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Sample records for interventional radiology treatment

  1. Interventional Radiologic Treatment for Idiopathic Portal Hypertension

    SciTech Connect

    Hirota, Shozo; Ichikawa, Satoshi; Matsumoto, Shinichi; Motohara, Tomofumi; Fukuda, Tetsuya; Yoshikawa, Takeshi

    1999-07-15

    Purpose: To evaluate the usefulness of interventional radiological treatment for idiopathic portal hypertension. Methods: Between 1995 and 1998, we performed an interventional radiological treatment in five patients with idiopathic portal hypertension, four of whom had refused surgery and one of whom had undergone surgery. Three patients with gastroesophageal varices (GEV) were treated by partial splenic embolization (PSE), one patient with esophageal varices (EV) and massive ascites by transjugular intrahepatic portosytemic shunt (TIPS) and PSE, and one patient with GEV by percutaneous transhepatic obliteration (PTO). Midterm results were analyzed in terms of the effect on esophageal and/or gastric varices. Results: In one woman with severe GEV who underwent three sessions of PSE, there was endoscopic confirmation that the GEV had disappeared. In one man his EV shrunk markedly after two sessions of PSE. In two patients slight reduction of the EV was obtained with one application of PSE combined with endoscopic variceal ligation therapy. PTO for GV in one patient resulted in good control of the varices. All patients have survived for 16-42 months since the first interventional treatment, and varices are well controlled. Conclusion: Interventional radiological treatment is effective for patients with idiopathic portal hypertension, whether or not they have undergone surgery.

  2. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology.

    PubMed

    Nanavati, Sujal M

    2014-12-01

    Since the 1960s, interventional radiology has played a role in the management of gastrointestinal bleeding. What began primarily as a diagnostic modality has evolved into much more of a therapeutic tool. And although the frequency of gastrointestinal bleeding has diminished thanks to management by pharmacologic and endoscopic methods, the need for additional invasive interventions still exists. Transcatheter angiography and intervention is a fundamental step in the algorithm for the treatment of gastrointestinal bleeding.

  3. Interventional radiology treatment for pulmonary embolism

    PubMed Central

    De Gregorio, Miguel A; Guirola, Jose A; Lahuerta, Celia; Serrano, Carolina; Figueredo, Ana L; Kuo, William T

    2017-01-01

    Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes. PMID:28794825

  4. Interventional radiology treatment for pulmonary embolism.

    PubMed

    De Gregorio, Miguel A; Guirola, Jose A; Lahuerta, Celia; Serrano, Carolina; Figueredo, Ana L; Kuo, William T

    2017-07-28

    Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.

  5. [Interventional Radiological Treatment of Intercostal Artery Bleedings - a Retrospective Analysis].

    PubMed

    Kupczyk, Patrick; Meyer, Carsten; Thomas, Daniel; Schild, Hans Heinz; Pieper, Claus Christian

    2017-08-01

    Background Intercostal artery bleedings are potentially fatal injuries. Apart from conservative and surgical treatment options, emergency interventional radiological treatment can also be performed. We report our experience with emergency intercostal artery embolisation. Materials and Methods Patients with acute arterial bleedings from the intercostal artery who were treated interventionally over a period of 7 years were identified retrospectively. Technical and clinical success, clinical and procedural parameters as well as overall survival were analysed. Results Between 2010 and 2017, a total of 27 embolisation procedures was performed in 24 patients (14 male, mean age 65.7 ± 13.9 years). The majority of patients suffered from iatrogenic intercostal artery bleedings (n = 17; 70.1%; especially after thoracocentesis). In five cases, thoracoscopic surgery was attempted prior to intervention but was unsuccessful. Primary technical success was obtained in 25/27 interventions. In two cases, there was re-bleeding via collateral arteries so that re-intervention became necessary (secondary technical success). In 15 cases, secondary surgery after successful interventional treatment was necessary to evacuate the haematoma/haemothorax. Intercostal artery embolisation was clinically successful in 23/24 patients. One patient died despite technically successful embolisation, due to extensive haemothorax. One case of spinal ischaemia was observed as a major complication. Conclusion Intercostal artery embolisation is an effective interventional radiological emergency measure in patients with acute bleeding and is an alternative to surgical treatment even after attempted, unsuccessful surgery. Because of potentially severe complications, the interventional procedure should be performed by an experienced interventionalist. Georg Thieme Verlag KG Stuttgart · New York.

  6. Interventional radiology in the treatment of early postoperative biliary complications.

    PubMed

    Fonio, P; Cassinis, M C; Rapellino, A; Righi, D; Gandini, G

    2013-04-01

    We sought to evaluate the feasibility and efficacy of percutaneous treatment of early postoperative biliary complications. The primary aims were to evaluate clinical and technical success and complications and perioperative mortality, and secondary aims were to evaluate treatment duration and recurrence rate. Between March 2007 and March 2010, 75 patients (42 men and 33 women; age range, 17-88 years; mean age, 60.8 years) underwent interventional radiology procedures to treat early postoperative biliary complications of biliary and pancreatic-duodenal surgery with biliodigestive anastomosis (37.7%), laparoscopic cholecystectomy (30.6%), hepatic resection (21.1%) and several other surgical procedures (10.6%). Complications included fistulas (73%), stenoses (20%) and complete bile duct transections (7%). Interventional radiology achieved complete clinical success in 74 cases (85.9%) and in particular in 95.2% of fistulas, 76.5% of stenoses and 33.3% of complete bile duct transections. Mean indwelling catheter time was 34.9 days, with an average of 4.1 procedures. There were two cases of severe haemobilia (2.3%). Minor complications occurred in 7% of cases. Perioperative mortality rate was 1.2% and overall recurrence rate 6.7% (range, 1-18 months; mean, 10 months), with recurrences occurring predominantly in stenoses. All patients were retreated successfully. Percutaneous procedures are feasible, effective and safe for treating early postoperative biliary complications. They provide a valuable alternative to presendoscopy, which is precluded in many of these patients, and to surgery, which has higher morbidity and mortality rates.

  7. Interventional Radiology Strategies in the Treatment of Pseudomyxoma Peritonei

    SciTech Connect

    Sonnenberg, Eric van Goodacre, Brian W.; Wittich, Gerhard R.; Ali, Seham; Silverman, Stuart G.; Shankar, Sridhar; Tuncali, Kemal

    2005-05-15

    Purpose. To describe percutaneous maneuvers to treat the unusual entity symptomatic pseudomyxoma peritonei (PMP). Methods. Four patients with PMP were treated by interventional radiology techniques that included large catheters (20-30 Fr) alone (n = 3), multiple catheters (n = 4), and dextran sulfate as a catalytic agent through smaller catheters (n = 1). The causes of the PMP were tumors in the ovary (2 patients), appendix (1 patient), and colon (1 patient). Each patient previously had undergone at least two operations to remove the PMP, and all patients had symptomatic recurrence. An in vitro analysis of catalytic agents also was performed. Results. All four patients improved symptomatically. Follow-up CT scans demonstrated marked reduction of PMP material in all cases. One patient underwent another interventional radiology session 5 months after the first; the other three patients had no recurrence of symptoms. One patient had reversible hypotension 2 hr after the procedure. The amount of material removed varied from 3 to 6 L. Conclusion. These interventional radiology techniques were effective and safe for PMP and suggest options for this difficult medical and surgical problem.

  8. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches

    PubMed Central

    Prajapati, H J S; Martin, L G; Patel, T H

    2014-01-01

    The term vascular anomaly represents a broad spectrum of vascular pathology, including proliferating vascular tumours and vascular malformations. While the treatment of most vascular anomalies is multifactorial, interventional radiology procedures, including embolic therapy, sclerotherapy and laser coagulation among others, are playing an increasingly important role in vascular anomaly management. This review discusses the diagnosis and treatment of common vascular malformations, with emphasis on the technique, efficacy and complications of different interventional radiology procedures. PMID:24588666

  9. Paediatric musculoskeletal interventional radiology

    PubMed Central

    Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo

    2016-01-01

    Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. PMID:26235144

  10. Pediatric Interventional Radiology: Vascular Interventions.

    PubMed

    Kandasamy, Devasenathipathy; Gamanagatti, Shivanand; Gupta, Arun Kumar

    2016-07-01

    Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery.

  11. Interventional radiological treatment of renal transplant complications: a pictorial review.

    PubMed

    Iezzi, Roberto; la Torre, Michele Fabio; Santoro, Marco; Dattesi, Roberta; Nestola, Massimiliano; Posa, Alessandro; Romagnoli, Jacopo; Citterio, Franco; Bonomo, Lorenzo

    2015-01-01

    Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management.

  12. Interventional Radiological Treatment of Renal Transplant Complications: A Pictorial Review

    PubMed Central

    la Torre, Michele Fabio; Santoro, Marco; Dattesi, Roberta; Nestola, Massimiliano; Posa, Alessandro; Romagnoli, Jacopo; Citterio, Franco; Bonomo, Lorenzo

    2015-01-01

    Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management. PMID:25995689

  13. Interventional Radiology in Paediatrics.

    PubMed

    Chippington, Samantha J; Goodwin, Susie J

    2015-01-01

    As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.

  14. Interventional Radiology in China

    SciTech Connect

    Teng Gaojun Xu Ke; Ni Caifang; Li Linsun

    2008-03-15

    With more than 3000 members, the Chinese Society of Interventional Radiology (CSIR) is one of the world's largest societies for interventional radiology (IR). Nevertheless, compared to other societies such as CIRSE and SIR, the CSIR is a relatively young society. In this article, the status of IR in China is described, which includes IR history, structure and patient management, personnel, fellowship, training, modalities, procedures, research, turf battle, and insightful visions for IR from Chinese interventional radiologists.

  15. How to Start Interventional Radiology

    PubMed Central

    Ghanaati, Hossein; Firouznia, Kavous; Jalali, Amir Hossein; Shakiba, Madjid

    2013-01-01

    Interventional techniques aim to find safer and better ways to treat vascular diseases even in many instances, the interventional radiology solutions has been considered the only treatment option for the patients. Interventional radiologists are specialists who perform minimally invasive procedures instead of surgery or other treatments. These procedures apply various imaging and catheterization procedures in order to diagnose and treat diseases. In each country, interventional radiology practice establishment of varies according to local factors, but following a standard strategy seems better to set up this facility. According to above mentioned points, we decided to establish this specialty in our hospital since 2001 as the pioneer center in Iran. In this presentation we will discuss about our experience for start interventional radiology. PMID:24693402

  16. Current Status of Interventional Radiology Treatment of Infrapopliteal Arterial Disease

    SciTech Connect

    Rand, T.; Uberoi, R.

    2013-06-15

    Treatment of infrapopliteal arteries has developed to a standard technique during the past two decades. With the introduction of innovative devices, a variety of techniques has been created and is still under investigation. Treatment options range from plain balloon angioplasty (POBA), all sorts of stent applications, such as bare metal, balloon expanding, self-expanding, coated and drug-eluting stents, and bio-absorbable stents, to latest developments, such as drug-eluting balloons. Regarding the scientific background, several prospective, randomized studies with relevant numbers of patients have been (or will be) published that are Level I evidence. In contrast to older studies, which primarily were based mostly on numeric parameters, such as diameters or residual stenoses, more recent study concepts focus increasingly on clinical features, such as amputation rate improvement or changes of clinical stages and quality of life standards. Although it is still not decided, which of the individual techniques might be the best one, we can definitely conclude that whatever treatment of infrapopliteal arteries will be used it is of substantial benefit for the patient. Therefore, the goal of this review is to give an overview about the current developments and techniques for the treatment of infrapopliteal arteries, to present clinical and technical results, to weigh individual techniques, and to discuss the recent developments.

  17. Practical interventional radiology

    SciTech Connect

    Von Sonnenberg, E.; Mueller, P.R.

    1988-01-01

    This book describes techniques employed in interventional radiology with emphasis on imaging leading to intervention. Includes the entire array of procedures available to the radiologist, discussing the indications, materials, technique, results, and complications for each. Covers the chest, abdomen, bone, pediatric considerations, and nursing care.

  18. Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies

    PubMed Central

    Fornazari, Vinicius Adami Vayego; Szejnfeld, Denis; Elito, Julio; Goldman, Suzan Menasce

    2015-01-01

    The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers. PMID:25993085

  19. Interventional radiology in the elderly

    PubMed Central

    Katsanos, Konstantinos; Ahmad, Farhan; Dourado, Renato; Sabharwal, Tarun; Adam, Andreas

    2009-01-01

    Interventional radiological percutaneous procedures are becoming all the more important in the curative or palliative management of elderly frail patients with multiple underlying comorbidities. They may serve either as alternative primary minimally invasive therapies or adjuncts to traditional surgical treatments. The present report provides a concise review of the most important interventional radiological procedures with a special focus on the treatment of the primary debilitating pathologies of the elderly population. The authors elaborate on the scientific evidence and latest developments of thermoablation of solid organ malignancies, palliative stent placement for gastrointestinal tract cancer, airway stenting for tracheobronchial strictures, endovascular management of aortic and peripheral arterial vascular disease, and cement stabilization of osteoporotic vertebral fractures. The added benefits of high technical and clinical success coupled with lower procedural mortality and morbidity are highlighted. PMID:19503761

  20. Interventional Radiological Treatment of Perihepatic Vascular Stenosis or Occlusion in Pediatric Patients After Liver Transplantation

    SciTech Connect

    Uller, Wibke; Knoppke, Birgit; Schreyer, Andreas G.; Heiss, Peter; Schlitt, Hans J.; Melter, Michael; Stroszczynski, Christian; Zorger, Niels; Wohlgemuth, Walter A.

    2013-12-15

    Purpose: Evaluation of the efficacy and safety of percutaneous treatment of vascular stenoses and occlusions in pediatric liver transplant recipients. Methods: Fifteen children (mean age 8.3 years) underwent interventional procedures for 18 vascular complications after liver transplantation. Patients had stenoses or occlusions of portal veins (n = 8), hepatic veins (n = 3), inferior vena cava (IVC; n = 2) or hepatic arteries (n = 5). Technical and clinical success rates were evaluated. Results: Stent angioplasty was performed in seven cases (portal vein, hepatic artery and IVC), and sole balloon angioplasty was performed in eight cases. One child underwent thrombolysis (hepatic artery). Clinical and technical success was achieved in 14 of 18 cases of vascular stenoses or occlusions (mean follow-up 710 days). Conclusion: Pediatric interventional radiology allows effective and safe treatment of vascular stenoses after pediatric liver transplantation (PLT). Individualized treatment with special concepts for each pediatric patient is necessary. The variety, the characteristics, and the individuality of interventional management of all kinds of possible vascular stenoses or occlusions after PLT are shown.

  1. Interventional radiological treatment of perihepatic vascular stenosis or occlusion in pediatric patients after liver transplantation.

    PubMed

    Uller, Wibke; Knoppke, Birgit; Schreyer, Andreas G; Heiss, Peter; Schlitt, Hans J; Melter, Michael; Stroszczynski, Christian; Zorger, Niels; Wohlgemuth, Walter A

    2013-12-01

    Evaluation of the efficacy and safety of percutaneous treatment of vascular stenoses and occlusions in pediatric liver transplant recipients. Fifteen children (mean age 8.3 years) underwent interventional procedures for 18 vascular complications after liver transplantation. Patients had stenoses or occlusions of portal veins (n = 8), hepatic veins (n = 3), inferior vena cava (IVC; n = 2) or hepatic arteries (n = 5). Technical and clinical success rates were evaluated. Stent angioplasty was performed in seven cases (portal vein, hepatic artery and IVC), and sole balloon angioplasty was performed in eight cases. One child underwent thrombolysis (hepatic artery). Clinical and technical success was achieved in 14 of 18 cases of vascular stenoses or occlusions (mean follow-up 710 days). Pediatric interventional radiology allows effective and safe treatment of vascular stenoses after pediatric liver transplantation (PLT). Individualized treatment with special concepts for each pediatric patient is necessary. The variety, the characteristics, and the individuality of interventional management of all kinds of possible vascular stenoses or occlusions after PLT are shown.

  2. Role of Interventional Radiology in the Treatment of Biliary Strictures Following Orthotopic Liver Transplantation

    SciTech Connect

    Righi, Dorico; Cesarani, Federico; Muraro, Emanuele; Gazzera, Carlo; Salizzoni, Mauro; Gandini, Giovanni

    2002-01-15

    Purpose: To evaluate the efficacy and safety of percutaneous treatment of biliary strictures complicating orthotopic liver transplantation (OLT). Methods: Between October 1990 and May 2000, 619 patients underwent 678 liver transplants. Seventy of the 619 (11%) patients were found to be affected by biliary strictures by July 2000. Bilioplasty was performed in 51 of these 70 (73%) patients. A cohort of 33 of 51 (65%) patients were clinically followed for more than 12 months after the last percutaneous treatment and included in the survey results. Results: After one to three treatments 24 of 33 (73%)patients were stricture-free on ultrasound and MR cholangiography follow-up. A delayed stricture recurrence required a fourth percutaneous bilioplasty in two of 33 (6%) patients. A surgical bilioenteric anastomosis was performed in six of 33 (18%) patients.Retransplantation was performed due to ischemic damage in one of 33(3%) patients. Conclusion: Interventional radiology is an effective therapeutic alternative for the treatment of most biliary strictures complicating OLT. It has a high success rate and should be considered before surgical interventions. Elective surgery may be necessary in a few failed cases or those with more severe and extensive biliary strictures.

  3. Cardiovascular and Interventional Radiological Society of Europe Commentary on the Treatment of Chronic Cerebrospinal Venous Insufficiency

    SciTech Connect

    Reekers, J. A.; Lee, M. J.; Belli, A. M.; Barkhof, F.

    2011-02-15

    directly approached by MS patients, contact the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) for advice. Worldwide, several centres are actively promoting and performing balloon dilatation, with or without stenting, for CCSVI. Thus far, no trial data are available, and there is currently no randomized controlled trial (RCT) in progress Therefore, the basis for this new treatment rests on anecdotal evidence and successful testimonies by patients on the Internet. CIRSE believes that this is not a sound basis on which to offer a new treatment, which could have possible procedure-related complications, to an often desperate patient population.

  4. Interventional radiology neck procedures.

    PubMed

    Zabala Landa, R M; Korta Gómez, I; Del Cura Rodríguez, J L

    2016-05-01

    Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.

  5. Poul Erik Andersen's radiological work on Osteochondrodysplasias and interventional radiology

    PubMed Central

    Andersen, Poul Erik

    2011-01-01

    Poul Erik Andersen is a Professor and Interventional Radiologist at the University of Southern Denmark, Odense and Odense University Hospital, Denmark. His innovative and expertise is primarily in vascular interventions where he has introduced and developed many procedures at Odense University Hospital. His significant experience and extensive scientific work has led to many posts in the Danish Society of Interventional Radiology, the European Society of Radiology and the Cardiovascular and Interventional Radiological Society of Europe, where he is a fellow and has passed the European Board of Interventional Radiology - The European qualification in Interventional Radiology. PMID:22022640

  6. Poul Erik Andersen's radiological work on Osteochondrodysplasias and interventional radiology.

    PubMed

    Andersen, Poul Erik

    2011-08-28

    Poul Erik Andersen is a Professor and Interventional Radiologist at the University of Southern Denmark, Odense and Odense University Hospital, Denmark. His innovative and expertise is primarily in vascular interventions where he has introduced and developed many procedures at Odense University Hospital. His significant experience and extensive scientific work has led to many posts in the Danish Society of Interventional Radiology, the European Society of Radiology and the Cardiovascular and Interventional Radiological Society of Europe, where he is a fellow and has passed the European Board of Interventional Radiology - The European qualification in Interventional Radiology.

  7. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention?

    PubMed

    Onel, D; Sari, H; Dönmez, C

    1993-02-01

    In this prospective study, 145 patients with lumbar spinal stenosis were evaluated for clinical signs and radiologic findings and conservative treatment results. Clinical parameters such as pain on motion, lumbar range of motion, straight leg raising test, deep tendon reflexes, dermatomal sensations, motor functions and neurogenic claudication distances were assessed at admission and were compared after a conservative treatment program was completed. A conservative treatment program consisted of physical therapy (infrared heating, ultrasonic diathermy and active lumbar exercises) and salmon calcitonin. Pain on motion (100%), restriction of extension (77%), limited straight leg raising test (23%), neurogenic claudication (100%), dermatomal sensory impairment (47%), motor deficit (29%), and reflex deficit (40%) were observed in the patients. All aforementioned disturbances except reflex deficits improved by the conservative treatment and results were statistically significant. The authors conclude that this conservative treatment should be the treatment of choice in elderly patients and in those patients without clinical surgical indications.

  8. Interventional Radiology: Equipment and Techniques.

    PubMed

    Scansen, Brian A

    2016-05-01

    The breadth of small animal diseases that can now be treated by a minimally invasive, transcatheter approach continues to expand. Interventional radiology is the field of medicine that affects a therapeutic outcome via minimally invasive catheterization of peripheral blood vessels or body orifices guided by imaging. The intent of this article is to provide an overview of the equipment required for interventional radiology in veterinary medicine with a discussion of technical uses in diseases of dogs and cats. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Interventional Radiology in Liver Transplantation

    SciTech Connect

    Karani, John B. Yu, Dominic F.Q.C.; Kane, Pauline A.

    2005-04-15

    Radiology is a key specialty within a liver transplant program. Interventional techniques not only contribute to graft and recipient survival but also allow appropriate patient selection and ensure that recipients with severe liver decompensation, hepatocellular carcinoma or portal hypertension are transplanted with the best chance of prolonged survival. Equally inappropriate selection for these techniques may adversely affect survival. Liver transplantation is a dynamic field of innovative surgical techniques with a requirement for interventional radiology to parallel these developments. This paper reviews the current practice within a major European center for adult and pediatric transplantation.

  10. White Paper: Curriculum in Interventional Radiology.

    PubMed

    Mahnken, Andreas H; Bücker, Arno; Hohl, Christian; Berlis, Ansgar

    2017-04-01

    Purpose Scope and clinical importance of interventional radiology markedly evolved over the last decades. Consequently it was acknowledged as independent subspecialty by the "European Union of Medical Specialists" (UEMS). Based on radiological imaging techniques Interventional Radiology is an integral part of Radiology. Materials und Methods In 2009 the German Society for Interventional Radiology and minimally-invasive therapy (DeGIR) developed a structured training in Interventional Radiology. In cooperation with the German Society of Neuroradiology (DGNR) this training was extended to also cover Interventional Neuroradiology in 2012. Tailored for this training in Interventional Radiology a structured curriculum was developed, covering the scope of this modular training. Results The curriculum is based on the DeGIR/DGNR modular training concept in Interventional Radiology. There is also an European Curriculum and Syllabus for Interventional Radiology developed by the "Cardiovascular and Interventional Radiological Society of Europe" (CIRSE). The presented curriculum in Interventional Radiology is designed to provide a uniform base for the training in Interventional Radiology in Germany, based on the competencies obtained during residency. Conclusion This curriculum can be used as a basis for training in Interventional Radiology by all training sites. Key Points: · Interventional Radiology is an integral part of clinical radiology. · The German Society for Interventional Radiology and minimally-invasive therapy (DeGIR) developed a curriculum in Interventional Radiology. · This curriculum is an integrative basis for the training in interventional. Citation Format · Mahnken AH, Bücker A, Hohl C et al. White Paper: Curriculum in Interventional Radiology. Fortschr Röntgenstr 2017; 189: 309 - 311. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Ruptured Internal Iliac Artery Aneurysm: Staged Emergency Endovascular Treatment in the Interventional Radiology Suite

    SciTech Connect

    Kelckhoven, Bas-Jeroen van Bruijninckx, Boy M. A.; Knippenberg, Bob; Overhagen, Hans van

    2007-07-15

    Ruptured aneurysms of the internal iliac artery (IIA) are rare and challenging to treat surgically. Due to their anatomic location they are difficult to operate on and perioperative morbidity is high. An endovascular approach can be helpful. We recently treated a patient with a ruptured IIA aneurysm in the interventional radiology suite with embolization of the side-branch of the IIA and placement of a covered stent in the ipsilateral common and external iliac arteries. A suitable stent-graft was not available initially and had to be brought in from elsewhere. An angioplasty balloon was temporarily placed across the ostium of the IIA to obtain hemostasis. Two hours later, the procedure was finished by placing the stent-graft.

  12. Treatment of urological complications in more than 1,000 kidney transplantations: the role of interventional radiology.

    PubMed

    Fonio, Paolo; Appendino, Elena; Calandri, Marco; Faletti, Riccardo; Righi, Dorico; Gandini, Giovanni

    2015-02-01

    The aim of this study is to evaluate the efficacy and safety of interventional radiology procedures in the treatment of major urological complications after kidney transplantation. Between 2000 and 2010, 1,146 kidney transplants were performed at our institution. A total of 146 major complications occurred, including 77 obstructions, 36 leaks and 33 associated perigraft fluid collections. Percutaneous treatment was carried out in 118/146 complications in 91 patients. In the case of stenosis-obstruction and fistulas (104 complications), the first therapeutic step was placement of a nephrostomy catheter, followed by balloon ureteroplasty, placement of external-internal catheters and double-J stents; 14/33 collections were drained under ultrasound guidance. In all 118 percutaneous interventions, we were able to place a nephrostomy or drainage catheter, with a technical success rate of 100 %. The long-term success rate was 49.6 %: in 57/115 (three patients were lost to follow-up) we obtained the complete resolution of the complication. The procedure-related mortality rate was 0 %. There was only one major complication and the rate of minor complications was 14.4 %. Interventional radiology is the first choice option in the treatment of urological complications after kidney transplantation.

  13. [Radiation protection in interventional radiology].

    PubMed

    Adamus, R; Loose, R; Wucherer, M; Uder, M; Galster, M

    2016-03-01

    The application of ionizing radiation in medicine seems to be a safe procedure for patients as well as for occupational exposition to personnel. The developments in interventional radiology with fluoroscopy and dose-intensive interventions require intensified radiation protection. It is recommended that all available tools should be used for this purpose. Besides the options for instruments, x‑ray protection at the intervention table must be intensively practiced with lead aprons and mounted lead glass. A special focus on eye protection to prevent cataracts is also recommended. The development of cataracts might no longer be deterministic, as confirmed by new data; therefore, the International Commission on Radiological Protection (ICRP) has lowered the threshold dose value for eyes from 150 mSv/year to 20 mSv/year. Measurements show that the new values can be achieved by applying all X‑ray protection measures plus lead-containing eyeglasses.

