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Mills AC, Goldman DT, Marinelli BS, Sanghvi J, Garcia-Reyes K, Shilo D, Nowakowski S, Patel RS, Patel RI, Kim E, Fischman AM, Lookstein RA, Bishay VL. Leveraging the virtual learning environment to enhance medical student engagement with interventional radiology. Clin Imaging 2023; 96:26-30. [PMID: 36738667 DOI: 10.1016/j.clinimag.2023.01.007] [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: 09/14/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate medical student engagement with Interventional Radiology (IR) before and after a virtual elective course. METHODS The elective was nine, one-hour lectures over ten weeks. An anonymous pre and post-course survey was administered to students. The hypothesis was that this course would increase student engagement with IR. Respondents answered nine questions to score their interest in, exposure to, familiarity with, and understanding of IR using a five-point Likert scale. Demographics were reported for the pre-course group only. A Wilcoxon signed-ranked test was performed to assess for significant mean change in pre and post-course responses. Among the 276 registered students, there were 144 individual, complete responses for the pre-course survey, and 60 paired responses for both surveys. RESULTS Thirty-seven percent of respondents were first or second year medical students. Thirty percent of participants were enrolled at an institution outside of the United States, 26% are the first in their family to attend college, and 41% identified as female. Thirty-six percent reported this virtual course was one of their earliest experiences with IR. There was a significant increase in student exposure to IR generally, familiarity with IR compared to other specialties, familiarity with the IR training pathway(s), understanding of what an Interventional Radiologist does, understanding of the difference between IR and Diagnostic Radiology, and understanding of when to consult IR for patient care after completion of the course. CONCLUSION A virtual IR elective is an effective means to increase exposure to, familiarity with, and understanding of IR.
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Affiliation(s)
- Ariana C Mills
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L., Levy Place, New York, NY 10029, United States of America.
| | - Daryl T Goldman
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Brett S Marinelli
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Jay Sanghvi
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L., Levy Place, New York, NY 10029, United States of America.
| | - Kirema Garcia-Reyes
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Dan Shilo
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Scott Nowakowski
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Rahul S Patel
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Rajesh I Patel
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Edward Kim
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Aaron M Fischman
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Robert A Lookstein
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
| | - Vivian L Bishay
- Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
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Sinha I, Goldman DT, Patel RS, Nowakowski FS. Endovascular Alternatives to Transhepatic Shunt Creation. Semin Intervent Radiol 2023; 40:73-78. [PMID: 37152800 PMCID: PMC10159693 DOI: 10.1055/s-0043-1767687] [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: 05/09/2023]
Abstract
Portomesenteric decompression is often necessary to treat patients with refractory symptoms of portal hypertension. When transjugular or direct intrahepatic portosystemic shunt creation is not feasible or is inadequate, surgical portosystemic shunt creation is considered, which carries significant morbidity and mortality in these high-risk patients. Surgery is further complicated in patients with portomesenteric thrombosis who require concurrent thrombectomy and long-term anticoagulation. In this article, we outline the technique for performing advanced endovascular alternatives to intrahepatic portosystemic shunt creation including mesocaval and splenorenal shunting. We will also discuss some of the clinical considerations for treating these patients with symptomatic portal hypertension and portomesenteric thrombosis.
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Affiliation(s)
- Ishan Sinha
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daryl T. Goldman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rahul S. Patel
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Francis S. Nowakowski
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Sinha I, Goldman DT, Patel RS, Nowakowski FS. Advanced Techniques for Accessing the Portal Vein during Transjugular Intrahepatic Portosystemic Shunt Creation. Semin Intervent Radiol 2023; 40:79-86. [PMID: 37152804 PMCID: PMC10159696 DOI: 10.1055/s-0043-1767688] [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: 05/09/2023]
Abstract
Transjugular portosystemic shunt (TIPS) placement is a widely accepted method for reducing portal pressures in conditions including symptomatic varices, refractory ascites, hepatic hydrothorax, portomesenteric thrombosis, and Budd-Chiari syndrome. The traditional method for performing TIPS involves "blind" access into a portal vein branch from a hepatic vein, typically right portal vein to right hepatic vein, using preoperative imaging and intraoperative wedged portography for guidance. However, standard access technique may not always be feasible due to occluded portal or hepatic veins, distorted anatomy, or prior TIPS. In this article we discuss alternative techniques for accessing the portal vein for TIPS placement when standard methods are not sufficient.
