Current trends in thrombolysis: implications for diagnostic and interventional radiology

Current trends in thrombolysis are of relevance to both diagnostic and interventional radiologists. In addition to the traditional use of thrombolytic therapy in conditions such as peripheral arterial thrombosis, venous thrombosis and pulmonary embolic disease, more recent interest has focused on the potential use of thrombolysis in acute stroke. There will be significant implications for the provision of radiological services if current trials show a favourable outcome for thrombolysis in stroke. This article looks at a range of conditions in which thrombolysis may be useful, on the strength of currently available evidence. Future trends will depend on the outcomes of the current trials.     

Recent trends in central venous catheter placement: a comparison of interventional radiology with other specialties

The authors determined changing trends and growth in tunneled and nontunneled central venous catheter placement procedures. With use of Medicare billing data for tunneled and nontunneled catheter placement, a comparison was made among interventional radiology (IR), surgery, anesthesia, and internal medicine. There has been substantial growth in the placement of central venous catheters. Currently, a minority of these procedures are performed in IR departments. However, there has been significant growth in the radiologic placement of both types of catheters.     

Current trends and perspectives in interventional radiology for gastrointestinal cancers

Gastrointestinal (GI) cancers often require a multidisciplinary approach involving surgeons, endoscopists, oncologists, and interventional radiologists to diagnose and treat primitive cancers, metastases, and related complications. In this context, interventional radiology (IR) represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques. In the last years, through the development of new devices, IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient. Arterial embolization, ablative techniques, and gene therapy represent useful and innovative IR tools in GI cancer treatment. Moreover, IR can be useful for the management of GI cancer-related complications, such as bleeding, abscesses, GI obstructions, and neurological pain. The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications, as well as to describe the future perspectives of IR in this oncologic field.     

Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology

The Mulliken and Glowacki classification (1982) differentiated vascular anomalies into two groups based on their endothelial characteristics: hemangiomas and vascular malformations. Vascular anomalies are localized defects of the vasculature that affect a limited number of vessels in a restricted area of the body. These defects are secondary to errors in vascular morphogenesis. Depending on the type of vessel involved, the vascular malformation group was subdivided into high-flow (such as arteriovenous malformation and arteriovenous fistula) and low-flow lesions (such as venous and lymphatic malformations). Depending on the type of lesion, the location and degree of involvement and the clinical effect, different types of treatment would be required. For the purpose of this review, we concentrate solely on vascular malformations: the clinical features, genetics, diagnosis, and current treatment options.     

2018—2020年陕西省部分医院介入放射学工作人员眼晶状体剂量分析

目的:分析2018—2020年陕西省部分医院介入放射学工作人员眼晶状体剂量水平,掌握介入放射学工作人员眼晶状体剂量水平现状。方法:抽取陕西省三级以上医院3家,2018—2020年连续3年采用热释光剂量计对介入放射工作人员眼晶状体剂量进行监测,共监测152人次,监测周期3个月,分析不同性别、岗位及科室介入放射学工作人员眼...     

Clinical services in interventional radiology: results from the national Medicare database and a Society of Interventional Radiology membership survey

PURPOSE: To evaluate trends in evaluation and management (E & M) services performed by interventional radiologists. MATERIALS AND METHODS: Recent national Medicare physician utilization data (1997-2000) were analyzed for trends in E & M services provided by interventional radiologists. The results were evaluated in conjunction with a recent Society of Interventional Radiology (SIR) membership survey in which 165 interventional radiology (IR) practices answered questions about clinical service issues. RESULTS: Despite the perception of frequent clinical services by interventional radiologists, paid Medicare claims for E & M services have increased only minimally, from 9,472 to 9,662 (+2.0%), and have lagged behind non-E & M procedural services, which have increased from 2,283,111 to 2,527,323 (+10.7%). The relative value unit (RVU) impact of E & M encounters has increased from 14,422 to 14,893 (+3.2%) while the RVU impact of procedural services has increased from 2,262,991 to 3,723,486 (+64.5%). E & M services account for only 0.39% of all Medicare claims, 0.49% of service RVUs, and 0.68% of all reimbursable time spent by interventionalists. However, when surveyed, interventional radiologists perceived that E & M services are much more frequent: 92% provide clinical services and indicate that 6.6% +/- 5.4 of physician time is spent providing E & M services. CONCLUSION: Despite perceptions by interventional radiologists that E & M services are common, Medicare claims for such services are infrequent and growth lags behind that of IR services overall. These discrepancies may be explained in part by practice and billing infrastructures that do not effectively translate actual clinical services into successful claims.     