  14. Minimally Invasive Radiologically Guided Intervention for the Treatment of Salivary Calculi

    SciTech Connect

    Brown, Jackie E.; Drage, Nicholas A.; Escudier, Michael P.; Wilson, Ron F.; McGurk, Mark

    2002-10-15

    Purpose: To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction. Methods: Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire. Results: Of 86 cases of sialolithiasis treated, in 55 (64%)it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1-49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed. Conclusions:Stone removal from the salivary duct system by radiologically guided,minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.

  15. Environmental monitoring in interventional radiology

    NASA Astrophysics Data System (ADS)

    Del Sol, S.; Garcia, R.; Sánchez, D.; Ramirez, G.; Chavarin, E. U.; Rivera, T.

    2017-01-01

    The procedures in Interventional Radiology involve long times of exposure and high number of radiographic images that bring higher radiation doses to patients, staff and environmental than those received in conventional Radiology. Currently for monitoring the dose, the thermoluminescent dosimetry use is recommended. The aim of this work was to carry out the monitoring of the environmental scattered radiation inside the IR room using two types of thermoluminescent dosimeters, TLD-100 (reference dosimeter), CaSO4:Dy (synthesized in our laboratory). The results indicate that the TLD-100 is not effective for the environmental monitoring of low-energy Rx rooms. The CaSO4:Dy presented good behaviour over the 6 months of study. The results will be specific to each room so it is recommended such studies as part of the program of quality control of each Rx room.

  16. Interventional Radiology of the Urinary Tract.

    PubMed

    Berent, Allyson C

    2016-05-01

    Minimally invasive treatment options using interventional radiology and interventional endoscopy for urologic disease have become more common over the past decade in veterinary medicine. Urinary tract obstructions and urinary incontinence are the most common reasons for urinary interventions. Ureteral obstructions are underdiagnosed and a common clinical problem in veterinary medicine. Ureteral obstructions should be considered an emergency, and decompression should be performed as quickly as possible. Diagnostic imaging is the mainstay in diagnosing a ureteral obstruction and has changed in the last few years, with ultrasound and radiographs being the most sensitive tools in making this diagnosis preoperatively. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Radiation exposure in interventional radiology

    NASA Astrophysics Data System (ADS)

    Pinto, N. G. V.; Braz, D.; Vallim, M. A.; Filho, L. G. P.; Azevedo, F. S.; Barroso, R. C.; Lopes, R. T.

    2007-09-01

    The aim of this study is to evaluate dose values in patients and staff involved in some interventional radiology procedures. Doses have been measured using thermoluminescent dosemeters for single procedures (such as renal and cerebral arteriography, transjungular intrahepatic portasystemic shunt (TIPS) and chemoembolization). The magnitude of doses through the hands of interventional radiologists has been studied. Dose levels were evaluated in three points for patients (eye, thyroid and gonads). The dose-area product (DAP) was also investigated using a Diamentor (PTW-M2). The dose in extremities was estimated for a professional who generally performed one TIPS, two chemoembolizations, two cerebral arteriographies and two renal arteriographies in a week. The estimated annual radiation dose was converted to effective dose as suggested by the 453-MS/Brazil norm The annual dose values were 137.25 mSv for doctors, 40.27 mSv for nurses and 51.95 mSv for auxiliary doctors, and all these annual dose values are below the limit established. The maximum values of the dose obtained for patients were 6.91, 10.92 and 15.34 mGy close to eye, thyroid and gonads, respectively. The DAP values were evaluated for patients in the same interventional radiology procedures. The dose and DAP values obtained are in agreement with values encountered in the literature.

  18. Interventional Radiology of Male Varicocele: Current Status

    SciTech Connect

    Iaccarino, Vittorio Venetucci, Pietro

    2012-12-15

    Varicocele is a fairly common condition in male individuals. Although a minor disease, it may cause infertility and testicular pain. Consequently, it has high health and social impact. Here we review the current status of interventional radiology of male varicocele. We describe the radiological anatomy of gonadal veins and the clinical aspects of male varicocele, particularly the physical examination, which includes a new clinical and ultrasound Doppler maneuver. The surgical and radiological treatment options are also described with the focus on retrograde and antegrade sclerotherapy, together with our long experience with these procedures. Last, we compare the outcomes, recurrence and persistence rates, complications, procedure time and cost-effectiveness of each method. It clearly emerges from this analysis that there is a need for randomized multicentre trials designed to compare the various surgical and percutaneous techniques, all of which are aimed at occlusion of the anterior pampiniform plexus.

  19. Pediatric Interventional Radiology: Non-Vascular Interventions.

    PubMed

    Kandasamy, Devasenathipathy; Gamanagatti, Shivanand; Gupta, Arun Kumar

    2016-07-01

    Pediatric interventional radiology (PIR), which includes variety of procedures done under image guidance has emerged as an essential adjunct to various surgical and medical conditions, plays a significant role in the delivery of safe and effective care by reducing surgical risks, decreasing the length of hospital stay and reducing costs. The application of interventional techniques in children has been delayed over years as compared to adults due to lack of special hardwares/equipments, lack of adequately trained physicians and also the lack of awareness among the pediatric practitioners. This situation is gradually changing now owing to the advancements in technology. In this review, authors will discuss various non-vascular interventional procedures undertaken in pediatric patients.

  20. [Interventional radiology: current problems and new directions].

    PubMed

    Santos Martín, E; Crespo Vallejo, E

    2014-01-01

    In recent years, vascular and interventional radiology has become one of the fastest growing diagnostic and therapeutic specialties. This growth has been based on a fundamental concept: performing minimally invasive procedures under imaging guidance. This attractive combination has led to the interest of professionals from other clinical specialties outside radiology in performing this type of intervention. The future of vascular and interventional radiology, although uncertain, must be linked to clinical practice and multidisciplinary teamwork.

  1. Cardiovascular and Interventional Radiological Society of Europe Guidelines on Endovascular Treatment in Aortoiliac Arterial Disease

    SciTech Connect

    Rossi, Michele; Iezzi, Roberto

    2013-11-06

    PurposeThese guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions.MethodsAny recommendation contained in the text comes from the highest level and extension of literature review available to date.ResultsThe success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature. Most of the complications can be managed by means of percutaneous techniques.ConclusionThe design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction.

  2. The interventional radiology business plan.

    PubMed

    Beheshti, Michael V; Meek, Mary E; Kaufman, John A

    2012-09-01

    Strategic planning and business planning are processes commonly employed by organizations that exist in competitive environments. Although it is difficult to prove a causal relationship between formal strategic/business planning and positive organizational performance, there is broad agreement that formal strategic and business plans are components of successful organizations. The various elements of strategic plans and business plans are not common in the vernacular of practicing physicians. As health care becomes more competitive, familiarity with these tools may grow in importance. Herein we provide an overview of formal strategic and business planning, and offer a roadmap for an interventional radiology-specific plan that may be useful for organizations confronting competitive and financial threats.

  3. Interventional radiology: a half century of innovation.

    PubMed

    Baum, Richard A; Baum, Stanley

    2014-11-01

    The evolution of modern interventional radiology began over half century ago with a simple question. Was it possible to use the same diagnostic imaging tools that had revolutionized the practice of medicine to guide the real-time treatment of disease? This disruptive concept led to rapid treatment advances in every organ system of the body. It became clear that by utilizing imaging some patients could undergo targeted procedures, eliminating the need for major surgery, while others could undergo procedures for previously unsolvable problems. The breadth of these changes now encompasses all of medicine and has forever changed the way we think about disease. In this brief review article, major advances in the field, as chronicled in the pages of Radiology, will be described.

  4. Radiological interventions in malignant biliary obstruction

    PubMed Central

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-01-01

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  5. Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology.

    PubMed

    Sommer, S A; Geissler, R; Stampfl, U; Wolf, M B; Radeleff, B A; Richter, G M; Kauczor, H-U; Pereira, P L; Sommer, C M

    2016-04-01

    On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology--with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liablity of malpractice law. •On February 26th, 2013 the new patient law came into effect. Materially, there was no fundamental remodeling of the German liability for medical malpractice. •Regarding a physician's liability for medical malpractice two different elements of an offence come into consideration: for one the liability for malpractice and, in turn, liability for errors made during medical consultation in the process of obtaining informed consent.

  6. Trends in utilization of transarterial treatments for hepatocellular carcinoma: results of a survey by the Italian Society of Interventional Radiology.

    PubMed

    Bargellini, Irene; Florio, Francesco; Golfieri, Rita; Grosso, Maurizio; Lauretti, Dario Luca; Cioni, Roberto

    2014-04-01

    This study was designed to provide an overview of the practice of locoregional treatments for HCC by the Italian centers of Interventional Radiology (IR) with particular reference to transarterial modalities. A questionnaire of 11 questions on locoregional treatment of HCC was e-mailed to 134 Italian IR centers. The response rate was 64.9% (87/135 centers). Of 8,959 procedures in 2011, 67% were transarterial treatments, 31% percutaneous ablations, and 2% Y90-radioembolizations. Regarding (chemo)embolization, approximately 59% of procedures were performed in the intermediate stage, 28% in the early stage, and 12.8% in the advanced stage. TACE techniques varied greatly; approximately 52% of procedures were performed with drug-eluting particles and 32% with lipiodol, drug, and reabsorbable particles. In selected cases, 53 of 78 (68%) centers combine chemoembolization and ablation, whereas 28 centers (35.9%) combine Sorafenib and chemoembolization. In 2011, 13 of 78 (16.7%) responding centers performed Y90-radioembolization, with approximately 52% of procedures performed in the advanced stage and 46% in the intermediate stage. Approximately 62% of Y90-radioembolizations were performed using resin spheres and 38% using glass spheres. With almost 9,000 procedures performed each year, locoregional treatments of HCC, most of all transarterial (chemo)embolizations, represent a major part of daily clinical practice in many Italian IR centers. The high variability in responses regarding transarterial treatments for HCC patients highlights the need for solid scientific evidence allowing better definition of clinical indications and standardization of technical approaches.

  7. Contemporary Treatment for Critical Ischemia: The Evidence for Interventional Radiology or Surgery

    PubMed Central

    Hussey, Keith; Chandramohan, Sivanathan

    2014-01-01

    This article is a review of the evidence regarding the management of patients with critical limb ischemia. The aim of the study is to discuss the definition, incidence, and clinical importance of critical limb ischemia, as well as the aims of treatment in terms of quality of life and limb salvage. Endovascular and surgical treatments should not be viewed as competing therapies. In fact, these are complementary techniques each with strengths and weaknesses. The authors will propose a strategy based on the available evidence for deciding the optimal approach to management of patients with critical limb ischemia. PMID:25435654

  8. The role of interventional radiology in the treatment of biliary strictures after paediatric liver transplantation.

    PubMed

    Fonio, Paolo; Calandri, Marco; Faletti, Riccardo; Righi, Dorico; Cerrina, Alessia; Brunati, Andrea; Salizzoni, Mauro; Gandini, Giovanni

    2015-03-01

    The aim of this study is to evaluate the safety and efficacy of percutaneous treatment of biliary strictures after paediatric liver transplantation. In the period between October 1999 and October 2010, a total of 92 transplants in 86 children were performed at our Liver Transplant Centre. Eighteen patients had anastomotic biliary strictures (in four cases associated with intrahepatic bile duct stenosis). Percutaneous treatment (transhepatic biliary drainage and conventional/cutting balloon dilatation) was proposed as a first approach in 13/18 patients. Strict radiation protection precautions were taken in accordance with the ALARA (as low as reasonably achievable) principle. Mean follow-up time was 2,364 days. Surgical correction was required in 3/13 patients; in 8/13 cases, there was complete disappearance of clinical symptoms without bile duct dilatation; in one case, an asymptomatic persistent bile duct dilatation was detected while in the other case, the liver is currently in cirrhotic degeneration (69 % clinical success including the asymptomatic patient with biliary dilatation). Two of the five patients who were initially treated with surgery required percutaneous revision (clinical success of 100 %). There were two cases of long-term restenosis and two cases of transient haemobilia. Percutaneous procedures are safe and effective therapeutic options for the treatment of biliary strictures after paediatric liver transplantation.

  9. What Does Competence Entail in Interventional Radiology?

    SciTech Connect

    Ahmed, Kamran; Keeling, Aoife N.; Khan, Reenam S.; Ashrafian, Hutan; Arora, Sonal; Nagpal, Kamal; Burrill, Joshua; Darzi, Ara; Athanasiou, Thanos; Hamady, Mohamad

    2010-02-15

    Interventional radiology is a relatively new speciality and may be referred to as 'image-guided surgery without a scalpel.' Training and accreditation bodies regard interventional radiology training as being 'different' from general radiology because of the additional need for dexterity and clinical acumen. Due to the multidimensional role of an interventional radiologist, a practitioner in this discipline must have a number of the competencies of anesthetists, surgeons, and radiologists. The attributes required of an interventional radiologist are akin to those required of a surgeon. This paper gives an overview of the skills required to be a competent interventional radiologist along with a succinct introduction to methods of assessment of technical and non-technical skills.

  10. Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology

    DTIC Science & Technology

    2010-01-01

    CIRSE GUIDELINES Occupational Radiation Protection in Interventional Radiology : A Joint Guideline of the Cardiovascular and Interventional Radiology ...Society of Europe and the Society of Interventional Radiology Donald L. Miller • Eliseo Vañó • Gabriel Bartal • Stephen Balter • Robert Dixon...December 2009 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009 Preamble The

  11. Interventional radiology in living donor liver transplant.

    PubMed

    Cheng, Yu-Fan; Ou, Hsin-You; Yu, Chun-Yen; Tsang, Leo Leung-Chit; Huang, Tung-Liang; Chen, Tai-Yi; Hsu, Hsien-Wen; Concerjero, Allan M; Wang, Chih-Chi; Wang, Shih-Ho; Lin, Tsan-Shiun; Liu, Yueh-Wei; Yong, Chee-Chien; Lin, Yu-Hung; Lin, Chih-Che; Chiu, King-Wah; Jawan, Bruno; Eng, Hock-Liew; Chen, Chao-Long

    2014-05-28

    The shortage of deceased donor liver grafts led to the use of living donor liver transplant (LDLT). Patients who undergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation (LT). Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplant. The aim of this paper is to review indications, diagnostic modalities, technical considerations, achievements and potential complications of interventional radiology procedures after LDLT.

  12. Radiological intervention of the hand and wrist

    PubMed Central

    Chopra, Annu; Rowbotham, Emma L

    2016-01-01

    The role of radiological guided intervention is integral in the management of patients with musculoskeletal pathologies. The key to image-guided procedures is to achieve an accurately placed intervention with minimal invasion. This review article specifically concentrates on radiological procedures of the hand and wrist using ultrasound and fluoroscopic guidance. A systematic literature review of the most recent publications relevant to image-guided intervention of the hand and wrist was conducted. During this search, it became clear that there is little consensus regarding all aspects of image-guided intervention, from the technique adopted to the dosage of injectate and the specific drugs used. The aim of this article is to formulate an evidence-based reference point which can be utilized by radiologists and to describe the most commonly employed techniques. PMID:26313500

  13. Interventional radiology residency: steps to implementation.

    PubMed

    Marx, M Victoria; Sabri, Saher S

    2015-08-01

    Implementation of an interventional radiology (IR) residency program requires significant planning, as well as clear communication and consensus among departmental and institutional stakeholders. The goal of this short article is to highlight key decisions and steps that are needed to launch an IR residency, and to illustrate a possible timeline for implementation of the integrated and independent IR residency models.

  14. Introduction to interventional radiology for the criticalist.

    PubMed

    Weisse, Chick

    2011-04-01

    To introduce the basic equipment necessary to perform interventional radiology (IR) techniques in the veterinary setting, particularly those procedures of interest to the criticalist. Veterinary and human literature as well as author's experience. Since the 1950s, diagnostic angiography has played an important role in human medicine. However, over the last 2-3 decades, this once purely diagnostic modality has become a subspecialty in human medicine with vast applications throughout the body. These techniques have replaced more invasive surgeries as the standard-of-care in many circumstances. Although comparable data are not available in the veterinary literature, many IR and interventional endoscopy techniques are poised to replace more invasive procedures in veterinary medicine. In addition, these techniques have already been shown to offer treatment options for patients in whom more traditional therapies have failed, have been declined, or are not indicated due to comorbidities or substantial risk to patient health. Like our human medical counterparts, the use of IR techniques will likely play and increasingly important role in the care of veterinary patients. With this in mind, it is important to become familiar with both the equipment used in these techniques as well as their applications both currently in clinical cases and in the near future. © Veterinary Emergency and Critical Care Society 2011.

  15. Antiplatelet and Anticoagulant Drugs in Interventional Radiology

    SciTech Connect

    Altenburg, Alexander; Haage, Patrick

    2012-02-15

    In treating peripheral arterial disease, a profound knowledge of antiplatelet and anticoagulative drug therapy is helpful to assure a positive clinical outcome and to anticipate and avoid complications. Side effects and drug interactions may have fatal consequences for the patient, so interventionalists should be aware of these risks and able to control them. Aspirin remains the first-line agent for antiplatelet monotherapy, with clopidogrel added where dual antiplatelet therapy is required. In case of suspected antiplatelet drug resistance, the dose of clopidogrel may be doubled; prasugrel or ticagrelor may be used alternatively. Glycoprotein IIb/IIIa inhibitors (abciximab or eptifibatide) may help in cases of hypercoagulability or acute embolic complications. Desmopressin, tranexamic acid, or platelet infusions may be used to decrease antiplatelet drug effects in case of bleeding. Intraprocedurally, anticoagulant therapy treatment with unfractionated heparin (UFH) still is the means of choice, although low molecular-weight heparins (LMWH) are suitable, particularly for postinterventional treatment. Adaption of LMWH dose is often required in renal insufficiency, which is frequently found in elderly patients. Protamine sulphate is an effective antagonist for UFH; however, this effect is less for LMWH. Newer antithrombotic drugs, such as direct thrombin inhibitors or factor X inhibitors, have limited importance in periprocedural treatment, with the exception of treating patients with heparin-induced thrombocytopenia (HIT). Nevertheless, knowing pharmacologic properties of the newer drugs facilitate correct bridging of patients treated with such drugs. This article provides a comprehensive overview of antiplatelet and anticoagulant drugs for use before, during, and after interventional radiological procedures.

  16. Prophylactic Antibiotic Guidelines in Modern Interventional Radiology Practice

    PubMed Central

    Moon, Eunice; Tam, Matthew D.B.S.; Kikano, Raghid N.; Karuppasamy, Karunakaravel

    2010-01-01

    Modern interventional radiology practice is continuously evolving. Developments include increases in the number of central venous catheter placements and tumor treatments (uterine fibroid therapy, radio- and chemoembolization of liver tumor, percutaneous radiofrequency and cryoablation), and new procedures such as abdominal aortic aneurysm stent-graft repair, vertebroplasty, kyphoplasty, and varicose vein therapies. There have also been recent advancements in standard biliary and urinary drainage procedures, percutaneous gastrointestinal feeding tube placement, and transjugular intrahepatic portosystemic shunts. Prophylactic antibiotics have become the standard of care in many departments, with little clinical data to support its wide acceptance. The rise in antibiotic-resistant strains of organisms in all hospitals worldwide have forced every department to question the use of prophylactic antibiotics. The authors review the evidence behind use of prophylactic antibiotics in standard interventional radiology procedures, as well as in newer procedures that have only recently been incorporated into interventional radiology practice. PMID:22550374

  17. Safety of Conscious Sedation In Interventional Radiology

    SciTech Connect

    Arepally, Aravind; Oechsle, Denise; Kirkwood, Sharon; Savader, Scott J.

    2001-05-15

    Purpose: To identify rates of adverse events associated with the use of conscious sedation in interventional radiology.Methods: In a 5-month period, prospective data were collected on patients undergoing conscious sedation for interventional radiology procedures (n = 594). Adverse events were categorized as respiratory, sedative, or major adverse events. Respiratory adverse events were those that required oral airway placement, ambu bag, or jaw thrust. Sedation adverse events were unresponsiveness, oxygen saturation less than 90%, use of flumazenil/naloxone, or agitation. Major adverse events were hypotension, intubation, CPR, or cardiac arrest. The frequency of adverse events for the five most common radiology procedures were determined.Results: The five most common procedures (total n = 541) were biliary tube placement/exchange (n = 182), tunneled catheter placement (n 135), diagnostic arteriography (n = 125), vascular interventions (n = 52), and other catheter insertions (n = 46). Rates for respiratory, sedation, and major adverse events were 4.7%, 4.2%, and 2.0%, respectively. The most frequent major adverse event was hypotension (2.0%). Biliary procedures had the highest rate of total adverse events (p < .05) and respiratory adverse events (p < .05).Conclusion: The frequency of adverse events is low with the use of conscious sedation during interventional procedures. The highest rates occurred during biliary interventions.

  18. Optimizing care for the obese patient in interventional radiology

    PubMed Central

    Aberle, Dwight; Charles, Hearns; Hodak, Steven; O’Neill, Daniel; Oklu, Rahmi; Deipolyi, Amy R.

    2017-01-01

    With the rising epidemic of obesity, interventional radiologists are treating increasing numbers of obese patients, as comorbidities associated with obesity preclude more invasive treatments. These patients are at heightened risk of vascular and oncologic disease, both of which often require interventional radiology care. Obese patients pose unique challenges in imaging, technical feasibility, and periprocedural monitoring. This review describes the technical and clinical challenges posed by this population, with proposed methods to mitigate these challenges and optimize care. PMID:28082253

  19. [Angiography and interventional radiology of the kidney].

    PubMed

    Hansmann, J; Richter, G M; Hallscheidt, P; Düx, M; Nöldge, G; Kauffmann, G W

    1999-05-01

    For imaging of renal pathology a broad spectrum of radiologic diagnostic procedures are available which are, sometimes and particularly more recently, competing among each other in their diagnostic yield and relevance. For tumorous lesions ultrasound, computed tomography and magnetic resonance imaging are performed predominantly. Angiography is no longer required with the exception of highly selected cases and in some specific preoperative workup requirements. Until recently, catheter based digital subtraction angiography has been considered as gold standard. However, non-invasive techniques such as CT-angiography and MR-angiography are evolving parallel to their quantum leap of resolutions and readiness to use. Nevertheless, well accepted criteria for quality assessement of these new modalities are still lacking. More comparison studies are urgently warranted. Despite the availability of ultrashort pulse sequences applying the T1 relaxation reduction effect of gadolinium enhanced MR techniques overestimation of renal artery stenosis still poses a substantial problem. Renal intervention implies a variety of procedures such as plain angioplasty, stent placement, embolization of traumatic and both benign and malignant tumors. These methods have emerged over the last two decades from a more experimental nature to a fully accepted treatment option. When renal artery angioplasty is embedded in an aggressive approach including stenting as an adjunct for more complex cases, renal ostial lesions and a well organized follow-up regimen its therapeutic potential for treatment of renal insufficiency, malignant hypertension, for organ preservation bears a very high potential. Provided adequat periinterventional drug regimen restenosis rates may be as low as 10%. In highly selected cases capillary embolization might be used as an alternative to nephrectomy with a similar clinical outcome. Particularly the development of superselective small caliber embolization catheters

  20. The Role of Interventional Radiology in Obstetric Hemorrhage

    SciTech Connect

    Gonsalves, M. Belli, A.

    2010-10-15

    Obstetric hemorrhage remains a major cause of maternal morbidity and mortality worldwide. Traditionally, in cases of obstetric hemorrhage refractory to conservative treatment, obstetricians have resorted to major surgery with the associated risks of general anesthesia, laparotomy, and, in the case of hysterectomy, loss of fertility. Over the past two decades, the role of pelvic arterial embolization has evolved from a novel treatment option to playing a key role in the management of obstetric hemorrhage. To date, interventional radiology offers a minimally invasive, fertility-preserving alternative to conventional surgical treatment. We review current literature regarding the role of interventional radiology in postpartum hemorrhage, abnormal placentation, abortion, and cervical ectopic pregnancy. We discuss techniques, success rates, and complications.

  1. From interventional radiology to laparoscopic liver resection as complementary strategies in the treatment of hepatic abscess caused by ingested foreign bodies.

    PubMed

    Riani, Eliano Bonaccorsi; Tancredi, Ilario; Sempoux, Christine; Hubert, Catherine; Goffette, Pierre; Gigots, Jean-François

    2012-01-01

    Hepatic abscess from orally ingested foreign bodies are uncommon. We report here two cases of such a condition treated by foreign body extraction by interventional radiology in one patient and by laparoscopic left lateral sectionectomy after failure of a percutaneous radiological approach in the second. Postoperative course was uneventful and after a clinical follow-up of 11 and 12 months, respectively, both patients were free of symptoms.

  2. Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

    PubMed Central

    Ray, David M; Srinivasan, Indu; Tang, Shou-Jiang; Vilmann, Andreas S; Vilmann, Peter; McCowan, Timothy C; Patel, Akash M

    2017-01-01

    Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient’s work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions. PMID:28396724

  3. 2000 RSNA annual oration in diagnostic radiology: The future of interventional radiology.

    PubMed

    Becker, G J

    2001-08-01

    Origins in imaging, procedural emphasis, and dependence on innovation characterize interventional radiology, which will continue as the field of image-guided minimally invasive therapies. A steady supply of innovators will be needed. Current workforce shortages demand that this problem be addressed and in an ongoing fashion. Interventional radiology's major identity problem will require multiple corrective measures, including a name change. Diagnostic radiologists must fully embrace the concept of the dedicated interventionalist. Interspecialty turf battles will continue, especially with cardiologists and vascular surgeons. To advance the discipline, interventional radiologists must remain involved in cutting-edge therapies such as endograft repair of aortic aneurysms and carotid stent placement. As the population ages, interventionalists will experience a shift toward a greater emphasis on cancer treatment. Political agendas and public pressure will improve access to care and result in managed health care reforms. Academic centers will continue to witness a decline in time and resources available to pursue academic missions. The public outcry for accountability will result in systems changes aimed at reducing errors and process changes in the way physicians are trained, certified, and monitored. Evidence-based medicine will be the watchword of this century. Interventional radiology will maintain its role through development of methods for delivery of genes, gene products, and drugs to specific target sites; control of angiogenesis and other biologic processes; and noninvasive image-guided delivery of various forms of energy for ablation.

