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Iguchi T, Yamakado K. IR in Japan. Cardiovasc Intervent Radiol 2022; 45:1559-1560. [PMID: 35441244 DOI: 10.1007/s00270-022-03137-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Toshihiro Iguchi
- Department of Radiological Technology, Okayama University Graduate School of Health Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan.
| | - Koichiro Yamakado
- Department of Radiology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
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2
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Woerner A, Chick JFB, Monroe EJ, Ingraham CR, Pereira K, Lee E, Hage AN, Makary MS, Shin DS. Interventional Radiology in the Coronavirus Disease 2019 Pandemic: Impact on Practices and Wellbeing. Acad Radiol 2021; 28:1209-1218. [PMID: 34210612 PMCID: PMC8185184 DOI: 10.1016/j.acra.2021.05.025] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To report the impact of the coronavirus disease 2019 (COVID-19) pandemic on interventional radiology (IR). MATERIALS AND METHODS A 78-question survey was distributed to practicing interventional radiologists and IR trainees. The survey consisted of demographic and practice environment queries. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) screener, and coping strategies were assessed using the Brief-Coping Orientation to Problems Experienced (Brief-COPE) questionnaire. RESULTS There were 422 respondents including 333 (78.9%) attending interventional radiologists and 89 (21.1%) interventional radiologists-in-training from 15 counties. Most respondents were from academic medical centers (n = 218; 51.7%). A large majority (n = 391; 92.7%) performed a procedure on a patient with confirmed COVID-19 infection. An N95 mask was the most common (n = 366; 93.6%) safety measure employed. Cancellation or limitation of elective procedures were reported by 276 (65.4%) respondents. Many respondents (n = 177; 41.9%) had self-reported anxiety (GAD-7 score >5) with an overall mean GAD-7 score of 4.64 ± 4.63 (range: 0-21). Factors associated with reporting anxiety included female gender (p = 0.045), increased call coverage (p = 0.048), lack of adequate departmental adjustments (p <0.0001), and lack of adjustments in a timely manner (p <0.0001). The most utilized coping strategy was acceptance (mean of 5.49 ± 1.88), while the most employed dysfunctional coping strategy was self-distraction (mean of 4.16 ± 1.67). The odds of reporting anxiety increased by >125% with adoption of dysfunctional strategies. CONCLUSION The COVID-19 pandemic induced practice alterations and high rates of self-reported anxiety in IR. Female gender, increased call coverage, and lack of adequate or timely departmental adjustments were associated with increased anxiety levels.
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Affiliation(s)
- Andrew Woerner
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington 98195
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington 98195; Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington 98105
| | - Eric J Monroe
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington 98195; Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington 98105
| | - Christopher R Ingraham
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington 98195
| | - Keith Pereira
- Department of Radiology, Division of Vascular Interventional Radiology, Saint Louis University Hospital, St. Louis, Missouri 63110
| | - Eunjee Lee
- Department of Information and Statistics, Chungnam National University, Yuseong-gu, Daejeon, South Korea
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, Thomas Jefferson Hospital, Philadelphia, Pennsylvania 19107
| | - Mina S Makary
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43210
| | - David S Shin
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, Washington 98195.
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Merriam AA, Huang Y, Wright JD, Goffman D, D'Alton ME, Friedman AM. Use of Uterine Tamponade and Interventional Radiology Procedures During Delivery Hospitalizations. Obstet Gynecol 2020; 135:674-684. [PMID: 32028498 PMCID: PMC7040521 DOI: 10.1097/aog.0000000000003722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize use of uterine tamponade and interventional radiology procedures. METHODS This retrospective study analyzed uterine tamponade and interventional radiology procedures in a large administrative database. The primary outcomes were temporal trends in these procedures 1) during deliveries, 2) by hospital volume, and 3) before hysterectomy for uterine atony or delayed postpartum hemorrhage. Three 3-year periods were analyzed: 2006-2008, 2009-2011, and 2012-2014. Risk of morbidity in the setting of hysterectomy with uterine tamponade and interventional radiology procedures as the primary exposures was additionally analyzed in adjusted models. RESULTS The study included 5,383,486 deliveries, which involved 6,675 uterine tamponade procedures, 1,199 interventional radiology procedures, and 1,937 hysterectomies. Interventional radiology procedures increased from 16.4 to 25.7 per 100,000 delivery hospitalizations from 2006-2008 to 2012-2014 (P<.01), and uterine tamponade increased from 86.3 to 158.1 (P<.01). Interventional radiology procedures use was highest (45.0/100,000 deliveries, 95% CI 41.0-48.9) in the highest and lowest (8.9/100,000, 95% CI 7.1-10.7) in the lowest volume quintile. Uterine tamponade procedures were most common in the fourth (209.8/100,000, 95% CI 201.1-218.5) and lowest in the third quintile (59.8/100,000, 95% CI 55.1-64.4). Interventional radiology procedures occurred before 3.3% of hysterectomies from 2006 to 2008 compared with 6.3% from 2012 to 2014 (P<.05), and uterine tamponade procedures increased from 3.6% to 20.1% (P<.01). Adjusted risks for morbidity in the setting of uterine tamponade and interventional radiology before hysterectomy were significantly higher (adjusted risk ratio [aRR] 1.63, 95% CI 1.47-1.81 and aRR 1.75 95% CI 1.51-2.03, respectively) compared with when these procedures were not performed. CONCLUSION This analysis found that uterine tamponade and interventional radiology procedures became increasingly common over the study period, are used across obstetric volume settings, and in the setting of hysterectomy may be associated with increased risk of morbidity, although this relationship is not necessarily causal.