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Affiliation(s)
- Ishan Sinha
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daryl T. Goldman
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rahul S. Patel
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Francis S. Nowakowski
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Carlon TA, Goldman DT, Marinelli BS, Korff RA, Watchmaker JM, Patel RS, Lipson SD, Bishay VL, Lookstein RA. Contemporary Management of Acute Pulmonary Embolism: Evolution of Catheter-based Therapy. Radiographics 2022; 42:1861-1880. [PMID: 36190861 DOI: 10.1148/rg.220026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Acute pulmonary embolism (PE) affects more than 100 000 people in the United States annually and is the third leading cardiovascular cause of death. The standard management for PE is systemic anticoagulation therapy. However, a subset of patients experience hemodynamic decompensation, despite conservative measures. Traditionally, these patients have been treated with systemic administration of thrombolytic agents or open cardiac surgery, although attempts at endovascular treatment have a long history that dates back to the 1960s. The technology for catheter-based therapy for acute PE is rapidly evolving, with multiple devices approved over the past decade. Currently available devices fall into two broad categories of treatment methods: catheter-directed thrombolysis and percutaneous suction thrombectomy. Catheter-directed thrombolysis is the infusion of thrombolytic agents directly into the occluded pulmonary arteries to increase local delivery and decrease the total dose. Suction thrombectomy involves the use of small- or large-bore catheters to mechanically aspirate a clot from the pulmonary arteries without the need for a thrombolytic agent. A thorough understanding of the various risk stratification schemes and the available evidence for each device is critical for optimal treatment of this complex entity. Multiple ongoing studies will improve our understanding of the role of catheter-based therapy for acute PE in the next 5-10 years. A multidisciplinary approach through PE response teams has become the management standard at most institutions. An invited commentary by Bulman and Weinstein is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Timothy A Carlon
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Daryl T Goldman
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Brett S Marinelli
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Ricki A Korff
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Jennifer M Watchmaker
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Rahul S Patel
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Scott D Lipson
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Vivian L Bishay
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Robert A Lookstein
- From the Department of Diagnostic, Molecular, and Interventional Radiology (T.A.C., D.T.G., B.S.M., R.A.K., J.M.W., R.S.P., V.L.B., R.A.L.) and Department of Anesthesiology (S.D.L.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
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L McDevitt J, T Goldman D, J Bundy J, N Hage A, K Jairath N, J Gemmete J, N Srinivasa R, Chick JFB. Gianturco Z-stent placement for the treatment of chronic central venous occlusive disease: implantation of 208 stents in 137 symptomatic patients. ACTA ACUST UNITED AC 2021; 27:72-78. [PMID: 33090095 DOI: 10.5152/dir.2020.19282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the technical successes, adverse events, and long-term stent patency rates of Gianturco Z-stents for management of chronic central venous occlusive disease. METHODS Overall, 137 patients, with mean age 48.6±16.1 years (range, 16-89 years), underwent placement of Gianturco Z-stents for chronic central venous occlusions. Presenting symptoms included lower extremity edema (n=66, 48.2%), superior vena cava syndrome (n=30, 21.9%), unilateral upper extremity swelling (n=20, 14.6%), hemodialysis fistula or catheter dysfunction (n=11, 8.0%), ascites (n=8, 5.8%), and both ascites and lower extremity edema (n=2, 1.5%). Most common etiologies of central venous