Physicians' liability in interventional radiology and endovascular therapy

INTRODUCTION/OBJECTIVE: Modern practice in Radiology has rapidly changed over the last decades incorporating invasive techniques. Additionally, litigation in medical practice has arisen as an important issue. This article aims to highlight issues related to malpractice in interventional radiology and endovascular therapy in order to point out the importance of the written informed consent. METHODS AND MATERIAL: Search of relevant literature from the Pubmed. RESULTS: The role of radiologist has been greatly transformed over the last decades. He is not only entitled to participate in the diagnosis but also he undertakes therapeutic procedures, either alone or as a member of a team. Thus the radiologist is now more exposed to actions that maximize litigation risk. Adequate communication and a written consent form seem to be mandatory before any invasive radiological procedure. Patient should know in detail the benefits and the risks of the scheduled procedure and whether the proposed therapy is a new form of treatment or part of a randomized trial. DISCUSSIONS AND CONCLUSION: Interventional radiologist or physician is exposed to high litigation risk. This certainly requires an urgent adaptation of his practice and attitude to the new reality. Written patient's informed consent remains an integral part of the communication between physicians and patients, and importantly is offering professional protection along these lines.     

Principles of medical liability and practice in medical imaging]

Radiologists are liable for all aspects of their practice, from the indication of an examination to the radiology report and follow-up, as well as for providing information and recommendations. They are liable for their decisions and actions. They are liable for their competence and continuous medical education. They are also liable for their own equipment and staff. In cases of litigation, the liability of a radiologist may be questioned. Four types of procedures must been known: penal, civil, administrative and disciplinary.     

三级妇产专科医院羊水栓塞13例诊治及文献复习

 目的 总结羊水栓塞患者的临床资料,探讨羊水栓塞的发生机制,分享羊水栓塞救治经验。方法 回顾性分析2011-03至2018-11在北京妇产医院孕晚期分娩并发羊水栓塞患者的症状、体征、实验室等辅助检查、用药救治过程,以及母儿妊娠结局与预后。结果 在109 401次孕晚期分娩记录中,共发生13例羊水栓塞,发病率11.88/10万。高龄(超过35岁)产妇占比53.8%(7/13),经产妇占比53.8%(7/13),存在过敏性体质患者4例,胎盘高危因素4例,妊娠期高血压疾病患者3例。84.6%(11/13)的患者出现了危及生命体征的临床表现(至少低血压、低血氧、DIC之一),3例出现心脏呼吸骤停,5例并发DIC,产后出血(>1000 ml以上)者9例[1100~6000 ml,(2963±406)ml]。4例血液中查找羊水成分,其中3例阳性,9例使用大量血管活性药物时间超过3 h,5例行子宫切除术,无患者死亡。结论 羊水栓塞主要依靠临床表现进行诊断;典型的羊水栓塞是产科罕见而凶险的并发症;及时准确的诊断以及训练有素的多学科快速反应团队,及时足量的抗过敏和血管活性药物以及后续充分的生命支持治疗是挽救羊水栓塞患者生命的关键措施。     

The role of interventional radiology in obstetric and gynaecology practice

Interventional radiology is continuing to reshape current practice in many specialties of clinical care. It is a relatively new and innovative branch of medicine in which physicians treat diseases non-operatively through small catheters guided to the target by fluoroscopic and other imaging modalities. The aim is to provide image-guided, minimally invasive alternatives to traditional surgical and medical procedures in suitable cohorts of patients. Procedures which previously required major surgery can now be performed by interventional radiologists, sometimes on an outpatient basis, with little patient discomfort. In this review, we highlight the importance of interventional radiology in treating a comprehensive range of obstetric and gynaecological pathologies.     

Analysis of obstetrics and gynecology professional liability claims in Catalonia,Spain (1986–2010)

ObjectiveTo identify relevant factors involved in obstetrics and gynecology (OG) professional liability claims to help archive better management of risks.Study designAnalysis of 885 OG claims opened between 1986 and 2010, with the identification of the most common events leading to a claim, the economical and juridical characteristics of the claims, as well as the relevant trends over the study period.ResultsMost claims related to obstetrics. Labor, delivery and its complications accounted for 33.1% of the claims; 12.77% related specifically to cesarean. Oncological diseases, fetus death during labor and delivery, neurologically impaired infant and histerectomy-related problems were the most frequently claimed events. Most cases ended up without an indemnity payment and 37.7% of closed files were solved by an out-of-court procedure. Average payment was higher for the obstetric procedures than for those concerning gynecology cases. The proportion of claims relating to obstetrics increased during the study period, as well as the average payment.ConclusionOG is at high-risk for malpractice claims, but compensation awards are not frequent. However, particular events, such as retained foreign objects, tubal ligation, ultrasound diagnosis or neurologically impaired newborns, deserve special attention regarding medico-legal issues.     