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Affiliation(s)
- Audrey A Merriam
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, Connecticut; and the Department of Obstetrics and Gynecology, Columbia University, New York, New York
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Cervi A, Douketis JD. Landmark trials in thrombotic vascular disease: a critical appraisal of potential practice-changing trials in 2016-2017. Intern Emerg Med 2019; 14:355-363. [PMID: 30054799 DOI: 10.1007/s11739-018-1910-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 07/12/2018] [Indexed: 12/16/2022]
Abstract
Recent years have witnessed an onslaught of large, multicenter, randomized controlled trials evaluating the prevention and management of thrombotic vascular diseases. While these trials have applied rigorous methodology to pragmatic and clinically relevant questions, several important gaps in knowledge remain. In this review, we critically appraise landmark studies in thrombosis published between 2016 and 2017 that address several ongoing areas of clinical uncertainty. Specifically, we review the role of endovascular therapy in the prevention of post-thrombotic syndrome following acute lower limb deep vein thrombosis (DVT) (ATTRACT trial), the efficacy of edoxaban as the first direct oral anticoagulant used for the treatment of cancer-associated thrombosis (HOKUSAI VTE-Cancer study), whether aspirin can be considered for thromboprophylaxis post-major orthopedic surgery (EPCAT-2 trial), and the need for anticoagulant therapy for treatment of isolated distal DVT (CACTUS trial). Using illustrative cases, we highlight the applicability of these trials to current practice and emphasize the unanswered questions that remain.
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Affiliation(s)
- Andrea Cervi
- Department of Medicine, St. Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave East, Hamilton, L8N 4A6, Canada
| | - James Demetrios Douketis
- Department of Medicine, St. Joseph's Healthcare Hamilton, McMaster University, Room F-544, 50 Charlton Ave East, Hamilton, L8N 4A6, Canada.
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Rivard DC, Reading BD. Pediatric Interventional Radiology: Blurring the Lines Between Specialties. Mo Med 2018; 115:361-364. [PMID: 30228768 PMCID: PMC6140263] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Medical imaging has transformed the ease and speed of patient care with provision of detailed evaluation of anatomic structures and disease processes. Interventional radiology uses imaging guided techniques to further diagnose or treat diseases with minimally invasive methods. These techniques are particularly helpful in treating pediatric patients.
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Affiliation(s)
- Douglas C Rivard
- Douglas C. Rivard, DO, is Radiologist-in-Chief, Children's Mercy Hospital, Associate Professor Pediatric Radiology, University of Missouri, Kansas City, Kansas City, Mo
| | - Brenton D Reading
- Brenton D. Reading, MD, is Assistant Professor, Pediatric Radiology, Children's Mercy, University of Missouri, Kansas City
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Affiliation(s)
- He Zhao
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiay-Wei Tsauo
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Wu Zhang
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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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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Abstract
Restenosis and the need for repeated interventions after percutaneous transluminal angioplasty (PTA) remain major drawbacks limiting a widespread application of this minimally invasive technique in the femoropopliteal segment. During the last decade, vascular brachytherapy (BT) emerged as a promising, novel technology with the potential to reduce the rates of restenosis. Meanwhile, several randomized controlled trials have suggested beneficial short and midterm effects of BT in the femoropopliteal arteries. However, despite substantial advances, many questions remain regarding the utility of vascular BT and its dissemination as a practical tool to prevent restenosis. The risk of complications, such as late stent thrombosis, edge effect, catch-up late restenosis, and potential aneurysm formation, as well as the logistical issues associated with the use of this technology in the catheterization laboratory, are delaying the acceptance of BT for routine use. This article reviews the developments of BT for restenosis prevention during the past decade, focusing on implications for peripheral endovascular treatment.