occlusion were prior central venous access placement (n=58, 42.3%), extrinsic compression (n=29, 21.2%), and post-surgical anastomotic stenosis (n=27, 19.7%). Number of stents placed, stent implantation location, stent sizes, technical successes, adverse events, need for re-intervention, follow-up evaluation, stent patencies, and mortality were recorded. Technical success was defined as recanalization and stent reconstruction with restoration of in-line venous flow. Adverse events were defined by the Society of Interventional Radiology Adverse Event Classification criteria. Primary and primary-assisted stent patencies were analyzed using Kaplan-Meier analysis. RESULTS In total, 208 Z-stents were placed. The three most common placement sites were the inferior vena cava (n=124, 59.6%), superior vena cava (n=44, 21.2%), and brachiocephalic veins (n=27, 13.0%). Technical success was achieved in 133 patients (97.1%). There were two (1.5%) severe adverse events (two cases of stent migration to the right atrium), one (0.7%) moderate adverse event, and one (0.7%) mild adverse event. Mean follow-up was 43.6±52.7 months. Estimated 1-, 3-, and 5-year primary stent patency was 84.2%, 84.2%, and 82.1%, respectively. Estimated 1-, 3-, and 5-year primary-assisted patency was 92.3%, 89.6%, and 89.6%, respectively. The 30- and 60- day mortality rates were 2.9% (n=4) and 5.1% (n=7), none of which were directly attributable to Z-stent placement. CONCLUSION Gianturco Z-stent placement is safe and effective for the treatment for chronic central venous occlusive disease with durable short- and long-term patencies.
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Affiliation(s)
- Joseph L McDevitt
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daryl T Goldman
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, New York, USA
| | - Jacob J Bundy
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Neil K Jairath
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Washington Medical Center, Seattle, Washington, USA
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Goldman DT, Bageac D, Mills A, Yim B, Yaeger K, Majidi S, Kellner CP, De Leacy RA. Transradial Approach for Neuroendovascular Procedures: A Single-Center Review of Safety and Feasibility. AJNR Am J Neuroradiol 2021; 42:313-318. [PMID: 33446499 DOI: 10.3174/ajnr.a6971] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In recent years, the transradial approach has become more widely adopted for neuroendovascular procedures. The purpose of this study was to evaluate the safety and feasibility of a transradial approach and distal transradial access for neuroendovascular procedures in a single center. MATERIALS AND METHODS Retrospective analysis was performed for all patients who underwent transradial approach or distal transradial access neuroendovascular procedures from January 2016 to August 2019 at a single center. Exclusion criteria included a Barbeau D waveform, a radial artery of <2 mm on sonographic evaluation, and known radial artery occlusion. Procedures were evaluated for technical success (defined as successful radial artery access and completion of the intended procedure without crossover to an auxiliary access site), complications, and adverse events during follow-up at 30 days. RESULTS The transradial approach or distal transradial access was attempted in 279 consecutive patients (58.1% women; median age, 57.7 years) who underwent 328 standard or distal transradial approach procedures. Two-hundred seventy-nine transradial approach and 49 distal transradial approach procedures were performed (cerebral angiography [n = 213], intracranial intervention [n = 64], head and neck intervention [n = 30], and stroke intervention [n = 21]). Technical success was 92.1%. Immediate adverse events (2.1%) included radial access site hematoma (n = 5), radial artery occlusion (n = 1), and acute severe radial artery spasm (n = 1). Thirty-day adverse events (0.3%) included a radial artery pseudoaneurysm (n = 1). Twenty-six cases (7.9%) required crossover to transfemoral access. CONCLUSIONS The transradial approach for neuroendovascular procedures is safe and feasible across a wide range of neuroendovascular interventions.