  4. Massive hemoptysis caused by tracheal hemangioma treated with interventional radiology.

    PubMed

    Zambudio, Antonio Ríos; Calvo, Maria Jose Roca; Lanzas, Juan Torres; Medina, J García; Paricio, Pascual Parrilla

    2003-04-01

    Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.

  5. The Provision of Interventional Radiology Services in Europe: CIRSE Recommendations.

    PubMed

    Tsetis, Dimitrios; Uberoi, Raman; Fanelli, Fabrizio; Roberston, Iain; Krokidis, Miltiadis; van Delden, Otto; Radeleff, Boris; Müller-Hülsbeck, Stefan; Szerbo-Trojanowska, Malgorzata; Lee, Michael; Morgan, Robert; Brountzos, Elias; Belli, Anna Maria

    2016-04-01

    Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, including training, certification, manpower, and accreditation. The ultimate challenge will be the adoption of these recommendations by different countries and health economies around the world, in turn ensuring equal access to IR treatments for all patients, the appropriate distribution of resources for IR service provision as well as the continued development of safe and high-quality IR services in Europe and beyond.

  6. Vascular Closure Devices in Interventional Radiology Practice.

    PubMed

    Patel, Rafiuddin; Muller-Hulsbeck, Stefan; Morgan, Robert; Uberoi, Raman

    2015-08-01

    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  7. Vascular Closure Devices in Interventional Radiology Practice

    SciTech Connect

    Patel, Rafiuddin; Muller-Hulsbeck, Stefan; Uberoi, Raman

    2015-08-15

    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  8. Navigational Tools for Interventional Radiology and Interventional Oncology Applications

    PubMed Central

    Chehab, Monzer A.; Brinjikji, Waleed; Copelan, Alexander; Venkatesan, Aradhana M.

    2015-01-01

    The interventional radiologist is increasingly called upon to successfully access challenging biopsy and ablation targets, which may be difficult based on poor visualization, small size, or the proximity of vulnerable regional anatomy. Complex therapeutic procedures, including tumor ablation and transarterial oncologic therapies, can be associated with procedural risk, significant procedure time, and measurable radiation time. Navigation tools, including electromagnetic, optical, laser, and robotic guidance systems, as well as image fusion platforms, have the potential to facilitate these complex interventions with the potential to improve lesion targeting, reduce procedure time, and radiation dose, and thus potentially improve patient outcomes. This review will provide an overview of currently available navigational tools and their application to interventional radiology and oncology. A summary of the pertinent literature on the use of these tools to improve safety and efficacy of interventional procedures compared with conventional techniques will be presented. PMID:26622105

  9. Challenges in Interventional Radiology: The Pregnant Patient

    PubMed Central

    Moon, Eunice K.; Wang, Weiping; Newman, James S.; Bayona-Molano, Maria Del Pilar

    2013-01-01

    A pregnant patient presenting to interventional radiology (IR) has a different set of needs from any other patient requiring a procedure. Often, the patient's care can be in direct conflict with the growth and development of the fetus, whether it be optimal fluoroscopic imaging, adequate sedation of the mother, or the timing of the needed procedure. Despite the additional risks and complexities associated with pregnancy, IR procedures can be performed safely for the pregnant patient with knowledge of the special and general needs of the pregnant patient, use of acceptable medications and procedures likely to be encountered during pregnancy, in addition to strategies to protect the patient and her fetus from the hazards of radiation. PMID:24436567

  10. Using simulation for interventional radiology training

    PubMed Central

    Gould, D

    2010-01-01

    Debate on the existence of innate skills has all but evaporated in the light of evidence that it is only the hours spent in deliberate practice that correlate with even the most elite levels of expertise. A range of simple to advanced technologies stands to address some of the many challenges to effective training of 21st century, procedural medicine. Simulation could train and assess behaviours remotely from patients, in complete safety, reducing the risks of inexperienced trainees learning critical tasks in patients while contributing to certification and revalidation. Understanding the strengths and limitations of these devices, determining and improving their effectiveness and identifying their roles, as well as those of individuals and teams, represents a cornerstone of successful adoption into the interventional radiology curriculum. This requires a simulation strategy that includes standards for simulator documentation. PMID:20603407

  11. [Diagnostic reference levels in interventional radiology].

    PubMed

    Vañó Carruana, E; Fernández Soto, J M; Sánchez Casanueva, R M; Ten Morón, J I

    2013-12-01

    This article discusses the diagnostic reference levels for radiation exposure proposed by the International Commission on Radiological Protection (ICRP) to facilitate the application of the optimization criteria in diagnostic imaging and interventional procedures. These levels are normally established as the third quartile of the dose distributions to patients in an ample sample of centers and are supposed to be representative of good practice regarding patient exposure. In determining these levels, it is important to evaluate image quality as well to ensure that it is sufficient for diagnostic purposes. When the values for the dose received by patients are systematically higher or much lower than the reference levels, an investigation should determine whether corrective measures need to be applied. The European and Spanish regulations require the use of these reference values in quality assurance programs. For interventional procedures, the dose area product (or kerma area product) values are usually used as reference values together with the time under fluoroscopy and the total number of images acquired. The most modern imaging devices allow the value of the accumulated dose at the entrance to the patient to be calculated to optimize the distribution of the dose on the skin. The ICRP recommends that the complexity of interventional procedures be taken into account when establishing reference levels. In the future, diagnostic imaging departments will have automatic systems to manage patient dosimetric data; these systems will enable continuous dosage auditing and alerts about individual procedures that might involve doses several times above the reference values. This article also discusses aspects that need to be clarified to take better advantage of the reference levels in interventional procedures. Copyright © 2013 SERAM. Published by Elsevier Espana. All rights reserved.

  12. Interventional radiology in the management of the liver transplant patient.

    PubMed

    Thornburg, Bartley; Katariya, Nitin; Riaz, Ahsun; Desai, Kush; Hickey, Ryan; Lewandowski, Robert; Salem, Riad

    2017-10-01

    Liver transplantation (LT) is commonly used to treat patients with end-stage liver disease. The evolution of surgical techniques, endovascular methods, and medical care has led to a progressive decrease in posttransplant morbidity and mortality. Despite these improvements, a multidisciplinary approach to each patient remains essential as the early diagnosis and treatment of the complications of transplantation influence graft and patient survival. The critical role of interventional radiology in the collaborative approach to the care of the LT patient will be reviewed. Liver Transplantation 23 1328-1341 2017 AASLD. © 2017 by the American Association for the Study of Liver Diseases.

  13. Personnel real time dosimetry in interventional radiology.

    PubMed

    Servoli, L; Bissi, L; Fabiani, S; Magalotti, D; Placidi, P; Scorzoni, A; Calandra, A; Cicioni, R; Chiocchini, S; Dipilato, A C; Forini, N; Paolucci, M; Di Lorenzo, R; Cappotto, F P; Scarpignato, M; Maselli, A; Pentiricci, A

    2016-12-01

    Interventional radiology and hemodynamic procedures have rapidly grown in number in the past decade, increasing the importance of personnel dosimetry not only for patients but also for medical staff. The optimization of the absorbed dose during operations is one of the goals that fostered the development of real-time dosimetric systems. Indeed, introducing proper procedure optimization, like correlating dose rate measurements with medical staff position inside the operating room, the absorbed dose could be reduced. Real-time dose measurements would greatly facilitate this task through real-time monitoring and automatic data recording. Besides real-time dose monitoring could allow automatic data recording. In this work, we will describe the calibration and validation of a wireless real-time prototype dosimeter based on a new sensor device (CMOS imager). The validation measurement campaign in clinical conditions has demonstrated the prototype capability of measuring dose-rates with a frequency in the range of few Hz, and an uncertainty smaller than 10%. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  14. [Potentials of interventional radiology: percutaneous radiofrequency ablation].

    PubMed

    Péter, Mózes; Tóth, Judit

    2004-02-15

    The efficacy of the treatment of hepatic malignancies has improved, mostly due to the physical procedures which affect the tumors locally. The authors performed 210 radio-frequency ablations in 1.38 patients. They recommend this procedure based on their experiences. RF treatment is performed together with other therapeutical procedures done by cooperation of oncology clinic. The main indication for the treatment of tumors is, lesions less than 4 cm in diameter and the number of masses is less than 4. The treatment can be performed by CT guidance and is documented well. The applied RF generator is made by Radionics, electrodes are cooled. In 68% of the tumors they achieved complete necrosis using this procedure. After the intervention patients experienced no serious complications. The only side effects were abdominal pain and discomfort. RF tumor ablation is an important and effective procedure in the treatment of hepatic tumors.

  15. A Checklist to Improve Patient Safety in Interventional Radiology

    SciTech Connect

    Koetser, Inge C. J.; Vries, Eefje N. de; Delden, Otto M. van; Smorenburg, Susanne M.; Boermeester, Marja A.; Lienden, Krijn P. van

    2013-04-15

    To develop a specific RADiological Patient Safety System (RADPASS) checklist for interventional radiology and to assess the effect of this checklist on health care processes of radiological interventions. On the basis of available literature and expert opinion, a prototype checklist was developed. The checklist was adapted on the basis of observation of daily practice in a tertiary referral centre and evaluation by users. To assess the effect of RADPASS, in a series of radiological interventions, all deviations from optimal care were registered before and after implementation of the checklist. In addition, the checklist and its use were evaluated by interviewing all users. The RADPASS checklist has two parts: A (Planning and Preparation) and B (Procedure). The latter part comprises checks just before starting a procedure (B1) and checks concerning the postprocedural care immediately after completion of the procedure (B2). Two cohorts of, respectively, 94 and 101 radiological interventions were observed; the mean percentage of deviations of the optimal process per intervention decreased from 24 % before implementation to 5 % after implementation (p < 0.001). Postponements and cancellations of interventions decreased from 10 % before implementation to 0 % after implementation. Most users agreed that the checklist was user-friendly and increased patient safety awareness and efficiency. The first validated patient safety checklist for interventional radiology was developed. The use of the RADPASS checklist reduced deviations from the optimal process by three quarters and was associated with less procedure postponements.

  16. The interventional radiology clinic: key ingredients for success.

    PubMed

    Siskin, Gary P; Bagla, Sandeep; Sansivero, Gail E; Mitchell, Nancy L

    2004-07-01

    During the past two decades, the practice of interventional radiology has evolved into one that mandates longitudinal patient care taking place before, during, and after interventional procedures. This requires the establishment of relationships between physicians and patients that often must be fostered in an outpatient clinic setting. Recognition of this practice shift was formally made by the American College of Radiology with the publication of a document concerning the importance of clinical patient management within the practice of interventional radiology. This article will review the clinical patient management as it relates to the practice of interventional radiology, with a focus on the physician-patient relationship and the components of a successful outpatient clinic.

  17. Virtual reality in radiology: virtual intervention

    NASA Astrophysics Data System (ADS)

    Harreld, Michael R.; Valentino, Daniel J.; Duckwiler, Gary R.; Lufkin, Robert B.; Karplus, Walter J.

    1995-04-01

    Intracranial aneurysms are the primary cause of non-traumatic subarachnoid hemorrhage. Morbidity and mortality remain high even with current endovascular intervention techniques. It is presently impossible to identify which aneurysms will grow and rupture, however hemodynamics are thought to play an important role in aneurysm development. With this in mind, we have simulated blood flow in laboratory animals using three dimensional computational fluid dynamics software. The data output from these simulations is three dimensional, complex and transient. Visualization of 3D flow structures with standard 2D display is cumbersome, and may be better performed using a virtual reality system. We are developing a VR-based system for visualization of the computed blood flow and stress fields. This paper presents the progress to date and future plans for our clinical VR-based intervention simulator. The ultimate goal is to develop a software system that will be able to accurately model an aneurysm detected on clinical angiography, visualize this model in virtual reality, predict its future behavior, and give insight into the type of treatment necessary. An associated database will give historical and outcome information on prior aneurysms (including dynamic, structural, and categorical data) that will be matched to any current case, and assist in treatment planning (e.g., natural history vs. treatment risk, surgical vs. endovascular treatment risks, cure prediction, complication rates).

  18. Musculoskeletal interventional radiology: ultrasound and CT.

    PubMed

    Martel Villagrán, J; Bueno Horcajadas, Á; Agrela Rojas, E

    2016-05-01

    We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  19. Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

    SciTech Connect

    Semiz-Oysu, Aslihan Keussen, Inger; Cwikiel, Wojciech

    2007-07-15

    Purpose. The purpose of this study was to retrospectively evaluate interventional radiological management of patients with symptomatic portal hypertension secondary to obstruction of splanchnic veins. Material and Methods. Twenty-four patients, 15 males and 9 females, 0.75 to 79 years old (mean, 36.4 years), with symptomatic portal hypertension, secondary to splanchnic venous obstruction, were treated by percutaneous methods. Causes and extent of splanchnic venous obstruction and methods are summarized following a retrospective evaluation. Results. Obstructions were localized to the main portal vein (n = 22), intrahepatic portal veins (n = 8), splenic vein (n = 4), and/or mesenteric veins (n = 4). Interventional treatment of 22 (92%) patients included recanalization (n = 19), pharmacological thrombolysis (n = 1), and mechanical thrombectomy (n = 5). Partial embolization of the spleen was done in five patients, in two of them as the only possible treatment. TIPS placement was necessary in 10 patients, while an existing occluded TIPS was revised in two patients. Transhepatic embolization of varices was performed in one patient, and transfemoral embolization of splenorenal shunt was performed in another. Thirty-day mortality was 13.6% (n=3). During the follow-up, ranging between 2 days and 58 months, revision was necessary in five patients. An immediate improvement of presenting symptoms was achieved in 20 patients (83%). Conclusion. We conclude that interventional procedures can be successfully performed in the majority of patients with obstruction of splanchnic veins, with subsequent improvement of symptoms. Treatment should be customized according to the site and nature of obstruction.

  20. [Gastrointestinal bleeding. Diagnostics and therapy by interventional radiology].

    PubMed

    Wingen, M; Günther, R W

    2006-02-01

    Modern imaging modalities such as (multislice) helical CT allow new diagnostic strategies for gastrointestinal hemorrhage. Today, interventional radiology with superselective transcatheter embolization or TIPS procedures allow minimally invasive therapeutic management which can support or replace surgery. This review is a synopsis of the possibilities and relative merits of diagnostic and therapeutic radiological procedures for gastrointestinal bleeding. Which of them to use should be decided collaboratively by gastroenterologist, surgeon, and radiologist depending on local availability, personal experience, and individual patient factors.

  1. Malignant biliary obstruction: the current role of interventional radiology

    PubMed Central

    Tsetis, Dimitrios; Krokidis, Μiltiadis; Negru, Dragos; Prassopoulos, Panagiotis

    2016-01-01

    Cholangiocarcinoma and pancreatic head cancer are still linked with extremely high 5-year mortality in the western world. The management of such patients is complex and typically requires a multidisciplinary approach in a tertiary care center. Interventional radiology offers minimally invasive, image-guided treatment for a variety of diseases and conditions. Regarding patients with malignant biliary obstruction, IR options are considered for more than two decades as a valid management tool for both operable and non-operable cases. The options include placement of percutaneous transhepatic biliary drains, preoperative embolization of the portal vein and deployment of covered and uncovered biliary stents. The purpose of this review is to describe the current evidence in this continuously evolving field. PMID:26752947

  2. Interventional radiology in bone and joint

    SciTech Connect

    Bard, M.; Laredo, J.D.

    1988-01-01

    Recent radiologic procedures in bone and joints, some of which eliminate the need for surgery are exposed, including: trephine biopsies of the thoracic and lumbar spine, sacro-iliac joints, peripheral bones synovial membrane and soft tissues, using either fluoroscopic echographic or CT guidance - chemonucleolysis - vascular embolization of skeletal tumors and management of vertebral hemangiomas - selective steroid injection in a broad spectrum of diseases including vertebral facet syndrome, cervicobrachial nerve root pain, rotator cuff calcium deposit, bone cysts.

  3. Nanotechnology and its relationship to interventional radiology. Part I: imaging.

    PubMed

    Power, Sarah; Slattery, Michael M; Lee, Michael J

    2011-04-01

    Nanotechnology refers to the design, creation, and manipulation of structures on the nanometer scale. Interventional radiology stands to benefit greatly from advances in nanotechnology because much of the ongoing research is focused toward novel methods of imaging and delivery of therapy through minimally invasive means. Through the development of new techniques and therapies, nanotechnology has the potential to broaden the horizon of interventional radiology and ensure its continued success. This two-part review is intended to acquaint the interventionalist with the field of nanotechnology, and provide an overview of potential applications, while highlighting advances relevant to interventional radiology. Part I of the article deals with an introduction to some of the basic concepts of nanotechnology and outlines some of the potential imaging applications, concentrating mainly on advances in oncological and vascular imaging.

  4. Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology

    PubMed Central

    Goldfarb, Stanley; McCullough, Peter A.; McDermott, John; Gay, Spencer B.

    2009-01-01

    Contrast-induced acute kidney injury (AKI) (also known as contrast-induced nephropathy) is an abrupt deterioration in renal function that can be associated with use of iodinated contrast medium. Although the increase in serum creatinine concentration is transient in most cases, contrast-induced AKI may lead to increased morbidity and mortality rates in selected at-risk populations. This review summarizes the findings of a multidisciplinary panel composed of computed tomography radiologists, interventional radiologists, cardiologists, and nephrologists convened to address the specialty-specific issues associated with minimizing the incidence of contrast-induced AKI. As part of this initiative, the panel developed specialty-specific protocols for preventing contrast-induced AKI, taking into account, for example, the variations in patient risk profile, inpatient or outpatient status, and staffing resources that characterize various clinical settings. The 3 protocols, each reflecting a consensus of expert opinion, address the prevention of contrast-induced AKI in interventional radiology, diagnostic computed tomography radiology, and interventional cardiology settings. The protocols are presented in the context of a review of recent guidelines and published reports of trials that discuss contrast-induced AKI and its prevention. The panel reviewed materials retrieved by a PubMed search covering the period January 1990 through January 2008 and used combinations of key words associated with the prevention and treatment of contrast-induced AKI. In addition, the panel reviewed the reference lists of selected articles and the tables of contents posted on the Web sites of selected journals for relevant publications not retrieved in the PubMed searches. PMID:19181651

  5. 100 classic papers of interventional radiology: A citation analysis.

    PubMed

    Crockett, Matthew T; Browne, Ronan Fj; MacMahon, Peter J; Lawler, Leo

    2015-04-28

    To define the 100 citation classic papers of interventional radiology. Using the database of Journal Citation Reports the 40 highest impact factor radiology journals were chosen. From these journals the 100 most cited interventional radiology papers were chosen and analysed. The top paper received 2497 citations and the 100(th) paper 200 citations. The average number of citations was 320. Dates of publication ranged from 1953 - 2005. Most papers originated in the United States (n = 67) followed by Italy (n = 20) and France (n = 10). Harvard University (n = 18) and Osped Civile (n = 11) were the most prolific institutions. Ten journals produced all of the top 100 papers with "Radiology" and "AJR" making up the majority. SN Goldberg and T Livraghi were the most prolific authors. Nearly two thirds of the papers (n = 61) were published after 1990. This analysis identifies many of the landmark interventional radiology papers and provides a fascinating insight into the changing discourse within the field. It also identifies topics, authors and institutions which have impacted greatly on the specialty.

  6. An interventional radiology clinical rotation to enhance student learning.

    PubMed

    Powell, Jason

    2007-10-01

    To achieve the goal of adequately preparing graduating nurses for entry into practice, an undergraduate clinical nursing curriculum was enhanced by including an interventional radiology clinical rotation. The author describes the basics of this experience and the planning steps prior to implementation, including hospital approval, preceptor selection, and evaluation of the overall clinical experience.

  7. Acute Pancreatitis: The Role of Imaging and Interventional Radiology

    SciTech Connect

    Maher, Michael M.; Lucey, Brian C.; Gervais, Debra A.; Mueller, Peter R.

    2004-09-15

    Acute pancreatitis can manifest as a benign condition with minimal abdominal pain and hyperamylasemia or can have a fulminant course, which can be life-threatening usually due to the development of infected pancreatic necrosis, and multisystem organ failure. Fortunately, 70-80% of patients with acute pancreatitis have a benign self-limiting course. The initial 24-48 hours after the initial diagnosis is usually the period that determines the subsequent course, and for many of the 20-30% of patients who subsequently have a fulminant course, this becomes apparent within this time frame. With reference to long-term outcome following acute pancreatitis, most cases recover without long-term sequelae with only a minority of cases progressing to chronic pancreatitis. In the initial management of acute pancreatitis, assessment of metabolic disturbances and systemic organ dysfunction is critical. However, the advent and continued refinement of cross-sectional imaging modalities over the past two decades has led to a prominent role for diagnostic imaging in assessing acute pancreatitis. Furthermore, these cross-sectional imaging modalities have enabled the development of diagnostic and therapeutic interventional techniques in the hands of radiologists. In this article we review the diagnostic features of acute pancreatitis, the clinical staging systems, complications and the role of imaging. The role of interventional radiology techniques in the management of acute pancreatitis will be discussed as well as potential complications associated with these treatments.

  8. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology.

    PubMed

    Khong, P-L; Ringertz, H; Donoghue, V; Frush, D; Rehani, M; Appelgate, K; Sanchez, R

    2013-04-01

    Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities - radiography and fluoroscopy, interventional radiology, and computed tomography - are subsequently covered in depth. The report concludes with a summary and recommendations. The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation, use

  9. Limitations Influencing Interventional Radiology in Canada: Results of a National Survey by the Canadian Interventional Radiology Association (CIRA)

    SciTech Connect

    O'Brien, Jeremy; Baerlocher, Mark Otto Asch, Murray R.; Hayeems, Eran; Kachura, John R.; Collingwood, Peter

    2007-09-15

    Purpose. To describe the current state and limitations to interventional radiology (IR) in Canada through a large, national survey of Canadian interventional radiologists. Methods. An anonymous online survey was offered to members of the Canadian Interventional Radiology Association (CIRA). Only staff radiologists were invited to participate. Results. Seventy-five (75) responses were received from a total of 247, giving a response rate of 30%. Respondents were split approximately equally between academic centers (47%) and community practice (53%), and the majority of interventional radiologists worked in hospitals with either 200-500 (49%) or 500-1,000 (39%) beds. Procedures listed by respondents as most commonly performed in their practice included PICC line insertion (83%), angiography and stenting (65%), and percutaneous biopsy (37%). Procedures listed as not currently performed but which interventional radiologists believed would benefit their patient population included radiofrequency ablation (36%), carotid stenting (34%), and aortic stenting (21%); the majority of respondents noted that a lack of support from referring services was the main reason for not performing these procedures (56%). Impediments to increasing scope and volume of practice in Canadian IR were most commonly related to room or equipment shortage (35%), radiologist shortage (33%), and a lack of funding or administrative support (28%). Conclusion. Interventional radiology in Canada is limited by a number of factors including funding, manpower, and referral support. A concerted effort should be undertaken by individual interventional radiologists and IR organizations to increase training capacity, funding, remuneration, and public exposure to IR in order to help advance the subspecialty.

  10. 100 classic papers of interventional radiology: A citation analysis

    PubMed Central

    Crockett, Matthew T; Browne, Ronan FJ; MacMahon, Peter J; Lawler, Leo

    2015-01-01

    AIM: To define the 100 citation classic papers of interventional radiology. METHODS: Using the database of Journal Citation Reports the 40 highest impact factor radiology journals were chosen. From these journals the 100 most cited interventional radiology papers were chosen and analysed. RESULTS: The top paper received 2497 citations and the 100th paper 200 citations. The average number of citations was 320. Dates of publication ranged from 1953 - 2005. Most papers originated in the United States (n = 67) followed by Italy (n = 20) and France (n = 10). Harvard University (n = 18) and Osped Civile (n = 11) were the most prolific institutions. Ten journals produced all of the top 100 papers with “Radiology” and “AJR” making up the majority. SN Goldberg and T Livraghi were the most prolific authors. Nearly two thirds of the papers (n = 61) were published after 1990. CONCLUSION: This analysis identifies many of the landmark interventional radiology papers and provides a fascinating insight into the changing discourse within the field. It also identifies topics, authors and institutions which have impacted greatly on the specialty. PMID:25918585

  11. Basic interventional radiology in the abdomen.

    PubMed

    Calero García, R; Garcia-Hidalgo Alonso, M I

    2016-05-01

    This article describes the different basic nonvascular interventional techniques in the abdomen that all general radiologists should be familiar with. It explains the indications and approaches for the different procedures (punctures, biopsies, drainage of collections, cholecystostomies, and nephrostomies). It also discusses the advantages and disadvantages of the different imaging techniques that can be used to guide these procedures (ultrasound, CT, and fluoroscopy) as well as the possible complications that can develop from each procedure. Finally, it shows the importance of following up patients clinically and of taking care of catheters.

  12. Thrombectomy and thrombolysis: the interventional radiology approach.

    PubMed

    Dunn, Marilyn E

    2011-04-01

    To present interventional therapeutic options for patients with thrombosis. Thrombosis in small animals results from an unbalance in the normal hemostatic mechanisms leading to vessel occlusion. In veterinary medicine, thrombosis is recognized as a common complication of many acquired diseases, including cardiac, endocrine, immunological, inflammatory, and neoplastic disorders. Clinical signs are variable depending on the location of the thrombus and various laboratory and imaging modalities can aid in its identification and localization. Once identified, a decision must be made to whether or not intervene and which method is most appropriate. A number of minimally invasive approaches for dealing with thrombosis are available and offer veterinarians a choice of therapeutic options when dealing with a thrombotic patient. In the presence of thrombosis, a combined approach of vessel balloon dilatation, catheter-directed thrombolysis and stenting may be most appropriate. Percutaneous mechanical thrombectomy, if available, may also be appropriate. Embolic trapping devices can be used with vena cava thrombosis to help prevent pulmonary embolism. Anticoagulant therapy may be indicated in the postoperative period to prevent further thrombus formation while the patient's fibrinolytic system breaks the clot down. Outcome is variable depending on the site of the thrombus formation. Arterial thrombosis can be life-threatening while venous thrombosis tends to be less life-threatening but may lead to pulmonary embolism. © Veterinary Emergency and Critical Care Society 2011.