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Golwala H, Pant S, Pandey A, Flaherty MP, Hirsch GA, Kirtane AJ. Heparin Versus Bivalirudin in ST-Segment Elevation Myocardial Infarction: A SCAI-Based National Survey From US Interventional Cardiologists. J Invasive Cardiol 2016; 28:351-356. [PMID: 27591687] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The use of antithrombotic therapy (ATT) (bivalirudin or unfractionated heparin) is a class I recommendation for patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). This survey was conducted to better understand current United States (US) practices in terms of preferences regarding the selection of ATT in STEMI-PPCI, particularly in light of recent clinical trials. METHODS An electronic survey consisting of 9 focused questions was forwarded to 2676 US interventional cardiologists who were members of the Society for Cardiovascular Angiography and Interventions (SCAI). RESULTS Among 390 responders (14.5%), bivalirudin with bail-out glycoprotein IIb/IIIa inhibitor (GPI) was the predominant strategy for 53% of operators, whereas 32% preferred heparin with bail-out GPI and 15% preferred heparin with more routine GPI. The duration of bivalirudin infusion varied widely among operators, and significant variability existed in the bolus dose of heparin that was preferred by operators. About 49% of respondents stated that the choice of ATT was not affected by the bleeding risk of the patient, although access site did appear to affect the choice of ATT for some operators. Notably, 43% of operators reported to have changed their practice regarding ATT in light of recent trial results. CONCLUSION There is marked variability in self-reported ATT use in STEMI-PPCI among US interventional cardiologists. Given the patient-related variability in bleeding risk and mixed clinical trial results between the two predominant ATT agents, bivalirudin and unfractionated heparin, more data are needed in order to further inform and potentially unify clinical practice in STEMI-PPCI.
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Affiliation(s)
| | | | | | | | | | - Ajay J Kirtane
- Center for Interventional Vascular Therapy, Columbia University Medical Center/New York Presbyterian Hospital, 161 Fort Washington Ave, 6th Floor, New York, NY 10032 USA.
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10
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Poudel S, Weir L, Dowling D, Medich DC. Changes in Occupational Radiation Exposures after Incorporation of a Real-time Dosimetry System in the Interventional Radiology Suite. Health Phys 2016; 111:S166-S171. [PMID: 27356166 DOI: 10.1097/hp.0000000000000546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A statistical pilot study was retrospectively performed to analyze potential changes in occupational radiation exposures to Interventional Radiology (IR) staff at Lawrence General Hospital after implementation of the i2 Active Radiation Dosimetry System (Unfors RaySafe Inc, 6045 Cochran Road Cleveland, OH 44139-3302). In this study, the monthly OSL dosimetry records obtained during the eight-month period prior to i2 implementation were normalized to the number of procedures performed during each month and statistically compared to the normalized dosimetry records obtained for the 8-mo period after i2 implementation. The resulting statistics included calculation of the mean and standard deviation of the dose equivalences per procedure and included appropriate hypothesis tests to assess for statistically valid differences between the pre and post i2 study periods. Hypothesis testing was performed on three groups of staff present during an IR procedure: The first group included all members of the IR staff, the second group consisted of the IR radiologists, and the third group consisted of the IR technician staff. After implementing the i2 active dosimetry system, participating members of the Lawrence General IR staff had a reduction in the average dose equivalence per procedure of 43.1% ± 16.7% (p = 0.04). Similarly, Lawrence General IR radiologists had a 65.8% ± 33.6% (p=0.01) reduction while the technologists had a 45.0% ± 14.4% (p=0.03) reduction.
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Affiliation(s)
- Sashi Poudel
- *Department of Physics, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609; †Department of Radiology, Lawrence General Hospital, 1 General St, Radiology Department, Lawrence, MA 01841
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[Thrombectomy in stroke: the most rapid transport and network formation is required]. ROFO-FORTSCHR RONTG 2016; 188:109-10. [PMID: 27077150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Groden C, Zeumer H. [Not Available]. Clin Neuroradiol 2015; 25 Suppl 2:111-3. [PMID: 26139539 DOI: 10.1007/s00062-015-0426-7] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Christoph Groden
- Abteilung für Neuroradiologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Hermann Zeumer
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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13
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Chambers CE. SCAI: home of interventional cardiology. Catheter Cardiovasc Interv 2015; 85:941-3. [PMID: 25904222 DOI: 10.1002/ccd.25917] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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de Baere T, Deschamps F, Tselikas L, Ducreux M, Planchard D, Pearson E, Berdelou A, Leboulleux S, Elias D, Baudin E. GEP-NETS update: Interventional radiology: role in the treatment of liver metastases from GEP-NETs. Eur J Endocrinol 2015; 172:R151-66. [PMID: 25385817 DOI: 10.1530/eje-14-0630] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuroendocrine tumors from gastro-pancreatic origin (GEP-NET) can be responsible for liver metastases. Such metastases can be the dominant part of the disease as well due to the tumor burden itself or the symptoms related to such liver metastases. Intra-arterial therapies are commonly used in liver only or liver-dominant disease and encompass trans-arterial chemoembolization (TACE), trans-arterial embolization (TAE), and radioembolization (RE). TACE performed with drug emulsified in Lipiodol has been used for the past 20 years with reported overall survival in the range of 3-4 years, with objective response up to 75%. Response to TACE is higher when treatment is used as a first-line therapy and degree of liver involvement is lower. Benefit of TACE over TAE is unproven in randomized study, but reported in retrospective studies namely in pancreatic NETs. RE provides early interesting results that need to be further evaluated in terms of benefit and toxicity. Radiofrequency ablation allows control of small size and numbered liver metastases, with low invasiveness. Ideal metastases to target are one metastasis <5 cm, or three metastases <3 cm, or a sum of diameter of all metastases below 8 cm. Ablation therapies can be applied in the lung or in the bones when needed, and more invasive surgery should be probably saved for large-size metastases. Even if the indication of image-guided therapy in the treatment of GEP-NET liver metastases needs to be refined, such therapies allow for manageable invasive set of treatments able to address oligometastatic patients in liver, lung, and bones. These treatments applied locally will save the benefit and the toxicity of systemic therapy for more advanced stage of the disease.
