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Keller EJ. Interventional Radiology's Professional Identity Crisis: A Medical Anthropology Perspective. J Am Coll Radiol 2024; 21:708-711. [PMID: 38157950 DOI: 10.1016/j.jacr.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, California.
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Webb T, Menard N, Hofmann HL, Repajic M, Han J, Keller EJ, Kothary N, Vairavamurthy J. The Prevalence of Financial Conflict of Interest Disclosures by Endovascular Specialists on X (Twitter). J Vasc Interv Radiol 2024:S1051-0443(24)00237-9. [PMID: 38513754 DOI: 10.1016/j.jvir.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Evaluate conflicts of interest (COI) among interventional radiologists and related specialties who mention specific devices or companies on the social media (SoMe) platform X, formerly Twitter. MATERIALS & METHODS 13,809 posts between 10/7/2021 and 12/31/2021 on X were evaluated. Posts by US interventional radiologists and related specialties that mentioned a specific device or company were identified. A positive COI was defined as receiving a payment from the device manufacturer or company within 36 months prior to posting. The CMS Open Payment database was used to identify financial payments. The prevalence and value of COIs were assessed and compared between posts mentioning a device or company and a paired control group using descriptive statistics and chi-squared tests and independent t-tests. RESULTS Eighty posts containing the mention of 100 specific devices or companies were evaluated. COIs were present in 53% (53/100). When mentioning a specific device or product, 40% interventional radiologists had a COI, neurosurgeons 62%. Physicians who mentioned a specific device or company were 3.7 times more likely to have a positive COI relative to the paired control group (53/100 vs 14/100, p<0.001). Of the 31 physicians with a COI, the median physician received $2,270. None of the positive COIs were disclosed. CONCLUSION Physicians posting on SoMe about a specific device or company are more likely to have a financial COI than authors of posts not mentioning a specific device or company. No disclosure of any COIs were present in the posts, limiting followers ability to weigh potential bias.
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Affiliation(s)
- Thomas Webb
- Medical Student, Keck School of Medicine of USC.
| | | | | | | | - Jesse Han
- Medical Student, Keck School of Medicine of USC
| | - Eric J Keller
- IR/DR Resident, Stanford University Hospitals and Clinics
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Josephs S, Keller EJ, Vadlamudi V, Annam A, Abi-Jaoudeh N. Subspecialty Training in IR. J Vasc Interv Radiol 2023; 34:2074-2075. [PMID: 38008541 DOI: 10.1016/j.jvir.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/13/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
- Shellie Josephs
- Division of Pediatric Interventional Radiology, Texas Children's Medical Center, Houston, Texas.
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
| | - Venu Vadlamudi
- Vascular/Interventional Radiology and Neurointerventional Surgery, Beacon Medical Group South Bend, Indiana; Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Aparna Annam
- Division of Pediatric Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Nadine Abi-Jaoudeh
- Division of Interventional Radiology, University of California-Irvine, Irvine, California
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Balesh E, Hund H, Keller EJ. Private Equity and Radiology: Productive Partnership or Inherently Misaligned? Semin Intervent Radiol 2023; 40:449-451. [PMID: 37927526 PMCID: PMC10622230 DOI: 10.1055/s-0043-1775720] [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: 11/07/2023]
Abstract
Private equity acquisition of medical groups and health care organizations is becoming increasingly important in medicine and is a trend that is likely to continue for the foreseeable future. Some question the ethical implications of private equity acquisitions, since the clear goal of such organizations is maximizing profitability, which may or may not be in the best interests of either the patient population or the provider group. This article will describe the role of private equity in the medical marketplace, with a focus on the role of private equity in radiology and interventional radiology specifically. Additionally, this article will explore this growing trend in the radiology marketplace and its anticipated effects upon patient care and professional satisfaction for radiologists.
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Affiliation(s)
- Elie Balesh
- Beverly Radiology Associates, Beverly, Massachusetts
| | - Hannah Hund
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Eric J. Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
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Forsman T, Silberstein S, Cyphers ED, Keller EJ, Makary MS. Informed consent for image-guided procedures: a nationwide survey of perceptions and current practices. Clin Radiol 2023; 78:730-736. [PMID: 37500335 DOI: 10.1016/j.crad.2023.06.008] [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] [Received: 03/22/2023] [Accepted: 06/08/2023] [Indexed: 07/29/2023]
Abstract
AIM To characterise the current landscape of informed consent practices for image-guided procedures, including location of consent, guideline availability, and utility of decision-aid resources. MATERIALS AND METHODS A survey of 159 interventional radiologists was conducted from April through June 2022. The survey evaluated participant demographics (gender, practice type, and level of training) and consent practices. Fifteen questions investigated discussion of benefits, risks, and alternatives, who obtained consent, location of consent conversations, how decision-making capacity is assessed, availability of formal guidance on consent discussions, and if and how decision-aids are used. RESULTS Most respondents (93.7%) were "extremely" or "very" comfortable discussing the benefits and risks of image-guided procedures during informed consent. Most respondents were "very" comfortable discussing alternative treatments within radiology (86.8%) while fewer felt confident regarding alternatives outside radiology (46.5%). Most respondents indicated obtaining consent in a pre-procedure area (89.9%), while 12.7% of respondents obtained consent in the procedure room. Of the respondents, 66.7% did not have formal education or documented guidance on what providers should disclose during consent. Ninety-two respondents (57.9%) reported using decision aids. The type of decision aid varied, with most reporting using illustrations or drawings (46.6%). Decision aid utility was more prevalent in non-teaching/academic (71.4%) versus academic (61%) institutions (p=0.02). CONCLUSION Regardless of demographics, interventionalists are confident in discussing benefits, risks, and alternative image-guided therapies, but are less confident discussing alternative treatment options outside of radiology. Formal education on informed consent is less common, and the use of decision aids varies between teaching and non-teaching institutions.