  13. Broken Esophageal Stent Successfully Treated by Interventional Radiology Technique

    SciTech Connect

    Zelenak, Kamil; Mistuna, Dusan; Lucan, Jaroslav; Polacek, Hubert

    2010-06-15

    Esophageal stent fractures occur quite rarely. A 61-year-old male patient was previously treated for rupture of benign stenosis, occurring after dilatation, by implanting an esophageal stent. However, a year after implantation, the patient suffered from dysphagia caused by the broken esophageal stent. He was treated with the interventional radiology technique, whereby a second implantation of the esophageal stent was carried out quite successfully.

  14. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    SciTech Connect

    Gebauer, Bernhard Teichgraeber, Ulf Karl; Podrabsky, Petr; Werk, Michael; Haenninen, Enrique Lopez; Felix, Roland

    2007-07-15

    Purpose. The purpose of this study was to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Materials and Methods. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5-F angiographic catheters (pigtail; Sos Omni), gooseneck snares, or combinations thereof. Results. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients port catheter malposition correction was not possible, because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. Conclusions. We conclude that in migrated catheter tips radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis port catheter correction is often more challenging.

  15. Active pixel as dosimetric device for interventional radiology

    NASA Astrophysics Data System (ADS)

    Servoli, L.; Baldaccini, F.; Biasini, M.; Checcucci, B.; Chiocchini, S.; Cicioni, R.; Conti, E.; Di Lorenzo, R.; Dipilato, A. C.; Esposito, A.; Fanó, L.; Paolucci, M.; Passeri, D.; Pentiricci, A.; Placidi, P.

    2013-08-01

    Interventional Radiology (IR) is a subspecialty of radiology comprehensive of all minimally invasive diagnostic and therapeutic procedures performed using radiological devices to obtain image guidance. The interventional procedures are potentially harmful for interventional radiologists and medical staff due to the X-ray diffusion by the patient's body. The characteristic energy range of the diffused photons spans few tens of keV. In this work we will present a proposal for a new X-ray sensing element in the energy range of interest for IR procedures. The sensing element will then be assembled in a dosimeter prototype, capable of real-time measurement, packaged in a small form-factor, with wireless communication and no external power supply to be used for individual operators dosimetry for IR procedures. For the sensor, which is the heart of the system, we considered three different Active Pixel Sensors (APS). They have shown a good capability as single X-ray photon detectors, up to several tens keV photon energy. Two dosimetric quantities have been considered, the number of detected photons and the measured energy deposition. Both observables have a linear dependence with the dose, as measured by commercial dosimeters. The uncertainties in the measurement are dominated by statistic and can be pushed at ˜5% for all the sensors under test.

  16. Action research regarding the optimisation of radiological protection for nurses during vascular interventional radiology.

    PubMed

    Mori, Hiroshige

    2015-06-01

    The optimisation and decision-making processes for radiological protection have been broadened by the introduction of re-examination or feedback after introducing protective measures. In this study, action research was used to reduce the occupational exposure of vascular interventional radiology (IR) nurses. Four radiological protection improvement measures were continuously performed in cooperation with the researchers, nurses and stakeholders, and the nurses' annual effective doses were compared before and after the improvements. First, the dosimetry equipment was changed from one electronic personal dosimeter (EPD) to two silver-activated phosphate glass dosimeters (PGDs). Second, the nurses were educated regarding maintaining a safe distance from the sources of scattered and leakage radiation. Third, portable radiation shielding screens were placed in the IR rooms. Fourth, the x-ray units' pulse rates were reduced by half. On changing the dosimetry method, the two PGDs recorded a 4.4 fold greater dose than the single EPD. Educating nurses regarding radiological protection and reducing the pulse rates by half decreased their effective doses to one-third and two-fifths of the baseline dose, respectively. No significant difference in their doses was detected after the placement of the shielding screens. Therefore, the action research effectively decreased the occupational doses of the vascular IR nurses.

  17. The role of morbidity and mortality meetings in interventional radiology.

    PubMed

    Mok, Philip S; Tan, Eva Y; Baerlocher, Mark O; Athreya, Sriharsha

    2012-11-01

    To understand the current practice of interventional radiology (IR) morbidity and mortality (M&M) meetings among interventional radiologists in Europe, and to develop a set of results-based recommendations to increase the prevalence of IR M&M meetings. Online electronic surveys were sent to members of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE). Each survey consisted of 18 questions pertaining to IR M&M meetings. A total of 150 CIRSE members responded to the survey. Approximately 47% of respondents held IR M&M meetings in their departments. Among those who held IR M&M meetings, 42% held them monthly and 68% rated the quality of the meetings as good or excellent. Of those who did not have M&M meetings, 94% were interested in incorporating M&M meetings into their future practice. The most common reasons for not holding IR M&M meetings were lack of time (68%) and small IR practice groups (43%). A total of 85% were interested in learning more about IR M&M meetings. The preferred method of education about M&M meetings included annual radiology meetings (44%), peer-reviewed articles in radiology journals (31%), websites (26%), and newsletters (15%). The data demonstrate that although current practice of M&M meetings in European IR departments is limited, the majority of respondents believe that M&M meetings are beneficial to their practice. There is a need for guidelines or standards of practice to incorporate such meetings in IR departments to prevent medical errors, which may ultimately lead to enhanced patient safety and outcomes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Medical treatment of radiological casualties: current concepts.

    PubMed

    Koenig, Kristi L; Goans, Ronald E; Hatchett, Richard J; Mettler, Fred A; Schumacher, Thomas A; Noji, Eric K; Jarrett, David G

    2005-06-01

    The threat of radiologic or nuclear terrorism is increasing, yet many physicians are unfamiliar with basic treatment principles for radiologic casualties. Patients may present for care after a covert radiation exposure, requiring an elevated level of suspicion by the physician. Traditional medical and surgical triage criteria should always take precedence over radiation exposure management or decontamination. External contamination from a radioactive cloud is easily evaluated using a simple Geiger-Muller counter and decontamination accomplished by prompt removal of clothing and traditional showering. Management of surgical conditions in the presence of persistent radioactive contamination should be dealt with in a conventional manner with health physics guidance. To be most effective in the medical management of a terrorist event involving high-level radiation, physicians should understand basic manifestations of the acute radiation syndrome, the available medical countermeasures, and the psychosocial implications of radiation incidents. Health policy considerations include stockpiling strategies, effective use of risk communications, and decisionmaking for shelter-in-place versus evacuation after a radiologic incident.

  19. Management of Dysfunctional Catheters and Tubes Inserted by Interventional Radiology

    PubMed Central

    Huang, Steven Y.; Engstrom, Bjorn I.; Lungren, Matthew P.; Kim, Charles Y.

    2015-01-01

    Minimally invasive percutaneous interventions are often used for enteral nutrition, biliary and urinary diversion, intra-abdominal fluid collection drainage, and central venous access. In most cases, radiologic and endoscopic placement of catheters and tubes has replaced the comparable surgical alternative. As experience with catheters and tubes grows, it becomes increasingly evident that the interventional radiologist needs to be an expert not only on device placement but also on device management. Tube dysfunction represents the most common complication requiring repeat intervention, which can be distressing for patients and other health care professionals. This manuscript addresses the etiologies and solutions to leaking and obstructed feeding tubes, percutaneous biliary drains, percutaneous catheter nephrostomies, and drainage catheters, including abscess drains. In addition, we will address the obstructed central venous catheter. PMID:26038615

  20. A Primer on Hemodialysis From an Interventional Radiology Perspective.

    PubMed

    Sheth, Rahul A; Sheth, Anil U

    2017-03-01

    Interventional radiologists play a central role in the care of patients with end-stage renal disease receiving renal replacement therapy. Ensuring that a patient׳s dialysis access remains suitable for high-quality dialysis is of paramount importance. However, although much has been spoken and written about endovascular techniques and outcomes based on angiographic criteria, little is generally known regarding the function and therefore the requirements of hemodialysis. In this article, we provide a heuristic overview of the mechanics of hemodialysis, with an emphasis on the "breaking points" in the extracorporeal circuit that trigger a patient׳s referral to Interventional Radiology. We also describe how dialysis quality is increasingly becoming linked with dialysis reimbursements. It is thus becoming progressively incumbent on the interventional radiologist to not only ensure that a patient receives high-quality outpatient dialysis but also that the patient׳s dialysis center meets its performance metrics. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. The Basics of Interventional Radiology Management in a Large Radiology Group: A Bird's-Eye View.

    PubMed

    Hill, Gregory Q; Bob Smouse, H

    2006-12-01

    Through nearly 6 decades of growth we have enjoyed and suffered under many different types of management structures. From these experiences we have become believers in a central committee structure that advances our agenda with hospital administrators and third-party payers. The best way to illustrate what we think is a winning solution is by describing our present management system. Herein we describe what we do and what works for our large radiology group as well as our interventional practice. Although this structure works well for our large medical group, it will likely work equally well for a smaller medical group.

  2. Current Trends in Heparin Use During Arterial Vascular Interventional Radiology

    SciTech Connect

    Durran, Alexandra C.; Watts, Christopher

    2012-12-15

    Purpose: This study was designed to assess the current use of heparinized saline and bolus doses of heparin in non-neurological interventional radiology and to determine whether consensus could be reached to produce guidance for heparin use during arterial vascular intervention. Methods: An interactive electronic questionnaire was distributed to members of the British Society of Interventional Radiology regarding their current practice in the use, dosage, and timing of heparin boluses and heparinized flushing solutions.ResultsA total of 108 completed questionnaires were received. More than 80% of respondents used heparinized saline with varying concentrations; the most prevalent was 1,000 IU/l (international units of heparin per liter) and 5,000 IU/l. Fifty-one percent of interventionalists use 3,000 IU as their standard bolus dose; however, the respondents were split regarding the timing of bolus dose with {approx}60% administering it after arterial access is obtained and 40% after crossing the lesion. There was no consensus on altering dose according to body weight, and only 4% monitored clotting parameters. Conclusions: There seems to be some coherence among practicing interventionalists regarding heparin administration. We hypothesize that heparinized saline should be used at a recognized standard concentration of 1,000 IU/l as a flushing concentration in all arterial vascular interventions and that 3,000 IU bolus is considered the standard dose for straightforward therapeutic procedures and 5000 IU for complex, crural, and endovascular aneurysm repair work. The bolus should be given after arterial access is obtained to allow time for optimal anticoagulation to be achieved by the time of active intervention and stenting. Further research into clotting abnormalities following such interventional procedures would be an interesting quantifiable follow-up to this initial survey of opinions and practice.

  3. Radiation dose to physicians’ eye lens during interventional radiology

    NASA Astrophysics Data System (ADS)

    Bahruddin, N. A.; Hashim, S.; Karim, M. K. A.; Sabarudin, A.; Ang, W. C.; Salehhon, N.; Bakar, K. A.

    2016-03-01

    The demand of interventional radiology has increased, leading to significant risk of radiation where eye lens dose assessment becomes a major concern. In this study, we investigate physicians' eye lens doses during interventional procedures. Measurement were made using TLD-100 (LiF: Mg, Ti) dosimeters and was recorded in equivalent dose at a depth of 0.07 mm, Hp(0.07). Annual Hp(0.07) and annual effective dose were estimated using workload estimation for a year and Von Boetticher algorithm. Our results showed the mean Hp(0.07) dose of 0.33 mSv and 0.20 mSv for left and right eye lens respectively. The highest estimated annual eye lens dose was 29.33 mSv per year, recorded on left eye lens during fistulogram procedure. Five physicians had exceeded 20 mSv dose limit as recommended by international commission of radiological protection (ICRP). It is suggested that frequent training and education on occupational radiation exposure are necessary to increase knowledge and awareness of the physicians’ thus reducing dose during the interventional procedure.

  4. Efficiency of personal dosimetry methods in vascular interventional radiology.

    PubMed

    Bacchim Neto, Fernando Antonio; Alves, Allan Felipe Fattori; Mascarenhas, Yvone Maria; Giacomini, Guilherme; Maués, Nadine Helena Pelegrino Bastos; Nicolucci, Patrícia; de Freitas, Carlos Clayton Macedo; Alvarez, Matheus; Pina, Diana Rodrigues de

    2017-05-01

    The aim of the present study was to determine the efficiency of six methods for calculate the effective dose (E) that is received by health professionals during vascular interventional procedures. We evaluated the efficiency of six methods that are currently used to estimate professionals' E, based on national and international recommendations for interventional radiology. Equivalent doses on the head, neck, chest, abdomen, feet, and hands of seven professionals were monitored during 50 vascular interventional radiology procedures. Professionals' E was calculated for each procedure according to six methods that are commonly employed internationally. To determine the best method, a more efficient E calculation method was used to determine the reference value (reference E) for comparison. The highest equivalent dose were found for the hands (0.34±0.93mSv). The two methods that are described by Brazilian regulations overestimated E by approximately 100% and 200%. The more efficient method was the one that is recommended by the United States National Council on Radiological Protection and Measurements (NCRP). The mean and median differences of this method relative to reference E were close to 0%, and its standard deviation was the lowest among the six methods. The present study showed that the most precise method was the one that is recommended by the NCRP, which uses two dosimeters (one over and one under protective aprons). The use of methods that employ at least two dosimeters are more efficient and provide better information regarding estimates of E and doses for shielded and unshielded regions. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  5. Interventional Radiological Procedures in Impaired Function of Surgically Implanted Catheter-Port Systems

    SciTech Connect

    Herrmann, Karin Anna; Waggershauser, Tobias; Heinemann, Volker; Reiser, Maximilian

    2001-01-15

    Purpose: System-related complications in surgically implanted catheter-port systems (CPS) for intraarterial (i.a.) chemotherapy are well known. In most cases of complications, the treatment must be interrupted and the catheter-port system must be repaired surgically. We describe microinvasive interventional radiological procedures to correct some dysfunctions of CPS.Methods: Five patients with repetitive dysfunction of CPS were treated with interventional techniques. Two patients presented with perfusion impairment, one patient had a pseudoaneurysm of the hepatic artery, and two patients presented with catheter displacement. Radiological interventions included mechanical recanalization with a guidewire, vascular stenting, and correction of catheter dislocation with a goose-neck snare.Results: In all cases, correct function of the CPS was restored. No intervention-related complications occurred and surgery was avoided. Chemotherapy could be continued for a period of 4-10 months.Conclusion: For some system-related complications, minimally invasive radiological interventions can be used to restore the function of CPS for i.a. chemotherapy.

  6. Informed Consent for Interventional Radiology Procedures: A Survey Detailing Current European Practice

    SciTech Connect

    O'Dwyer, H.M.; Lyon, S.M.; Fotheringham, T.; Lee, M.J.

    2003-09-15

    Purpose: Official recommendations for obtaining informed consent for interventional radiology procedures are that the patient gives their consent to the operator more than 24 hr prior to the procedure. This has significant implications for interventional radiology practice. The purpose of this study was to identify the proportion of European interventional radiologists who conform to these guidelines. Methods: A questionnaire was designed consisting of 12 questions on current working practice and opinions regarding informed consent. These questions related to where, when and by whom consent was obtained from the patient. Questions also related to the use of formal consent forms and written patient information leaflets. Respondents were asked whether they felt patients received adequate explanation regarding indications for intervention,the procedure, alternative treatment options and complications. The questionnaire was distributed to 786 European interventional radiologists who were members of interventional societies. The anonymous replies were then entered into a database and analyzed. Results: Two hundred and fifty-four (32.3%) questionnaires were returned. Institutions were classified as academic (56.7%),non-academic (40.5%) or private (2.8%). Depending on the procedure,in a significant proportion of patients consent was obtained in the outpatient department (22%), on the ward (65%) and in the radiology day case ward (25%), but in over half (56%) of patients consent or re-consent was obtained in the interventional suite. Fifty percent of respondents indicated that they obtain consent more than 24 hr before some procedures, in 42.9% consent is obtained on the morning of the procedure and 48.8% indicated that in some patients consent is obtained immediately before the procedure. We found that junior medical staff obtained consent in 58% of cases. Eighty-two percent of respondents do not use specific consent forms and 61% have patient information leaflets. The

  7. Needlestick Injuries in Interventional Radiology Are Common and Underreported.

    PubMed

    Deipolyi, Amy R; Prabhakar, Anand M; Naidu, Sailendra; Oklu, Rahmi

    2017-06-19

    Purpose To determine the prevalence of and risk factors for needlesticks in interventional radiology physicians, as well as the attitudes, behaviors, and conditions that promote or interfere with reporting of these injuries. Materials and Methods A total of 3889 interventional radiologists from academic and private practice in the United States were surveyed by emailing all interventional radiologist members of the Society of Interventional Radiology, including attending-level physicians and trainees (April-August 2016). The institutional review board waived the need for consent. Questions inquired about the nature, frequency, and type of needlestick and sharps injuries and whether and to whom these incidents were reported. Stepwise regression was used to determine variables predicting whether injuries were reported. Results In total, 908 (23%) interventional radiologists completed at least a portion of the survey. Eight hundred fourteen (91%) of 895 respondents reported a prior needlestick injury, 583 (35%) of 895 reported at least one injury while treating an HIV-positive patient, and 626 (71%) of 884 reported prior training regarding needlestick injury. There was, on average, one needlestick for every 5 years of practice. Most needlestick or sharps injuries were self inflicted (711 [87%] of 817) and involved a hollow-bore device (464 [56%] of 824). Only 566 (66%) of 850 injuries were reported. The most common reasons for not reporting included perceived lack of utility of reporting (79 [28%] of 282), perceived low risk for injury (56 [20%] of 282), noncontaminated needle (53 [19%] of 282), too-lengthy reporting process (37 [13%] of 282), and associated stigma (23 [8%] of 282). Only 156 (25%) of 624 respondents informed their significant other. Stepwise regression assessing variables affecting the likelihood of reporting showed that male sex (P = .009), low-risk patient (P < .0001), self injury (P = .010), trainee status (P < .0001), and the total number of prior

  8. Reconciling quality and cost: A case study in interventional radiology.

    PubMed

    Zhang, Li; Domröse, Sascha; Mahnken, Andreas

    2015-10-01

    To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

  9. Interventional Radiology in Hemodialysis Fistulae and Grafts: A Multidisciplinary Approach

    SciTech Connect

    Turmel-Rodrigues, Luc; Pengloan, Josette; Bourquelot, Pierre

    2002-01-15

    Purpose: To review the place of interventional radiology in arteriovenous access for hemodialysis. Methods: Prophylactic dilation of stenoses greater than 50% associated with clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. Stents are placed only in selected cases with clearly insufficient results of dilation but they must never overlap major side veins and obviate future access creation. Thrombosed fistulae and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. Results: The success rates are over 90% for dilation, with frequent resort to stents in central veins. Long-term results in the largest series are better in forearm native fistulae compared with grafts (best 1-year primary patency: 51% versus 40%). The success rates for declotting are better in grafts compared with forearm fistulae but early rethrombosis is frequent in grafts so that primary patency rates can be better for native fistulae from the first month's follow-up (best 1-year primary patency: 49% versus 26%). Conclusion: Radiology achieves results comparable with surgery, with minimal invasiveness and better venous preservation. However, wide variations in the results suggest that the degree of commitment of physicians might be as important as the type of technique used.

  10. Competitiveness of the match for interventional radiology and neuroradiology fellowships.

    PubMed

    Chen, Jim Y; Agarwal, Vikas; Orons, Philip D

    2014-11-01

    Overall resident interest in certain subspecialties changes with time. We sought to investigate the latest 6-year trend in interventional radiology (IR) and neuroradiology fellowship applications and how it has affected competitiveness in obtaining a position. We analyzed statistics published by the National Resident Matching Program in Results and Data: Specialties Matching Service from 2008 to 2013. From these data, we calculated the positions per IR applicant (PPIRA) and positions per neuroradiology applicant (PPNRA) for each year. The number of positions per applicant is one way to assess specialty competitiveness on a supply-and-demand basis. A lower PPIRA or PPNRA indicates a more competitive year. PPIRA has decreased every year, from 1.71 to the present 0.84, and contributed to 52 applicants being unmatched in 2013, up from 9 in 2008. Accordingly, the number of unfilled positions has decreased from 86 in 2008 to 8 in 2013. PPNRA waxed and waned from 2008 to 2010 but stabilized at around 1.15 thereafter. The number of unfilled positions has never dropped below 46. The number of unmatched applicants was consistently in the teens, except in 2011, when it increased to 23. Interest in IR fellowship has increased significantly over the past 6 years, whereas interest in neuroradiology fellowships has plateaued. IR fellowships have become increasingly competitive, leading to many unmatched residents. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  11. Sedation, analgesia and anesthesia for interventional radiological procedures in adults. Part II. Recommendations for interventional radiologists.

    PubMed

    Venneman, I; Lamy, M

    2000-06-01

    Benzodiazepines are given orally as a premedication before an interventional radiological procedure. Local analgesia is achieved by drugs such as lidocaine, bupivacaine or ropivacaine. General analgesia is obtained by non opioid analgesics and opioid narcotics. For intravenous sedation, benzodiazepines such as ketamine or propofol should be administered under the supervision of an anesthesiologist. A preprocedure consultation with the anesthesiologist is recommended. Monitoring equipments, drugs and nursing staff assistance should be provided in the interventional suite. Vital signs should be monitored for several hours until patient's discharge. Close collaboration between anesthesiologists and interventional radiologists is a prerequisite for achieving high standard sedation and analgesia.

  12. Pediatric interventional radiology and dose-reduction techniques.

    PubMed

    Johnson, Craig; Martin-Carreras, Teresa; Rabinowitz, Deborah

    2014-08-01

    The pediatric interventional radiology community has worked diligently in recent years through education and the use of technology to incorporate numerous dose-reduction strategies. This article seeks to describe different strategies where we can significantly lower the dose to the pediatric patient undergoing a diagnostic or therapeutic image-guided procedure and, subsequently, lower the dose several fold to the staff and ourselves in the process. These strategies start with patient selection, dose awareness and monitoring, shielding, fluoroscopic techniques, and collimation. Advanced features such as cone-beam technology, dose-reduction image processing algorithms, overlay road mapping, and volumetric cross-sectional hybrid imaging are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Analysis of Radiological Case Presentations and their Impact on Therapy and Treatment Concepts in Internal Medicine.

    PubMed

    Dendl, Lena-Marie; Teufel, Andreas; Schleder, Stephan; Rennert, Janine; Stroszczynski, Christian; Mueller-Schilling, Martina; Schreyer, Andreas G

    2017-03-01

    patient management in over ⅓ of all cases.. · In radiological clinical case conferences an experienced radiologist can initiate diagnostic and interventional radiological methods that can be correctly implemented in therapeutic pathways.. · "Talking radiology" improves the quality of therapy and patient care.. Citation Format · Dendl L. M., Teufel A., Schleder S. et al. Analysis of Radiological Case Presentations and their Impact on Therapy and Treatment Concepts in Internal Medicine. Fortschr Röntgenstr 2017; 189: 239 - 246.

  14. Radium and Other Radiological Chemicals: Drinking Water Treatment Strategies

    EPA Science Inventory

    Radium and Other Radiological Chemicals: Drinking Water Treatment Technologies Topics include: Introduction to Rad Chemistry, Summary of the Rad, Regulations Treatment Technology, and Disposal. The introductions cover atoms, ions, radium and uranium and the removal of radioac...

  15. Radium and Other Radiological Chemicals: Drinking Water Treatment Strategies

    EPA Science Inventory

    Radium and Other Radiological Chemicals: Drinking Water Treatment Technologies Topics include: Introduction to Rad Chemistry, Summary of the Rad, Regulations Treatment Technology, and Disposal. The introductions cover atoms, ions, radium and uranium and the removal of radioac...

  16. Current Status of Interventional Radiology in the Management of Gastro-Entero-Pancreatic Neuroendocrine Tumours (GEP-NETs)

    SciTech Connect

    Orgera, Gianluigi; Krokidis, Miltiadis; Cappucci, Matteo; Gourtsoyianni, Sofia; Tipaldi, Marcello Andrea; Hatzidakis, Adam; Rebonato, Alberto; Rossi, Michele

    2015-02-15

    Within the group of Gastro-Entero-Pancreatic Neuroendocrine tumours (GEP-NETs), several heterogeneous malignancies are included with a variety of clinical manifestations and imaging characteristics. Often these cases are inoperable and minimal invasive treatment offered by image-guided procedures appears to be the only option. Interventional radiology offers a valid solution in the management of primary and metastatic GEP-NETs. The purpose of this review article is to describe the current status of the role of Interventional Radiology in the management of GEP-NETs.

  17. CADASIL: pathogenesis, clinical and radiological findings and treatment.

    PubMed

    André, Charles

    2010-04-01

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common genetic cause of ischemic strokes and a most important model for the study of subcortical vascular dementia. This unrelentlessly progressive disease affects many hundreds of families all over the world but is not well studied in Brazil. This manuscript reviews pathogenetic, clinical, radiological and therapeutic features of CADASIL. The causal mutations are now very well known, but the same can not be said about its intimate pathogenetic mechanisms. The variable clinical presentation should lead physicians to actively pursue the diagnosis in many settings and to more thoroughly investigate family history in first degree relatives. A rational approach to genetic testing is however needed. Treatment of CADASIL is still largely empiric. High-quality therapeutic studies involving medications and cognitive interventions are strongly needed in CADASIL.

  18. Placement of the AbbVie PEG-J tube for the treatment of Parkinson's disease in the interventional radiology suite.

    PubMed

    Montgomery, Mark L; Miner, Noel K; Soileau, Michael J; McDonald, Douglas K

    2016-10-01

    The primary treatment for Parkinson's disease is dopaminergic stimulation. Although levodopa has historically been administered orally, maintaining a predictable plasma concentration of the drug is challenging. As a result, enteral administration of carbidopa/levodopa (Duopa) has emerged as a promising tool in the treatment of the disease. This requires placement of an enteric catheter, two of which have been approved by the Food and Drug Administration for delivery of Duopa. The approved tubes are placed using the "peroral" or "pull" technique, a method traditionally requiring endoscopy. This technical note describes placement of the AbbVie PEG-J tube by means of the peroral route while utilizing only sonographic and fluoroscopic guidance. After placing an orogastric tube and achieving percutaneous access to the stomach under fluoroscopic visualization, a snare catheter is advanced through the percutaneous access into the stomach. The orogastric tube is engaged with the snare and retracted, bringing the attached snare with it to the mouth. The AbbVie PEG tube is attached to the snare, pulled back down the esophagus and into the stomach before being retracted through the percutaneous access to the skin. Finally, the AbbVie J tube is advanced through the gastrostomy tube into the proximal jejunum and attached with the provided connectors. As demonstrated, the AbbVie PEG-J tube can be placed safely and effectively using a percutaneous image-guided technique without the use of an endoscope.