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Affiliation(s)
- D T Goldman
- From the Departments of Radiology (D.T.G., R.A.D.L.)
| | - D Bageac
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - A Mills
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - B Yim
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - K Yaeger
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - S Majidi
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - C P Kellner
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - R A De Leacy
- From the Departments of Radiology (D.T.G., R.A.D.L.)
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
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Goldman DT, Sharma H, Finkelstein M, Carlon T, Marinelli B, Doshi AH, Delman BN, Lookstein R. The Role of Telemedicine in the Maintenance of IR Outpatient Evaluation and Management Volume During the COVID-19 Global Pandemic. J Vasc Interv Radiol 2020; 32:479-481. [PMID: 33509609 PMCID: PMC7834179 DOI: 10.1016/j.jvir.2020.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Daryl T Goldman
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Himanshu Sharma
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Mark Finkelstein
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Timothy Carlon
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Brett Marinelli
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Amish H Doshi
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Bradley N Delman
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Robert Lookstein
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY 10029
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Watchmaker JM, Goldman DT, Lee JY, Choi S, Mills AC, Toussie D, Finkelstein M, Sher AR, Jacobi AH, Bernheim AM, Chung MS, Eber CD, Lookstein RA. Increased Incidence of Acute Pulmonary Embolism in Emergency Department Patients During the COVID-19 Pandemic. Acad Emerg Med 2020; 27:1340-1343. [PMID: 33015866 PMCID: PMC7675433 DOI: 10.1111/acem.14148] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Jennifer M. Watchmaker
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Daryl T. Goldman
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Jun Yeop Lee
- the Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Seulah Choi
- the Icahn School of Medicine at Mount Sinai New York NYUSA
| | | | - Danielle Toussie
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Mark Finkelstein
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Alex R. Sher
- the Department of Surgery Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Adam H. Jacobi
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Adam M. Bernheim
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Michael S. Chung
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
- and theDepartment of Medicine Division of Cardiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Corey D. Eber
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
| | - Robert A. Lookstein
- From the Department of Diagnostic, Molecular and Interventional Radiology Icahn School of Medicine at Mount Sinai New York NYUSA
- the Department of Surgery Icahn School of Medicine at Mount Sinai New York NYUSA
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Martin JG, Goldman DT, Dabrowiecki AM, Newsome J, Bercu ZL, Gilliland C. Additional Magnetic Resonance or Nuclear Scintigraphy Imaging Influences Approach to Vertebral Augmentation: A Single Institution Experience. Spine (Phila Pa 1976) 2020; 45:E927-E932. [PMID: 32675605 DOI: 10.1097/brs.0000000000003420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To ascertain impact of preprocedural magnetic resonance imaging (MRI) or nuclear medicine Tc99m-DMP scintigraphy on the treatment plan when compared with plain films and/or computed tomography prior to vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA Over 1 million vertebral compression fractures (VCFs) occur in the United States annually with over 150,000 individuals hospitalized each year. Physical examination and history are essential to the workup of VCFs, but imaging remains necessary for confirming the diagnosis. VCFs can be imaged with various modalities and there is limited data on the comparative effectiveness of different imaging modalities. METHODS Six hundred fifty consecutive patients treated with vertebral augmentation at a single institution between May of 2013 and April of 2018 were reviewed. Preprocedure imaging of the spine obtained within 30 days prior to the procedure were reviewed. Preprocedure imaging results were cross-referenced against the levels treated by vertebral augmentation to determine whether there was a change in the levels treated after receiving an MRI or NM imaging study. RESULTS Three hundred sixty-three patients had adequate imaging for inclusion. One hundred fifty-four of these 363 patients (42.4%) had an alteration of their treatment plan based upon the MR or NM imaging. Fewer vertebral levels were treated in 33, different levels were treated in 41, and more levels were treated in 80 patients. CONCLUSION MRI or nuclear medicine bone scan imaging prior to vertebral augmentation altered the location and number of levels treated in a large percentage of patients, adding specificity to treatment over findings on radiographs or computed tomography alone. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jonathan G Martin