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Affiliation(s)
- T Forsman
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - S Silberstein
- Department of General Surgery, Einstein Healthcare Network, Philadelphia, PA, USA
| | - E D Cyphers
- Department of Bioethics, Columbia University, New York, NY, USA; Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - E J Keller
- Division of Interventional Radiology, Department of Radiology, Stanford University, Stanford, CA, USA
| | - M S Makary
- Division of Interventional Radiology, Department of Radiology, The Ohio State University Medical Center, Columbus, OH, USA
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Cyphers ED, Keller EJ, Makary MS. Trainee Ethics in Interventional Radiology. Semin Intervent Radiol 2023; 40:472-474. [PMID: 37927524 PMCID: PMC10622242 DOI: 10.1055/s-0043-1772816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Eric D. Cyphers
- Department of Bioethics, Columbia University, New York, New York
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Eric J. Keller
- Division of Interventional Radiology, Department of Radiology, Stanford University, Stanford, California
| | - Mina S. Makary
- Division of Interventional Radiology, Department of Radiology, The Ohio State University, Columbus, Ohio
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Rockwell HD, Cyphers ED, Makary MS, Keller EJ. Ethical Considerations for Artificial Intelligence in Interventional Radiology: Balancing Innovation and Patient Care. Semin Intervent Radiol 2023; 40:323-326. [PMID: 37484438 PMCID: PMC10359128 DOI: 10.1055/s-0043-1769905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Affiliation(s)
- Helena D. Rockwell
- School of Medicine, University of California, San Diego, La Jolla, California
| | - Eric D. Cyphers
- Department of Bioethics, Columbia University, New York, New York
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Mina S. Makary
- Division of Interventional Radiology, Department of Radiology, The Ohio State University, Columbus, Ohio
| | - Eric J. Keller
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
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Cyphers ED, Keller EJ, Reis SP, Makary MS. Sinners and Saints: Medical Business Ethics in Interventional Radiology. Semin Intervent Radiol 2023; 40:113-116. [PMID: 37152798 PMCID: PMC10159702 DOI: 10.1055/s-0043-1767689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Eric D. Cyphers
- Department of Bioethics, Columbia University, New York, New York
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Eric J. Keller
- Division of Interventional Radiology, Department of Radiology, Stanford University, Stanford, California
| | - Stephen P. Reis
- Division of Interventional Radiology, Department of Radiology, Columbia University, New York, New York
| | - Mina S. Makary
- Division of Interventional Radiology, Department of Radiology, The Ohio State University, Columbus, Ohio
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Abstract
Informed consent is an important part of the clinician-patient relationship. However, studies suggest consent practices tend to be limited in consistency and completeness. This may be particularly challenging for interventional radiology given more limited public awareness and the often fast-paced, dynamic nature of our practices. This article reviews these challenges as well as ideal consent practices and potential approaches to improve consent in interventional radiology.
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Affiliation(s)
- Tia Forsman
- 12321The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Eric J Keller
- Division of Interventional Radiology, 6429Stanford University, Stanford, CA, USA
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10
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Chan SM, Laage Gaupp FM, Rockwell HD, Perez AW, Rukundo I, Keller EJ. Global Health and Interventional Radiology: Ethical Considerations. Cardiovasc Intervent Radiol 2022; 45:1881-1883. [PMID: 35918432 DOI: 10.1007/s00270-022-03236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 11/02/2022]
Affiliation(s)
| | - Fabian M Laage Gaupp
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Helena D Rockwell
- University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Andrew W Perez
- Vascular and Interventional Radiology Division, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ivan Rukundo
- Section of Interventional Radiology, Department of Radiology and Imaging, Rwanda Military Hospital, Kigali, Rwanda
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, CA, 94305, USA
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Keller EJ, de Castro CM, Ghanouni P, Shah J. Confirmation of Ectopic Pancreatic Tissue: A Novel Use for 18 F-Fluciclovine PET. Clin Nucl Med 2022; 47:e570-e571. [PMID: 35261353 DOI: 10.1097/rlu.0000000000004134] [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: 11/26/2022]
Abstract
ABSTRACT This case features a 21-year-old woman with a history of ulcerative colitis who was incidentally found to have a para-jejunal mass when she presented with an ulcerative colitis flare. The mass was further characterized on MR enterography as most likely representing ectopic pancreatic tissue. Given the normal intense pancreatic uptake of 18 F-fluciclovine, PET/CT was subsequently used to confirm that the mass represented ectopic pancreatic tissue.
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Rockwell H, Keller EJ, Tadros A, Newton I. VIP Patients in Interventional Radiology: Do Some Patients Deserve "Better" Care? Semin Intervent Radiol 2022; 39:454-458. [PMID: 36406034 PMCID: PMC9671680 DOI: 10.1055/s-0042-1757316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Helena Rockwell
- School of Medicine, University of California – San Diego, La Jolla, California
| | - Eric J. Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
| | - Anthony Tadros
- Department of Radiology, University of California – San Diego, La Jolla, California
| | - Isabel Newton
- Department of Radiology, University of California – San Diego, La Jolla, California
- Division of Interventional Radiology, Veterans Administration San Diego Healthcare System, La Jolla, California
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13
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Cyphers E, Silberstein S, Keller EJ. Suspending Do Not Resuscitate/Do Not Intubate Orders for Image-Guided Procedures. Semin Intervent Radiol 2022; 39:338-340. [PMID: 36062229 PMCID: PMC9433145 DOI: 10.1055/s-0042-1751290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Eric Cyphers
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | | | - Eric J. Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
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14
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Keller EJ, Mlambo VC, Resnick SA, Vogelzang RL. #PauseBeforeYouPost: Ethical and Legal Issues Involving Medical Social Media. Semin Intervent Radiol 2022; 39:203-206. [PMID: 35781993 DOI: 10.1055/s-0042-1745717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
| | - Vongai C Mlambo
- Stanford School of Medicine, Stanford University, Stanford, California
| | - Scott A Resnick
- Division of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Robert L Vogelzang
- Division of Interventional Radiology, Northwestern University, Chicago, Illinois
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Wu X, Rabei R, Keller EJ, King B, Kothary N, Kohi M, Taylor A, Heller M. Tunneled Peritoneal Catheter vs Repeated Paracenteses for Recurrent Ascites: A Cost-Effectiveness Analysis. Cardiovasc Intervent Radiol 2022; 45:972-982. [PMID: 35292833 DOI: 10.1007/s00270-022-03103-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the cost-effectiveness of tunneled peritoneal catheter (TPC) versus serial large-volume paracenteses (LVP) for patients with recurrent ascites. MATERIALS AND METHODS Retrospective, single-institution analysis of 100 consecutive patients undergoing LVP and eventual TPC placement (2015-2018) was performed with extraction of procedural complications and hospital admissions. LVPs were associated with 17 adverse events (AEs) while only 9 AEs occurred after TPC placement. While undergoing routine LVP, the patients had 30 hospitalizations monthly (177 days in total) and 10 hospitalizations monthly (51 days) after TPC placement. A cost-effectiveness analysis with Markov modeling was performed comparing TPC and LVP. Costs were based on Medicare reimbursement rates. Statistical analyses include base case calculation, Monte Carlo simulations, and deterministic sensitivity analyses. RESULTS TPC placement was the dominant strategy with a comparable health benefit of 0.08060 quality-adjusted life-years (QALY) (LVP: 0.08057 QALY) at a lower cost of $4151 (LVP: $8401). Probabilistic sensitivity analysis showed TPC was superior in 97.49% of simulations. Deterministic sensitivity analysis demonstrated the superiority of TPC compared to LVP if the TPC complication rate was < 9.47% per week and the complication rate for LVP was > 1.32% per procedure. TPC was more cost-effective when its procedural cost was < $5427 (base case: 1174.5), and remained as such when the cost of LVP was varied as much as $10,000 (base case: $316.48). CONCLUSION In this study, TPC was more cost-effective than LVP in patients with recurrent ascites due to the reduced risk of infection, emergency department visits, and length of hospitalization stays.