  19. Placement of the AbbVie PEG-J tube for the treatment of Parkinson's disease in the interventional radiology suite

    PubMed Central

    Montgomery, Mark L.; Miner, Noel K.; Soileau, Michael J.

    2016-01-01

    The primary treatment for Parkinson's disease is dopaminergic stimulation. Although levodopa has historically been administered orally, maintaining a predictable plasma concentration of the drug is challenging. As a result, enteral administration of carbidopa/levodopa (Duopa) has emerged as a promising tool in the treatment of the disease. This requires placement of an enteric catheter, two of which have been approved by the Food and Drug Administration for delivery of Duopa. The approved tubes are placed using the “peroral” or “pull” technique, a method traditionally requiring endoscopy. This technical note describes placement of the AbbVie PEG-J tube by means of the peroral route while utilizing only sonographic and fluoroscopic guidance. After placing an orogastric tube and achieving percutaneous access to the stomach under fluoroscopic visualization, a snare catheter is advanced through the percutaneous access into the stomach. The orogastric tube is engaged with the snare and retracted, bringing the attached snare with it to the mouth. The AbbVie PEG tube is attached to the snare, pulled back down the esophagus and into the stomach before being retracted through the percutaneous access to the skin. Finally, the AbbVie J tube is advanced through the gastrostomy tube into the proximal jejunum and attached with the provided connectors. As demonstrated, the AbbVie PEG-J tube can be placed safely and effectively using a percutaneous image-guided technique without the use of an endoscope. PMID:27695184

  20. Process mapping of PTA and stent placement in a university hospital interventional radiology department.

    PubMed

    de Bucourt, Maximilian; Busse, Reinhard; Güttler, Felix; Reinhold, Thomas; Vollnberg, Bernd; Kentenich, Max; Hamm, Bernd; Teichgräber, Ulf K

    2012-08-01

    To apply the process mapping technique in an interdisciplinary approach in order to visualize, better understand, and efficiently organize percutaneous transluminal angioplasty (PTA) and stent placement procedures in a university hospital's interventional radiology department. After providing an overview of seven established mapping techniques for medical professionals, the process mapping technique was chosen and applied in an interdisciplinary approach including referrers (physicians, nurses, and other staff in referring departments, e.g., vascular surgery), providers (interventional radiologists, nurses, technicians, and staff of the angiography suite), and specialists of the hospital's controlling department. A generally binding and standardized process map was created, describing the entire procedure for a patient in whom the radiological intervention of PTA or stent treatment is contemplated from admission to the department of vascular surgery until discharge after successful treatment. This visualization tool assists in better understanding (especially given natural staff fluctuation over time) and efficiently organizing PTA and stent procedures. Process mapping can be applied for streamlining workflow in healthcare, especially in interdisciplinary settings. By defining exactly what a business entity does, who is responsible, to what standard a process should be completed, and how the success can be assessed, this technique can be used to eliminate waste and inefficiencies from the workplace while providing high-quality goods and services easily, quickly, and inexpensively. Process mapping can be used in a university hospital's interventional radiology department. • Process mapping can describe the patient's entire process from admission to PTA/stent placement until discharge. • Process mapping can be used in interdisciplinary teams (e.g., referrers, providers, and controlling specialists). • Process mapping can be used in order to more efficiently

  1. Entrance surface dose in cerebral interventional radiology procedures

    NASA Astrophysics Data System (ADS)

    Barrera-Rico, M.; López-Rendón, X.; Rivera-Ordóñez, C. E.; Gamboa-deBuen, I.

    2012-10-01

    At the Instituto Nacional de Neurología y Neurocirugía (INNN) diagnostic as well as therapeutic procedures of interventional radiology are carried out. Since the procedures can last from some minutes to several hours, the absorbed dose for the patient could increase dangerously. An investigation had begun in order to determine the entrance surface dose (ESD) using 25 thermoluminiscent dosimeters TLD-100 and 8 strips of 15 ×1 cm2 of Gafchromic XR-QA2 film bound in a holder of 15×15 cm2 in the posteroanterior (PA) and lateral (LAT) positions during all the procedure. The results show that maximum ESD could be from 0.9 to 2.9 Gy for the PA position and between 1.6 and 2.5 Gy for the lateral position. The average ESD was between 0.7 and 1.3 Gy for the PA position, and from 0.44 to 1.1 Gy for the lateral position in a therapeutic procedure.

  2. Entrance surface dose in cerebral interventional radiology procedures

    SciTech Connect

    Barrera-Rico, M.; Lopez-Rendon, X.; Rivera-Ordonez, C. E.; Gamboa-deBuen, I.

    2012-10-23

    At the Instituto Nacional de Neurologia y Neurocirugia (INNN) diagnostic as well as therapeutic procedures of interventional radiology are carried out. Since the procedures can last from some minutes to several hours, the absorbed dose for the patient could increase dangerously. An investigation had begun in order to determine the entrance surface dose (ESD) using 25 thermoluminiscent dosimeters TLD-100 and 8 strips of 15 Multiplication-Sign 1 cm{sup 2} of Gafchromic XR-QA2 film bound in a holder of 15 Multiplication-Sign 15 cm{sup 2} in the posteroanterior (PA) and lateral (LAT) positions during all the procedure. The results show that maximum ESD could be from 0.9 to 2.9 Gy for the PA position and between 1.6 and 2.5 Gy for the lateral position. The average ESD was between 0.7 and 1.3 Gy for the PA position, and from 0.44 to 1.1 Gy for the lateral position in a therapeutic procedure.

  3. Patient Dose Reference Levels for Interventional Radiology: A National Approach

    SciTech Connect

    Vano, Eliseo Sanchez, R.; Fernandez, J. M.; Gallego, J. J.; Verdu, J. F.; Garay, M. Gonzalez de; Azpiazu, A.; Segarra, A.; Hernandez, M. T.; Canis, M.; Diaz, F.; Moreno, F.; Palmero, J.

    2009-01-15

    A set of patient dose reference levels (RLs) for fluoroscopically guided interventional procedures was obtained in a survey launched by the National Society of Interventional Radiology (IR), involving 10 public hospitals, as recommended by the European Medical Exposures Directive. A sample of 1391 dose values (kerma area product [KAP]) was collected randomly during clinical procedures for seven of the most frequent procedures. Third quartiles of the KAP distributions were used to set the RLs. A regular quality control of the X-ray systems and a calibration of the dose meters were performed during the survey. The fluoroscopy time and total number of digital subtraction angiography images per procedure were also analyzed. The RL values proposed were 12 Gy cm{sup 2} for fistulography (hemodialysis access; sample of 180 cases), 73 Gy cm{sup 2} for lower limb arteriography (685 cases), 89 Gy cm{sup 2} for renal arteriography (55 cases), 80 Gy cm{sup 2} for biliary drainage (205 cases), 289 Gy cm{sup 2} for hepatic chemoembolization (151 cases), 94 Gy cm{sup 2} for iliac stent (70 cases), and 236 Gy cm{sup 2} for uterine embolization (45 cases). The provisional national RL values are lower than those obtained in a similar survey carried out in the United States from 2002 to 2004. These new values could be used to improve the practice of centers consistently working with doses higher than the RLs. This national survey also had a positive impact, as it helped increase the awareness of the members of the National Society of IR on a topic as crucial as patient dose values and programs on radiation protection.

  4. The Clinical Practice of Interventional Radiology: A European Perspective

    SciTech Connect

    Keeling, Aoife N.; Reekers, Jim A.; Lee, Michael J.

    2009-05-15

    The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management's refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

  5. Is Your Interventional Radiology Service Ready for SARS?: The Singapore Experience

    SciTech Connect

    Lau, Te-Neng; Teo, Ngee; Tay, Kiang-Hiong; Chan, Ling-Ling; Wong, Daniel; Lim, Winston E.H.; Tan, Bien-Soo

    2003-09-15

    The recent epidemic of severe acute respiratory syndrome caught many by surprise. Hitherto, infection control has not been in the forefront of radiological practice. Many interventional radiology (IR) services are therefore not equipped to deal with such a disease. In this review, we share our experience from the interventional radiologist's perspective, report on the acute measures instituted within our departments and explore the long-term effects of such a disease on the practice of IR.

  6. The Radiologist Is in, but Was it Worth the Wait? Radiology Resident Note Quality in an Outpatient Interventional Radiology Clinic.

    PubMed

    Abboud, Salim E; Soriano, Stephanie; Abboud, Rayan; Patel, Indravadan; Davidson, Jon; Azar, Nami R; Nakamoto, Dean A

    2016-11-10

    Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents.

  7. Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values.

    PubMed

    Vano, E; Fernandez, J M; Resel, L E; Moreno, J; Sanchez, R M

    2016-03-01

    The purpose of this work is to evaluate radiation doses to the lens of urologists during interventional procedures and to compare them with values measured during interventional radiology, cardiology and vascular surgery. The measurements were carried out in a surgical theatre using a mobile C-arm system and electronic occupational dosimeters (worn over the lead apron). Patient and staff dose measurements were collected in a sample of 34 urology interventions (nephrolithotomies). The same dosimetry system was used in other medical specialties for comparison purposes. Median and 3rd quartile values for urology procedures were: patient doses 30 and 40 Gy cm(2); personal dose equivalent Hp(10) over the apron (μSv/procedure): 393 and 848 (for urologists); 21 and 39 (for nurses). Median values of over apron dose per procedure for urologists resulted 18.7 times higher than those measured for radiologists and cardiologists working with proper protection (using ceiling suspended screens) in catheterisation laboratories, and 4.2 times higher than the values measured for vascular surgeons at the same hospital. Comparison with passive dosimeters worn near the eyes suggests that dosimeters worn over the apron could be a reasonable conservative estimate for ocular doses for interventional urology. Authors recommend that at least the main surgeon uses protective eyewear during interventional urology procedures.

  8. Monte Carlo calculations for reporting patient organ doses from interventional radiology

    NASA Astrophysics Data System (ADS)

    Huo, Wanli; Feng, Mang; Pi, Yifei; Chen, Zhi; Gao, Yiming; Xu, X. George

    2017-09-01

    This paper describes a project to generate organ dose data for the purposes of extending VirtualDose software from CT imaging to interventional radiology (IR) applications. A library of 23 mesh-based anthropometric patient phantoms were involved in Monte Carlo simulations for database calculations. Organ doses and effective doses of IR procedures with specific beam projection, filed of view (FOV) and beam quality for all parts of body were obtained. Comparing organ doses for different beam qualities, beam projections, patients' ages and patient's body mass indexes (BMIs) which generated by VirtualDose-IR, significant discrepancies were observed. For relatively long time exposure, IR doses depend on beam quality, beam direction and patient size. Therefore, VirtualDose-IR, which is based on the latest anatomically realistic patient phantoms, can generate accurate doses for IR treatment. It is suitable to apply this software in clinical IR dose management as an effective tool to estimate patient doses and optimize IR treatment plans.

  9. Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach.

    PubMed

    Dunne, Ruth; McCarthy, Eoghan; Joyce, Eimear; McEniff, Niall; Guiney, Michael; Ryan, J Mark; Beddy, Peter

    2013-12-01

    Endoscopic sphincterotomy is an integral component of endoscopic retrograde cholangiopancreatography. Post-sphincterotomy hemorrhage is a recognized complication. First line treatment involves a variety of endoscopic techniques performed at the time of sphincterotomy. If these are not successful, transcatheter arterial embolization or open surgical vessel ligation are therapeutic considerations. To evaluate the technical and clinical success of transcatheter arterial embolization via micro coils in the management of bleeding post-endoscopic sphincterotomy (ES). An 8-year retrospective review of all patients referred for transcatheter arterial embolization (TAE) for management of post-ES bleeding not controlled by endoscopy was performed. We analyzed the findings at endoscopy, angiography, interventional procedure, and the technical and clinical success. Twelve embolization procedures were performed in 11 patients. Technical success was achieved in 11 of 12 procedures. Branches embolized included the gastroduodenal artery (GDA) in 11 cases, the superior pancreaticoduodenal artery (SPDA) in one case, and the inferior pancreaticoduodenal artery (IPDA) in four cases. Clinical success was achieved in 10 of 11 patients. One patient was referred for surgical intervention due to rebleeding from the IPDA. Our experience demonstrates that TAE can effectively control bleeding post-ES avoiding the need for invasive surgery in most patients.

  10. Interventional Radiology in the Diagnosis, Management, and Follow-Up of Pseudoaneurysms

    SciTech Connect

    Keeling, A. N.; McGrath, F. P.; Lee, M. J.

    2009-01-15

    Arterial wall disruption, as a consequence of inflammation/infection, trauma (penetrating or blunt), or iatrogenic causes, may result in pseudoaneurysm formation. Currently, iatrogenic causes are increasing as a result of the growth of endovascular intervention. The frequency of other causes also seems to be increasing, but this may simply be the result of increased diagnosis by better imaging techniques, such as multidetector contrast-enhanced computed tomography. Clinically, pseudoaneurysms may be silent, may present with local or systemic signs, or can rupture with catastrophic consequences. Open surgical repair, previously the mainstay of treatment, has largely been replaced by image-guided occlusion methods. On the basis of an experience of over 100 pseudoaneurysms, treatments at various anatomical sites, imaging modalities used for accurate diagnosis, current changing therapeutic options for pseudoaneurysm management, approved embolization agents, and clinical follow-up requirements to ensure adequate treatment will be discussed. Image-guided direct percutaneous and endovascular embolization of pseudoaneurysms are established treatment options with favorable success rates and minimal morbidity. The pendulum has now swung from invasive surgical repair of pseudoaneurysms to that of image-guided interventional radiology.

  11. Image Gently, Step Lightly: promoting radiation safety in pediatric interventional radiology.

    PubMed

    Sidhu, Manrita; Goske, Marilyn J; Connolly, Bairbre; Racadio, John; Yoshizumi, Terry T; Strauss, Keith J; Coley, Brian D; Utley, Tara

    2010-10-01

    The Image Gently, Step Lightly campaign is an education and awareness campaign focusing on radiation safety in pediatric interventional radiology. To promote radiation safety by standardizing workflow and encouraging team responsibility, the campaign Website includes a procedural checklist that the medical team may use to review radiation safety steps before each pediatric interventional procedure. Use of this checklist can be an effective tool in the ongoing effort to maximize radiation safety during interventional procedures.

  12. The Changing Face of Vascular Interventional Radiology: The Future Role of Pharmacotherapies and Molecular Imaging

    SciTech Connect

    Tapping, Charles R. Bratby, Mark J.

    2013-08-01

    Interventional radiology has had to evolve constantly because there is the ever-present competition and threat from other specialties within medicine, surgery, and research. The development of new technologies, techniques, and therapies is vital to broaden the horizon of interventional radiology and to ensure its continued success in the future. In part, this change will be due to improved chronic disease prevention altering what we treat and in whom. The most important of these strategies are the therapeutic use of statins, Beta-blockers, angiotensin-converting enzyme inhibitors, and substances that interfere with mast cell degeneration. Molecular imaging and therapeutic strategies will move away from conventional techniques and nano and microparticle molecular technology, tissue factor imaging, gene therapy, endothelial progenitor cells, and photodynamic therapy will become an important part of interventional radiology of the future. This review looks at these new and exciting technologies.

  13. The changing face of vascular interventional radiology: the future role of pharmacotherapies and molecular imaging.

    PubMed

    Tapping, Charles R; Bratby, Mark J

    2013-08-01

    Interventional radiology has had to evolve constantly because there is the ever-present competition and threat from other specialties within medicine, surgery, and research. The development of new technologies, techniques, and therapies is vital to broaden the horizon of interventional radiology and to ensure its continued success in the future. In part, this change will be due to improved chronic disease prevention altering what we treat and in whom. The most important of these strategies are the therapeutic use of statins, Beta-blockers, angiotensin-converting enzyme inhibitors, and substances that interfere with mast cell degeneration. Molecular imaging and therapeutic strategies will move away from conventional techniques and nano and microparticle molecular technology, tissue factor imaging, gene therapy, endothelial progenitor cells, and photodynamic therapy will become an important part of interventional radiology of the future. This review looks at these new and exciting technologies.

  14. The Importance of Curriculum-Based Training and Assessment in Interventional Radiology

    SciTech Connect

    Belli, Anna-Maria; Reekers, Jim A.; Lee, Michael

    2013-10-30

    Physician performance and outcomes are being scrutinised by health care providers to improve patient safety and cost efficiency. Patients are best served by physicians who have undergone appropriate specialist training and assessment and perform large numbers of cases to maintain their skills. The Cardiovascular and Interventional Radiological Society of Europe has put into place a curriculum for training in interventional radiology (IR) and a syllabus with an examination, the European Board of Interventional Radiology, providing evidence of attainment of an appropriate and satisfactory skill set for the safe practice of IR. This curriculum is appropriate for IR where there is a high volume of image-guided procedures in vascular and nonvascular organ systems with cross-use of minimally invasive techniques in patients with a variety of disease processes. Other specialties may require different, longer, and more focused training if their experience is “diluted” by the need to master a different skill set.

  15. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology.

    PubMed

    Vano, E; Sanchez, R M; Fernandez, J M

    2015-07-01

    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties.

  16. Cesarean delivery in the interventional radiology suite: a novel approach to obstetric hemostasis.

    PubMed

    O'Rourke, Nollag; McElrath, Thomas; Baum, Richard; Camann, William; Tuomala, Ruth; Stuebe, Alison; Kodali, Bhavani Shankar

    2007-05-01

    The adjunctive use of interventional radiology procedures to minimize and control bleeding at the time of cesarean delivery has become increasingly common. These procedures require modern imaging equipment and supplies not available in traditional operating rooms. We describe three women who strongly desired continued reproductive function in clinical circumstances where postpartum hemorrhage and hysterectomy were likely. Cesarean delivery was performed in the interventional radiology suite after selective uterine artery balloon placement and/or embolotherapy, which successfully minimized blood loss during delivery. We propose that this novel surgical location is feasible, and may offer advantages in select patients.

  17. Biological Treatment of Petroleum in Radiologically Contaminated Soil

    SciTech Connect

    BERRY, CHRISTOPHER

    2005-11-14

    This chapter describes ex situ bioremediation of the petroleum portion of radiologically co-contaminated soils using microorganisms isolated from a waste site and innovative bioreactor technology. Microorganisms first isolated and screened in the laboratory for bioremediation of petroleum were eventually used to treat soils in a bioreactor. The bioreactor treated soils contaminated with over 20,000 mg/kg total petroleum hydrocarbon and reduced the levels to less than 100 mg/kg in 22 months. After treatment, the soils were permanently disposed as low-level radiological waste. The petroleum and radiologically contaminated soil (PRCS) bioreactor operated using bioventing to control the supply of oxygen (air) to the soil being treated. The system treated 3.67 tons of PCRS amended with weathered compost, ammonium nitrate, fertilizer, and water. In addition, a consortium of microbes (patent pending) isolated at the Savannah River National Laboratory from a petroleum-contaminated site was added to the PRCS system. During operation, degradation of petroleum waste was accounted for through monitoring of carbon dioxide levels in the system effluent. The project demonstrated that co-contaminated soils could be successfully treated through bioventing and bioaugmentation to remove petroleum contamination to levels below 100 mg/kg while protecting workers and the environment from radiological contamination.

  18. In the Lead Again Horizontal-Ellipsis [Journal of Cardiovascular and Interventional Radiology

    SciTech Connect

    Vorwerk, Dierk

    2013-10-15

    The 2013 ISI journal rankings are out and it is my pleasure to inform our readership that CVIR ranks 43/120 (2012: 46/118) journals in the field of radiology. The 2013 impact factor further improved to 2.138 (2012: 2.093). This means that Cardiovascular and Interventional Radiology again continues to be the highest ranked journal dedicated to the field of interventional radiology in 2013.This is mainly due to the great support we achieve by you as authors and readers of CVIR, your dedication to the profession, and your loyalty both to the journal and to CIRSE. For all of this, we owe you our thanks and respect.

  19. Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

    SciTech Connect

    Ganeshan, Arul; Upponi, Sara; Hon, Lye-Quen; Uthappa, M. C.; Warakaulle, Dinuke R.; Uberoi, Raman

    2007-11-15

    Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.

  20. Health literacy in vascular and interventional radiology: a comparative analysis of online patient education resources.

    PubMed

    Hansberry, David R; Kraus, Carl; Agarwal, Nitin; Baker, Stephen R; Gonzales, Sharon F

    2014-08-01

    The Internet is frequently accessed by patients as a resource for medical knowledge. However, the provided material is typically written at a level well above the recommended 7th grade level. A clear understanding of the capabilities, limitations, risks, and benefits of interventional radiology by patients, both current and prospective, is hindered when the textual information offered to the public is pitched at a level of sophistication too high for general comprehension. In January 2013, all 25 patient education resources from the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) Web site ( http://www.cirse.org ) and all 31 resources from the Society of Interventional Radiology (SIR) Web site ( http://www.sirweb.org ) were analyzed for their specific level of readability using ten quantitative scales: Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning fog index, New Fog Count, Coleman-Liau index, FORCAST formula, Fry graph, Raygor Readability Estimate, and New Dale-Chall. Collectively, the patient education resources on the CIRSE Web site are written at the 12.3 grade level, while the resources on the SIR Web site are written at the 14.5 grade level. Educational health care materials available on both the CIRSE and the SIR Web sites are presented in language in the aggregate that could be too difficult for many lay people to fully understand. Given the complex nature of vascular and interventional radiology, it may be advantageous to rewrite these educational resources at a lower reading level to increase comprehension.

  1. Ethylene vinyl alcohol copolymer (Onyx®) in peripheral interventional radiology: indications, advantages and limitations.

    PubMed

    Saeed Kilani, M; Izaaryene, J; Cohen, F; Varoquaux, A; Gaubert, J Y; Louis, G; Jacquier, A; Bartoli, J M; Moulin, G; Vidal, V

    2015-04-01

    Onyx(®) is a remarkable liquid embolizing agent that may allow a well-trained operator to undertake challenging embolization procedures. In multiple interventional radiology indications, the physico-chemical properties of Onyx(®) allow safe embolization. The purpose of this article is to review the advantages and disadvantages of Onyx(®) and identify its main indications.

  2. Interventional radiology in infants and children: clinical and technical aspects

    SciTech Connect

    Diament, M.J.; Boechat, M.I.; Kangarloo, H.

    1985-02-01

    The authors performed 53 extravascular interventional procedures in 47 pediatric patients between July 1981 and September 1983. Except for transhepatic cholangiography in patients without intrahepatic biliary dilatation, the success rate was high. There were few complications, and none that were life-threatening or required surgery. Factors essential to safe and successful intervention in infants, children, and adolescents, in the authors' opinion, include (a) active involvement by the radiologist, (b) guidance by real-time imaging, (c) careful matching of needles, catheters, and guidewires to patient size, and (d) adequate sedation and analgesia.

  3. The Role of Interventional Radiology in the Diagnosis and Management of Male Impotence

    SciTech Connect

    Spiliopoulos, Stavros; Shaida, Nadeem; Katsanos, Konstantinos; Krokidis, Miltiadis

    2013-10-15

    Erectile dysfunction (ED) is defined as the persistent inability to reach or maintain penile rigidity enough for sexual satisfaction. Nearly 30% of the men between ages 40 and 70 years are affected by ED. A variety of pathologies, including neurological, psychological, or endocrine disorders and drug side effects, may incite ED. A commonly identified cause of ED is vascular disease. Initial diagnostic workup includes a detailed physical examination and laboratory tests. Whilst duplex ultrasound is considered the first-line diagnostic modality, intra-arterial digital subtraction angiography is still considered the 'gold standard' for the diagnosis of arteriogenic impotence. Percutaneous endovascular treatment may be offered in patients with vasculogenic ED that has failed to respond to oral medical therapy as an alternative to penile prosthesis or open surgical repair. In arteriogenic ED balloon angioplasty of the aorto-iliac axis, and in veno-occlusive ED, percutaneous venous ablation using various embolization materials has been reported to be safe and to improve sexual performance. Recently, the ZEN study investigated the safety and feasibility of drug-eluting stents for the treatment of arteriogenic ED attributed to internal pudendal artery stenosis with promising preliminary results. This manuscript highlights the role of interventional radiology in the diagnosis and minimally invasive treatment of male impotence.

  4. Sedation, analgesia and anesthesia for interventional radiological procedures in adults. Part I. Survey of interventional radiological practice in Belgium.

    PubMed

    Trotteur, G; Stockx, L; Dondelinger, R F

    2000-06-01

    A questionnaire was mailed to 217 interventional radiologists to evaluate current practice in analgesia and sedation in adults. Response rate was 15% (33/217). Diagnostic angiography was performed with local anesthesia in 94% to 99%; for PTA, local thrombolysis or stent placement, light sedation was added in 0.1%. Premedication was given in 43% of diagnostic angiographies and in 68% of therapeutic procedures. Radiologists consulted an anesthesiologist before administration of intravenous sedation, always in 54% of cases, occasionally in 19% and never in 27%. General anesthesia with artificial ventilation was applied in 56% of TIPS, in 70% of aortic stent grafting and in 82% of neuroradiological interventions. Intravenous sedation was applied given in 53% of percutaneous biliary drainage, in 42% of bile duct dilatation or stenting, in 40% of percutaneous nephrostomy and in 72% of ureteral balloon dilatation. Patient monitoring during an interventional procedure was always carried out by an anesthesiologist in 52% of cases. 21% of radiologists never visited the patient before a therapeutic procedure, and 36% never did so after completion of a procedure. This survey showed that high standard practice of sedation and analgesia, with the assistance of anesthesiologists, is underused by interventional radiologists in Belgium.

