Portal Vein Embolization: What Do We Know?

Portal vein embolization (PVE) has been developed to increase the size of the future remnant liver (FRL) left in place after major hepatectomy, thus reducing the risk of postoperative liver insufficiency. PVE consist in embolizing preoperatively portal branches of the segments that will be resected. Indication is based on preoperative measurements of the FRL by computed tomography and its ratio with either the theoretical liver volume or by direct measurement of the functional liver volume. After PVE, the volume and function of the FRL increases in 3 to 6?weeks, permitting extensive resections in patients otherwise contraindicated for liver resection. The PVE technique is variable from one center to another; however n-butyl-cyano-acrylate provides an interesting compromise between hypertrophy rate and procedure risk.     

COVID-19: What Should Interventional Radiologists Know and What Can They Do?

The outbreak of coronavirus disease 2019 (COVID-19) in late December 2019 in Wuhan, China, has been characterized as a “pandemic” by the World Health Organization and has resulted in 81,603 confirmed cases in China, among the 334,981 cases confirmed in 189 countries as of 09:00 am, March 24, 2020 (China central standard time). During the past 3 months, hundreds of thousands of Chinese health care workers, including interventional radiologists (IRs), have been fighting this battle against the horrifying COVID-19 disease. As IRs, what should we know and what can we do when facing this challenge? This paper shares the experience we have gone through.     

Morphometric scores for renal tumors: What does the radiologist need to know?

Numerous therapeutic options are possible in the treatment of renal carcinomas including radical nephrectomy, partial nephrectomy, cryoablation, radiofrequency, active follow-up and among surgical treatments, different approaches may be used such as laparotomy, laparoscopy, robotic-assisted intervention. The choice between these different procedures is partially based on the anatomic conditions of the tumors. Different anatomic scores determined from cross-sectional imaging have been built to predict the complexity of the surgical procedure. The goals of this article are to review the relevant morphologic pattern for management of patients with renal tumors, to know how to calculate these different scores and to understand the clinical applications of these scores.     

Preventing injuries to competitive and recreational adult golfers: What is the evidence?

Although injuries to golfers are not common, both survey studies and hospital emergency department records have provided objective evidence that golfers are sometimes at risk of injury. While many golf injury studies describe the associated mechanisms and types of injuries, less attention has been given to research relating to the various injury prevention measures for this sport. This paper provides a critical review of the range of countermeasures to prevent golf injuries and highlights areas to be considered for future research, development, and implementation. In particular, it focuses on the strength of the evidence for the effectiveness of these measures. This review concludes that there needs to be more formal evaluation of the suggested countermeasures to prevent golf injuries. Particular attention should be given to evaluations of the golf swing and its relationship to particular injuries such as low-back, wrist, and shoulder problems. These countermeasures and associated strategies are recommended to reduce the incidence of injury in this popular and accessible sport.     

Radiation Dose to the Radiologist’s Hand During Continuous CT Fluoroscopy-Guided Interventions

Computed tomography fluoroscopy (CT fluoroscopy) enables real-time image control over the entire body with high geometric accuracy and, for the most part, without significant interfering artifacts, resulting in increased target accuracy, reduced intervention times, and improved biopsy specimens [1–4]. Depending on the procedure being used, higher radiation doses than in conventional CT-supported interventions might occur. Because the radiologist is present in the CT room during the intervention, he is exposed to additional radiation, which is an important aspect. Initial experience with CT fluoroscopically guided interventions is from the work of Katada et al. in 1994 [5] and only relatively few reports on radiation aspects in CT fluoroscopy are found in the literature [1, 2, 6–11]. To date, there are no reported injuries to patients and radiologists occurring with CT fluoroscopy. The time interval since the wide use of CT fluoroscopy is too short to have data on late effects to the operator using CT fluoroscopy on a daily basis. In addition, the spectrum of CT fluoroscopically guided interventional procedures will expand and more sophisticated procedures requiring longer fluoroscopy times will be performed. Thus, effective exposure reduction is very important. The purpose of our study was to assess the radiation dose to the operator’s hand by using data from phantom measurements. In addition, we investigated the effect of a lead drape on the phantom surface adjacent to the scanning plane, the use of thin radiation protective gloves, and the use of different needle holders.     

What do clinicians understand about deaths reportable to the Coroner?

SettingThe study setting is a tertiary referral hospital of over 980 beds, in Victoria, Australia. The hospital is a long established major academic public health service providing healthcare, health professional education and health research. The hospital has 103,756 in-patient admissions, 190,756 outpatient attendances and over 82,000 presentations to the Emergency Department annually.Participants22 clinicians completed an in-depth, audio-recorded interview: 12 medical and 10 nursing staff, with a variety of clinical experience.Intervention(s)Each audio recorded interview was transcribed verbatim for thematic analysis. The semi structured questions were designed to explore the clinician's understanding of deaths that meet the criteria to be reported to Coroners Court of Victoria (CCOV), and why such reporting was required. There was also the opportunity to identify any barriers or enablers to the reporting process, whether internal or external to the organisation.ResultsTwo main themes emerged from the interviews: 1. lack of awareness of which deaths are reportable to the coroner and 2. the need for educational support. Several subthemes were also identified such as accountability, the need for feedback and blame.DiscussionThe understanding of clinicians as to which deaths meet the reportable criteria in healthcare is quite variable and this indicates that there might be a level of under reporting. Apart from the potential of not meeting legal obligations, there may also be the loss of a valuable opportunity for lessons to inform clinical practice and enhance the delivery of safe patient care.