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Affiliation(s)
- Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Rana Rabei
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, CA, USA
| | - Bradley King
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Nishita Kothary
- Division of Interventional Radiology, Stanford University, Stanford, CA, USA
| | - Maureen Kohi
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew Taylor
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Michael Heller
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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Keller EJ, Nixon K, Oladini L, Chrisman HB, Chaudhari A, Milad MP, Vogelzang RL. The power of proximity: Effects of a multidisciplinary fibroid clinic on inter-specialty perceptions and practice patterns. PLoS One 2022; 17:e0263058. [PMID: 35077500 PMCID: PMC8789146 DOI: 10.1371/journal.pone.0263058] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multidisciplinary collaboration has generally been shown to have positive effects on healthcare but can be difficult to facilitate. This study assessed the effects of a multidisciplinary fibroid clinic on practice patterns and clinician perceptions to better understand drivers of interspecialty collaboration. Materials and methods Annual rates of hysterectomies, myomectomies, and uterine fibroid embolizations (UFEs) performed in an urban healthcare system were collected from 2012–2019. Rates of each procedure were compared over time before and after launching a multidisciplinary fibroid clinic at the academic medical center. Referral rates were also compared. The gynecologists and interventional radiologists (IRs) involved in the clinic were interviewed 2 years prior to and after the clinic launch about their approaches to fibroids and perceptions of others who treat this condition. A phenomenological approach was used to identify and compare themes within the interviews by two researchers with excellent inter-rater agreement (κ = 0.80). Results and discussion Annual rates of fibroid procedures increased over time (p<0.01) but the relative number of UFEs decreased (p = 0.01). UFE referrals by the clinic gynecologists significantly increased as did the number of combined fibroid procedures (p<0.01). However, the rates of one fibroid procedure relative to others were not different between the clinic and rest of the healthcare system (p = 0.55). Specialty-specific perceptions of fibroid treatments and inter-specialty dynamics did not change. Despite this, clinicians unanimously perceived the clinic and post-clinic practice patterns as positive and distinct from their previous work and relationships between gynecology and IR elsewhere. Limitations of this study included its single clinic design and potential confounder of differences in advertising pre- versus post-clinic. Conclusion Creating the right practice environment may be more important for fostering inter-specialty collaboration and work satisfaction than shared mental models or procedural volumes in certain practice settings.
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Affiliation(s)
- Eric J. Keller
- Division of Interventional Radiology, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | - Kayla Nixon
- Division of Minimally Invasive Gynecologic Surgery, Northwestern University, Chicago, IL, United States of America
| | - Lola Oladini
- Division of Interventional Radiology, Stanford University, Stanford, CA, United States of America
| | - Howard B. Chrisman
- Division of Interventional Radiology, Northwestern University, Chicago, IL, United States of America
| | - Angela Chaudhari
- Division of Minimally Invasive Gynecologic Surgery, Northwestern University, Chicago, IL, United States of America
| | - Magdy P. Milad
- Division of Minimally Invasive Gynecologic Surgery, Northwestern University, Chicago, IL, United States of America
| | - Robert L. Vogelzang
- Division of Interventional Radiology, Northwestern University, Chicago, IL, United States of America
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Wu X, Keller EJ, Rabei R, Rockwell H, Beeson S, Heller M, Kothary N. Cost-effectiveness of tunneled peritoneal catheters versus repeat paracenteses for recurrent ascites in gynecologic malignancies. Gynecol Oncol 2022; 164:639-644. [DOI: 10.1016/j.ygyno.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
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18
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Rockwell HD, Beeson SA, Keller EJ, Kothary N, Dickey K. Perceptions of Ethics in Interventional Radiology. Curr Probl Diagn Radiol 2021; 51:733-736. [PMID: 34955285 DOI: 10.1067/j.cpradiol.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To characterize perceptions of ethics among interventional radiologists to guide the development of an applied, specialty-specific approach to ethics. MATERIALS AND METHODS A 17-question survey on perceptions of ethics and use of ethics resources was developed and vetted via cognitive interviewing of 15 diverse, representative members of the target population. The survey was distributed via the Society of Interventional Radiology, receiving 685 responses (48% participation and 90% completion rates). Responses were compared between different demographics, and common themes from free text responses were identified via content analysis. RESULTS Most respondents indicated ethics is important for IR (93%) and more focus on practical approaches to ethical issues is needed (73%). Various ethical issues were perceived to be important for IR, but differentiating palliative from futile care was ranked as the top ethical issue. Trainees had more ethics training (P=0.05) but less confidence in navigating ethical issues (P<0.01). Regardless of career stage, those with ethics training (44%) were more confident in navigating ethical issues (P<0.01). Use of resources such as information sheets for patients and resources for coping with complications were variable and limited by lack of availability or knowledge of such resources in IR. CONCLUSIONS Interventional radiologists believe ethics is important and face diverse ethical issues, but they are challenged by variable experiences and access to practical tools to navigate these challenges.
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Affiliation(s)
- Helena D Rockwell
- School of Medicine, University of California San Diego, La Jolla, CA
| | - Summer A Beeson
- School of Medicine, University of California San Diego, La Jolla, CA
| | - Eric J Keller
- Department of Radiology, Stanford University, Stanford, CA..
| | | | - Kevin Dickey
- Department of Radiology, Medical Center Boulevard Wake Forest School of Medicine, Winston-Salem, NC
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Hsieh LJ, Madadi SR, Shore KT, Keller EJ, Makary MS. Potential Bias in Image-Guided Procedure Research: A Retrospective Analysis of Disclosed Conflicts of Interest and Open Payment Records. J Vasc Interv Radiol 2021; 33:141-147. [PMID: 34756998 DOI: 10.1016/j.jvir.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/14/2021] [Accepted: 08/29/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To assess the prevalence of positive conflict of interest (COI) disclosures in U.S.-based interventional radiology (IR) research as well as the level of agreement between disclosed financial relationships and open payment data for top-cited image-guided procedure research. MATERIALS AND METHODS All publications in volume 30 (2019) of the Journal of Vascular and Interventional Radiology (JVIR) were reviewed to estimate the prevalence of COI disclosures in IR research. Publications were categorized as primary research, systematic review, or other. Prevalence was then compared across JVIR publication subtype, categories, and whether they were device-focused with chi-squared tests. Additionally, the Web of Science database was searched for the top 10 cited studies of 10 common image-guided procedures with available U.S. physician payment data. Payments were categorized as historical (>1 year prior to publication) or active (<1 year prior to publication) and compared to disclosed financial COIs with one-way ANOVA. RESULTS Positive COI disclosures were present in 29% (114 of 397) of publications in JVIR volume 30. Positive COI disclosures were most prevalent in Standards of Practice (50%, p = 0.01) and more prevalent in device-focused publications (54% vs 23%, p < 0.01). Among the 396 authors of 100 U.S.-based top-cited image-guided procedure publications, 383 (97%) failed to disclose at least one active financial relationship, with an average of $57,937 in undisclosed payments per publication. CONCLUSION Conflicts of interest are prevalent in IR, like other areas of healthcare research, and conflicts of interest in top-cited image-guided procedure research are often underreported.