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Affiliation(s)
- Thierry de Baere
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Frederic Deschamps
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Lambros Tselikas
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Michel Ducreux
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - David Planchard
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Ernesto Pearson
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Amandine Berdelou
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Sophie Leboulleux
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Dominique Elias
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Eric Baudin
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
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Affiliation(s)
- Steven E Seltzer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas H Lee
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Ajay K Wakhloo
- Received December 17, 2013; final revision received December 23, 2013; accepted December 24, 2013
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17
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Abstract
Successful recanalization and percutaneous revascularization of coronary arteries with chronic total occlusion (CTO) is one of the 'last frontiers' in coronary interventions. Conquering this obstacle will enable complete percutaneous revascularization in an increasing number of patients. The introduction within the last few years of enhanced guidewires combined with increasing operator experience and creative procedural techniques, such as the retrograde approach and the re-entry subintimal tracking technique (STAR), have significantly reduced the number of CTOs that should now be considered unapproachable. In addition, novel devices have been developed over recent years that may increase the success rate, as well as the safety, of the procedure. The Safe-Cross radiofrequency combines optical coherence reflectometry that warns the operator when the wire tip moves to within 1 mm of the outer vessel wall, combined with radiofrequency energy pulses to facilitate the passage. The CROSSER catheter mechanically vibrates against the face of the CTO at 20 kHz at a stroke depth of approximately 20 microm, creating a channel through the CTO. The most novel approach is the biologic one, in which proteolytic enzymes that digest the CTO cap to facilitate mechanical passage. The success rates for otherwise refractory CTOs will continue to improve with the development and validation of new imaging modalities and active energy source catheters.
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Affiliation(s)
- Giora Weisz
- Columbia University Medical Center, Center for Interventional Vascular Therapy, 161 Fort Washington Avenue, IP-5 Floor, New York, NY 10032, USA.
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18
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Cwikiel W, Keussen I. [Interventional radiology is strong in the therapy arsenal. New methods are being introduced in both malignant and benign diseases]. Lakartidningen 2013; 110:2297-2299. [PMID: 24501908] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Wojciech Cwikiel
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Inger Keussen
- Bild- och funktionsdiagnostiskt centrum/röntgenavdelningen, Skånes universitetssjukhus, Lund
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Bargellini I, Florio F, Golfieri R, Grosso M, Lauretti DL, Cioni R. Trends in utilization of transarterial treatments for hepatocellular carcinoma: results of a survey by the Italian Society of Interventional Radiology. Cardiovasc Intervent Radiol 2013; 37:438-44. [PMID: 23719667 DOI: 10.1007/s00270-013-0656-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/30/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was designed to provide an overview of the practice of locoregional treatments for HCC by the Italian centers of Interventional Radiology (IR) with particular reference to transarterial modalities. METHODS A questionnaire of 11 questions on locoregional treatment of HCC was e-mailed to 134 Italian IR centers. RESULTS The response rate was 64.9% (87/135 centers). Of 8,959 procedures in 2011, 67% were transarterial treatments, 31% percutaneous ablations, and 2% Y90-radioembolizations. Regarding (chemo)embolization, approximately 59% of procedures were performed in the intermediate stage, 28% in the early stage, and 12.8% in the advanced stage. TACE techniques varied greatly; approximately 52% of procedures were performed with drug-eluting particles and 32% with lipiodol, drug, and reabsorbable particles. In selected cases, 53 of 78 (68%) centers combine chemoembolization and ablation, whereas 28 centers (35.9%) combine Sorafenib and chemoembolization. In 2011, 13 of 78 (16.7%) responding centers performed Y90-radioembolization, with approximately 52% of procedures performed in the advanced stage and 46% in the intermediate stage. Approximately 62% of Y90-radioembolizations were performed using resin spheres and 38% using glass spheres. CONCLUSIONS With almost 9,000 procedures performed each year, locoregional treatments of HCC, most of all transarterial (chemo)embolizations, represent a major part of daily clinical practice in many Italian IR centers. The high variability in responses regarding transarterial treatments for HCC patients highlights the need for solid scientific evidence allowing better definition of clinical indications and standardization of technical approaches.