  5. The Role of Interventional Radiology in Urologic Tract Trauma

    PubMed Central

    Mani, Naganathan B.S.; Kim, Lauren

    2011-01-01

    The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. Several classification systems convey the severity of injury to kidneys, ureter, bladder, and urethra. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according the size of laceration and its proximity to the renal hilum. Ureteral injury is graded according to its extent relative to the circumference of the ureter and the extent of associated devascularization. Bladder injury is graded according to its location relative to the peritoneum. Urethral injury is graded according to the extent of damage to surrounding anatomic structures. Although these classification schema may not be always used in common parlance, they do help delineate most important features of urologic tract injury that impact patient management and interventions. PMID:23204640

  6. Thermal and hydrodynamic modelling of active catheters for interventional radiology.

    PubMed

    Marchandise, Emilie; Flaud, Patrice; Royon, Laurent; Blanc, Raphaël; Szewczyk, Jérome

    2011-07-01

    Interventional radiologists desire to improve their operating tools such as catheters. Active catheters in which the tip is moved using shape memory alloy actuators activated using the Joule effect present a promising approach for easier navigation in the small vessels. However, the increase in temperature caused by this Joule effect must be controlled in order to prevent damage to blood cells and tissues. This paper is devoted to the simulation and experimental validation of a fluid-thermal model of an active catheter prototype. Comparisons between computer-predicted and experimentally measured temperatures are presented for both experiments in air and water at 37°C. Good agreement between the computational and experimental results is found, demonstrating the validity of the developed computer model. These comparisons enable us to highlight some important issues in the modelling process and to determine the optimal current for the activation of the catheter.

  7. Needs-Based Innovation in Interventional Radiology: The Biodesign Process.

    PubMed

    Steinberger, Jonathan D; Denend, Lyn; Azagury, Dan E; Brinton, Todd J; Makower, Josh; Yock, Paul G

    2017-06-01

    There are many possible mechanisms for innovation and bringing new technology into the marketplace. The Stanford Biodesign innovation process is based in a deep understanding of clinical unmet needs as the basis for focused ideation and development. By identifying and vetting a compelling unmet need, the aspiring innovator can "derisk" a project and maximize chances for successful development in an increasingly challenging regulatory and economic environment. As a specialty founded by tinkerers, with a history of disruptive innovation that has yielded countless new ways of delivering care with minimal invasiveness, lower morbidity, and lower cost, interventional radiologists are uniquely well positioned to identify unmet needs and develop novel solutions free of dogmatic convention. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Navigation with Electromagnetic Tracking for Interventional Radiology Procedures

    PubMed Central

    Wood, Bradford J.; Zhang, Hui; Durrani, Amir; Glossop, Neil; Ranjan, Sohan; Lindisch, David; Levy, Eliott; Banovac, Filip; Borgert, Joern; Krueger, Sascha; Kruecker, Jochen; Viswanathan, Anand; Cleary, Kevin

    2008-01-01

    PURPOSE To assess the feasibility of the use of preprocedural imaging for guide wire, catheter, and needle navigation with electromagnetic tracking in phantom and animal models. MATERIALS AND METHODS An image-guided intervention software system was developed based on open-source software components. Catheters, needles, and guide wires were constructed with small position and orientation sensors in the tips. A tetrahedral-shaped weak electromagnetic field generator was placed in proximity to an abdominal vascular phantom or three pigs on the angiography table. Preprocedural computed tomographic (CT) images of the phantom or pig were loaded into custom-developed tracking, registration, navigation, and rendering software. Devices were manipulated within the phantom or pig with guidance from the previously acquired CT scan and simultaneous real-time angiography. Navigation within positron emission tomography (PET) and magnetic resonance (MR) volumetric datasets was also performed. External and endovascular fiducials were used for registration in the phantom, and registration error and tracking error were estimated. RESULTS The CT scan position of the devices within phantoms and pigs was accurately determined during angiography and biopsy procedures, with manageable error for some applications. Preprocedural CT depicted the anatomy in the region of the devices with real-time position updating and minimal registration error and tracking error (<5 mm). PET can also be used with this system to guide percutaneous biopsies to the most metabolically active region of a tumor. CONCLUSIONS Previously acquired CT, MR, or PET data can be accurately codisplayed during procedures with reconstructed imaging based on the position and orientation of catheters, guide wires, or needles. Multimodality interventions are feasible by allowing the real-time updated display of previously acquired functional or morphologic imaging during angiography, biopsy, and ablation. PMID:15802449

  9. The European Board of Interventional Radiology Examination: A Cross-Sectional Web-Based Survey.

    PubMed

    Tong, Emma; Spooner, Muirne; Van Delden, Otto; Uberoi, Raman; Sheehan, Mark; O'Neill, Damien C; Lee, Michael

    2017-08-15

    The Cardiovascular and Interventional Radiology Society of Europe established the European Board of Interventional Radiology (EBIR) as an international examination in Interventional Radiology (IR), in 2010. The main objective of this study was to examine candidates' variables which could influence examination success. The secondary objective was to evaluate candidate feedback. This study was a cross-sectional web-based survey incorporating 30 questions which reviewed candidates' demographics; use of English language; education; and radiology training. Free-text responses provided perspective on the examination process and any potential career implications. This survey was distributed via Surveygizmo(TM) and emailed to 227 candidates, and the results were then anonymised and analysed. A total of 115 candidates responded to the survey. 4.4% (N = 5/115) of candidates were women, and 38.3% (N = 44/115) of candidates were fluent in English. Over 45.2% (N = 52/115) of the respondents achieved a distinction, or >70% equivalent in their medical degree, and 60.8% (N = 70/115) achieved some form of higher degree after medical school. 54.8% (N = 63/115) spent time in other medical specialties, of which the majority (33.8%, N = 39/115) was in surgery. 67.5% (N = 77/114) completed a dedicated fellowship in IR. 61.9% (70/113) felt the EBIR qualification helped their career, for example with academic promotion or increased clinical privileges. EBIR applicants were predominantly male (>95%). Clinical training, prior to radiology training, was very common in this cohort. Overall, most candidates expressed satisfaction with the examination process, and many felt this qualification helped their career. The recent recognition by national accreditation bodies should hopefully improve the profile of the examination greatly.

  10. Diagnostic and interventional radiology for Budd-Chiari syndrome.

    PubMed

    Cura, Marco; Haskal, Ziv; Lopera, Jorge

    2009-01-01

    Budd-Chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction that involves one or more draining hepatic veins. Its occurrence in populations in the western hemisphere is commonly associated with hypercoagulative states. Clinical manifestations in many cases are nonspecific, and imaging may be critical for early diagnosis of venous obstruction and accurate assessment of the extent of disease. If Budd-Chiari syndrome is not treated promptly and appropriately, the outcome may be dismal. Comprehensive imaging evaluations, in combination with pathologic analyses and clinical testing, are essential for determining the severity of disease, stratifying risk, selecting the appropriate therapy, and objectively assessing the response. The main goal of treatment is to alleviate hepatic congestion, thereby improving hepatocyte function and allowing resolution of portal hypertension. Various medical, endovascular, and surgical treatment options are available. Percutaneous and endovascular procedures, when performed in properly selected patients, may be more effective than medical treatment methods for preserving liver function and arresting disease progression in the long term. In addition, such procedures are associated with lower morbidity and mortality than are open surgical techniques.

  11. [Vascular interventional radiology: a fundamental procedure for the management of paediatric trauma].

    PubMed

    Bordón Cabrera, E; Laín, A; Gander, R; Pérez Lafuente, M; Díez Miranda, I; Fontecha, C G; Seidler, L; Delgado, I; Cañadas Palazón, S; Lloret, J

    2016-01-25

    The management of active bleeding with haemodinamic lability in the paediatric trauma patient is difficult and generally leads to damage control surgery. Vascular Interventional Radiology (VIR) techniques are useful for the diagnosis as for the definitive treatment. The aim of our study was to describe our experience and evaluate effectiveness of VIR in the management of the paediatric trauma patient with active bleeding signs. Retrospective analysis (2003-2014) of politraumatic patients who showed contrast blush on computed tomography and then treated by VIR techniques. In the reported study period 16 patients underwent VIR procedures. Medium age was 13 years (5-17). The most frequent lesion mechanism was traffic accident (8 out of 17) and 93,75% were blunt traumas. Findings on initial Computed Tomography were 12 contrast blushes and 2 absences of arterial flow. In 2 cases the contrast blush appeared 48 hours after the accident. Arteriography allowed us to localize the bleeding vessels in all the cases, performing selective or supraselective renal (7), pelvic (5), hepatic (3), splenic (1) and intercostal (1) embolization. One patient required an endoprothesis for renal revascularization. Two cases needed additional surgical procedures (2 nephrectomies) because of complete section of the renal artery (1) and disruption of the ureteropelvic junction (1). One case required hemofiltration in relation to rhabdomyolysis. In our experience VIR is a valuable diagnostic and therapeutic procedure for the management of paediatric trauma patients, with high effectiveness and a low complication rate.

  12. Lessons from surgery and anaesthesia: evaluation of non-technical skills in interventional radiology.

    PubMed

    Pang, Chun L; Patel, Salil B; Pilkington, Nicola

    2015-12-01

    In the medical profession, surgery and anaesthesia are leading the way in identifying human errors that negatively affect patient safety. Evidence suggests that the implementation of non-technical skills assessments reduces such errors. Interventional Radiology is a procedural based speciality and therefore may also benefit from formal assessment of non-technical skills. This literature review supports the use of standardised assessment tools used in surgery and anaesthesia. Using the Downing framework of internal validity, the tools demonstrated good internal consistency but a spectrum of inter-rater variability, which can be partially improved with training. At present, a formal Interventional Radiology non-technical skills assessment tool is probably not suitable to be a stand-alone 'high stakes' assessment, but may be a useful adjunct to the existing array of workplace-based assessments.

  13. Venous malformations: classification, development, diagnosis, and interventional radiologic management.

    PubMed

    Legiehn, Gerald M; Heran, Manraj K S

    2008-05-01

    Venous malformations are categorized as low-flow vascular malformations within the domain of vascular anomalies and are the most common vascular malformation encountered clinically. Venous malformations are by definition present at birth, undergo pari passu growth, and present clinically because of symptoms related to mass effect or stasis. Although diagnosis can usually be made by clinical history and examination, differentiation from other vascular and nonvascular entities often requires an imaging work-up that includes ultrasound, CT, MR imaging, and diagnostic phlebography. All decisions regarding imaging work-up and decision to treat must be coordinated though referral and discussions with a multidisciplinary team and be based on clearly defined clinical indications. Percutaneous image-guided sclerotherapy has become the mainstay of treatment for venous malformations and involves the introduction of any one of a number of endothelial-cidal sclerosants into the vascular spaces of the lesion, with each sclerosant possessing its own unique spectrum of advantages and disadvantages.

  14. Cost analysis in interventional radiology--A tool to optimize management costs.

    PubMed

    Clevert, D-A; Stickel, M; Jung, E M; Reiser, M; Rupp, N

    2007-01-01

    The objective of the study was to analyze the methods to reduce cost in interventional radiology departments by reorganizing procurement. All products used in the Department of Interventional Radiology were inventoried. An ABC-analysis was completed and A-products (high-value and high turnover products) underwent a XYZ-analysis which predicted demand on the basis of ordering frequency. Then criteria for a procurement strategy for the different material categories were fixed. The net working capital (NWC) was calculated using an interest rate of 8%/year. Total annual material turnover was 353,000 euro. The value of all A-products determined by the inventory was 260,000 euro. Changes in the A-product procurement strategy tapped a cost reduction potential of 14,500/year euro. The resulting total saving was 17,200 euro. Improved stores management added another 37,500 euro. The total cost cut of 52,000 euro is equivalent to 14.7% of annual expenses. A flexible procurement strategy helps to reduce the storage and capital tie-up costs of A-products in interventional radiology without affecting the quality of service provided to patients.

  15. Feasibility of a semiconductor dosimeter to monitor skin dose in interventional radiology.

    PubMed

    Meyer, P; Regal, R; Jung, M; Siffert, P; Mertz, L; Constantinesco, A

    2001-10-01

    The design and preliminary test results of a semiconductor silicon dosimeter are presented in this article. Use of this dosimeter is foreseen for real-time skin dose control in interventional radiology. The strong energy dependence of this kind of radiation detector is well overcome by filtering the silicon diode. Here, the optimal filter features have been calculated by numerical Monte Carlo simulations. A prototype has been built and tested in a radiological facility. The first experimental results show a good match between the filtered semiconductor diode response and an ionization chamber response, within 2% fluctuation in a 2.2 to 4.1 mm Al half-value layer (HVL) energy range. Moreover, the semiconductor sensor response is linear from 0.02 Gy/min to at least 6.5 Gy/min, covering the whole dose rate range found in interventional radiology. The results show that a semiconductor dosimeter could be used to monitor skin dose during the majority of procedures using x-rays below 150 keV. The use of this device may assist in avoiding radiation-induced skin injuries and lower radiation levels during interventional procedures.

  16. Evaluation of an Intervention to Improve Skills in Diagnostic Radiology of Rural Physicians over One Year in Four Rural Hospitals

    PubMed Central

    Niu, Wenxin; Wu, Hengjing; Jiang, Chenghua

    2014-01-01

    Background Primary health care and patient triage are two basic functions of rural hospitals. As a routine test, the diagnostic radiology is still unavailable in some rural hospitals in China. Therefore, high-level hospitals are often the first choice of rural residents when they feel unwell. It brings serious social problems. This study was designed to propose an on-the-job drilling schema with integration of practical medical recordings and experienced radiological doctors as tutors to improve skills in diagnostic radiology of rural physicians. Methods The information technology was used to help the contact between rural doctors and tutors. In a longitudinal pre/post-test control study design, a cohort of 20 young physicians, each of whom was working in a rural hospital and had a work experience less than two years, were established as the trial group over one year. Another 20 similar counterparts were established as the control group. Participants' performances were evaluated in four categories at five-time point (TP). Results The trial group significantly outscored the control group on the style of writing at the second TP (d = 2.28); on the accuracy of the image description at final TP (d = 1.11); on the accuracy of the diagnosis at the fourth TP (d = 3.62); and on the correct treatment selection at the third TP (d = 6.45). The aspects with the most improvement were the accuracies of the diagnosis and the treatment selection. Conclusion This study provided the detailed evidences that applying the on-the-job drilling schema has a significant effect on the skills improvement in diagnostic radiology of rural physicians. It was also concluded that the educational intervention based on practical cases was better than that only based on didactic slides presentation. PMID:24705822

  17. Anesthesia Practice and Clinical Trends in Interventional Radiology: A European Survey

    SciTech Connect

    Haslam, Philip J.; Yap, Bernard; Mueller, Peter R.; Lee, Michael J.

    2000-07-15

    Purpose: To determine current European practice in interventional radiology regarding nursing care, anesthesia, and clinical care trends.Methods: A survey was sent to 977 European interventional radiologists to assess the use of sedoanalgesia, nursing care, monitoring equipment, pre- and postprocedural care, and clinical trends in interventional radiology. Patterns of sedoanalgesia were recorded for both vascular and visceral interventional procedures. Responders rated their preferred level of sedoanalgesia for each procedure as follows: (a) awake/alert, (b) drowsy/arousable, (c) asleep/arousable, (d) deep sedation, and (e) general anesthesia. Sedoanalgesic drugs and patient care trends were also recorded. A comparison was performed with data derived from a similar survey of interventional practice in the United States.Results: Two hundred and forty-three of 977 radiologists responded (25%). The total number of procedures analyzed was 210,194. The majority (56%) of diagnostic and therapeutic vascular procedures were performed at the awake/alert level of sedation, 32% were performed at the drowsy/arousable level, and 12% at deeper levels of sedation. The majority of visceral interventional procedures were performed at the drowsy/arousable level of sedation (41%), 29% were performed at deeper levels of sedation, and 30% at the awake/alert level. In general, more sedoanalgesia is used in the United States. Eighty-three percent of respondents reported the use of a full-time radiology nurse, 67% used routine blood pressure/pulse oximetry monitoring, and 46% reported the presence of a dedicated recovery area. Forty-nine percent reported daily patient rounds, 30% had inpatient hospital beds, and 51% had day case beds.Conclusion: This survey shows clear differences in the use of sedation for vascular and visceral interventional procedures. Many, often complex, procedures are performed at the awake/alert level of sedation in Europe, whereas deeper levels of sedation are

  18. Organ motion due to respiration: the state of the art and applications in interventional radiology and radiation oncology

    NASA Astrophysics Data System (ADS)

    Cleary, Kevin R.; Mulcahy, Maureen; Piyasena, Rohan; Zhou, Tong; Dieterich, Sonja; Xu, Sheng; Banovac, Filip; Wong, Kenneth H.

    2005-04-01

    Tracking organ motion due to respiration is important for precision treatments in interventional radiology and radiation oncology, among other areas. In interventional radiology, the ability to track and compensate for organ motion could lead to more precise biopsies for applications such as lung cancer screening. In radiation oncology, image-guided treatment of tumors is becoming technically possible, and the management of organ motion then becomes a major issue. This paper will review the state-of-the-art in respiratory motion and present two related clinical applications. Respiratory motion is an important topic for future work in image-guided surgery and medical robotics. Issues include how organs move due to respiration, how much they move, how the motion can be compensated for, and what clinical applications can benefit from respiratory motion compensation. Technology that can be applied for this purpose is now becoming available, and as that technology evolves, the subject will become an increasingly interesting and clinically valuable topic of research.

  19. Damage control interventional radiology (DCIR) in prompt and rapid endovascular strategies in trauma occasions (PRESTO): A new paradigm.

    PubMed

    Matsumoto, J; Lohman, B D; Morimoto, K; Ichinose, Y; Hattori, T; Taira, Y

    2015-01-01

    This article proposes an innovative concept of interventional radiology for hemodynamically unstable trauma patients. Damage control interventional radiology (DCIR) is an aggressive and time-conscious algorithm that prioritizes saving life of the hemorrhaging patient in extremis which conventional emergency interventional radiology (CEIR) cannot efficiently do. Briefly, DCIR aims to save life while CEIR aims to control bleeding with a constant concern to time-awareness. This article also presents the concept of "Prompt and Rapid Endovascular Strategies in Traumatic Occasions" (PRESTO) that entirely oversees and manages trauma patients from arrival to the trauma bay until initial completion of hemostasis with endovascular techniques. PRESTO's "Start soon and finish sooner" relies on the earlier activation of interventional radiology team but also emphasizes on a rapid completion of hemostasis in which DCIR has been specifically tailored. Both DCIR and PRESTO expand the role of IR and represent a paradigm shift in the realm of trauma care.

  20. Radiological changes following second-line zoledronic acid treatment in breast cancer patients with bone metastases.

    PubMed

    Amir, E; Whyne, C; Freedman, O C; Fralick, M; Kumar, R; Hardisty, M; Clemons, M

    2009-01-01

    Initiation of bisphosphonate therapy in bisphosphonate-naïve patients is known to be associated with radiological changes such as increased bone density in both osteolytic and osteoblastic metastases. It is not known, however, whether switching from a second-generation bisphosphonate to a more potent agent is associated with similar changes. This study aimed to prospectively explore radiological changes, as assessed by thoracolumbar CT scanning, in patients switching from an early generation bisphosphonate (i.e., oral clodronate or intravenous pamidronate) to intravenous zoledronic acid. Patients with progressive bone metastases despite use of an earlier generation bisphosphonate were switched to zoledronic acid as part of a study to evaluate the palliative benefit of this intervention. Quantitative computed tomography (QCT) scanning of the thoracolumbar spine was carried out at baseline, and repeated 4 months after commencing zoledronic acid. The effect of this change of therapy was explored in terms of bone density, as well as volume of osteolytic and osteoblastic disease. Fifteen patients were assessed. Switching of bisphosphonate therapy was associated with a significant increase in bone density, and an increase in osteoblastic volume. There was an insignificant trend towards reduced osteolytic volume. In conclusion, switching from early generation bisphosphonates to a more potent agent is associated with radiological changes similar to those seen when commencing a bisphosphonate in treatment-naïve patients. This is consistent with the observed palliative benefit. The use of QCT may be of benefit in the monitoring of bone metastases.

  1. Radiological Instrumentation Assessment for King County Wastewater Treatment Division

    SciTech Connect

    Strom, Daniel J.; McConn, Ronald J.; Brodzinski, Ronald L.

    2005-05-19

    The King County Wastewater Treatment Division (WTD) have concern about the aftermath of a radiological dispersion event (RDE) leading to the introduction of significant quantities of radioactive material into its combined sanitary and storm sewer system. Radioactive material could come from the use of a radiological dispersion device (RDD). RDDs include "dirty bombs" that are not nuclear detonations but are explosives designed to spread radioactive material. Radioactive material also could come from deliberate introduction or dispersion of radioactive material into the environment, including waterways and water supply systems. Volume 2 of PNNL-15163 assesses the radiological instrumentation needs for detection of radiological or nuclear terrorism, in support of decisions to treat contaminated wastewater or to bypass the West Point Treatment Plant (WPTP), and in support of radiation protection of the workforce, the public, and the infrastructure of the WPTP. Fixed radiation detection instrumentation should be deployed in a defense-in-depth system that provides 1) early warning of significant radioactive material on the way to the WPTP, including identification of the radionuclide(s) and estimates of the soluble concentrations, with a floating detector located in the wet well at the Interbay Pump Station and telemetered via the internet to all authorized locations; 2) monitoring at strategic locations within the plant, including 2a) the pipe beyond the hydraulic ram in the bar screen room; 2b) above the collection funnels in the fine grit facility; 2c) in the sampling tank in the raw sewage pump room; and 2d) downstream of the concentration facilities that produce 6% blended and concentrated biosolids. Engineering challenges exist for these applications. It is necessary to deploy both ultra-sensitive detectors to provide early warning and identification and detectors capable of functioning in high-dose rate environments that are likely under some scenarios, capable

  2. [Materials management system in interventional radiology -- initial experience with a computer-supported program].

    PubMed

    Clevert, D-A; Jung, E M; Reiser, M; Rupp, N

    2004-10-01

    To perform a cost analysis for assessing options of reorganizing material supplies and reducing costs of the radiology division through the introduction of a materials management system. A materials management system (Piranha, Boston Scientific) was installed on an existing computer system. All consumables were inventoried and entered into the system. An ABC analysis determined further action. On the basis of order frequencies and availability requirements for emergencies, safety levels were agreed with physicians and other medical staff. Inventory costs were computed using these data. The interest rate for the capital tied up in the inventory was 8 % per year. The inventory showed that the capital tied up in stocks was euro 260,000 in 2001 and euro 190,000 in 2002. A change in supply strategy reduced inventory cost in 2001 and 2002. Annual interest expense was lowered by euro 18,420. Another saving of euro 2,700 was achieved by a reduction in storage cost. Annual inventory turnover totaled euro 298,000. The total cost cut through improved inventory management was euro 21,120 per year, which is equivalent to 7 % of the annual expenses. Adding the decline in the cost of shelf time overruns equal to 5 % of the annual expenses, the saving was approximately 12 % of total interventional radiology cost in 2001 and some 11 % in 2002. Flexible supply strategies and the introduction of a materials management program can help to reduce inventory costs in interventional radiology divisions without any impact on service levels.

  3. On-line data collection platform for national dose surveys in diagnostic and interventional radiology.

    PubMed

    Vassileva, J; Simeonov, F; Avramova-Cholakova, S

    2015-07-01

    According to the Bulgarian regulation for radiation protection at medical exposure, the National Centre of Radiobiology and Radiation Protection (NCRRP) is responsible for performing national dose surveys in diagnostic and interventional radiology and nuclear medicine and for establishing of national diagnostic reference levels (DRLs). The next national dose survey is under preparation to be performed in the period of 2015-16, with the aim to cover conventional radiography, mammography, conventional fluoroscopy, interventional and fluoroscopy guided procedures and CT. It will be performed electronically using centralised on-line data collection platform established by the NCRRP. The aim is to increase the response rate and to improve the accuracy by reducing human errors. The concept of the on-line dose data collection platform is presented. Radiological facilities are provided with a tool to determine local typical patient doses, and the NCRRP to establish national DRLs. Future work will include automatic retrieval of dose data from hospital picture archival and communicating system. The on-line data collection platform is expected to facilitate the process of dose audit and optimisation of radiological procedures in Bulgarian hospitals. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Collaborative work during interventional radiological procedures based on a multicast satellite-terrestrial network.

    PubMed

    Gortzis, Lefteris G; Papadopoulos, Homer; Roelofs, Theo A; Rakowsky, Stefan; Karnabatidis, Dimitris; Siablis, Dimitris; Makropoulos, Constantinos; Nikiforidis, George; Graschew, Georgi

    2007-09-01

    Collaboration is a key requirement in several contemporary interventional radiology procedures (IRPs). This work proposes a multicast hybrid satellite system capable of supporting advanced IRP collaboration, and evaluates its feasibility and applicability. Following a detailed IRP requirements study, we have developed a system which supports IRP collaboration through the employment of a hybrid satellite-terrestrial network, a prototype multicast version of wavelet based interactive communication system (WinVicos) application, and a partition aggregation and conditional coding (PACC) wavelet codec. A semistructured questionnaire was also used to receive evaluative feedback from collaborating participants. The departments of interventional radiology of University Hospital of Patras, Greece and of Charite Hospital of Berlin, Germany have been connected on the system. Eight interventional radiologists and a vascular surgeon participated periodically in three satellite-terrestrial "fully collaborative" IRPs (average time 90 min) of high complexity and in four terrestrial educational sessions with great success, evidenced by considerable improving the IRP outcomes (clinical and educational). In case of high complexity, where the simultaneous presence of remote interventional expert and/or surgeon is required, advanced collaboration among staff of geographically dispersed international centers is feasible via integration of existing networking and other technologies.

  5. Auditing an Online Self-reported Interventional Radiology Adverse Event Database for Compliance and Accuracy.

    PubMed

    Burch, Ezra A; Shyn, Paul B; Chick, Jeffrey F; Chauhan, Nikunj R

    2017-04-01

    The purpose of this study was to determine whether auditing an online self-reported interventional radiology quality assurance database improves compliance with record entry or improves the accuracy of adverse event (AE) reporting and grading. Physicians were trained in using the database before the study began. An audit of all database entries for the first 3 months, or the first quarter, was performed, at which point physicians were informed of the audit process; entries for the subsequent 3 months, or the second quarter, were again audited. Results between quarters were compared. Compliance with record entry improved from the first to second quarter, but reminders were necessary to ensure 100% compliance with record entry. Knowledge of the audit process did not significantly improve self-reporting of AE or accuracy of AE grading. However, auditing significantly changed the final AE reporting rates and grades. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  6. Automatic management system for dose parameters in interventional radiology and cardiology.

    PubMed

    Ten, J I; Fernandez, J M; Vaño, E

    2011-09-01

    The purpose of this work was to develop an automatic management system to archive and analyse the major study parameters and patient doses for fluoroscopy guided procedures performed in cardiology and interventional radiology systems. The X-ray systems used for this trial have the capability to export at the end of the procedure and via e-mail the technical parameters of the study and the patient dose values. An application was developed to query and retrieve from a mail server, all study reports sent by the imaging modality and store them on a Microsoft SQL Server data base. The results from 3538 interventional study reports generated by 7 interventional systems were processed. In the case of some technical parameters and patient doses, alarms were added to receive malfunction alerts so as to immediately take appropriate corrective actions.