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Affiliation(s)
- Lee J Hsieh
- School of Medicine, University of California San Diego, San Diego, CA.
| | | | | | - Eric J Keller
- Division of Interventional Radiology, Stanford Hospitals & Clinics, Stanford, CA
| | - Mina S Makary
- Division of Interventional Radiology, The Ohio State University Medical Center, Columbus, OH
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Habib H, Keller EJ. Disability in Interventional Radiology. Semin Intervent Radiol 2021; 38:500-503. [PMID: 34629721 DOI: 10.1055/s-0041-1735604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hasan Habib
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
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21
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Garg T, Shnayder-Adams MM, Keller EJ, Makary MS. Ethical Issuing Arising Around Biliary Interventions. Semin Intervent Radiol 2021; 38:388-392. [PMID: 34393351 DOI: 10.1055/s-0041-1731407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Eric J Keller
- Division of Vascular and Interventional Radiology, Stanford University, Stanford, California
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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22
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Silberstein S, Shnayder-Adams MM, Keller EJ, Makary MS. Ethics in Interventional Radiology: A Case-Based Primer. Cardiovasc Intervent Radiol 2021; 44:1510-1517. [PMID: 34231013 DOI: 10.1007/s00270-021-02894-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
As the field of interventional radiology assumes a larger role in patient care, the specialty has a growing responsibility to recognize and understand ethical dilemmas within the field. We present a case-based primer on common ethical issues in IR, including requests for potentially inappropriate procedures, surrogate decision making, informed consent, and managing conflicts of interest and procedural complications. This primer is intended to be used as a guide for discussion-based training in ethics in IR while inspiring further research in applied ethics in IR.
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Affiliation(s)
- Sara Silberstein
- Albany Medical College, 75 New Scotland Avenue, Albany, NY, 12208, USA.
| | - Michelle M Shnayder-Adams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Eric J Keller
- Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Hsieh LJ, Keller EJ, Shnayder-Adams MM, Salamo RM, Vairavamurthy JP. The Ethics of Trauma Care: What Interventional Radiologists Should Know. Semin Intervent Radiol 2021; 38:239-242. [PMID: 34108812 DOI: 10.1055/s-0041-1729154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lee J Hsieh
- School of Medicine, University of California San Diego, La Jolla, California
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
| | | | - Russell M Salamo
- Division of Interventional Radiology, University of Southern California, Los Angeles, California
| | - Jenanan P Vairavamurthy
- Division of Interventional Radiology, University of Southern California, Los Angeles, California
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Abstract
The integrated interventional radiology (IR) residency accepted its first applicants in 2017. Achieving specialty status represents a significant milestone for IR; recognizing the expanding role of IR as part of an interdisciplinary team. However, this transition has had challenges that were well predicted by Heitkamp and Gunderman in 2014 and are reflected in the history of many specialties. New specialties often have complex relationships with their "parent" specialties, creating debates and tension regarding training, licensure, and scope of practice. Many of these factors have been discussed in opinion pieces by leaders in the field, reflecting upon the transition. There have also been surveys of matched IR/DR residents. However, there are few firsthand accounts of the challenges faced by trainees during such a transition, challenges that often are not well captured by an online survey.
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Affiliation(s)
- Daryl Goldman
- Icahn School of Medicine at Mount Sinai, New York, NY
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25
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Rook JM, Wood E, Boeck MA, Blair KJ, Monroy A, Ludi E, Keller EJ, Victorson D, Foíanini E, Swaroop M. The Bolivian trauma patient's experience: A qualitative needs assessment. Injury 2021; 52:167-174. [PMID: 33386153 DOI: 10.1016/j.injury.2020.12.014] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite a significant burden of injury-related deaths, the Plurinational State of Bolivia (Bolivia), a lower- middle-income country in South America, lacks a formalized trauma system. This study sought to examine Bolivian trauma care from the patient perspective in order to determine barriers to care and targets for improvement. METHODS Investigators conducted 15 semi-structured interviews with trauma patients admitted at four hospitals in Santa Cruz de la Sierra, Bolivia in June and July of 2016. Interviews were transcribed, translated, and analyzed through content and discourse analysis to identify key themes and perceptions of trauma care. RESULTS Participants primarily presented with orthopedic injuries due to road traffic incidents and falls. Only one participant reported receiving first aid from a layperson at the scene of injury. Of the 15 participants, 12 did not know any number to contact emergency medical services (EMS). Participants expressed negative views of EMS as well as concerns for slow response times and inadequate personnel and training. Two thirds of participants were initially brought to a hospital without adequate resources to care for their injuries. Participants generally expressed positive views regarding healthcare workers involved in their hospital-based medical care. CONCLUSIONS This region of Bolivia has a disorganized, underutilized, and distrusted trauma system. In order to increase survival, interventions should focus on improving prehospital trauma care. Potential interventions include the implementation of layperson trauma first responder courses, the establishment of a medical emergency hotline, the unification of EMS, the implementation of basic training requirements for EMS personnel, and public education campaigns to increase trust in EMS.
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Affiliation(s)
- Jordan M Rook
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA; David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA.
| | - Ethan Wood
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Marissa A Boeck
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA; Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, MA, USA; New York Presbyterian Hospital/Columbia University, Department of Surgery, New York City, NY, USA; University of California San Francisco School of Medicine, Department of Surgery, San Francisco, CA, USA
| | - Kevin J Blair
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA; David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA
| | - Alexa Monroy
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA; Children's Hospital Los Angeles, Department of Pediatrics, Los Angeles, CA, USA
| | - Erica Ludi
- Emory University School of Medicine, Department of Surgery, Atlanta, GA, USA
| | - Eric J Keller
- Stanford University School of Medicine, Department of Interventional Radiology, Palo Alto, CA, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL, USA
| | - Esteban Foíanini
- Clínica Foíanini, Department of Surgery, Santa Cruz de la Sierra, Bolivia
| | - Mamta Swaroop
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA
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Keller EJ, Rabei R, Heller M, Kothary N. Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis. Cardiovasc Intervent Radiol 2020; 44:127-133. [PMID: 33078233 DOI: 10.1007/s00270-020-02675-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To characterize perceptions of palliative versus futile care in interventional radiology (IR) as a roadmap for quality improvement. METHODS Interventional radiologists (IRs) and referring physicians were recruited for anonymous interviews and/or focus groups to discuss their perceptions and experiences related to palliative verse futile care in IR. Sessions were recorded, transcribed, and systematically analyzed using dedicated software, content analysis, and grounded theory. Data collection and analysis continued simultaneously until additional interviews stopped revealing new themes: 24 IRs (21 males, 3 females, 1-39 years of experience) and 7 referring physicians (3 males, 4 females, 6-14 years of experience) were analyzed. RESULTS Many IRs (75%) perceived futility as an important issue. Years of experience (r = 0.60, p = 0.03) and being in academics (r = 0.62, p = 0.04) correlated with greater perceived importance. Perceptions of futility and whether a potentially inappropriate procedure was performed involved a balance between four sets of factors (patient, clinician, procedural, and cultural). These assessments tended to be qualitative in nature and are challenged by a lack of data, education, and consistent workflows. Referring clinicians were unaware of this issue and assumed IR had guidelines for differentiating between palliation and futility. CONCLUSION This study characterized the complexity and qualitative nature of assessments of palliative verses futile care in IR while highlighting potential means of improving current practices. This is important given the number of critically ill patients referred to IR and costs of potentially inappropriate interventions.