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Affiliation(s)
- Irene Bargellini
- Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy,
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20
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Playing music can lower sedation requirements during interventional radiology procedures. Health Devices 2012; 41:334. [PMID: 23444678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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21
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Kaufman JA. The 28th Annual Dr. Charles T. Dotter Lecture: IR 360-the external and internal forces that shape our specialty. J Vasc Interv Radiol 2012; 23:1117-24. [PMID: 22920975 DOI: 10.1016/j.jvir.2012.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/10/2012] [Accepted: 06/11/2012] [Indexed: 11/30/2022] Open
MESH Headings
- Competitive Behavior
- Diffusion of Innovation
- Economic Competition
- Endovascular Procedures/economics
- Endovascular Procedures/history
- Endovascular Procedures/trends
- Health Care Costs
- Health Services Needs and Demand/organization & administration
- History, 20th Century
- History, 21st Century
- Humans
- Models, Organizational
- Radiography, Interventional/economics
- Radiography, Interventional/history
- Radiography, Interventional/trends
- Radiology, Interventional/economics
- Radiology, Interventional/history
- Radiology, Interventional/organization & administration
- Radiology, Interventional/trends
- Specialization/economics
- Specialization/history
- Specialization/trends
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22
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Santos Martín E, Crespo Vallejo E. [Interventional radiology: current problems and new directions]. Radiologia 2012; 56:103-6. [PMID: 22898472 DOI: 10.1016/j.rx.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/08/2011] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 11/16/2022]
Abstract
In recent years, vascular and interventional radiology has become one of the fastest growing diagnostic and therapeutic specialties. This growth has been based on a fundamental concept: performing minimally invasive procedures under imaging guidance. This attractive combination has led to the interest of professionals from other clinical specialties outside radiology in performing this type of intervention. The future of vascular and interventional radiology, although uncertain, must be linked to clinical practice and multidisciplinary teamwork.
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Affiliation(s)
- E Santos Martín
- Interventional Radiology Division, Department of Radiology, UPMC, Pittsburgh, USA.
| | - E Crespo Vallejo
- Radiología Intervencionista, Departamento de Radiología, Hospital Universitario Infanta Leonor, Madrid, España
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23
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Trillaud H. [The new format of the Journal of Radiology]. J Radiol 2011; 92:871. [PMID: 22000607 DOI: 10.1016/j.jradio.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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24
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25
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Abstract
Interventional radiology is a rapidly growing discipline in paediatrics. Many non-vascular interventional techniques may be used in the gastrointestinal tract in children. The technically simpler and more common of these may be adopted by any paediatric radiologist with an interest in interventional radiology. Other rarer and more complex techniques are currently restricted to specialist centres with a higher overall caseload. This review emphasizes the common procedures such as oesophageal dilatation, gastrostomy, insertion of transgastric jejunal feeding tubes and biopsy. Less common salivary, hepatobiliary, pancreatic and intestinal interventions are also described.
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Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, WC1N 3JH, UK.
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26
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Laméris JS. [Radiology: from diagnostic tool to interventional procedures]. Ned Tijdschr Geneeskd 2011; 155:A3069. [PMID: 21447227] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article represents the author's personal view and experience on the gradual shift from diagnostic to interventional radiology during the past 30 years. The first interventional procedures almost exclusively concerned vascular medicine. Progress in cross-sectional imaging with ultrasound, CT and MRI opened opportunities for further applications such as abdominal and musculoskeletal interventional procedures. Interventional radiology takes place in a grey area between specialties. Interspecialty turf battles can be the result, often at the expense of the interests of the patient. Training programmes have been devised that can be followed by professionals from different specialties, and it may be expected that physicians other than radiologists could perform radiological interventions, at least in part. This development should stimulate close cooperation between specialties, rather than the exclusive claiming of certain procedures. The progress of interventional radiology has benefitted from the multidisciplinary approach to clinical problems; this multidisciplinary approach should also be the basis for future developments in minimally invasive image-guided interventional procedures.
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Affiliation(s)
- J S Laméris
- Academisch Medisch Centrum, afd. Radiologie, Amsterdam, The Netherlands.
