Role of diagnostic imaging technologists during the COVID-19 pandemic: the importance of organization and planning in the first line

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.

Role of diagnostic imaging technologists during the COVID-19 pandemic: The importance of organization and planning in the first line

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception.

In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.

Access to Endovascular Treatment in Remote Areas

Background and Purpose—

Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model.

Methods—

We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups.

Results—

Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C. Time from symptom onset to groin puncture was 82 minutes longer in group B (312 minutes [245–435]) and 120 minutes longer in group C (350 minutes [284–408]) compared with group A (230 minutes [160–407]; P <0.001).

Conclusions—

Accessibility to EVT from remote areas is hampered by lower rate and longer time to treatment compared with areas covered directly by Comprehensive Stroke Centers.

[Natural history of hepatocellular carcinoma in a cohort of pacients from a county hospital]

BACKGROUND

hepatocellular carcinoma (HCC) is a cancer with high incidence and mortality.

OBJECTIVE

our aim was to describe the natural history of a patient cohort with HCC, and to identify the factors associated with survival.

PATIENTS AND METHODS

a retrospective and descriptive study of patients diagnosed with HCC between 1995 and 2002. Qualitative variables were expressed as frequencies and percentages. Quantitative variables were expressed as medians and standard deviations. Survival was calculated using the Kaplan-Meier method and log rank.

RESULTS

a total of 154 patients were analyzed. The men-to-women ratio was 2.9/1. Mean age was 68 +/- 9 years. 82% of patients died during a median follow-up of 28 months. Median survival was 21.5 months (95% CI: 16.98-26.04). Curative treatment was done in 40.3% of diagnosed patients, and 59.7% of patients received palliative treatment. Factors associated with survival were: ascites, number of lesions at diagnosis, and curative treatment. No statistical differences were found for the next factors: age, sex, etiology of cirrhosis, and Child-Pugh stage at diagnosis.

CONCLUSIONS

factors associated with low survival in patients with HCC were ascites and number of lesions. Curative treatment is associated with a higher survival when compared to palliative treatment.

[Extravasation of contrast medium after carotid stent with brain infarction symptoms]

Angioplasty, with or without stent placement, as a carotid revascularisation technique, has become an alternative treatment for carotid stenosis, it being considered under certain circumstances the treatment of choice. The main concern about this technique is the distal embolisation during the procedure, while other, less frequent, complícations have also been described such as dissection, vasospasm or even arterial rupture. Some of the infrequent complications include the hyperperfusion syndrome, and, more exceptionally, cases of extravasation of the contrast medium. We present the case of a patient who was subjected to angioplasty and stent insertion due to carotid stenosis with signs of calcification who suffered a stroke-like disorder in her right medial brain artery as a consequence of the extravasation of contrast medium after the rupture of the angioplasty balloon, a situation which has never been described in the literature before.

[Carotid stenosis: appropriate diagnosis and treatment]

Ischemic cerebral infarcts represent a serious health problem with important social and economic repercussions in the western world. The presence of carotid stenosis is one of the main risk factors for the appearance of cerebral infarcts. Carotid stenosis represents a challenge for the medical community, both because of the enormous amount of scientific information available and because of the constant advances in diagnostic procedures and especially in revascularization techniques for treatment. General radiologists as well as those specializing in vascular pathology need to have ample knowledge of how to reach the diagnosis and of the different treatment options for this pathology if they are to play a successful role in multidisciplinary teams dealing with carotid stenosis. This update aims to present the basic information that we consider to be essential in a simple way to enable radiologists to meet this challenge.

[Ischemic renal disease: revascularization or conservative treatment?]

Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations. The atherosclerosis is a systemic disease and it provides the general prognosis of patients. We conclude that ischemic renal disease is a nephropathy of smoker men, with proteinuria excretion similar to nephropathy with unilateral stenosis. The age of patients is the clinical feature that decide the treatment: surgery, angioplasty/stent or medical management. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization and medically treated patients have proved that the advanced chronic renal insufficiency is associated with an unfavourable response of treatment of the ischemic nephropathy. But, in this nephropathy the revascularization can be the better therapy for selected patients. The revascularization with angioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiency has a doubtful effectiveness, as the chronic renal failure is result of nephroangiosclerosis.