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Affiliation(s)
- Eric J Keller
- Department of Radiology, Stanford University, Stanford, 300 Pasteur Drive, H3630, Stanford, CA, 94305, USA.
| | - Rana Rabei
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143, USA
| | - Michael Heller
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143, USA
| | - Nishita Kothary
- Department of Radiology, Stanford University, Stanford, 300 Pasteur Drive, H3630, Stanford, CA, 94305, USA
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Shnayder MM, Keller EJ, Makary MS. COVID-19 Ethics: What Interventional Radiologists Need to Know. J Vasc Interv Radiol 2020; 31:1720-1723. [PMID: 32943297 PMCID: PMC7489880 DOI: 10.1016/j.jvir.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michelle M Shnayder
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr B1D502, Ann Arbor, MI 48109-5030.
| | - Eric J Keller
- Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Han TM, Bondarev S, Keller EJ, Vogelzang RL, Resnick SA. Efficacy of endovascular Z-configuration stenting for malignant versus nonmalignant caval obstruction. J Vasc Surg Venous Lymphat Disord 2020; 8:939-944. [PMID: 32414673 DOI: 10.1016/j.jvsv.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/29/2019] [Accepted: 02/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to assess factors associated with symptom resolution after endovascular stenting for superior or inferior vena cava syndrome. METHODS Eighty-six consecutive vena cava Z-configuration stent placements in 82 patients (53 ± 14 years old) at a single institution were reviewed for patient demographics, comorbidities, and durability of stent patency (also evaluated were persistent or recurrent symptoms, stent occlusion, and need for repeated stenting). Logistic regression was used to identify independent factors associated with stent patency, and Φ coefficients and analysis of variance were used to compare cases subdivided by lesion location (superior vena cava, inferior vena cava) and the presence or absence of malignant disease. RESULTS Clinical follow-up was available in 77 of 86 (90%) cases. Technical success with clinical failure (persistent symptoms) occurred in 40% of these cases with a median follow-up of 67 (interquartile range, 14-570) days and mortality rate of 63% during this period. Malignant obstructions had a significantly higher clinical failure rate of 54% compared with 15% for nonmalignant obstructions (Φ = 0.34; P = .002). However, only metastatic disease was independently associated with clinical failure when controlling for demographics, other comorbidities, and differential follow-up (adjusted odds ratio, 8.27; 95% confidence interval, 2.79-24.50). CONCLUSIONS Vena cava Z-stenting effectively resolves symptoms in 85% of nonmalignant obstructions compared with only 46% of malignant obstructions. Patients should be counseled accordingly, and those with malignant obstructions may require closer follow-up to evaluate the need for reintervention and goals of care.
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Affiliation(s)
- Timothy M Han
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Ill
| | - Sergey Bondarev
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Ill
| | - Eric J Keller
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert L Vogelzang
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Scott A Resnick
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Bozorghadad S, Newton IG, Perez AW, Makary MS, Keller EJ. Research Ethics in IR: The Intersection Between Care and Progress. J Vasc Interv Radiol 2020; 31:846-848. [PMID: 32359529 DOI: 10.1016/j.jvir.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Isabel G Newton
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California
| | - Andrew W Perez
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mina S Makary
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Eric J Keller
- Department of Radiology, Division of Vascular and Interventional Radiology, Stanford University, 300 Pasteur Drive, H3630, Stanford, CA 94305.
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Keller EJ, Perez AW, Makary MS. Informed Consent: Beating a Dead Horse or an Opportunity for Quality Improvement? J Vasc Interv Radiol 2020; 31:139-140. [DOI: 10.1016/j.jvir.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/27/2019] [Accepted: 08/06/2019] [Indexed: 10/25/2022] Open
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Bozorghadad S, Perez AW, Makary MS, Keller EJ. You're Performing My Procedure: Teamwork and Tribalism in IR. J Vasc Interv Radiol 2019; 31:178-179. [PMID: 31771897 DOI: 10.1016/j.jvir.2019.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sayeh Bozorghadad
- Divison of Interventional Radiology, Stanford University, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Andrew W Perez
- Divison of Interventional Radiology, Stanford University, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Mina S Makary
- Divison of Interventional Radiology, Stanford University, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Eric J Keller
- Divison of Interventional Radiology, Stanford University, 300 Pasteur Drive, H3630, Stanford, CA 94305
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Bondarev S, Keller EJ, Han T, Young VA, Gupta S, Vogelzang RL, Eskandari M, Resnick SA. Predictors of Disease Recurrence after Venoplasty and Stent Placement for May–Thurner Syndrome. J Vasc Interv Radiol 2019; 30:1549-1554. [DOI: 10.1016/j.jvir.2019.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/08/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022] Open
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Clark JM, Keller EJ. Reconsidering Requests-Futility in IR. J Vasc Interv Radiol 2019; 30:961-962. [PMID: 31126607 DOI: 10.1016/j.jvir.2019.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/09/2019] [Accepted: 01/19/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jessica M Clark
- Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, Missouri
| | - Eric J Keller
- Department of Radiology, Santa Clara Valley Medical Center, 300 Pasteur Dr, Stanford, CA 94305.
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Abstract
Clinicians, particularly those in procedural specialties, tend to feel personally responsible when complications occur. Medical errors among surgeons have been studied and provide an insightful window into the ethics of complications. Ethically we must consider what we owe patient and families, ourselves, and our colleagues. To some degree, the answers are similar: reflection, confession, and resolution . We owe patients and families an explanation and lack of abandonment; we owe ourselves thoughtful reflection on what caused the complication and how we can learn from it; and we owe our colleagues assistance managing our complications and a chance to learn from our mistakes. As a specialty that prides itself on innovation and novel therapies, interventional radiology has a unique relationship with complications that has not been well developed. As the specialty grows, it will be important to provide forums for further understanding the ethical challenges in interventional radiology.
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Affiliation(s)
- Eric J Keller
- Division of Vascular and Interventional Radiology, Stanford University Medical Center, Stanford, California
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35
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Keller EJ, Vogelzang RL. Who We Are and What We Can Become: The Anthropology of IR and Challenges of Forming a New Specialty. J Vasc Interv Radiol 2019; 29:1703-1704.e2. [PMID: 30502878 DOI: 10.1016/j.jvir.2018.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Eric J Keller
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, California; Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, NMH/Feinberg Room 4-7105, 251 East Huron Street, Chicago, IL 60611
| | - Robert L Vogelzang
- Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, NMH/Feinberg Room 4-7105, 251 East Huron Street, Chicago, IL 60611; Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, NMH/Feinberg Room 4-7105, 251 East Huron Street, Chicago, IL 60611.