- Division of Interventional Radiology, Department of Radiology, Duke University, Durham, NC
| | - Daryl T Goldman
- Division of Interventional Radiology, Department of Radiology, Ichan School of Medicine at Mount Sinai, New York, NY
| | - Alexander M Dabrowiecki
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Janice Newsome
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Zachary L Bercu
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
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Goldman DT, Conway AM, Tran NN, Stoffels G, Vismer M, Giangola G, Carroccio A. Extreme obesity is associated with angulation during inferior vena cava filter placement. J Vasc Surg Venous Lymphat Disord 2020; 8:594-600. [PMID: 31926822 DOI: 10.1016/j.jvsv.2019.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/05/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Placement of inferior vena cava (IVC) filters can be complicated by venous injury, filter misplacement, angulation, insertion site injury, and procedure-related death. Currently, no studies exist evaluating the correlation between obesity and adverse outcomes of IVC filters. We aimed to assess the outcomes of IVC filter placement in the obese population using the Vascular Quality Initiative database. METHODS The Vascular Quality Initiative registry identified 7258 patients who underwent IVC filter placement from January 2013 to June 2017. Patients were divided into three groups based on their body mass index (BMI): normal/overweight (BMI <30), obese (BMI 30-40), and extremely obese (BMI >40). Periprocedural outcomes were analyzed. RESULTS The mean age was 63.6 ± 16.6 years and 3444 patients (47%) were female. BMI was less than 30 in 4115 (56.7%), 30 to 40 in 2148 (29.6%), and greater than 40 in 995 (13.7%) patients. A complication or IVC filter-related death occurred in 142 patients (2.6%). Adverse events included angulation (1.3%), IVC filter misplacement (0.5%), insertion site injury (0.3%), IVC filter-related death (0.1%), and venous injury (0.06%). In multivariable analysis, increased BMI was found to be associated with angulation (P = .03), but was not associated with IVC filter misplacement (P = .43), or any complication or IVC filter-related death (P = .22). A subgroup analysis of IVC filter placements using only fluoroscopy demonstrated that the risk of angulation was significantly higher in patients with a BMI of greater than 40 compared with a BMI of less than 30 (odds ratio, 2.12; 95% confidence interval, 1.07-4.21; P = .03). There was not enough evidence to conclude that BMI was associated with any other outcome. CONCLUSIONS IVC filter insertion has low complication rates. Increased BMI is associated with an increased risk of IVC filter angulation; there is no evidence of association between BMI and other periprocedural complications.
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Affiliation(s)
- Daryl T Goldman
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.
| | - Allan M Conway
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Nhan Nguyen Tran
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Guillaume Stoffels
- The Feinstein Institute for Medical Research, Northwell Health, New York, NY
| | - Marta Vismer
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Gary Giangola
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alfio Carroccio
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
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Goldman DT, Singh M, Patel RS, Nowakowski FS, Bishay V, Ranade M, Lookstein RA, Fischman AM. Balloon-Occluded Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma: A Single-Center US Preliminary Experience. J Vasc Interv Radiol 2019; 30:342-346. [PMID: 30819475 DOI: 10.1016/j.jvir.2018.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 01/03/2023] Open
Abstract
This report describes a single-center experience with balloon-occluded transarterial chemoembolization for liver-directed therapy. A total of 26 patients (11 male, 4 female; mean age, 65 y ± 7) with 28 tumors (mean diameter, 2.7 cm; range, 1.1-5.9 cm) were treated. Technical success rate was 100% (28 of 28 cases), with 1 minor complication of left portal vein thrombosis and small liver infarct. Of the 15 tumors analyzed for response, 60% (9 of 15) exhibited complete response, 33.3% (5 of 15) exhibited partial response, and 6.6% (1 of 15) had stable disease on follow-up. Eight patients exhibited overall progression with a new hepatic lesion and a median time to progression of 7.9 months (range, 5-11 mo).
