Variceal and Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Management: Indications and Role of Interventional Radiology

For over 60 years, diagnostic and interventional radiology have been heavily involved in the evaluation and treatment of patients presenting with gastrointestinal bleeding. For patients who present with upper GI bleeding and have a contraindication to endoscopy or have an unsuccessful attempt at endoscopy for identifying or controlling the bleeding, interventional radiology is often consulted for evaluation and consideration of catheter-based intervention.

Challenges, Barriers, and Successes of Standardized Report Templates: Results of a Society of Interventional Radiology Survey

Registry data are being increasingly used to establish treatment guidelines, set benchmarks, allocate resources, and make payment decisions. Although many registries rely on manual data entry, the Society of Interventional Radiology (SIR) is using automated data extraction for its VIRTEX registry. This process relies on participants using consistent terminology with highly structured data in physician-developed standardized reports (SR). To better understand barriers to adoption, a survey was sent to 3,178 SIR members. Responses were obtained from 451 interventional radiology practitioners (14.2%) from 92 unique academic and 151 unique private practices. Of these, 75% used structured reports and 32% used the SIR SR. The most common barriers to the use of these reports include SR length (35% of respondents), lack of awareness about the SR (31%), and lack of agreement on adoption within practices (27%). The results demonstrated insights regarding barriers in the use and/or adoption of SR and potential solutions.

A History and Modern Framework for Quality Improvement in Interventional Radiology

Quality improvement (QI) initiatives have benefited patients as well as the broader practice of medicine. Large-scale QI has been facilitated by multi-institutional data registries, many of which were formed out of national or international medical society initiatives. With broad participation, QI registries have provided benefits that include but are not limited to establishing treatment guidelines, facilitating research related to uncommon procedures and conditions, and demonstrating the fiscal and clinical value of procedures for both medical providers and health systems. Because of the benefits offered by these databases, Society of Interventional Radiology (SIR) and SIR Foundation have committed to the development of an interventional radiology (IR) clinical data registry known as VIRTEX. A large IR database with participation from a multitude of practice environments has the potential to have a significant positive impact on the specialty through data-driven advances in patient safety and outcomes, clinical research, and reimbursement. This article reviews the current landscape of societal QI programs, presents a vision for a large-scale IR clinical data registry supported by SIR, and discusses the anticipated results that such a framework can produce.

Inferior vena cava syndrome caused by postoperative positional changes in the liver

Inferior vena cava (IVC) compression is well reported in the literature with the most common etiology being secondary to malignancy in neighboring structures (liver, kidney, pancreas, etc.). We present a novel case of IVC compression secondary to altered liver position following nephrectomy. This case report describes the clinical course, patient evaluation, and procedural considerations of this unique case.

"Quick" MRIs without contrast in the setting of pediatric abscess drainage: A comparative analysis of clinical outcomes

BACKGROUND/PURPOSE

To assess the use of "quick" MRI without contrast in the setting of percutaneous drain management in pediatric patients.

METHODS

A retrospective medical record review was conducted to compare "quick" MRI without contrast to CT in the pediatric percutaneous drain placement setting. The study included 111 patients under 18-years-old having undergone percutaneous drain placement between January 2014 and January 2019. The "quick" MRI protocol consists of axial single-shot-fast-spin-echo (SSFSE) and fat-saturated SSFSE coronal sequences. Primary clinical outcomes included number of additional drain placement procedures, complications, length of hospitalization, and repeat drainage within 6 months following drain-free interval. The use of "quick" MRI post-procedurally was also investigated.

RESULTS

Patients with pre-drain "quick" MRIs instead of CTs had no significant difference in the need for additional drain placement (p = 1), length of hospitalization (p = 0.275), or drainage complications (p = 0.728). Patients receiving "quick" MRI for follow-up imaging post-drain placement had no greater rate of repeat drainage within 6 months of initial drain discontinuation (p = 0.90) when compared to patients having CT.

CONCLUSIONS

Pre and post-drainage procedure "quick" MRIs were found to be equivalent to CT in regard to several key clinical outcomes.

Recurrent spontaneous pneumothoraxes as a complication of osteosarcoma metastases: a case report

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. Osteosarcomas are highly aggressive tumors that historically have had a dismal prognosis. However, the survival rate has improved significantly with the addition of adjuvant and neoadjuvant chemotherapy. Here, we present a case report of a 13-year-old male with a history of a left humeral osteosarcoma whose course was complicated by recurrent sarcoma-related pneumothoraces. Despite recurrent pneumothoraces being a relatively uncommon complication of osteosarcoma, they present a great challenge to providing treatment that optimizes outcomes and quality of life for patients.

Superselective embolization in posttraumatic high-flow priapism

We present a case of a 24 year old man who presented with high flow priapism. Priapism is defined as an erection lasting four or more hours, either after or unrelated to sexual stimulation. Priapism can be categorized into low-flow, stuttering, and high-flow types, each with unique mechanisms and treatments. High-flow priapism is caused by an abnormal communication between the artery and sinusoids of the penis, often in the form of an arteriovenous fistula. Super-selective embolization is the treatment of choice for high-flow priapism if conservative measures fail. Super-selective embolization is associated with an 80% success rate and a low chance of post-procedure erectile dysfunction.

Medical Student Knowledge and Interest in Interventional Radiology following a Rotation Integrated into the Surgery Clerkship

Objective:

The objective of the study was to evaluate how early exposure to interventional radiology (IR) affects medical students’ knowledge and interest in IR.

Methods:

Surveys assessing students’ awareness of IR training pathways, IR services, and interest in IR were distributed in 2018. Descriptive statistics were calculated. Likert scale data were evaluated using Mann–Whitney U-test. We hypothesized that students’ interest in IR and knowledge of the specialty would increase following their rotations.

Results:

16/20 (80%) pre-rotation and 13/20 post-rotation (65%) students responded to the surveys. About 73% of pre and 85% of post students knew that IR had its own new residency program. About 50% of pre and 100% of post students knew that integrated IR residency was a new training pathway. About 38% of pre and 46% of post students knew that independent IR residency was a new training pathway. About 38% of pre and 62% of post students knew that early specialization was a new training pathway. The number of students who knew IR had admitting privileges doubled (62% post vs. 31% pre). More students knew that IR had a clinic at our hospital (85% vs. 63%). The level of interest in becoming an IR increased from 3.00 to 3.23 (P = 0.36), and the level of interest in becoming a diagnostic radiologist increased from 2.56 to 2.69 (P = 0.91).

Conclusion:

Awareness of IR as a clinical specialty and familiarity with the new training pathways increased after an IR elective integrated into a surgery rotation. Students’ interest in pursuing IR also non-significantly increased.