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36
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Keller EJ, Gupta SA, Bondarev S, Sato KT, Vogelzang RL, Resnick SA. Single-Center Retrospective Review of Radiofrequency Wire Recanalization of Refractory Central Venous Occlusions. J Vasc Interv Radiol 2018; 29:1571-1577. [DOI: 10.1016/j.jvir.2018.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/29/2018] [Accepted: 06/25/2018] [Indexed: 12/01/2022] Open
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37
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Keller EJ, Lewandowski RJ, Goodwin L, Yaghmai V, Nemcek A, Carr JC, Collins JD. Reinforcing the Importance and Feasibility of Implementing a Low-dose Protocol for CT-guided Biopsies. Acad Radiol 2018; 25:1146-1151. [PMID: 29426686 DOI: 10.1016/j.acra.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/25/2017] [Revised: 12/15/2017] [Accepted: 01/06/2018] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses. MATERIALS AND METHODS Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner. RESULTS Voluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity. CONCLUSIONS Implementation of a low-dose protocol for CT-guided biopsies resulted in 21% and 36% of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety.
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Affiliation(s)
- Eric J Keller
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611.
| | - Robert J Lewandowski
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Lee Goodwin
- Department of Radiology, Division of Body Imaging, Northwestern University, Chicago, Illinois
| | - Vahid Yaghmai
- Department of Radiology, Division of Body Imaging, Northwestern University, Chicago, Illinois
| | - Albert Nemcek
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611; Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611; Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Jeremy D Collins
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611; Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
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38
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Keller EJ, Porter M, Garrett JE, Varie M, Wang H, Pollok KE, Turchi JJ, Zaleski JM, Dynlacht JR. Characterization of Thermally Activated Metalloenediyne Cytotoxicity in Human Melanoma Cells. Radiat Res 2018; 190:107-116. [PMID: 29763378 DOI: 10.1667/rr15019.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Enediynes are a highly cytotoxic class of compounds. However, metallation of these compounds may modulate their activation, and thus their cytotoxicity. We previously demonstrated that cytotoxicity of two different metalloenediynes, including (Z)-N,N'-bis[1-pyridyl-2-yl-meth-(E)-ylidene]octa-4-ene-2,6-diyne-1,8-diamine] (PyED), is potentiated when the compounds are administered to HeLa cells during hyperthermia treatment at concentrations that are minimally or not cytotoxic at 37°C. In this study, we further characterized the concentration, time and temperature dependence of cytotoxicity of PyED on human U-1 melanoma cells. We also investigated the potential mechanisms by which PyED cytotoxicity is enhanced during hyperthermia treatment. Cell killing with PyED was dependent on concentration, temperature during treatment and time of exposure. Potentiation of cytotoxicity was observed when cells were treated with PyED at temperatures ≥39.5°C, and enhancement of cell killing increased with temperature and with increasing time at a given temperature. All cells treated with PyED were shown to have DNA damage, but substantially more damage was observed in cells treated with PyED during heating. DNA repair was also inhibited in cells treated with the drug during hyperthermia. Thus, potentiation of PyED cytotoxicity by hyperthermia may be due to enhancement of drug-induced DNA lesions, and/or the inhibition of repair of sublethal DNA damage. While the selective thermal activation of PyED supports the potential clinical utility of metalloenediynes as cancer thermochemotherapeutic agents, therapeutic gain could be optimized by identifying compounds that produce minimal toxicity at 37°C but which become activated and show enhancement of cytotoxicity within a tumor subjected to localized hyperthermic or thermal ablative treatment, or which might act as bifunctional agents. We thus also describe the development and initial characterization of a novel cofactor complex of PyED, platinated PyED (Pt-PyED). Pt-PyED binds to DNA-like cisplatin, and much like PyED, cytotoxicity is greatly enhanced after treatment with the drug at elevated temperatures. However, in contrast to PyED, Pt-PyED is only minimally cytotoxic at 37°C, at concentrations at which cytotoxicity is enhanced by hyperthermia. Further development of cisplatin-based enediynes may result in compounds which, when activated, will possess multiple DNA binding modalities similar to cisplatin, but produce less side effects in tissues at normothermic temperatures.
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Affiliation(s)
| | - Meghan Porter
- d Department of Chemistry, Indiana University, Bloomington, Indiana
| | | | | | | | | | - John J Turchi
- c Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Keller EJ, Kennedy KY, Patel AP, Ivanovic M, Collins JD, Sato K, Thornburg BG, Riaz A, Nemcek AA, Desai K, Lewandowski RJ, Salem R, Vogelzang RL, Hickey R. Perceptions of Quality in Interventional Oncology. J Vasc Interv Radiol 2018; 29:367-372.e1. [PMID: 29395900 DOI: 10.1016/j.jvir.2017.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To inductively characterize perceptions of quality in interventional oncology (IO) based on values and experiences of patients and referring providers. MATERIALS AND METHODS Brief ethnographic interviews were completed with referring providers and patients before and after a variety of liver-directed procedures about their experiences, concerns, and perceptions of IO services at a single institution. Constructivist grounded theory was used to systematically analyze interview transcripts for themes until thematic saturation was achieved. All transcripts were analyzed by a reviewer with 3-years of experience performing such analyses, and 50% were randomly selected to be coded by 2 additional blinded reviewers. Interreviewer agreement was assessed via Cohen κ. RESULTS Interviews with 22 patients (mean age, 65 y ± 13; 9 women) and 12 providers (mean age, 54 y ± 9; 6 women) were required to reach and confirm thematic saturation. Interreviewer agreement for interview themes was excellent (κ = 0.78; P < .001). Perceptions of high-quality IO care relied on interventional radiologists being responsive, friendly, and open; engaging in multidisciplinary collaboration; having thoughtful, dedicated support staff; and facilitating well-coordinated care after procedures and follow-up more than technical expertise and periprocedural comfort. Patient and provider perceptions of quality differed, but disjointed care after procedures was the most common critique among both groups. CONCLUSIONS An inductive qualitative approach effectively characterized specific aspects of perceptions of high-quality IO care among patients and referring providers.