  7. The role of interventional radiology in the management of hepatocellular carcinoma

    PubMed Central

    Molla, N.; AlMenieir, N.; Simoneau, E.; Aljiffry, M.; Valenti, D.; Metrakos, P.; Boucher, L.M.; Hassanain, M.

    2014-01-01

    Background Hepatocellular carcinoma (hcc) is one of the most common causes of cancer-related death worldwide. Overall, liver transplantation and resection are the only available treatments with potential for cure. Various locoregional therapies are widely used to manage patients with advanced hcc or as a bridging therapy for patients with early and intermediate disease. This article reviews and evaluates the role of interventional radiology in the management of such cases by assessing various aspects of each method, such as effect on rates of survival, recurrence, tumour response, and complications. Methods A systemic search of PubMed, medline, Ovid Medline In-Process, and the Cochrane Database of Systematic Reviews retrieved all related scientific papers for review. Results Needle core biopsy is a highly sensitive, specific, and accurate method for hcc grading. Portal-vein embolization provides adequate expansion of the future liver remnant, making more patients eligible for resection. In focal or multifocal unresectable early-stage disease, radiofrequency ablation tops all other thermoablative methods. However, microwave ablation is preferred in large tumours and in patients with Child–Pugh B disease. Cryoablation is preferred in recurrent disease and in patients who are poor candidates for anesthesia. Of the various transarterial modalities—transarterial chemoembolization (tace), drug-eluting beads, and transarterial radio-embolization (tare)—tace is the method of choice in Child–Pugh A disease, and tare is the method of choice in hcc cases with portal vein thrombosis. Conclusions The existing data support the importance of a multidisciplinary approach in hcc management. Large randomized controlled studies are needed to provide clear indication guidelines for each method. PMID:24940108

  8. A pilot experience launching a national dose protocol for vascular and interventional radiology.

    PubMed

    Vano, E; Segarra, A; Fernandez, J M; Ordiales, J M; Simon, R; Gallego, J J; del Cerro, J; Casasola, E; Verdu, J F; Ballester, T; Sotil, J; Aspiazu, A; Garcia, M A; Moreno, F; Carreras, F; Canis, M; Soler, M M; Palmero, J; Ciudad, J; Diaz, F; Hernandez, J; Gonzalez, M; Rosales, P

    2008-01-01

    The design of a national dose protocol for interventional radiology has been one of the tasks during the European SENTINEL Coordination Action. The present paper describes the pilot experience carried out in cooperation with the Spanish Society on Vascular and Interventional Radiology (SERVEI). A prospective sample of procedures was initially agreed. A common quality control of the X-ray systems was carried out, including calibration of the air kerma area product (KAP) meters. Occupational doses of the radiologists involved in the survey were also included in the survey. A total of 10 Spanish hospitals with interventional X-ray units were involved. Six hundred and sixty-four patient dose data were collected from 397 diagnostic and 267 therapeutic procedures. Occupational doses were evaluated in a sample of 635 values. The obtained KAP median/mean values (Gy.cm2) for the gathered procedures were: biliary drainage (30.6/68.9), fistulography (4.5/9.8), lower limb arteriography (52.2/60.7), hepatic chemoembolisation (175.8/218.3), iliac stent (45.9/73.2) and renal arteriography (39.1/59.8). Occupational doses (mean monthly values, in mSv) were 1.9 (over apron); 0.3 (under apron) and 4.5 (on hands). With this National experience, a protocol was agreed among the SENTINEL partners to conduct future similar surveys in other European countries.

  9. A new reference point for patient dose estimation in neurovascular interventional radiology.

    PubMed

    Kawasaki, Kohei; Imazeki, Masaharu; Hasegawa, Ryota; Shiba, Shinichi; Takahashi, Hiroyuki; Sato, Kazuhiko; Ota, Jyoji; Suzuki, Hiroaki; Awai, Kazuo; Sakamoto, Hajime; Tajima, Osamu; Tsukamoto, Atsuko; Kikuchi, Tatsuya; Kageyama, Takahiro; Kato, Kyoichi

    2013-07-01

    In interventional radiology, dose estimation using the interventional reference point (IRP) is a practical method for obtaining the real-time skin dose of a patient. However, the IRP is defined in terms of adult cardiovascular radiology and is not suitable for dosimetry of the head. In the present study, we defined a new reference point (neuro-IRP) for neuro-interventional procedures. The neuro-IRP was located on the central ray of the X-ray beam, 9 cm from the isocenter, toward the focal spot. To verify whether the neuro-IRP was accurate in dose estimation, we compared calculated doses at the neuro-IRP and actual measured doses at the surface of the head phantom for various directions of the X-ray projection. The resulting calculated doses were fairly consistent with actual measured doses, with the error in this estimation within approximately 15%. These data suggest that dose estimation using the neuro-IRP for the head is valid.

  10. Prophylactic Plasma Transfusion Before Interventional Radiology Procedures Is Not Associated With Reduced Bleeding Complications.

    PubMed

    Warner, Matthew A; Woodrum, David A; Hanson, Andrew C; Schroeder, Darrell R; Wilson, Gregory A; Kor, Daryl J

    2016-08-01

    To determine the association between prophylactic plasma transfusion and periprocedural red blood cell (RBC) transfusion rates in patients with elevated international normalized ratio (INR) values undergoing interventional radiology procedures. In this retrospective cohort study, adult patients undergoing interventional radiology procedures with a preprocedural INR available within 30 days of the procedure during a study period of January 1, 2009, to December 31, 2013, were eligible for inclusion. Baseline characteristics, coagulation parameters, transfusion requirements, and procedural details were extracted. Univariate and multivariable propensity-matched analyses were used to assess the relationships between prophylactic plasma transfusion and the outcomes of interest, with a primary outcome assessed a priori of RBC transfusion occurring during the procedure or within the first 24 hours postprocedurally. A total of 18,204 study participants met inclusion criteria for this study, and 1803 (9.9%) had an INR of 1.5 or greater before their procedure. Of these 1803 patients, 196 patients (10.9%) received prophylactic plasma transfusion with a median time of 1.9 hours (interquartile range [IQR], 1.1-3.2 hours) between plasma transfusion initiation and procedure initiation. In multivariable propensity-matched analysis, plasma administration was associated with increased periprocedural RBC transfusions (odds ratio, 2.20; 95% CI, 1.38-3.50; P<.001) and postprocedural intensive care unit admission rates (odds ratio, 2.11; 95% CI, 1.41-3.14; P<.001) as compared with those who were not transfused preprocedurally. Similar relationships were seen at higher INR thresholds for plasma transfusion. In patients undergoing interventional radiology procedures, preprocedural plasma transfusions given in the setting of elevated INR values were associated with increased periprocedural RBC transfusions. Additional research is needed to clarify this potential association between

  11. Quality of interventional radiology literature: a review of articles published in JVIR and CVIR.

    PubMed

    Meyer, Jared; Nsouli-Maktabi, Hala; Spies, James B

    2009-10-01

    To evaluate the quality of reporting of clinical studies published in two interventional radiology journals. Two investigators reviewed all articles reporting the outcomes from therapies in 12 consecutive months of Journal of Vascular and Interventional Radiology (JVIR) (August 2007 to July 2008) and CardioVascular and Interventional Radiology (CVIR) (July/August 2007 to May/June 2008). The included studies were evaluated by means of a score sheet adapted from the Consolidated Standards of Reporting Trials criteria. The score sheet was comprised of 22 categories, with each given a score of 0-2. These scores were summed (maximum score, 44) and the comparative results analyzed by using the Wilcoxon rank sum and chi(2) tests. A total of 129 articles were reviewed from JVIR and 86 from CVIR. JVIR's mean score was 23.3 +/- 4.9, which was significantly higher than CVIR's mean score of 19.8 +/- 5.7 (P< .0001). Prospective studies comprised 38% (49 of 129) of JVIR's articles and 35% (31 of 86) of CVIR's studies (P = .9076). The mean sample sizes were larger for JVIR than for CVIR (130.8 and 66.3, respectively) (P = .0173). Both journals primarily published case series (112/129 [86.8%] for JVIR and 76/86 [88%] for CVIR). Only six of the 129 articles (4.6%) in JVIR and seven of the 87 (8.1%) in CVIR were randomized studies. Key weaknesses in reporting include lack of randomization, blinding of outcome assessment, sample size analysis, and proper reporting of outcomes. Articles published in both journals displayed substantial weaknesses that potentially limit the validity of their conclusions.

  12. Medical Management of Tumor Lysis Syndrome, Postprocedural Pain, and Venous Thromboembolism Following Interventional Radiology Procedures

    PubMed Central

    Faramarzalian, Ali; Armitage, Keith B.; Kapoor, Baljendra; Kalva, Sanjeeva P.

    2015-01-01

    The rapid expansion of minimally invasive image-guided procedures has led to their extensive use in the interdisciplinary management of patients with vascular, hepatobiliary, genitourinary, and oncologic diseases. Given the increased availability and breadth of these procedures, it is important for physicians to be aware of common complications and their management. In this article, the authors describe management of select common complications from interventional radiology procedures including tumor lysis syndrome, acute on chronic postprocedural pain, and venous thromboembolism. These complications are discussed in detail and their medical management is outlined according to generally accepted practice and evidence from the literature. PMID:26038627

  13. Interventional radiology fellowship website content: what is the relevance to potential applicants?

    PubMed

    Charalel, Resmi A; Pua, Bradley B; Galla, Naveen; Trehan, Samir K; Madoff, David C

    To assess the accessibility and content of query Interventional Radiology (IR) fellowship program websites and determine the impact of these websites on applicants. All IR fellowship programs were individually evaluated, and all IR fellowship applicants to our institution were surveyed. In 2015, 44.3% of programs had an appropriate functional link to the fellowship website. Most provided a program description and application information. In our survey, applicants reported that website quality was moderately important to their overall impression of a fellowship. The most important aspects were didactics and facilities information. Fellowship website content and quality are important to applicants. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Radiological Risk Assessment for King County Wastewater Treatment Division

    SciTech Connect

    Strom, Daniel J.

    2005-08-05

    Staff of the King County Wastewater Treatment Division (WTD) have concern about the aftermath of a radiological dispersion event (RDE) leading to the introduction of significant quantities of radioactive material into the combined sanitary and storm sewer system in King County, Washington. Radioactive material could come from the use of a radiological dispersion device (RDD). RDDs include "dirty bombs" that are not nuclear detonations but are explosives designed to spread radioactive material (National Council on Radiation Protection and Measurements (NCRP) 2001). Radioactive material also could come from deliberate introduction or dispersion of radioactive material into the environment, including waterways and water supply systems. This document develops plausible and/or likely scenarios, including the identification of likely radioactive materials and quantities of those radioactive materials to be involved. These include 60Co, 90Sr, 137Cs, 192Ir, 226Ra, plutonium, and 241Am. Two broad categories of scenarios are considered. The first category includes events that may be suspected from the outset, such as an explosion of a "dirty bomb" in downtown Seattle. The explosion would most likely be heard, but the type of explosion (e.g., sewer methane gas or RDD) may not be immediately known. Emergency first responders must be able to quickly detect the radioisotopes previously listed, assess the situation, and deploy a response to contain and mitigate (if possible) detrimental effects resulting from the incident. In such scenarios, advance notice of about an hour or two might be available before any contaminated wastewater reaches a treatment plant. The second category includes events that could go initially undetected by emergency personnel. Examples of such a scenario would be the inadvertent or surreptitious introduction of radioactive material into the sewer system. Intact rogue radioactive sources from industrial radiography devices, well-logging apparatus, or

  15. Assessment of the occupational eye lens dose for clinical staff in interventional radiology, cardiology and neuroradiology.

    PubMed

    Omar, Artur; Kadesjö, Nils; Palmgren, Charlotta; Marteinsdottir, Maria; Segerdahl, Tony; Fransson, Annette

    2017-03-20

    In accordance with recommendations by the International Commission on Radiological Protection, the current European Basic Safety Standards has adopted a reduced occupational eye lens dose limit of 20 mSv yr(-1). The radiation safety implications of this dose limit is of concern for clinical staff that work with relatively high dose x-ray angiography and interventional radiology. Presented in this work is a thorough assessment of the occupational eye lens dose based on clinical measurements with active personal dosimeters worn by staff during various types of procedures in interventional radiology, cardiology and neuroradiology. Results are presented in terms of the estimated equivalent eye lens dose for various medical professions. In order to compare the risk of exceeding the regulatory annual eye lens dose limit for the widely different clinical situations investigated in this work, the different medical professions were separated into categories based on their distinct work pattern: staff that work (a) regularly beside the patient, (b) in proximity to the patient and (c) typically at a distance from the patient. The results demonstrate that the risk of exceeding the annual eye lens dose limit is of concern for staff category (a), i.e. mainly the primary radiologist/cardiologist. However, the results also demonstrate that the risk can be greatly mitigated if radiation protection shields are used in the clinical routine. The results presented in this work cover a wide range of clinical situations, and can be used as a first indication of the risk of exceeding the annual eye lens dose limit for staff at other medical centres.

  16. Imaging and radiological interventions in extra-hepatic portal vein obstruction

    PubMed Central

    Pargewar, Sudheer S; Desai, Saloni N; Rajesh, S; Singh, Vaibhav P; Arora, Ankur; Mukund, Amar

    2016-01-01

    Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS. PMID:27358683

  17. Enhancing the case log by coding the level of trainee participation in vascular interventional radiology procedures.

    PubMed

    Thornton, Raymond H; Erinjeri, Joseph P; Brody, Lynn A; Solomon, Stephen B

    2011-06-01

    The purpose of this article is to describe a new method for coding trainee participation in vascular interventional radiology procedures. From July 2008 through June 2009, all interventional radiology fellows maintained an enhanced case log at our institution; 748 unique cases were logged by procedure type, supervising physician, and level of participation in the case. Level of participation was classified on a 5-point scale that included designations for observation, first assistant, performance of basic techniques, performance of advanced techniques, and primary operation. Descriptive statistics of participation scores were calculated for each quarter and were analyzed by procedure type and by teaching faculty member. As expected, analysis by procedure type showed that average participation scores increased from one quarter to the next in most cases. By the fourth quarter, the modal participation score was 5, indicating primary operation or performance of multiple critical steps. Analysis by teaching faculty member revealed three patterns: those attending physicians facilitating increasing levels of participation in every quarter, those facilitating maximal growth within the first 6 months, and those with irregular trainee participation profiles. Data from a 5-point participation scale add information to the procedure case log that could be used to quantitatively track the technical progress of trainees while providing education quality feedback to both teaching physicians and program directors.

  18. Imaging and radiological interventions in extra-hepatic portal vein obstruction.

    PubMed

    Pargewar, Sudheer S; Desai, Saloni N; Rajesh, S; Singh, Vaibhav P; Arora, Ankur; Mukund, Amar

    2016-06-28

    Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.

  19. A multifaceted intervention to improve primary care radiology referral quality and value in Canterbury.

    PubMed

    Holland, Kieran; McGeoch, Graham; Gullery, Carolyn

    2017-04-28

    This article describes a seven-year multifaceted intervention leading to sustained improvement in primary care radiology referral quality and value in Canterbury, New Zealand, and discusses the transferability to other health systems. Access criteria were developed with input from general practitioners and hospital-based specialists, and embedded in locally developed clinical pathways. A referral management service was created to streamline referral processes. Systems were developed to enable electronic referral and triage, and to provide visibility of prior imaging. A team of general practitioners was formed to continually review referrals relative to agreed criteria and to provide advice to referrers. Referring general practitioners were provided data and education about their referral patterns relative to their peers. A clinical audit programme was introduced to ensure quality and safety of care. The service achieved sustained improvements in referral quality (referral acceptance rates increased from 78% to 88%, urgent referrals reduced from 59% to 22%) and value (plain film volumes reduced by 40%). Sustained improvement to primary care radiology referral quality and value is achievable at scale using a multifaceted intervention. The transferability of this outcome is likely to be connected to supporting factors present in the Canterbury health system.

  20. British Society of Interventional Radiology Iliac Artery Angioplasty-Stent Registry III

    SciTech Connect

    Uberoi, Raman Milburn, Simon; Moss, Jon

    2009-09-15

    The objective of this study was to audit current practice in iliac artery intervention in the United Kingdom. In 2001 the British Society of Interventional Radiology Iliac Artery Angioplasty-Stent (BIAS) III registry provided the first national database for iliac intervention. It recommended that data collection needed to continue in order to facilitate the dissemination of comparative data to individual units. BIAS III was designed to continue this work and has a simplified data set with an online submission form. Interventionalists were invited to complete a 3-page tick sheet for all iliac angioplasties and stents. Questions covered risk factors, procedural data, and outcome. Data for 2233 patients were submitted from 37 institutions over a 43-month period. Consultants performed 80% of the procedures, 62% of which were for claudication. Fifty-four percent of lesions were treated with stents and 25% of patients underwent bilateral intervention, resulting in a residual stenosis of <50% in 98%. Ninety-seven percent of procedures had no limb complication and there was a 98% inpatient survival rate. In conclusion, these figures provide an essential benchmark for both audit and patient information. National databases need to be expanded across the range of interventional procedures, and their collection made simple and, preferably, online.

  1. MOrtality and infectious complications of therapeutic EndoVAscular interventional radiology: a systematic and meta-analysis protocol.

    PubMed

    Mellouk Aid, Kaoutar; Tchala Vignon Zomahoun, Hervé; Soulaymani, Abdelmajid; Lebascle, Karin; Silvera, Stephane; Astagneau, Pascal; Misset, Benoit

    2017-04-24

    Endovascular interventional radiology (EIR) is an increasingly popular, mini invasive treatment option for patient with symptomatic vascular disease. The EIR practiced by qualified hands is an effective, well-tolerated procedure that offers relief of patient's symptoms with a low risk of complications. During acute post procedural period, immediate complications may relate to vascular access, restenosis, thromboembolic events, uterine ischemia, infection, necrosis, sepsis, ICU stay, surgical recovery, pain management, treatment failure, and death. Moreover, additional non-life-threatening complications exist, but they are not well described and represent disparate information. A range of databases will be screened consulted to identify the relevant studies: PubMed, EMBASE, The Cochrane Library, NosoBase, and Google Scholar (to identify articles not yet indexed). Scientist librarian used Medical Subject Headings (MeSH) and free terms to construct the search strategy in PubMed. This search strategy will be adapted in other databases. Two coauthors will independently select the relevant studies, extract the relevant data, and assess the risk of bias in the included studies. Any disagreements between the two authors will be solved by a third author. This systematic review will provide a synthesis of EIR complications. The spotlighted results will be analyzed in order to provide a state-of-knowledge synopsis of the current evidence base in relation to the epidemiology of the infectious complications after EIR. In the event of conclusive results, our findings will serve as a reference background to assess guidelines on reality of the problem of the infections linked to endovascular interventional radiology and to formulate of assumptions and propose preventive measures, based on the results of our investigations. These propositions will aim to reduce the risk and/or the severity of these complications in the concerned population in favor a positive medical economics

  2. MCNP simulation of radiation doses distributions in a water phantoms simulating interventional radiology patients

    NASA Astrophysics Data System (ADS)

    He, Wenjun; Mah, Eugene; Huda, Walter; Selby, Bayne; Yao, Hai

    2011-03-01

    Purpose: To investigate the dose distributions in water cylinders simulating patients undergoing Interventional Radiological examinations. Method: The irradiation geometry consisted of an x-ray source, dose-area-product chamber, and image intensifier as currently used in Interventional Radiology. Water cylinders of diameters ranging between 17 and 30 cm were used to simulate patients weighing between 20 and 90 kg. X-ray spectra data with peak x-ray tube voltages ranging from 60 to 120 kV were generated using XCOMP3R. Radiation dose distributions inside the water cylinder (Dw) were obtained using MCNP5. The depth dose distribution along the x-ray beam central axis was normalized to free-in-air air kerma (AK) that is incident on the phantom. Scattered radiation within the water cylinders but outside the directly irradiated region was normalized to the dose at the edge of the radiation field. The total absorbed energy to the directly irradiated volume (Ep) and indirectly irradiated volume (Es) were also determined and investigated as a function of x-ray tube voltage and phantom size. Results: At 80 kV, the average Dw/AK near the x-ray entrance point was 1.3. The ratio of Dw near the entrance point to Dw near the exit point increased from ~ 26 for the 17 cm water cylinder to ~ 290 for the 30 cm water cylinder. At 80 kV, the relative dose for a 17 cm water cylinder fell to 0.1% at 49 cm away from the central ray of the x-ray beam. For a 30 cm water cylinder, the relative dose fell to 0.1% at 53 cm away from the central ray of the x-ray beam. At a fixed x-ray tube voltage of 80 kV, increasing the water cylinder diameter from 17 to 30 cm increased the Es/(Ep+Es) ratio by about 50%. At a fixed water cylinder diameter of 24 cm, increasing the tube voltage from 60 kV to 120 kV increased the Es/(Ep+Es) ratio by about 12%. The absorbed energy from scattered radiation was between 20-30% of the total energy absorbed by the water cylinder, and was affected more by patient size

  3. The insertion of chronic indwelling central venous catheters (Hickman lines) in interventional radiology suites.

    PubMed

    Page, A C; Evans, R A; Kaczmarski, R; Mufti, G J; Gishen, P

    1990-08-01

    The insertion of Hickman central venous catheters for chronic venous access is a procedure usually conducted in the operating theatre under local or general anaesthesia. In a prospective study over a one year period we have assessed the feasibility of radiologists inserting central venous catheters for long term access. A subclavicular approach to the subclavian vein with prior digital subtraction angiography or video imaging of the vein was the technique of choice. Thirty-one Hickman catheters were inserted in 21 patients. All but two patients had a haematological malignancy. Ages ranged from 19 to 77 years. The mean time for insertion was 43 min (range 20-80 min). The catheters remained in situ for between 2 days and 242 days with a mean of 86 days. There was one documented line infection; nine patients had episodes of septicaemia with identified organisms, and a further six had pyrexias of unknown origin during the line indwelling period. There were four documented line and or ipsilateral subclavian vein thromboses, and one death occurred within 36 hours of the procedure. We conclude that radiological placement is an excellent alternative to 'blind' surgical placement. Screening during insertion provides immediate facilities for correction of malposition and monitoring of immediate complications. The time taken for catheter insertion did not impede the usual patient throughout in the interventional radiology suite.

  4. Transition in occupational radiation exposure monitoring methods in diagnostic and interventional radiology.

    PubMed

    Lönnroth, Nadja; Hirvonen-Kari, Mirja; Timonen, Marjut; Savolainen, Sauli; Kortesniemi, Mika

    2012-08-01

    Radiation exposure monitoring is a traditional keystone of occupational radiation safety measures in medical imaging. The aim of this study was to review the data on occupational exposures in a large central university hospital radiology organisation and propose changes in the radiation worker categories and methods of exposure monitoring. An additional objective was to evaluate the development of electronic personal dosimeters and their potential in the digitised radiology environment. The personal equivalent dose of 267 radiation workers (116 radiologists and 151 radiographers) was monitored using personal dosimeters during the years 2006-2010. Accumulated exposure monitoring results exceeding the registration threshold were observed in the personal dosimeters of 73 workers (59 radiologists' doses ranged from 0.1 to 45.1 mSv; 14 radiographers' doses ranged from 0.1 to 1.3 mSv). The accumulated personal equivalent doses are generally very small, only a few angiography radiologists have doses >10 mSv per 5 y. The typical effective doses are <10 µSv y(-1) and the highest value was 0.3 mSv (single interventional radiologist). A revised categorisation of radiation workers based on the working profile of the radiologist and observed accumulated doses is justified. Occupational monitoring can be implemented mostly with group dosimeters. An active real-time dosimetry system is warranted to support radiation protection strategy where optimisation aspects, including improving working methods, are essential.

  5. Physics-based virtual environment for training core skills in vascular interventional radiological procedures.

    PubMed

    John, N W; Luboz, V; Bello, F; Hughes, C; Vidal, F; Lim, I S; How, T V; Zhai, J; Johnson, S; Chalmers, N; Brodlie, K; Bulpitt, A; Song, Y; Kessel, D O; Phillips, R; Ward, J W; Pisharody, S; Zhang, Y; Crawshaw, C M; Gould, D A

    2008-01-01

    Recent years have seen a significant increase in the use of Interventional Radiology (IR) as an alternative to open surgery. A large number of IR procedures commences with needle puncture of a vessel to insert guidewires and catheters: these clinical skills are acquired by all radiologists during training on patients, associated with some discomfort and occasionally, complications. While some visual skills can be acquired using models such as the ones used in surgery, these have limitations for IR which relies heavily on a sense of touch. Both patients and trainees would benefit from a virtual environment (VE) conveying touch sensation to realistically mimic procedures. The authors are developing a high fidelity VE providing a validated alternative to the traditional apprenticeship model used for teaching the core skills. The current version of the CRaIVE simulator combines home made software, haptic devices and commercial equipments.

  6. Criteria to optimise a dynamic flat detector system used for interventional radiology.

    PubMed

    Simon, R; Vano, E; Prieto, C; Fernandez, J M; Ordiales, J M; Martinez, D

    2008-01-01

    An analysis of the relationship between image quality and incident air kerma has been carried out for a dynamic flat detector X-ray system used for interventional radiology. A phantom of polymethyl methacrylate (PMMA) to simulate patients and two different image test objects, Leeds TOR 18FG and NEMA XR 21, were used to evaluate the quality of the obtained images. Measurements were made simulating clinical configuration with different PMMA thicknesses (16, 20, 24 and 28 cm), available fields of view of 22, 31, 42 and 48 cm (diagonal dimension), in the three default fluoroscopy modes and in one of the most used digital subtraction angiography image acquisition modes. The obtained results are being used to help in the optimisation of clinical procedures.