Stomal metastases complicating percutaneous endoscopic gastrostomy: CT findings and the argument for radiologic tube placement

OBJECTIVE: This article describes the CT appearance of metastatic implantation at the percutaneous endoscopic gastrostomy (PEG) tract in patients with malignancy of the upper aerodigestive tract. Cumulative data from previous case reports are also considered for insight into causes of metastasis and the implications for gastrostomy placement in these patients. CONCLUSION: CT showed lobulated soft tissue involving the entire abdominal wall PEG tract in all proven cases. CT is an effective method for evaluation because the tumor burden lies predominately in the abdominal wall and not at the entry or exit site. The stomal implant is often the only site of metastatic disease at presentation. In general, CT findings of mildly increased soft tissue along the PEG tract are nonspecific, but a lobulated mass is highly suspicious for tumor implantation, especially if the one-sided thickness exceeds 1 cm. The preponderance of evidence from the existing literature points to direct tumor implantation during endoscopic placement as the likely cause (rather than hematogenous spread). This conclusion would support the alternative of radiologic tube placement in these patients.     

Malpractice claims in interventional radiology: frequency, characteristics and protective measures

Purpose

The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process.

Materials and methods

The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006.

Results

In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient’s death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity.

Discussion

Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status.

Conclusions

Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient’s right to autonomy also implies adopting clear and rigorous processes for obtaining the patient’s informed consent to the medical procedure.     

内镜直视联合X线监视置人支架治疗胃十二指肠恶性梗阻47例

目的 探讨金属内支架置入治疗胃十二指肠恶性梗阻的操作技术及疗效。方法 本组47例胃十二指肠恶性梗阻患者均在内镜直视联合X线监视下,置入54枚金属内支架治疗。结果 47例患者支架置入均获得了成功,随访期间患者均能进食流质或普食,呕吐减轻,生活质量提高,未出现严重并发症。结论 内镜直视联合X线监视下金属内支架置入治疗胃十二指肠恶性梗阻,安全有效,操作简便、时间短,患者痛苦小,定位准确,支架一次性置入成功率高、覆盖病变完全,具有临床推广应用价值。     

MDCT, MR and interventional radiology in biliary atresia candidates for liver transplantation

The multi-detector computed tomography (MDCT) scan and magnetic resonance (MR) of the abdomen play a key role in the work-up to liver transplantation (LT) by identifying congenital anomalies or cirrhosis-related modifications, conditions that can require changes in surgical technique. Moreover, the MDCT and MR scans allow identification of cirrhotic liver hepatic masses, extrahepatic porto-systemic shunts, eventual thrombosis of portal system and radiological signs of portal hypertension associated with biliary atresia (BA). The aim of this paper is to review MDCT, MR imaging and interven-tional radiology procedures performed to evaluate morphological changes and degree of portal hypertension in pediatric patients with end-stage liver disease secondary to BA, who are candidates for LT. Advances in the field of MR, MDCT and in percutaneous minimally invasive techniques have increased the importance of radiology in the management of pediatric patients with BA who are candidates for LT.     

Gadolinium chelates in angiography and interventional radiology: a useful alternative to iodinated contrast media for angiography

Gadolinium has physical properties that are well suited for radiographic imaging. Digital subtraction angiography with a gadolinium chelate as contrast medium can provide images of suitable quality for diagnosis and intervention. The overall safety profile of gadolinium-based contrast media is excellent. In particular, these contrast media are well tolerated in patients with renal insufficiency when administered intraarterially in doses of less than 0.3-0.4 mmol per kilogram body weight, with a decreased incidence of contrast medium-induced nephropathy, as compared with similar volumes of iodinated contrast material. The currently available formulations of gadolinium chelates can be injected safely into every arterial and venous structure. However, substantial data are lacking on the intraarterial use of gadolinium in patients with renal insufficiency, particularly at doses that exceed those routinely used in magnetic resonance angiography. Gadolinium chelates in appropriate volumes are useful alternative contrast media in selected high-risk patients undergoing angiographic studies.