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Affiliation(s)
- Eric J Keller
- Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611.
| | - Kristie Y Kennedy
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Akash P Patel
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Maja Ivanovic
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Jeremy D Collins
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Kent Sato
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Bartley G Thornburg
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Ahsun Riaz
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Albert A Nemcek
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Kush Desai
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Robert J Lewandowski
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Riad Salem
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Robert L Vogelzang
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Ryan Hickey
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611
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Keller EJ, McGee KA, Resnick SA, Trerotola SO, Valji K, Johnson MS, Collins JD, Vogelzang RL. Who We Are and What We Can Become: An Analysis of Professional Identity Formation in IR. J Vasc Interv Radiol 2017; 28:850-856. [DOI: 10.1016/j.jvir.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022] Open
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Keller EJ, Collins JD, Rigsby C, Carr JC, Markl M, Schnell S. Superior Abdominal 4D Flow MRI Data Consistency with Adjusted Preprocessing Workflow and Noncontrast Acquisitions. Acad Radiol 2017; 24:350-358. [PMID: 27940231 DOI: 10.1016/j.acra.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/13/2016] [Accepted: 10/19/2016] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the impact of an alternative preprocessing workflow on noncontrast- and contrast-enhanced abdominal four-dimensional flow magnetic resonance imaging (4D flow MRI) data consistency. MATERIALS AND METHODS Twenty patients with cirrhosis and portal hypertension (5 women; 53 ± 10 years old) underwent 4D flow MRI at 3.0T before and after administration of 0.03 mmol/kg of gadofosveset trisodium with velocity sensitivities of 100 and 50 cm/s for arterial and venous flow quantifications, respectively. 4D flow MRI data were preprocessed using the conventional workflow (workflow 1), applying noise filters prior to eddy current correction, and an alternative workflow (workflow 2), first correcting for eddy currents and using noise filtering only if needed for anti-aliasing. Vessel segmentation quality was ranked by independent reviewers and compared via Wilcoxon signed-rank tests. Flow quantification and conservation of mass at two portal and one arterial branch points were compared via paired t tests. RESULTS Segmentation quality was significantly higher for workflow 2 (P < 0.05) with excellent interobserver agreement (κ = 0.92). Workflow 2 resulted in larger flow values (P < 0.05) with improved conservation of mass (7.3 ± 6.1% vs. 27.7 ± 25.0%, P < 0.001 [portal]; 10.7 ± 9.0% vs. 21.7 ± 21.6%, P = 0.02 [arterial]). Peak velocities and abdominal aortic flow were similar (P > 0.05). Noncontrast acquisitions yielded significantly smaller portal flow values (P < 0.05) with improved conservation of mass (5.8 ± 4.7% vs. 8.7 ± 6.9%, P = 0.05 [portal]; 6.2 ± 4.5% vs. 13.7 ± 10.2%, P = 0.03 [arterial]). CONCLUSIONS Superior abdominal 4D flow MRI data consistency was obtained by applying eddy current correction before any other data manipulation, using noise masking and velocity anti-aliasing cautiously, and using noncontrast acquisitions.
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Keller EJ, Fang S, Lin K, Freed BH, Smith PM, Spottiswoode BS, Davids R, Carr M, Jolly MP, Markl M, Carr JC, Collins JD. The consistency of myocardial strain derived from heart deformation analysis. Int J Cardiovasc Imaging 2017; 33:1169-1177. [DOI: 10.1007/s10554-017-1090-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/02/2017] [Indexed: 11/24/2022]
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Keller EJ, Crowley-Matoka M, Collins JD, Chrisman HB, Milad MP, Vogelzang RL. Fostering better policy adoption and inter-disciplinary communication in healthcare: A qualitative analysis of practicing physicians' common interests. PLoS One 2017; 12:e0172865. [PMID: 28235088 PMCID: PMC5325554 DOI: 10.1371/journal.pone.0172865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/12/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose In response to limited physician adoption of various healthcare initiatives, we sought to propose and assess a novel approach to policy development where one first characterizes diverse physician groups’ common interests, using a medical student and constructivist grounded theory. Methods In 6 months, a medical student completed 36 semi-structured interviews with interventional radiologists, gynecologists, and vascular surgeons that were systematically analyzed according to constructivist grounded theory to identifying common themes. Common drivers of clinical decision making and professional values across 3 distinct specialty groups were derived from physicians’ descriptions of their clinical decision making, stories, and concerns. Results Common drivers of clinical decision making included patient preference/benefit, experience, reimbursement, busyness/volume, and referral networks. Common values included honesty, trustworthiness, loyalty, humble service, compassion and perseverance, and practical wisdom. Although personal gains were perceived as important interests, such values were easily sacrificed for the good of patients or other non-financial interests. This balance was largely dependent on the incentives and security provided by physicians’ environments. Conclusions Using a medical student interviewer and constructivist grounded theory is a feasible means of collecting rich qualitative data to guide policy development. Healthcare administrators and medical educators should consider incorporating this methodology early in policy development to anticipate how value differences between physician groups will influence their acceptance of policies and other broad healthcare initiatives.
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Affiliation(s)
- Eric J. Keller
- Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Megan Crowley-Matoka
- Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jeremy D. Collins
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Howard B. Chrisman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Magdy P. Milad
- Department of Obstetrics and Gynecology-Reproductive Endocrinology & Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Robert L. Vogelzang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
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Keller EJ, Crowley-Matoka M, Collins JD, Chrisman HB, Milad MP, Vogelzang RL. Specialty-Specific Values Affecting the Management of Symptomatic Uterine Fibroids. J Vasc Interv Radiol 2017; 28:420-428. [PMID: 28082073 DOI: 10.1016/j.jvir.2016.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/15/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To better understand why interventional radiologists and gynecologists differ in their approaches to symptomatic uterine fibroids. METHODS Conversational interviews were conducted with 26 interventional radiologists and gynecologists about their professional roles, clinical reasoning, and practice variation within and outside their specialty. Interview transcripts were systematically analyzed using NVivo 10 software (QSR International, Burlington, Massachusetts) according to grounded theory and content analysis to identify key themes and compare themes across specialties and practice environments. Data were supplemented with retrospective analysis of 7,659 patients with symptomatic uterine fibroids treated at a large academic center over 11 years. RESULTS Interventional radiologists' shares of symptomatic uterine fibroid treatment and endovascular stent treatments have remained constant (P > .05) for 11 y at a large medical center, whereas minimally invasive gynecologic fibroid treatments and the percentage of interventional radiology (IR) procedures reimbursed by Medicaid/Medicare have increased significantly (r > .90, P < .001 and r = .93, P < .001). Interventional radiologists and gynecologists shared a commitment to do "the right thing" for patients, but each group possessed distinct professional values affecting how they viewed medical evidence, outcomes, and their colleagues. When differences were apparent and concerning, physicians tended to suspect ulterior motives not in patients' best interests. CONCLUSIONS Interventional radiologists and gynecologists demonstrated wide-ranging perspectives regarding their role in caring for patients with symptomatic uterine fibroids. To promote genuine collaboration and adoption of shared goals, stakeholders should seek and promote a deeper understanding of specialty-specific values and culture.
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Affiliation(s)
- Eric J Keller
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611; Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Megan Crowley-Matoka
- Department of Medical Humanities & Bioethics Program, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Jeremy D Collins
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Howard B Chrisman
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Magdy P Milad
- Department of Obstetrics and Gynecology-Reproductive Endocrinology & Infertility, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611
| | - Robert L Vogelzang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg Room 4-7105, Chicago, IL60611.