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27
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Nakamura H, Ichida T. [Outstanding radiation medicine: its present, future and harmony between man and technology--IVR]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2010; 66:641-643. [PMID: 20873033 DOI: 10.6009/jjrt.66.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
For over 20 years, interventional methods have improved the outcomes of patients with cardiovascular disease. However, these procedures require an intricate combination of visual and tactile feedback and extensive training. In this paper, we describe a series of novel approaches that have led to the development of a high-fidelity simulation system for interventional neuroradiology. In particular, we focus on a new approach for real-time deformation of devices such as catheters and guidewires during navigation inside complex vascular networks. This approach combines a real-time incremental Finite Element Model (FEM), an optimization strategy based on substructure decomposition, and a new method for handling collision response in situations where the number of contact points is very large. We also briefly describe other aspects of the simulation system, from patient-specific segmentation to the simulation of contrast agent propagation and fast volume-rendering techniques for generating synthetic X-ray images in real time. Although currently targeted at stroke therapy, our results are applicable to the simulation of any interventional radiology procedure.
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Affiliation(s)
- C Duriez
- INRIA-Futurs, Université de Lille, Villeneuve d'Ascq, France.
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29
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Ledger K. Intervening specialists. Minn Med 2009; 92:28-32. [PMID: 20092166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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30
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Kane K, Rosero EB, Clagett GP, Adams-Huet B, Timaran CH. Trends in workforce diversity in vascular surgery programs in the United States. J Vasc Surg 2009; 49:1514-9. [PMID: 19398186 PMCID: PMC2752717 DOI: 10.1016/j.jvs.2009.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 01/21/2009] [Accepted: 02/02/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND U.S. black and Hispanic populations are growing at a steady pace. In contrast, the medical profession lacks the same minority growth and representation. Women are also under-represented in many surgical disciplines. The purpose of this study was to assess trends in the proportion of women, blacks, and Hispanics admitted to vascular surgery (VS) and related specialties, and to compare them with each other and with a surgical specialty, orthopedic surgery (OS), with a formal diversity initiative. METHODS Data on the fellowship pool of VS, interventional radiology (IR), and interventional cardiology (IC), as well as the resident pools of general surgery (GS) and orthopedic surgery (OS), were obtained from U.S. graduate medical education reports for 1999 through 2005. Cochrane-Armitage trend tests were used to assess trends in the proportion of females, blacks, and Hispanics in relation to the total physician workforce for each subspecialty. RESULTS No significant trends in the proportion of females, blacks, or Hispanics accepted into VS and IC fellowship programs occurred during the study period. In contrast, IR, GS, and OS programs revealed significant trends for increasing proportions of at least one of the underrepresented study groups. In particular, OS, which has implemented a diversity awareness program, showed a positive trend in female and Hispanic trainees (P < .04 and P < .02, respectively). Blacks showed a significant increasing trend only in IR (P = .05). Conversely, a positive trend toward continued growth in the Hispanic group was seen in GS (P < .001), IR, and OS (P = .04 and P = .02, respectively). CONCLUSIONS The racial/ethnic and gender composition of the physician trainee pool in vascular specialties, particularly VS, has not matched the increasing growth of underrepresented groups in the US population of patients with vascular disease. Formal programs to recruit qualified women and minorities appear successful in increasing workforce diversity.
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Affiliation(s)
- Katherine Kane
- Division of Vascular and Endovascular Surgery, Department of Surgery, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA
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31
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Heffernan DS, Adams CA. Advancing boundaries in the care of the trauma patient. Med Health R I 2009; 92:166-169. [PMID: 19530480] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Daithi S Heffernan
- The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Division of Trauma & Surgical Critical Care, USA.
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32
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Picard L, Bracard S, Anxionnat R. [Interventional neuroradiology. Current status--future prospects]. Bull Acad Natl Med 2009; 193:873-881. [PMID: 20120277] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
First developed in the 1960s, interventional neuroradiology has vastly improved the management of patients with vascular diseases of the brain and spine, including vascular malformations and stroke. Gradually replacing open-skull neurosurgical approaches, endovascular occlusion of ruptured intracranial aneurysms has improved the post-bleed prognosis. With the increasing number of fortuitously discovered aneurysms, international randomized studies are being organized to determine whether preventive treatment is better than abstention. A wide range of therapeutic strategies are available for brain arteriovenous malformations, including hyperselective embolization, open-skull surgery, radiosurgery, and abstention. The choice depends on multiple parameters, including symptoms, clinical status, the angioarchitecture of the malformation, and the patient's psychology and wishes (...).