[Arteriovenous fistula: complication of renal biopsy. Superselective embolization]

The arteriovenous fistula can be a major and late complication of percutaneous renal biopsies of native kidneys. The incidence of arteriovenous fistulas appears to be low and has been infrequently mentioned in large series of biopsies although there are a number of individual reports. In most part of cases, no systemic effects of the arteriovenous fistulas were observed, so they close by themselves. Optimization of renal biopsy techniques aims not only at obtaining kidney tissue technically adequate for diagnosis, but at reducing biopsy-induced complications. When these complications are done, the new transvascular techniques can get the healing of fistula with the embolism by catheters. We describe the case of a 37-year-old woman who had chronic renal failure by a possible chronic glomerulonephritis. She developed deterioration of renal function after the percutaneous renal biopsy. An arteriovenous fistula of high flow was detected by Doppler ultrasound. Then, it was confirmed angiographically and closed by embolism's catheter without damage of renal tissue.

Occult liver involvement by polyarteritis nodosa

The diagnosis of panarteritis nodosa is usually difficult because of the variability of clinical manifestations. Herein is presented a case of occult liver involvement by polyarteritis nodosa. Several biopsies were performed but the diagnosis was made with the contribution of a hepatic arteriography.

[Angioplasty for intracranial internal carotid artery stenosis]

INTRODUCTION

Percutaneous transluminal angioplastia has in recent years become an alternative to surgery and increasingly used for revascularization of the extracranial arteries in patients with cerebral ischemia. However, intracranial angioplasty is a technique which is still not widely used since it is technically more difficult and until now endoprotheses (stents) have not been available specifically designed for intracranial territory.

CLINICAL CASE

A 73 year old patient with extensive extracranial and intracranial atheromatous lesions, multiple vascular risk factors and cardiac ischemia which contraindicated surgical treatment which was treated consecutively by angioplasty and angioplasty with implantation of stents in both carotid bifurcations. Subsequently, he was treated by angioplasty for a stenosing lesion of 90% of the right carotid siphon with clinical and hemodynamic repercussions. Following the procedure, which was well-tolerated by the patient, there was clinical and angiographic improvement and return to normal of the hemodynamic parameters measured by transcranial Doppler.

CONCLUSIONS

Angioplasty is a technique which may be used in intracranial stenosing atheromatous lesions. Even without perfect angiographic correction, adequate blood flow is established in the hemodynamically affected lesions. As far as we know this is the first case of intracranial angioplasty of a lesion of the carotid siphon reported in Spain.

Balloon catheter sphincteroplasty and biliary stone expulsion into the duodenum in patients with an indwelling T tube

BACKGROUND

To present an alternate approach for treating residual biliary stones in patients with indwelling T tube that uses the immature tract created by the T tube to carry out both sphincteroplasty and expulsion of the calculi with the same angioplasty balloon catheter.

METHODS

This technique was performed in five patients. Access to the bile duct was through an 8-Fr T tube. First a guidewire was inserted and advanced beyond the obstructing stone to the duodenal lumen. The T tube was removed over the guidewire, and a balloon catheter was introduced. Sphincteroplasty was carried out. Then the balloon was deflated and retracted to a position proximal to the stone. It was then reinflated and used to push the stone, expelling it into the duodenum.

RESULTS

In all cases, all biliary stones were expelled without pain, in a single session, and with no immediate complications. All patients showed rapid clinical and analytic improvement. During clinical and echographic follow-up of 2-22 months (mean = 12.4 months), there were no complications or relapses.

CONCLUSIONS

Our limited experience indicates that sphincteroplasty and expulsion of biliary stones with angioplasty balloon catheters through the T tube immature tract is a simple, safe, low-cost technique that gives good results.

[Cost-effectiveness of and morbidity from digital subtraction angiography. A study of 5,817 cases]

This study was based on 5,817 patients examined by digital subtraction angiography (DSA) between 1984 and 1990. 5,209 patients received an intravenous injection of contrast agent and 608 received an intra-arterial injection. Digital subtraction angiography has become a routine procedure for the diagnosis of vascular disease in the various fields studied, as it provides images of diagnostic quality in 97% of cases: diagnostic quality of 95% after intravenous injection and 99% after intra-arterial injection. The morbidity is 1.65% for the intravenous route and 4.8% for the intra-arterial route. The morbidity of brachial artery catheterization is 5.5% DSA by intravenous injection is a low-risk angiographic technique which represents a major economy in terms of the cost of the examination and the examination time, a reduction of hospital stay and waiting lists; these advantages are very important in the current context of public health.