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Keller EJ, Collins JD, Crowley-Matoka M, Chrisman HB, Milad MP, Vogelzang RL. Why Vascular Surgeons and Interventional Radiologists Collaborate or Compete: A Look at Endovascular Stent Placements. Cardiovasc Intervent Radiol 2017; 40:814-821. [DOI: 10.1007/s00270-017-1570-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/02/2017] [Indexed: 11/24/2022]
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Keller EJ, Smith PM, Freed B, Allen BD, Spottiswoode BS, Carr ML, Jolly MP, Lin K, Carr JC, Collins JD. Comparison of derived strain values of myocardial regions, levels, and segments by field strength and temporal resolution via cine bSSFP MR imaging. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032394 DOI: 10.1186/1532-429x-18-s1-q16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Keller EJ, Vogelzang RL, Freed BH, Carr JC, Collins JD. Physicians' professional identities: a roadmap to understanding "value" in cardiovascular imaging. J Cardiovasc Magn Reson 2016; 18:52. [PMID: 27566058 PMCID: PMC5002193 DOI: 10.1186/s12968-016-0274-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality improvement efforts in cardiovascular imaging have been challenged by limited adoption of initiatives and policies. In order to better understand this limitation and inform future efforts, the range clinical values related to cardiovascular imaging at a large academic hospital was characterized. MATERIALS AND METHODS 15 Northwestern Medicine physicians from internal medicine, cardiology, emergency medicine, cardiac/vascular surgery, and radiology were interviewed about their use of cardiovascular imaging and imaging guidelines. Interview transcripts were systemically analyzed according to constructivist grounded theory and combined with 56 previous interviews with interventional radiologists, interventional cardiologists, gynecologists, and vascular surgeons to develop a model describing specialty-specific values. This model was applied to the 15 pilot interviews focused on cardiovascular imaging, highlighting specialty specific differences in values and practice patterns. Transcripts were also reviewed independently by a cardiologist and 2 radiologists followed by a group discussion to assess reproducibility and achieve a consensus regarding the results. RESULTS Differences in perceived value of cardiovascular imaging and use of guidelines among physicians were well explained by three value-associated identity categories (managers, diagnosticians, and fixers) that were further differentiated along three axes (broad v. focused-thinkers, complex v. definitive-answer-seekers, and public visibility). CONCLUSIONS Quality improvement in cardiovascular imaging may be limited by a lack of understanding and incorporation of the complexity of medical culture into ongoing initiatives. Both individually and during policy development, it is important to first understand the complexity of stakeholders' diverse perceptions of "value," "quality," and "appropriateness."
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Affiliation(s)
- Eric J. Keller
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave Suite 1600, Chicago, IL 60611 USA
| | - Robert L. Vogelzang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave Suite 1600, Chicago, IL 60611 USA
| | - Benjamin H. Freed
- Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - James C. Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave Suite 1600, Chicago, IL 60611 USA
| | - Jeremy D. Collins
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave Suite 1600, Chicago, IL 60611 USA
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Abstract
Over the last few years, an increasing number of lawsuits have been filed involving inferior vena cava filters. This has prompted the U.S. Judicial Panel on Multidistrict Litigation to centralize these lawsuits into two multidistrict litigations: one for Cook's filters and one for Bard's. Both sets of cases share similar questions of facts, in particular whether these filters' design and manufacturing practices made them unreasonably prone to serious complications. The resolution of these cases will add to a larger legal debate concerning how much legal protection the 1976 Medical Device Amendments should offer firms from tort liability. As a specialty that often relies on medical devices, it is not only important for interventional radiologists to have a general understanding of medical device litigation but also to reflect upon the approaches to informed consent regarding these devices.
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Affiliation(s)
- Eric J Keller
- Department of Radiology, Northwestern University, Chicago, Illinois; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Bioethics and Medical Humanities, Northwestern University, Chicago, Illinois
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Keller EJ, Malaisrie SC, Kruse J, McCarthy PM, Carr JC, Markl M, Barker AJ, Collins JD. Reduction of aberrant aortic haemodynamics following aortic root replacement with a mechanical valved conduit. Interact Cardiovasc Thorac Surg 2016; 23:416-23. [PMID: 27245620 DOI: 10.1093/icvts/ivw173] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 02/05/2016] [Accepted: 04/20/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Previous work suggests that aortic root and valve prostheses alter blood flow patterns in the ascending aorta, creating aberrant haemodynamics compared with those of healthy volunteers. Various valve designs have been proposed to better restore physiological haemodynamics. In this study, magnetic resonance imaging (MRI) was used to non-invasively assess three-dimensional (3D) ascending aortic haemodynamics after aortic root replacement (ARR) with a mechanical valved conduit postulated to create less turbulent blood flow. METHODS Ten patients (40 ± 9 years) underwent transthoracic echocardiography and contrast-enhanced multidimensional four-dimensional (4D) flow MRI at 1.5 T after ARR with an On-X mechanical valved conduit. Preoperative 4D flow MRI was available in 7 patients. Ten age- and gender-matched healthy volunteers (42 ± 13 years) were also analysed to characterize physiological flow. The presence of vortex/helix formation was graded by two blinded observers. Peak transvalvular pressure gradients were computed using the simplified Bernoulli equation. Patients' postoperative pressure gradients and helicity/vorticity grades were compared with preoperative gradients and those from healthy volunteers. RESULTS Intra- and interobserver ratings showed good agreement (κ = 0.93, P < 0.01 and κ = 0.84, P < 0.01, respectively). Highly helical and/or vortical flow was observed in all patients preoperatively, which was significantly reduced postoperatively (P < 0.01 and <0.01, respectively), restoring similar flow patterns similar to those seen in volunteers (P = 0.56 and 0.56). Peak transvalvular pressure gradients (ΔP) were also significantly reduced [43 ± 21 vs 12 ± 7 mmHg, P < 0.05 (Echo); 48 ± 22 vs 16 ± 9 mmHg, P < 0.05 (MRI)], but remained significantly higher than those of volunteers (6 ± 1 mmHg, P < 0.01). CONCLUSIONS Preliminary evidence suggests that ARR with an On-X mechanical valve significantly reduces aberrant aortic haemodynamics, producing flow patterns that resemble those in healthy volunteers.
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Affiliation(s)
- Eric J Keller
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - S Chris Malaisrie
- Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, IL, USA
| | - Jane Kruse
- Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, IL, USA
| | - Patrick M McCarthy
- Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, IL, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, USA Department of Biomedical Engineeringy, Northwestern University, Evanston, IL, USA
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, IL, USA Department of Biomedical Engineeringy, Northwestern University, Evanston, IL, USA
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, Chicago, IL, USA
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Keller EJ, Malaisrie SC, Kruse J, Ooij PV, Semaan E, McCarthy P, Carr JC, Markl M, Barker AJ, Collins JD. Restoration of physiologic hemodynamics in the ascending aorta following aortic valve Rreplacement: a 4D flow MR study. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032619 DOI: 10.1186/1532-429x-18-s1-p346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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