent, construct, content, and face validity have been demonstrated for a sensor-fitted simulator for upper airway examination, which is therefore accurate enough to be used as an academic tool for learning and evaluation of learning.
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Affiliation(s)
- Nieves Díez
- Simulation Center, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Sofía Pacheco
- Simulation Center, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Marcos Llorente
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Secundino Fernández
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
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Zorn C, Bauer E, Feffer ML, Moerschel E, Bierry G, Choquet P, Dillenseger JP. Building and Exploitation of Learning Curves to Train Radiographer Students in X-Ray CT Image Postprocessing. J Med Imaging Radiat Sci 2020; 51:173-181. [PMID: 32057745 DOI: 10.1016/j.jmir.2019.11.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/08/2019] [Accepted: 11/19/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aims to construct learning curves related to the realization of standardized postprocessing by radiographer students and to discuss their exploitation and interest. MATERIALS AND METHODS This study was carried out in 21 French students in their 3rd year of training. Two postprocessing protocols in CT (#1 traumatic shoulder; #2 petrous bone) were repeated 15 times by each student. Each achievement was timed to obtain overall learning curves. The realization accuracy was also assessed for each student at each repetition. RESULTS The learning rates for the two protocols are 63% and 56%, respectively. The number of repetitions to reach the reference time for each protocol is 11 and 12, respectively. In both protocols, the standard deviations are significantly reduced and stabilized during repetitions. The mean accuracy progresses more quickly in protocol #1. DISCUSSION The measured learning rates reflect a rapid learning process for each protocol. The analysis of the standard deviations shows that students have reached a homogeneous level. The average times and accuracies measured during the last repetitions show that the group has reached a high level of performance. Building learning curves helps students measure their progress and motivates them. CONCLUSION Obtaining learning curves allows trainers/supervisors to qualify the learning difficulty of a task while motivating students/radiographers. The use of learning curves is inline with the competency-based training paradigm.
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Affiliation(s)
- Claudine Zorn
- Section Imagerie Médicale et Radiologie Thérapeutique, Lycée Jean Rostand, Académie de Strasbourg, Strasbourg, France; Comité scientifique de l'Association Française du Personnel Paramédical d'Electroradiologie Médicale (AFPPE), Montrouge, Paris, France
| | - Eric Bauer
- Section Imagerie Médicale et Radiologie Thérapeutique, Lycée Jean Rostand, Académie de Strasbourg, Strasbourg, France
| | - Marie-Laurence Feffer
- Section Imagerie Médicale et Radiologie Thérapeutique, Lycée Jean Rostand, Académie de Strasbourg, Strasbourg, France
| | - Elisabeth Moerschel
- Section Imagerie Médicale et Radiologie Thérapeutique, Lycée Jean Rostand, Académie de Strasbourg, Strasbourg, France
| | - Guillaume Bierry
- Pôle d'imagerie médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France
| | - Philippe Choquet
- Pôle d'imagerie médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; ICube - UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France
| | - Jean-Philippe Dillenseger
- Section Imagerie Médicale et Radiologie Thérapeutique, Lycée Jean Rostand, Académie de Strasbourg, Strasbourg, France; Comité scientifique de l'Association Française du Personnel Paramédical d'Electroradiologie Médicale (AFPPE), Montrouge, Paris, France; Pôle d'imagerie médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Weyland CS, Hemmerich F, Möhlenbruch MA, Bendszus M, Pfaff JAR. Radiation exposure and fluoroscopy time in mechanical thrombectomy of anterior circulation ischemic stroke depending on the interventionalist’s experience—a retrospective single center experience. Eur Radiol 2019; 30:1564-1570. [DOI: 10.1007/s00330-019-06482-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022]
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Javan R, Ellenbogen AL, Greek N, Haji-Momenian S. A prototype assembled 3D-printed phantom of the glenohumeral joint for fluoroscopic-guided shoulder arthrography. Skeletal Radiol 2019; 48:791-802. [PMID: 29948036 DOI: 10.1007/s00256-018-2979-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the methodology of constructing a three-dimensional (3D) printed model of the glenohumeral joint, to serve as an interventional phantom for fluoroscopy-guided shoulder arthrography training. MATERIALS AND METHODS The osseous structures, intra-articular space and skin surface of the shoulder were digitally extracted as separate 3D meshes from a normal CT arthrogram of the shoulder, using commercially available software. The osseous structures were 3D-printed in gypsum, a fluoroscopically radiopaque mineral, using binder jet technology. The joint capsule was 3D printed with rubber-like TangoPlus material, using PolyJet technology. The capsule was secured to the humeral head and glenoid to create a sealed intra-articular space. A polyamide mold of the skin was printed using selective laser sintering. The joint was stabilized inside the mold, and the surrounding soft tissues were cast in silicone of varying densities. Fluoroscopically-guided shoulder arthrography was performed using anterior, posterior, and rotator interval approaches. CT arthrographic imaging of the phantom was also performed. RESULTS A life-size phantom of the glenohumeral joint was constructed. The radiopaque osseous structures replicated in-vivo osseous corticomedullary differentiation, with dense cortical bone and less dense medullary cancellous bone. The glenoid labrum was successfully integrated into the printed capsule, and visualized on CT arthrography. The phantom was repeatedly used to perform shoulder arthrography using all three conventional approaches, and simulated the in vivo challenges of needle guidance. CONCLUSIONS 3D printing of a complex capsule, such as the glenohumeral joint, is possible with this technique. Such a model can serve as a valuable training tool.
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Affiliation(s)
- Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
| | - Amy L Ellenbogen
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA
| | - Nicholas Greek
- Clinical Learning and Simulation Skills (CLASS) Center, George Washington University School of Medicine, 2300 I (Eye) Street, NW, Ross Hall 405, Washington, DC, USA
| | - Shawn Haji-Momenian
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA
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Walker MA, MacCormick MR, Kilkenny JJ, Phillips J, Singh A, zur Linden A. Visuospatial skills are better predictors than dexterity for basic ultrasonographic and fluoroscopic skills in veterinary students. Vet Radiol Ultrasound 2018; 60:81-92. [DOI: 10.1111/vru.12678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/30/2018] [Accepted: 06/20/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Meagan A. Walker
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
| | - Mathew R.A MacCormick
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
| | - Jessica J. Kilkenny
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
| | - John Phillips
- College of Arts; University of Guelph; Guelph Ontario Canada
| | - Ameet Singh
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
| | - Alex zur Linden
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
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