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Affiliation(s)
- Luc Picard
- Neuroradiologie Diagnostique et Thérapeutique, Pôle Neuro tête et Cou. CHU, Hopital Neurologique, 29 Avenue Maréchal de Lattre de Tassigny, 54035 Nancy Cedex
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34
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35
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Pruvo JP. [The SFR is a hundred years old]. J Radiol 2009; 90:5-6. [PMID: 19182707 DOI: 10.1016/s0221-0363(09)70071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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36
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Acsády G. [Finding the way to save Hungarian vascular surgery]. Magy Seb 2008; 61:259-262. [PMID: 19028656 DOI: 10.1556/maseb.61.2008.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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37
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Abstract
The current radiology workflow model is inherently flawed by its emphasis on quantity over quality, limited accountability, and relative inflexibility of the technology. This adverse affect of technology inflexibility is of particular importance within radiology, because it is the single medical specialty completely dependent on technology for all its existence. For practicing radiologists, the human-computer interaction involves a multitude of individual events that collectively constitute the interpretation process. These individual workflow steps include image retrieval, display, presentation, navigation, processing, manipulation, decision support, and reporting. Considering the heterogeneous nature of the diverse population of end users, it is no surprise that the relative rigidity of the supporting technology creates a tremendous burden on radiologists' performance. The ideal scenario would be the creation of adaptive technology, which would consist of flexible and intuitive software that adapts to the unique needs and preferences of each individual end user, as well as the specific task at hand, while maintaining "best practice" guidelines. This interactive software would take into account a number of variables (education and training, computer experience, personality, visual perception, motor skills) to create user-specific profiles, which can be stored in a centralized database, independent of the specific vendor and technology being used. This user-specific software would also integrate affective computing technologies to dynamically adjust to end users' ever changing emotional states and stress levels. The end result would be the creation of intuitive technology that dynamically adapts to the changing needs and abilities of users, as opposed to the current inflexible technology paradigm.
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Affiliation(s)
- Bruce Reiner
- Baltimore VA Medical Center, Baltimore, Maryland 21201, USA.
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38
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Woolfson JP, Baerlocher MO, Giroux MF, Simons M, Millward SF. Why should the Royal College of Physicians and Surgeons of Canada recognize interventional radiology as a subspecialty within radiology? A summary of the application for subspecialty recognition. Can Assoc Radiol J 2008; 59:55-60. [PMID: 18533393] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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39
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Gould D, Patel A, Becker G, Connors B, Cardella J, Dawson S, Glaiberman C, Kessel D, Lee M, Lewandowski W, Phillips R, Reekers J, Sacks D, Sapoval M, Scerbo M. SIR/RSNA/CIRSE Joint Medical Simulation Task Force Strategic Plan Executive Summary. J Vasc Interv Radiol 2007; 18:953-5. [PMID: 17675610 DOI: 10.1016/j.jvir.2007.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Derek Gould
- Department of Radiology, Royal Liverpool University Trust, Liverpool, England
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40
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Duprez TP. Belgian Neuroradiology in 2007: where are we and where are we going to? JBR-BTR 2007; 90:237-246. [PMID: 17966236] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Neuroimaging is a sub-specialized field of radiology experiencing major and rapid changes in both the day-to-day clinical practice and the investigative field. In the present review article we summarize which are ongoing debates and challenges, and which are the domains of excellence of Belgian Neuroradiology.
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Affiliation(s)
- Th P Duprez
- Department of Radiology and Medical Imaging, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium.
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41
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Berthelsen AK, Dobbs J, Kjellén E, Landberg T, Möller TR, Nilsson P, Specht L, Wambersie A. What's new in target volume definition for radiologists in ICRU Report 71? How can the ICRU volume definitions be integrated in clinical practice? Cancer Imaging 2007; 7:104-16. [PMID: 17594916 PMCID: PMC1906985 DOI: 10.1102/1470-7330.2007.0013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2007] [Indexed: 11/16/2022] Open
Abstract
The optimal definition of the size, shape and location of gross tumour volume is one of the most important steps in the planning of radiation therapy, and necessitates a proper understanding of the procedure from both the oncologic radiologist and the radiation oncologist. This overview reports on the different terms and concepts that have been recommended in the ICRU Reports for this purpose; the latest Report 71 focuses on both previously given recommendations, and especially on electron beam therapy. This paper also highlights some of the problems that are encountered in the use of the International Commission on Radiation Units and Measurements (ICRU) recommendations in clinical practice, and at the interface between the radiation oncologist and the diagnostic oncologist.
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Affiliation(s)
- Anne Kiil Berthelsen
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
| | - Jane Dobbs
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
| | - Elisabeth Kjellén
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
| | - Torsten Landberg
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
| | - Torgil R. Möller
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
| | - Per Nilsson
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
| | - Lena Specht
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
| | - André Wambersie
- PET & Cyclotron Unit/Department of Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, St. Thomas Hospital, London, UK; Department of Oncology, University Hospital, Lund, Sweden; Department of Oncology/Radiotherapy, Finsen Center, Rigshospitalet, Copenhagen, Denmark; Department of Cancer Epidemiology/Oncological Center, University Hospital, Lund, Sweden; Department of Radiation Physics, University Hospital, Lund, Sweden; UCL, University Hospital St Luc, Brussels, Belgium
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42
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Affiliation(s)
- Gary J Becker
- National Cancer Institute, Division of Cancer Treatment and Diagnosis Cancer Imaging Program, Bethesda, MD 20892, USA.