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Affiliation(s)
- Daryl T Goldman
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave., MC Level, New York, NY 10029.
| | - Manu Singh
- Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Rahul S Patel
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave., MC Level, New York, NY 10029
| | - F Scott Nowakowski
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave., MC Level, New York, NY 10029
| | - Vivian Bishay
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave., MC Level, New York, NY 10029
| | - Mona Ranade
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave., MC Level, New York, NY 10029
| | - Robert A Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave., MC Level, New York, NY 10029
| | - Aaron M Fischman
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Ave., MC Level, New York, NY 10029
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Goldman DT, Magnowski A, Rochon PJ, Bream PR, Kondo KL, Peters G, Martin JG, Fischman AM. The State of Medical Student Teaching of Interventional Radiology: Implications for the Future. J Am Coll Radiol 2018; 15:1761-1764. [PMID: 30245218 DOI: 10.1016/j.jacr.2018.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/07/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The formation of integrated interventional radiology (IR) residency programs has changed the training paradigm. This change mandates the need to provide adequate exposure to allow students to explore IR as a career option and to allow programs to sufficiently evaluate students. This study aims to highlight the availability of medical student education in IR and proposes a basic framework for clinical rotations. MATERIALS AND METHODS The Liaison Committee on Medical Education (LCME) website was utilized to generate a list of accredited medical schools in the United States. School websites and course listings were searched for availability of IR and diagnostic radiology rotations. The curricula of several well-established IR rotations were examined to identify and categorize course content. RESULTS In all, 140 LCME-accredited medical schools had course information available. Of those schools, 70.5% offered an IR rotation; 84.6% were only available to senior medical students and only 2% were offered for preclinical students; and 8.1% of courses were listed as subinternships. Well-established IR clerkships included a variety of clinical settings, including preprocedure evaluation, experience performing procedures, postprocedure management, and discharge planning. CONCLUSION Medical student exposure to IR is crucial to the success of integrated IR residency programs. Current research shows few institutions with formal IR subinternship rotations. Although 70.5% of institutions have some form of nonstandardized IR course, 84.6% are available only to fourth-year students, and 2% are offered to preclinical students. This suggests there is a significant opportunity for additional formal exposure to IR through increasing availability of IR rotations and exposure during the clinical and preclinical years.
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Goldman DT, Piechowiak R, Nissman D, Bagla S, Isaacson A. Current Concepts and Future Directions of Minimally Invasive Treatment for Knee Pain. Curr Rheumatol Rep 2018; 20:54. [PMID: 30033492 DOI: 10.1007/s11926-018-0765-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/11/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the percutaneous interventions available for the treatment of osteoarthrosis of the knee that address pain and prolong the time to arthroplasty. RECENT FINDINGS Corticosteroid injection and viscosupplementation have been the most studied, but there is still no consensus about their value. Thermal nerve ablation, including both radiofrequency ablation and cryoneurolysis, is a promising new modality of therapy that may increase in clinical use given current data showing favorable outcomes. Of the future therapies that are currently under investigation, synovial embolization via the geniculate arteries represents an exciting new approach that may soon be available clinically. There are various percutaneous interventions available for the treatment of osteoarthrosis of the knee that address pain and prolong the time to arthroplasty.
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Affiliation(s)
| | - Rachel Piechowiak
- Vascular & Interventional Radiology, Vascular Institute of Virginia, Woodbridge, Prince William County, VA, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sandeep Bagla
- Vascular & Interventional Radiology, Vascular Institute of Virginia, Woodbridge, Prince William County, VA, USA
| | - Ari Isaacson
- Vascular and Interventional Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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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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Goldman DT. The metric system: standards & practice. IEEE Eng Med Biol Mag 1984; 3:30-33. [PMID: 19493731 DOI: 10.1109/memb.1984.5006024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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