Simulation: Moving from Technology Challenge to Human Factors Success

Recognition of the many limitations of traditional apprenticeship training is driving new approaches to learning medical procedural skills. Among simulation technologies and methods available today, computer-based systems are topical and bring the benefits of automated, repeatable, and reliable performance assessments. Human factors research is central to simulator model development that is relevant to real-world imaging-guided interventional tasks and to the credentialing programs in which it would be used.     

Identifying Barriers and Facilitators of Success for Female Radiology Researchers: An Analysis of In-Depth Interviews With Nationally Recognized Leaders of the Field

ObjectiveWomen are highly underrepresented among leadership positions within radiology research, disproportionate to their underrepresentation in radiology overall. We sought to identify the causes and solutions of such disparity at the personal, organizational, and institutional levels among female radiology researchers who are leaders in the field.Subjects and methodsWe used purposive sampling to identify nationally recognized female leaders in radiology research. We developed a semistructured interview guide and conducted in-depth one-on-one telephone interviews with participants (n = 16) that ranged from 36 to 65 min. All interviews were recorded and transcribed. Data were analyzed by two researchers trained in qualitative methods using Saldana’s first- and second-cycle coding method. Themes were identified using a grounded theory approach to identify meaningful patterns that addressed the research question.ResultsParticipants identified barriers to their professional development and success, including personal and professional obstacles often associated with work-life balance and the nonlinear nature of women’s careers because of caregiving responsibilities. Participants also identified facilitators of success that operated at the individual, organizational, and institutional level, such as purposeful networking, having an advocate, and participating in leadership events.ConclusionThis study represents the first effort to qualitatively capture the facilitators of success for nationally recognized female radiology researchers. Findings suggest that synergistic efforts can be undertaken by early-career female radiologists and their colleagues, national radiology organizations, and academic institutions to systematically enable the inclusion and participation of women. The field of radiology should consider how to work dynamically at multiple levels to implement the identified potential changes.     

Ablation Zones and Weight-Bearing Bones: Points of Caution for the Palliative Interventionalist

PurposeTo evaluate and classify underlying mechanisms of adverse outcomes after percutaneous computed tomography (CT)–guided cryoablation for palliation of painful musculoskeletal metastatic disease.Materials and MethodsData were collected for patients who underwent CT-guided percutaneous palliative cryoablation for painful musculoskeletal metastatic disease between January 2010 and December 2012. Cases with adverse outcomes or suboptimal response were identified and classified according to the Society of Interventional Radiology (SIR) classification system for complications by outcome and according to underlying mechanism of the outcome as delineated on follow-up examination.ResultsThere were 61 patients who received ablation for painful musculoskeletal metastatic disease. Six patients with adverse outcomes were identified. Two were minor complications (A, n = 1; B, n = 1), and four were major complications (C, n = 1; D, n = 3). Four patients incurred sequelae related to damage of ancillary structures included in the ablation zone, and two patients developed complete fractures after ablation of lesions in weight-bearing bones.ConclusionsComplete cryoablation of a painful musculoskeletal metastatic lesion may lead to ancillary damage of adjacent structures or fracture in weight-bearing bones.     

Field surgery department: from origin and history to modern times

Field Surgery Department of the Kirov Military Medical Academy celebrates the 80th anniversary/The distinguished Russian surgeon V.A. Oppel created not only the team having the general goal to study thoroughly main laws of combat pathology, but also installed basic knowledge concerning surgical care administration in future local wars. Contribution of Field Surgery Department to updating of main principles of field surgery, development of military tenet, treating tenet, training of highly qualified panel surgeons treating patients with severe wounds shown in this paper.     

Radiotherapy of the Neuroaxis for Palliative Treatment of Leptomeningeal Carcinomatosis

BACKGROUND: Leptomeningeal carcinomatosis occurs in about 5% of solid tumors and may seriously compromise quality of life. Aim of the present study was to evaluate the feasibility of craniospinal irradiation with and without intrathecal chemotherapy and its efficacy with regard to symptom palliation and survival. PATIENTS AND METHODS: 16 patients (mean age 46 years; nine breast cancers, five lung cancers, one renal cell cancer, one tumor of unknown primary site) with leptomeningeal carcinomatosis occurring after a median interval from primary tumor diagnosis of 5 months (0-300 months) received craniospinal irradiation between October 1995 and May 2000. The median total dose was 36 Gy (à 1.6-2.0 Gy). Ten patients were additionally treated with intrathecal methotrexate (15 mg per cycle, 2-8 cycles). RESULTS: Median survival was 12 weeks, 8 weeks after radiotherapy alone, 16 weeks after combined modality treatment. 14 patients died from disease. Eleven patients (68%) experienced regression of their neurological symptoms during or soon after completion of radiotherapy. Seven patients regained their ability to walk, six had pain reduction, three regression of bladder and bowel incontinence. In three patients symptom progression and in two patients no change occurred. Side effects were: myelosuppression (CTC) Grade I: n = 2, Grade II: n = 4, Grade III: n = 4 patients and Grade IV: n = 1. Nine patients had dysphagia, seven mucositis, three suffered from nausea. No late toxicity was observed. CONCLUSION: Craniospinal radiotherapy is feasible and effective for palliative treatment of leptomeningeal carcinomatosis. As far as the small patient number permits any definite conclusions, combined modality treatment seems superior to irradiation alone.     