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43
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Abstract
There has been increased interest in implementing image-guided brachytherapy to better define the structures of interest and assess the radiation dose distribution in tumors and surrounding normal tissues. This is particularly helpful in the treatment of pelvic malignancies such as cervix cancer and prostate cancer, in which the tumor lies in close relationship to the bladder and rectosigmoid. This provides a forum for the collaboration of diagnostic radiologists and radiation oncologists.
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Affiliation(s)
- Beth Erickson
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, WI 53110, USA.
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Abstract
Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatments for EVs. In the 1970s, interventional radiology procedures such as transportal obliteration, left gastric artery embolization, and partial splenic artery embolization were introduced, improving the survival of patients with bleeding EVs. In the 1980s, endoscopic treatment, endoscopic injection sclerotherapy (EIS), and endoscopic variceal ligation (EVL), further contributed to improved survival. We combined IVR with endoscopic treatment or EIS with EVL. Most patients with EVs treated endoscopically required follow-up treatment for recurrent varices. Proper management of recurrent EVs can significantly improve patients’ quality of life. Recently, we have performed EVL at 2-mo (bi-monthly) intervals for the management of EVs. Longer intervals between treatment sessions resulted in a higher rate of total eradication and lower rates of recurrence and additional treatment.
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Abstract
When introducing new interventional radiology techniques or devices, it is important to learn from previous experiences and to remember that there are numerous examples of new techniques that were initially enthusiastically promoted and then subsequently abandoned when early promise was not realized. Appropriateness of new or established interventional radiology techniques to specific clinical conditions must be determined from clinical experience, from communication with experts in the field and/or careful review of available medical literature, and on an individual patient basis by means of review of clinical notes and diagnostic imaging studies. Several paradigms for evidence-based practice (EBP) exist. One model proposes that a central specialized process involving academic centers should primarily construct valid guidelines to direct practice at all levels of medical practice ("top-down" model). An alternative model integrates "the best research evidence with clinical expertise and patient values" ("bottom-up" model). This article will focus on the bottom-up model and describe the use of EBP by individual practitioners or groups of practitioners in optimizing literature review and critical appraisal. EBP is applied to two scenarios as a means of deciding the appropriateness of introducing interventional radiology techniques in a community hospital setting. The authors will also briefly discuss other applications for EBP techniques in interventional radiology, including development of practice guidelines or policy to ensure appropriate and safe practices.
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Affiliation(s)
- Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
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46
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Affiliation(s)
- David M Pelz
- The University of Western Ontario, London, Ontario, Canada.
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47
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van den Bosch MA. Re: Interventional Radiology: Veni, Vidi, Vanished? J Vasc Interv Radiol 2007; 18:165; author reply 165-6. [PMID: 17296721 DOI: 10.1016/j.jvir.2006.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Abstract
OBJECTIVE To review the current applications of Interventional Radiology (IR), outline newer technologies and techniques and emphasize the role of Interventional Radiologists as clinical practitioners. BACKGROUND IR is a clinical modality that makes use of imaging guidance for the performance of minimally invasive treatment. The development of new imaging technologies and interventional devices has greatly increased the number of medical conditions that may now be treated by IR. SUMMARY Promising new treatments in cancer therapy, the treatment of fibroids, venous access and spine interventions as well as advances in non-invasive vascular imaging, pharmacological therapies and peripheral arterial and venous interventions are providing exciting opportunities for IR, attracting significant patient interest and promising tremendous public benefit.
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Affiliation(s)
- Tarun Sabharwal
- Interventional Radiology Department, Guys' and St Thomas' Hospital, London, UK.
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49
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Affiliation(s)
- Andreas Adam
- Department of Radiology, First Floor, Lambeth Wing, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom.
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50
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Abstract
Treatment of deep vein thrombosis traditionally has focused on preventing the potentially life-threatening complication of pulmonary embolism rather than on removing or reducing the thrombus. Although treatment with anticoagulants may prevent thrombus propagation, the body's intrinsic thrombolytic system is left to attempt clot dissolution. Because this natural process is generally ineffective in its ability to fully recanalize a proximal vein, the risks of recurrent thrombosis as well as the disabling complication of postthrombotic syndrome increase. Moreover, the long-term consequences of postthrombotic syndrome include pain, disability, and, for many, a significant decrease in the quality of life. Recent technology using high-frequency, low-power ultrasound, or mechanical thrombectomy with catheter-directed delivery of a thrombolytic drug directly into the clot is available and showing promise. Nurses are caring for patients who receive endovascular interventions with lytic infusions. The nursing challenge is to provide safe and effective patient care.
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Affiliation(s)
- Gail Marchigiano
- Saint Joseph's College of Maine, 278 Whytes Bridge Road, Standish, ME 04084, USA.
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