Facility wide benefits of radiology vascular access teams

Many PICC lines are inserted in the radiology department and, at the rate they are inserted, can have serious financial implications for a facility. These costs combined with the increase in the number of line placements performed annually have imaging leadership evaluating alternatives for catheter placements in their departments. Several benefits to forming an in-house vascular access team include increased patient satisfaction, improved care, decreased length of stay, optimizing DRG reimbursement, and increased revenue. Considerations prior to initiating a vascular access team include: staff members involved, location of insertions, and up front funds available.     

Techniques in vascular and interventional radiology: pediatric central venous access

Interventional radiologists (IRs) with expertise in image guidance have an inherent skill set for the safe and reliable placement of central venous access catheters (CVACs) in children. Above and beyond the technical requirements, IRs have an integral role as consultants in evaluating children for the most appropriate catheter to meet their short- and long-term needs. This article is meant to serve as a reference for decision making along with tips and pearls on how we approach placing CVACs in pediatric patients at our Children's Hospital.     

Costs and benefits of low-osmolality contrast agents in radiology

We have examined the costs and benefits associated with the introduction of low-osmolality contrast agents into general radiology. The result is a cost of $2,000,000 to save a life and $100,000 to save a year-of-life if it is assumed that these agents are ten times safer than conventional contrast agents in terms of fatality rates. These values are comparable to the costs of saving a life, and a year-of-life, associated with radiation protection practice, but appear to be over an order of magnitude higher than the corresponding costs in contexts such as mammography screening programs. Cost-benefit analysis provides a useful insight into medical decision making when available resources are limited. It raises the important question of whether society at large is allocating sufficient resources to health care.     

Collaborative interdepartmental teams: benefits,challenges, alternatives,and the ingredients for team success

Radiology practices often employ collaborative interdepartmental teams to address complex projects. These teams benefit from their diversity of viewpoints and the potential for innovative, high-quality solutions. However, collaborative interdepartmental teams also suffer from challenges: interpersonal conflicts, team member mistrust, competing individual priorities, and obstructive turf concerns. When tackling projects, radiologists should consider alternative group models such as single department teams, two-person partnerships, and small workgroups. Each of these group models has strengths and weaknesses relative to collaborative interdepartmental teams and may be more efficient in some scenarios. Finally, when radiologists launch collaborative interdepartmental teams, four key ingredients should be optimized to improve team performance: right goal, right culture, right leadership, and right people.     

Noninvasive radiology of vascular complications in renal transplantation

The gamekeeper's or skier's thumb is a very common injury. Nondisplaced tears of the ulnar collateral ligament of the thumb (UCL) may be treated conservatively. For that reason an accurate diagnosis is mandatory for choosing the correct therapy. Ultrasound is able to depict the position of the torn UCL correctly in approximately 90 % of cases. Sonographic pitfalls can be caused by a dislocation of the palmar joint capsule to the ulnar joint space, by a scalloping of the adductor aponeurosis due to the displaced UCL, and by scar tissue or technical mistakes. It is important to know about those pitfalls because conservative treatment of displaced UCL tears leads to instability. Therefore, the use of MRI is recommended whenever a nondisplaced UCL tear is suspected by US and a conservative therapy is suggested. Splitting the diagnostic pathway between US and MRI and preferring conservative therapy in nondisplaced UCL tears should help to save money in this field. Received 14 December 1995; Revision received 27 December 1995; Accepted 25 January 1996     

血液透析分流通道狭窄和闭塞的介入治疗

目的 总结35例自体血管瘘道（桡动脉与头静脉侧端吻合）机能不全和闭塞的血管造影诊断及介入治疗结果。方法 对35例自体血管瘘道机能不全和闭塞患者行血管造影。26例血栓形成闭塞患者行溶栓治疗,15例行经皮血管成形术（PTA）。结果 初次造影结果,9例单纯血管狭窄,26例血栓闭塞。溶栓即时开通率为88．4％（23／26）,其中13例伴血管狭窄中7例及单纯性狭窄中8例共15例进行了PTA治疗,成功12例,失败3例。追踪观察6例溶栓后伴狭窄未处理及PTA失败者（3例）。1个月内7例发生再阻塞,3个月内全部再阻塞。结论 血管造影及介入治疗对血液透析分流通道机能不全和闭塞具有重要意义。     

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.     

血液透析中血管通路的CO2血管造影初步研究

目的探讨CO2血管造影在血液透析的血管通路评价中的应用技术及其价值。方法对10例慢性肾衰经桡动脉内瘘进行血液透析的患者进行CO2静脉造影，7例于内瘘远侧手背静脉穿刺，3例直接行内瘘穿刺，快速推注CO2每次40～60ml，完成到上腔静脉的全程引流静脉造影，并于肘部加压后完成1次前臂静脉造影。使用Toshiba Infinix Vc-i旋转DSA机，直接以减影模式实时显示，并对图像作叠加处理。结果所有病人均顺利安全地完成检查，静脉表现为流畅连续的管状结构或显示为一连串气泡，7例手背静脉进针中仅1例清晰显示粗大的引流头静脉，其余显示了较多旁支；3例经内瘘直接进针，均清晰显示引流的头静脉，旁支稀少。5例手背静脉进针加压后造影显示2例头静脉发生变化，其余未见明显变化。所有上臂段头静脉，以及腋静脉、锁骨下静脉均显示较清晰，叠加后图像更好地显示了连续流畅的血管。结论血管通路CO2静脉造影是安全经济和快速有效的手段；肾衰病人血管通路引流静脉有其自身特点，内瘘直接穿刺造影是引流静脉造影的最佳途径，充分利用各种技巧能够更好地显示靶血管及其病变。     

血管性介入在肝脏移植中的应用

目的探讨血管性介入技术在肝脏移植前后诊治中的应用。方法对2003年1月~2005年2月对拟行肝脏移植的30例患者术前行肝动脉、肠系膜上动脉选择造影及经肠系膜上动脉间接门静脉造影;并对6例肝脏移植术后怀疑血管并发症的患者行造影及介入下溶栓及内支架治疗。结果30例患者术前造影中提示肝癌11例;4例患者动脉造影显示动脉血管变异。29例患者间接门脉造影成功,其中2例肝癌患者发现门脉癌栓,26例存在不同程度的静脉曲张。对6例怀疑胆道和血管并发症的患者作血管造影及相关介入治疗。其中2例成功行狭窄动脉吻合口金属内支架治疗,1例行动脉溶栓治疗,造影显示肝动脉血流恢复通畅;其他3例介入治疗效果不满意。结论血管造影能够提供准确的动脉和门静脉解剖和变异信息;血管介入技术有助于对肝移植术后早期血管并发症诊断和处理。     

Problem-solving with MRI in acute abdominopelvic conditions,part 2: gynecological,obstetric, vascular,and renal diseases

Emergency Radiology - The purpose of this article is to illustrate the benefits of magnetic resonance imaging (MRI) in the setting of abdominopelvic emergencies. Owing to intrinsically high...