Radiotherapy of the Neuroaxis for Palliative Treatment of Leptomeningeal Carcinomatosis

Background: Leptomeningeal carcinomatosis occurs in about 5% of solid tumors and may seriously compromise quality of life. Aim of the present study was to evaluate the feasibility of craniospinal irradiation with and without intrathecal chemotherapy and its efficacy with regard to symptom palliation and survival. Patients and Methods: 16 patients (mean age 46 years; nine breast cancers, five lung cancers, one renal cell cancer, one tumor of unknown primary site) with leptomeningeal carcinomatosis occurring after a median interval from primary tumor diagnosis of 5 months (0-300 months) received craniospinal irradiation between October 1995 and May 2000. The median total dose was 36 Gy (à 1.6-2.0 Gy). Ten patients were additionally treated with intrathecal methotrexate (15 mg per cycle, 2-8 cycles). Results: Median survival was 12 weeks, 8 weeks after radiotherapy alone, 16 weeks after combined modality treatment. 14 patients died from disease. Eleven patients (68%) experienced regression of their neurological symptoms during or soon after completion of radiotherapy. Seven patients regained their ability to walk, six had pain reduction, three regression of bladder and bowel incontinence. In three patients symptom progression and in two patients no change occurred. Side effects were: myelosuppression (CTC) Grade I: n = 2, Grade II: n = 4, Grade III: n = 4 patients and Grade IV: n = 1. Nine patients had dysphagia, seven mucositis, three suffered from nausea. No late toxicity was observed. Conclusion: Craniospinal radiotherapy is feasible and effective for palliative treatment of leptomeningeal carcinomatosis. As far as the small patient number permits any definite conclusions, combined modality treatment seems superior to irradiation alone. Hintergrund: Eine Leptomeningeosis carcinomatosa, die bei ca. 5% aller soliden Tumoren auftritt, kann die Lebensqualität erheblich beeinträchtigen. Ziel der Studie war es, Machbarkeit und Effektivität einer kraniospinalen Bestrahlung mit und ohne intrathekale Chemotherapie in Bezug auf neurologische Ausfälle und Überleben zu untersuchen. Patienten und Methodik: 16 Patient/innen (medianes Alter 46 Jahre; neun Mammakarzinome, füf Bronchialkarzinome, ein Nierenzellkarzinom, ein unbekannter Primärtumor) mit Meningeosis carcinomatosa, die nach einem medianen Intervall zur Erstdiagnose von 5 Monaten (0-300 Monaten) auftrat, erhielten zwischen Oktover 1995 und Mai 2000 eine Bestrahlung der Neuroachse mit einer medianen Dosis von 36 Gy (à 1,6-2,0 Gy). Zehn Patienten erhielten zusätzlich zwei- bis achtmal eine intrathekale Chemotherapie mit jeweils 15 mg MTX. Resultate: Das mediane Überleben ab Nachweis der Meningeosis betrug 12 Wochen (4-84 Wochen), nach alleiniger Radiatio 8 Wochen, nach kombinierter Therapie 16 Wochen. 14 Patienten verstarben tumorbedingt. Bei elf Patienten (68%) trat während bzw. unmittelbar im Anschluss an die Radiatio ein anhaltender Rückgang der neurologischen Beschwerdesymptomatik ein (siebenmal Wiedererlangung der Gehfähigkeit, sechsmal Schmerzreduktion, dreimal Rückbildung der Blasen- und Mastdarmstörungen). Bei drei Patienten bestand unter Therapie einer Progression der Symptome, in zwei Fällen ein Status idem. Nebenwirkungen waren: Hämatotoxizität (CTC) Grad I: n = 2, Grad II: n = 4, Grad III: n = 4, Grad IV: n = 1. Schluckbeschwerden traten bei neun, eine Mukositis bei sieben und Übelkeit bei drei Patienten auf. Schlussfolgerung: Durch Bestrahlung der Neuroachse ist bei Meningeosis carcinomatosa ein substantieller palliativer Effekt auf die neurologische Symptomatik bei akzeptablen Nebenwirkungen erzielbar. Sofern bei der geringen Fallzahl zu beurteilen, erscheint eine Verlängerung der Überlebenszeit nur durch Kombination mit einer intrathekalen MTX-Chemotherapie erzielbar.