Ultrasound in gynecology

This paper reviews the various examination thechniques, the clinical indications, and the imaging findings for US studies of the female pelvis in patients with gynecological problems. Ultrasound, in fact, is the preferred imaging modality in the study of the female pelvis, and provides information of basic importance in detecting and characterizing pelvic masses of uterine, ovarian, or adnexal origin, providing also criteria useful in predicting their benign vs malignant nature. In patients with abnormal bleeding, transvaginal US helps in determining the presence of morphological and structural changes of the endometrium and, with the use of sonohysterography, provides excellent delineation of the endometrial cavity, guiding appropriate planning of therapeutic procedures. Ultrasound plays a very important role in the evaluation of patients with acute pelvic pain. It allows identification of ovarian torsion and has both diagnostic and therapeutic capabilities in patients with pelvic inflammatory disease through guidance of abscess drainage via the transvaginal route. In suspected ectopic pregnancy, US, together with quantitative measurements of hCG levels, can be considered the best imaging procedure to guide to the diagnosis. Ultrasound has an important role also in the study of female infertility. In this field it can be used to identify and document the integrity of the reproductive tract as a conduit for the passage of gametes and embryos, to detect pathological changes that may be causes or contributing factors of female infertility, to monitor cyclic changes of pelvic organs to document normal physiology or pathological situations, and to guide infertility treatment. Electronic Publication     

妇产科学进展与发展设想

目的 综述国内外妇产科学的最新进展及研究动态,为研究我军今后妇产科相关技术的发展方向提供依据.方法 分别通过PubMed及CHKD检索近10年来妇产科的国内外文献,就妇产科领域的新进展、新技术进行分析、归纳及总结.结果 近10年来,妇产科领域取得的进展有:微创概念及微创手术迅速发展,内镜手术、介入治疗、经阴道及小切口等微创化手术的术式得到普及与发展,随着微创技术的发展,恶性肿瘤的早期诊断技术也随之提高;辅助生殖技术逐渐成熟,在此基础上提出了卵巢移植观点,卵巢移植技术为年轻恶性肿瘤患者提供了妊娠的希望;产前诊断技术已发展到种植前遗传学诊断水平,可以在妊娠更早的阶段对遗传缺陷疾病进行筛查,及时发现和处理存在遗传缺陷的胎儿.结论 "十二五"期间,我军妇产科学的发展应紧跟最新前沿动态,发展最新技术,并将这些技术向卫勤保障及战时应用转化.     

Three-dimensional ultrasound in obstetrics and gynecology

Three-dimensional ultrasound is a new modality finding its way into clinical practice. Most of the major ultrasound vendors are now developing three-dimensional ultrasound capabilities. We expect that although three-dimensional ultrasound will not replace two-dimensional ultrasound, many additional benefits will be identified and its use will continue to grow. The ability to evaluate anatomy and pathology with multiplanar and surface-rendered images provides physicians additional valuable clinical information. Volume data allows for a specific point in space to be evaluated from many different orienta tions by rotating, slicing, and referencing the slice to other orthogonal slices. It also allows for new volume-rendering displays that show depth, curvature, and surface images not available with conventional methods. The current limitations of image resolution, intuitive interfaces for obtaining and displaying optimal images, and technologic limitations for data storage and manipulation (including real-time three-dimensional ultrasound) will surely be overcome in the near future.     

MR imaging in obstetrics and gynecology

Excellent tissue contrast in MRI permits noninvasive visualization of the normal anatomy, physiology, and disease processes of the female pelvis. Although MRI has various disadvantages, including its higher cost compared with sonography and CT and its long scanning time, many studies have reported a positive impact of MRI on treatment decisions and net cost analysis in the evaluation of gynecologic diseases. In addition to traditional static images, recent advances in ultrafast MR imaging have provided MR angiography, MR urography, and kinematic images of the pelvis. Kinematic evaluation of the pelvis by MR imaging is an epoch-making event. Kinematic images can be obtained by a cine-mode display of many images obtained by ultrafast imaging techniques such as FISP, HASTE, SSFSE, and others. Pelvic floor descent, an adhesion caused by endometriosis or surgery, and uterine peristalsis can be clearly shown on kinematic images. Since disorders in uterine peristalsis are hypothesized to be the causes of a variety of clinical symptoms such as fertility problems and dysmenorrhea, ultrafast MRI may be a powerful tool for elucidating the functions of the uterus in the future.