  7. StarClose Vascular Closure Device: Prospective Study on 222 Deployments in an Interventional Radiology Practice

    SciTech Connect

    Imam, Atique; Carter, Ranjana M. S. Phillips-Hughes, Jane; Boardman, Philip; Uberoi, Raman

    2007-07-15

    The StarClose device (Abbott Vascular Devices; Abbott Laboratories, Redwood City, CA) utilizes an externally placed Nitinol clip to achieve arterial closure following femoral artery puncture. The objectives of this study were to assess the efficacy and complications of the StarClose device in patients undergoing interventional radiological procedures. Preprocedural clotting status, pulse and blood pressure, severity of vessel calcification, sheath size, and time to deployment were recorded. Postdeployment complications immediately postprocedure, at 1 h, at 2 h, and at 1 week were recorded. A duplex scan was performed in the first 10 patients to assess any immediate vascular complications. Deployments were successful in 96% achieving immediate hemostasis. Mean deployment time was 48 s. There were no major complications. The StarClose device was found to have a high technical and clinical efficacy.

  8. Characterization of workplaces in interventional radiology using active dosemeters ALARA OD.

    PubMed

    Prlić, I; Surić-Mihić, M; Milković-Kraus, S; Mestrović, T; Vrtar, M

    2007-01-01

    Because of progressive development and extended use of interventional radiology (IR) procedures it is highly recommended that all individuals involved in the process should be aware of the potential for both stochastic and deterministic effects due to occupational exposure. IR procedures are performed in such a manner that certain number of medical staff are always needed near the patient, near the X-ray unit. The new challenge to regular radiation protection is to ensure 'safe' working environment in such radiation X-ray field geometry. In this work the patient is physically regarded as a secondary radiation source emitting scattered X-rays. Passive dosemeters will give us clear data only about the monthly integrated occupational dose; there is concern over the frequency and duration, actual pattern of receiving this dose. We have developed active electronic dosemeter (AED) device, which provides additional dosimetry data about the frequency and duration of professional low level X-ray exposure burden.

  9. Development of an ATM-based radiology consultation workstation for radiotherapy treatment planning

    NASA Astrophysics Data System (ADS)

    Kempner, Kenneth M.; Chow, David; Choyke, Peter L.; Cox, Jerome R., Jr.; Elson, Jeremy E.; Johnson, Calvin A.; Okunieff, Paul; Ostrow, Harold; Pfeifer, John C.; Martino, Robert L.

    1997-05-01

    The radiology consultation workstation is a multimedia, medical imaging workstation being developed for use in an electronic radiology environment, utilizing a prototype asynchronous transfer mode telemedicine network, in support of radiotherapy treatment planning. A radiation oncologist in the radiation oncology department, and a radiologist in the Diagnostic Radiology Department, will be able to consult, utilizing high-quality audio/video channels and high-resolution medical image displays, prior to the design of a treatment plan. Organ and lesion contouring is performed via a shared-cursor feature, in a consultation mode, allowing medical specialists to fully interact during the identification and delineation of lesions and other features.

  10. Characterization of a MOSkin detector for in vivo skin dose measurements during interventional radiology procedures

    SciTech Connect

    Safari, M. J.; Wong, J. H. D.; Ng, K. H.; Jong, W. L.; Cutajar, D. L.; Rosenfeld, A. B.

    2015-05-15

    Purpose: The MOSkin is a MOSFET detector designed especially for skin dose measurements. This detector has been characterized for various factors affecting its response for megavoltage photon beams and has been used for patient dose measurements during radiotherapy procedures. However, the characteristics of this detector in kilovoltage photon beams and low dose ranges have not been studied. The purpose of this study was to characterize the MOSkin detector to determine its suitability for in vivo entrance skin dose measurements during interventional radiology procedures. Methods: The calibration and reproducibility of the MOSkin detector and its dependency on different radiation beam qualities were carried out using RQR standard radiation qualities in free-in-air geometry. Studies of the other characterization parameters, such as the dose linearity and dependency on exposure angle, field size, frame rate, depth-dose, and source-to-surface distance (SSD), were carried out using a solid water phantom under a clinical x-ray unit. Results: The MOSkin detector showed good reproducibility (94%) and dose linearity (99%) for the dose range of 2 to 213 cGy. The sensitivity did not significantly change with the variation of SSD (±1%), field size (±1%), frame rate (±3%), or beam energy (±5%). The detector angular dependence was within ±5% over 360° and the dose recorded by the MOSkin detector in different depths of a solid water phantom was in good agreement with the Markus parallel plate ionization chamber to within ±3%. Conclusions: The MOSkin detector proved to be reliable when exposed to different field sizes, SSDs, depths in solid water, dose rates, frame rates, and radiation incident angles within a clinical x-ray beam. The MOSkin detector with water equivalent depth equal to 0.07 mm is a suitable detector for in vivo skin dosimetry during interventional radiology procedures.

  11. The novel application of Benford's second order analysis for monitoring radiation output in interventional radiology.

    PubMed

    Cournane, S; Sheehy, N; Cooke, J

    2014-06-01

    Benford's law is an empirical observation which predicts the expected frequency of digits in naturally occurring datasets spanning multiple orders of magnitude, with the law having been most successfully applied as an audit tool in accountancy. This study investigated the sensitivity of the technique in identifying system output changes using simulated changes in interventional radiology Dose-Area-Product (DAP) data, with any deviations from Benford's distribution identified using z-statistics. The radiation output for interventional radiology X-ray equipment is monitored annually during quality control testing; however, for a considerable portion of the year an increased output of the system, potentially caused by engineering adjustments or spontaneous system faults may go unnoticed, leading to a potential increase in the radiation dose to patients. In normal operation recorded examination radiation outputs vary over multiple orders of magnitude rendering the application of normal statistics ineffective for detecting systematic changes in the output. In this work, the annual DAP datasets complied with Benford's first order law for first, second and combinations of the first and second digits. Further, a continuous 'rolling' second order technique was devised for trending simulated changes over shorter timescales. This distribution analysis, the first employment of the method for radiation output trending, detected significant changes simulated on the original data, proving the technique useful in this case. The potential is demonstrated for implementation of this novel analysis for monitoring and identifying change in suitable datasets for the purpose of system process control. Copyright © 2013 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  12. Touchless interaction with software in interventional radiology and surgery: a systematic literature review.

    PubMed

    Mewes, André; Hensen, Bennet; Wacker, Frank; Hansen, Christian

    2017-02-01

    In this article, we systematically examine the current state of research of systems that focus on touchless human-computer interaction in operating rooms and interventional radiology suites. We further discuss the drawbacks of current solutions and underline promising technologies for future development. A systematic literature search of scientific papers that deal with touchless control of medical software in the immediate environment of the operation room and interventional radiology suite was performed. This includes methods for touchless gesture interaction, voice control and eye tracking. Fifty-five research papers were identified and analyzed in detail including 33 journal publications. Most of the identified literature (62 %) deals with the control of medical image viewers. The others present interaction techniques for laparoscopic assistance (13 %), telerobotic assistance and operating room control (9 % each) as well as for robotic operating room assistance and intraoperative registration (3.5 % each). Only 8 systems (14.5 %) were tested in a real clinical environment, and 7 (12.7 %) were not evaluated at all. In the last 10 years, many advancements have led to robust touchless interaction approaches. However, only a few have been systematically evaluated in real operating room settings. Further research is required to cope with current limitations of touchless software interfaces in clinical environments. The main challenges for future research are the improvement and evaluation of usability and intuitiveness of touchless human-computer interaction and the full integration into productive systems as well as the reduction of necessary interaction steps and further development of hands-free interaction.

  13. Lean manufacturing and Toyota Production System terminology applied to the procurement of vascular stents in interventional radiology.

    PubMed

    de Bucourt, Maximilian; Busse, Reinhard; Güttler, Felix; Wintzer, Christian; Collettini, Federico; Kloeters, Christian; Hamm, Bernd; Teichgräber, Ulf K

    2011-08-01

    OBJECTIVES: To apply the economic terminology of lean manufacturing and the Toyota Production System to the procurement of vascular stents in interventional radiology. METHODS: The economic- and process-driven terminology of lean manufacturing and the Toyota Production System is first presented, including information and product flow as well as value stream mapping (VSM), and then applied to an interdisciplinary setting of physicians, nurses and technicians from different medical departments to identify wastes in the process of endovascular stent procurement in interventional radiology. RESULTS: Using the so-called seven wastes approach of the Toyota Production System (waste of overproducing, waiting, transport, processing, inventory, motion and waste of defects and spoilage) as well as further waste characteristics (gross waste, process and method waste, and micro waste), wastes in the process of endovascular stent procurement in interventional radiology were identified and eliminated to create an overall smoother process from the procurement as well as from the medical perspective. CONCLUSION: Economic terminology of lean manufacturing and the Toyota Production System, especially VSM, can be used to visualise and better understand processes in the procurement of vascular stents in interventional radiology from an economic point of view.

  14. The Effect of Realtime Monitoring on Dose Exposure to Staff Within an Interventional Radiology Setting

    SciTech Connect

    Baumann, Frederic Katzen, Barry T.; Carelsen, Bart; Diehm, Nicolas; Benenati, James F.; Peña, Constantino S.

    2015-10-15

    PurposeThe purpose of this study is to evaluate a new device providing real-time monitoring on radiation exposure during fluoroscopy procedures intending to reduce radiation in an interventional radiology setting.Materials and MethodsIn one interventional suite, a new system providing a real-time radiation dose display and five individual wireless dosimeters were installed. The five dosimeters were worn by the attending, fellow, nurse, technician, and anesthesiologist for every procedure taking place in that suite. During the first 6-week interval the dose display was off (closed phase) and activated thereafter, for a 6-week learning phase (learning phase) and a 10-week open phase (open phase). During these phases, the staff dose and the individual dose for each procedure were recorded from the wireless dosimeter and correlated with the fluoroscopy time. Further subanalysis for dose exposure included diagnostic versus interventional as well as short (<10 min) versus long (>10 min) procedures.ResultsA total of 252 procedures were performed (n = 88 closed phase, n = 50 learning phase, n = 114 open phase). The overall mean staff dose per fluoroscopic minute was 42.79 versus 19.81 µSv/min (p < 0.05) comparing the closed and open phase. Thereby, anesthesiologists were the only individuals attaining a significant dose reduction during open phase 16.9 versus 8.86 µSv/min (p < 0.05). Furthermore, a significant reduction of total staff dose was observed for short 51 % and interventional procedures 45 % (p < 0.05, for both).ConclusionA real-time qualitative display of radiation exposure may reduce team radiation dose. The process may take a few weeks during the learning phase but appears sustained, thereafter.

  15. WE-EF-BRD-04: MR in the OR: The Growth and Applications of MRI for Interventional Radiology and Surgery

    SciTech Connect

    Fahrig, R.

    2015-06-15

    MRI-guided treatment is a growing area of medicine, particularly in radiotherapy and surgery. The exquisite soft tissue anatomic contrast offered by MRI, along with functional imaging, makes the use of MRI during therapeutic procedures very attractive. Challenging the utility of MRI in the therapy room are many issues including the physics of MRI and the impact on the environment and therapeutic instruments, the impact of the room and instruments on the MRI; safety, space, design and cost. In this session, the applications and challenges of MRI-guided treatment will be described. The session format is: Past, present and future: MRI-guided radiotherapy from 2005 to 2025: Jan Lagendijk Battling Maxwell’s equations: Physics challenges and solutions for hybrid MRI systems: Paul Keall I want it now!: Advances in MRI acquisition, reconstruction and the use of priors to enable fast anatomic and physiologic imaging to inform guidance and adaptation decisions: Yanle Hu MR in the OR: The growth and applications of MRI for interventional radiology and surgery: Rebecca Fahrig Learning Objectives: To understand the history and trajectory of MRI-guided radiotherapy To understand the challenges of integrating MR imaging systems with linear accelerators To understand the latest in fast MRI methods to enable the visualisation of anatomy and physiology on radiotherapy treatment timescales To understand the growing role and challenges of MRI for image-guided surgical procedures My disclosures are publicly available and updated at: http://sydney.edu.au/medicine/radiation-physics/about-us/disclosures.php.

  16. Applying a structured innovation process to interventional radiology: a single-center experience.

    PubMed

    Sista, Akhilesh K; Hwang, Gloria L; Hovsepian, David M; Sze, Daniel Y; Kuo, William T; Kothary, Nishita; Louie, John D; Yamada, Kei; Hong, Richard; Dhanani, Riaz; Brinton, Todd J; Krummel, Thomas M; Makower, Joshua; Yock, Paul G; Hofmann, Lawrence V

    2012-04-01

    To determine the feasibility and efficacy of applying an established innovation process to an active academic interventional radiology (IR) practice. The Stanford Biodesign Medical Technology Innovation Process was used as the innovation template. Over a 4-month period, seven IR faculty and four IR fellow physicians recorded observations. These observations were converted into need statements. One particular need relating to gastrostomy tubes was diligently screened and was the subject of a single formal brainstorming session. Investigators collected 82 observations, 34 by faculty and 48 by fellows. The categories that generated the most observations were enteral feeding (n = 9, 11%), biopsy (n = 8, 10%), chest tubes (n = 6, 7%), chemoembolization and radioembolization (n = 6, 7%), and biliary interventions (n = 5, 6%). The output from the screening on the gastrostomy tube need was a specification sheet that served as a guidance document for the subsequent brainstorming session. The brainstorming session produced 10 concepts under three separate categories. This formalized innovation process generated numerous observations and ultimately 10 concepts to potentially to solve a significant clinical need, suggesting that a structured process can help guide an IR practice interested in medical innovation. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  17. A method to reduce patient's eye lens dose in neuro-interventional radiology procedures

    NASA Astrophysics Data System (ADS)

    Safari, M. J.; Wong, J. H. D.; Kadir, K. A. A.; Sani, F. M.; Ng, K. H.

    2016-08-01

    Complex and prolonged neuro-interventional radiology procedures using the biplane angiography system increase the patient's risk of radiation-induced cataract. Physical collimation is the most effective way of reducing the radiation dose to the patient's eye lens, but in instances where collimation is not possible, an attenuator may be useful in protecting the eyes. In this study, an eye lens protector was designed and fabricated to reduce the radiation dose to the patients' eye lens during neuro-interventional procedures. The eye protector was characterised before being tested on its effectiveness in a simulated aneurysm procedure on an anthropomorphic phantom. Effects on the automatic dose rate control (ADRC) and image quality are also evaluated. The eye protector reduced the radiation dose by up to 62.1% at the eye lens. The eye protector is faintly visible in the fluoroscopy images and increased the tube current by a maximum of 3.7%. It is completely invisible in the acquisition mode and does not interfere with the clinical procedure. The eye protector placed within the radiation field of view was able to reduce the radiation dose to the eye lens by direct radiation beam of the lateral x-ray tube with minimal effect on the ADRC system.

  18. Eye dosimetry in interventional radiology and cardiology: current challenges and practical considerations.

    PubMed

    Ciraj-Bjelac, O; Rehani, M M

    2014-12-01

    Interventional radiology and cardiology are areas with high potential for risk to eye lens. Accurate assessment of eye dose is one of the most important aspects of correlating doses with observed lens opacities among workers in interventional suites and ascertaining compliance with regulatory limits. The purpose of this paper is to review current approaches and opportunities in eye dosimetry and assess challenges in particular in accuracy and practicality. The possible approaches include practical dosimetry using passive dosemeters or active dosemeters with obvious advantage of active dosimetry. When neither of these is available, other approaches are based on either retrospective dose assessment using scatter radiation dose levels or correlations between patient dose indices and eye doses to the operators. In spite of all uncertainties and variations, estimation of eye dose from patient dose can be accepted as a compromise. Future challenges include development of practical methods for regular monitoring of individual eye doses and development of better techniques to estimate eye dose from measurements at some reference points.

  19. Assessment of eye lens doses for workers during interventional radiology procedures.

    PubMed

    Urboniene, A; Sadzeviciene, E; Ziliukas, J

    2015-07-01

    The assessment of eye lens doses for workers during interventional radiology (IR) procedures was performed using a new eye lens dosemeter. In parallel, the results of routine individual monitoring were analysed and compared with the results obtained from measurements with a new eye lens dosemeter. The eye lens doses were assessed using Hp(3) measured at the level of the eyes and were compared with Hp(10) measured with the whole-body dosemeter above the lead collar. The information about use of protective measures, the number of performed interventional procedures per month and their fluoroscopy time was also collected. The assessment of doses to the lens of the eye was done for 50 IR workers at 9 Lithuanian hospitals for the period of 2012-2013. If the use of lead glasses is not taken into account, the estimated maximum annual dose equivalent to the lens of the eye was 82 mSv. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Effect of real-time radiation dose feedback on pediatric interventional radiology staff radiation exposure.

    PubMed

    Racadio, John; Nachabe, Rami; Carelsen, Bart; Racadio, Judy; Hilvert, Nicole; Johnson, Neil; Kukreja, Kamlesh; Patel, Manish

    2014-01-01

    To measure and compare individual staff radiation dose levels during interventional radiologic (IR) procedures with and without real-time feedback to evaluate whether it has any impact on staff radiation dose. A prospective trial was performed in which individuals filling five different staff roles wore radiation dosimeters during all IR procedures during two phases: a 12-week "closed" phase (measurements recorded but display was off, so no feedback was provided) and a 17-week "open" phase (display was on and provided real-time feedback). Radiation dose rates were recorded and compared by Mann-Whitney U test. There was no significant difference in median procedure time, fluoroscopy time, or patient dose (dose-area product normalized to fluoroscopy time) between the two phases. Overall, the median staff dose was lower in the open phase (0.56 µSv/min of fluoroscopy time) than in the closed phase (3.01 µSv/min; P < .05). The IR attending physician dose decreased significantly for procedures for which the physicians were close to the patient, but not for ones for which they were far away. A radiation dose monitoring system that provides real-time feedback to the interventional staff can significantly reduce radiation exposure to the primary operator, most likely by increasing staff compliance with use of radiation protection equipment and dose reduction techniques. Copyright © 2014. Published by Elsevier Inc.

  1. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 1: Patient Assessment and Laboratory Tests)

    SciTech Connect

    Taslakian, Bedros; Sebaaly, Mikhael Georges Al-Kutoubi, Aghiad

    2016-03-15

    Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care after the procedure is completed. After patient referral, contact with the referring physician and multidisciplinary team approach is vital. In addition, clinical history, physical examination, as well as full understanding of the pre-procedural laboratory results and imaging findings can guide the interventional radiologist to implement the most appropriate management plan, avoid unnecessary procedures, and prevent complications to achieve a successful outcome. We provide a comprehensive, methodical review of pre-procedural care and management in patients undergoing vascular and interventional radiology procedures.

  2. Role of Interventional Radiology in the Emergent Management of Acute Upper Gastrointestinal Bleeding

    PubMed Central

    Navuluri, Rakesh; Patel, Jay; Kang, Lisa

    2012-01-01

    Approximately 100,000 cases of upper gastrointestinal bleeding (UGIB) require inpatient admission annually in the United States. When medical management and endoscopic therapy are inadequate, endovascular intervention can be lifesaving. These emergent situations highlight the importance of immediate competence of the interventional radiologist in the preangiographic evaluation as well as the endovascular treatment of UGIB. We describe a case of UGIB managed with endovascular embolization and detail the angiographic techniques used. The case description is followed by a detailed discussion of the treatment approach to UGIB, with attention to both nonvariceal and variceal algorithms. PMID:23997408

  3. The Role of Interventional Radiology in the Management of Abdominal Visceral Artery Aneurysms

    SciTech Connect

    Belli, Anna-Maria Markose, George; Morgan, Robert

    2012-04-15

    Abdominal visceral artery aneurysms (VAA) include true and false aneurysms. The majority are asymptomatic and are discovered on cross-sectional imaging performed for unrelated clinical indications. With the maturation of techniques and devices used for embolization procedures and the treatment of aneurysms in other locations, most VAAs are now suitable for treatment by minimally invasive transcatheter techniques. The choice of technique used greatly depends on the local anatomy of the VAA and the experience of the interventional radiologist in complex vascular interventional techniques.

  4. Clinical Efficacy, Safety, and Feasibility of Using Video Glasses during Interventional Radiologic Procedures: A Randomized Trial.

    PubMed

    Fang, Adam S; Movva, Lalita; Ahmed, Shah; Waldman, David; Xue, Jingbing

    2016-02-01

    To evaluate the clinical efficacy, safety, and feasibility of implementing video glasses in a variety of interventional radiologic (IR) procedures. Between August 2012 and August 2013, 83 patients undergoing outpatient IR procedures were randomized to a control group (n = 44) or an experimental group outfitted with video glasses (n = 39). State-Trait Anxiety Inventory (STAI) scores, sedation and analgesia doses, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pain scores, and procedure times were obtained. Complications and adverse events related to the use of video glasses were recorded. Postprocedural staff surveys and patient satisfaction surveys were completed. Women had greater preprocedural anxiety than men (P = .0056), and patients undergoing vascular interventions had greater preprocedural anxiety than those undergoing nonvascular interventions (P = .0396). When assessed after the procedure, patients who wore video glasses had significantly reduced levels of anxiety (-7.7 vs -4.4, respectively; P = .0335) and average MAP (-6.3 vs 2.1, respectively; P = .0486) compared with control patients. There was no significant difference in amount of sedation and analgesia, HR, RR, pain score, or procedure time between groups. No significant adverse events related to the use of video glasses were observed. Postprocedural surveys showed that video glasses were not distracting and did not interfere or pose a safety issue during procedures. Patients enjoyed using the video glasses and would use them again for a future procedure. Video glasses can be safely implemented during IR procedures to reduce anxiety and improve a patient's overall experience. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  5. Occupational radiation dose to eyes from interventional radiology procedures in light of the new eye lens dose limit from the International Commission on Radiological Protection.

    PubMed

    O'Connor, U; Walsh, C; Gallagher, A; Dowling, A; Guiney, M; Ryan, J M; McEniff, N; O'Reilly, G

    2015-05-01

    In 2011, the International Commission on Radiological Protection (ICRP) recommended a substantial reduction in the equivalent dose limit for the lens of the eye, in line with a reduced threshold of absorbed dose for radiation-induced cataracts. This is of particular relevance in interventional radiology (IR) where it is well established that staff doses can be significant, however, there is a lack of data on IR eye doses in terms of Hp(3). Hp(3) is the personal dose equivalent at a depth of 3 mm in soft tissue and is used for measuring lens dose. We aimed to obtain a reliable estimate of eye dose to IR operators. Lens doses were measured for four interventional radiologists over a 3-month period using dosemeters specifically designed to measure Hp(3). Based on their typical workloads, two of the four interventional radiologists would exceed the new ICRP dose limit with annual estimated doses of 31 and 45 mSv to their left eye. These results are for an "unprotected" eye, and for IR staff who routinely wear lead glasses, the dose beneath the glasses is likely to be significantly lower. Staff eye dose normalized to patient kerma-area product and eye dose per procedure have been included in the analysis. Eye doses to IR operators have been established using a dedicated Hp(3) dosemeter. Estimated annual doses have the potential to exceed the new ICRP limit. We have estimated lens dose to interventional radiologists in terms of Hp(3) for the first time in an Irish hospital setting.

  6. Exposures in interventional radiology using Monte Carlo simulation coupled with virtual anthropomorphic phantoms.

    PubMed

    Santos, William S; Neves, Lucio P; Perini, Ana P; Belinato, Walmir; Caldas, Linda V E; Carvalho, Albérico B; Maia, Ana F

    2015-12-01

    In this work we investigated the way in which conversion coefficients from air kerma-area product for effective doses (CCE) and entrance skin doses (CCESD) in interventional radiology (IR) are affected by variations in the filtration, projection angle of the X-ray beam, lead curtain attached to the surgical table, and suspended shield lead glass in regular conditions of medical practice. Computer simulations were used to model an exposure scenario similar to a real IR room. The patient and the physician were represented by MASH virtual anthropomorphic phantoms, inserted in the MCNPX 2.7.0 radiation transport code. In all cases, the addition of copper filtration also increased the CCE and CCESD values. The highest CCE values were obtained for lateral, cranial and caudal projections. In these projections, the X-ray tube was located above the table, and more scattered radiation reached the middle and upper portions of the physician trunk, where most of the radiosensitive organs are located. Another important result of this study was to show that the physician's protection is 358% higher when the lead curtain and suspended shield lead glasses are used. The values of CCE and CCESD, presented in this study, are an important resource for calculation of effective doses and entrance skin doses in clinical practice.

  7. Using the Monte Carlo technique to calculate dose conversion coefficients for medical professionals in interventional radiology

    NASA Astrophysics Data System (ADS)

    Santos, W. S.; Carvalho, A. B., Jr.; Hunt, J. G.; Maia, A. F.

    2014-02-01

    The objective of this study was to estimate doses in the physician and the nurse assistant at different positions during interventional radiology procedures. In this study, effective doses obtained for the physician and at points occupied by other workers were normalised by air kerma-area product (KAP). The simulations were performed for two X-ray spectra (70 kVp and 87 kVp) using the radiation transport code MCNPX (version 2.7.0), and a pair of anthropomorphic voxel phantoms (MASH/FASH) used to represent both the patient and the medical professional at positions from 7 cm to 47 cm from the patient. The X-ray tube was represented by a point source positioned in the anterior posterior (AP) and posterior anterior (PA) projections. The CC can be useful to calculate effective doses, which in turn are related to stochastic effects. With the knowledge of the values of CCs and KAP measured in an X-ray equipment, at a similar exposure, medical professionals will be able to know their own effective dose.

  8. Radiation effects in interventional radiology using biological and physical dosimetry methods: a case-control study.

    PubMed

    Ramos, Miguel; Montoro, Alegria; Almonacid, Miguel; Ferrer, Silvia; Barquinero, Joan Francesc; Tortosa, Ricardo; Verdú, Gumersindo; Rodríguez, Pilar; Barrios, Lleonard; Villaescusa, Juan Ignacio

    2008-01-01

    Interventional radiologists and staff members are frequently exposed to protracted and fractionated low doses of ionizing radiation, which extend during all their professional activities. These exposures can derive, due to the irradiation of skin tissues and peripheral blood, in deterministic effects (radiodermitis, aged skin, hands depilation) or stochastic ones (skin and non-solid cancers incidence). Epidemiological studies of population exposed to ionizing radiation provide information of radio-induced effects. The radiation risk or radiological detriment has been estimated from a group of six exposed interventionist radiologists of the Hospital La Fe (Valencia, Spain). Dosimetry has been periodically registered from TLDs and wrist dosimeters (physical methods) and estimated through translocations in lymphocytes of peripheral blood (biological methods), by extrapolating the yield of translocations to their respective dose-effect curves. The probability of non-melanoma skin cancer and leukaemia (acute myelogenous, acute lymphocytic and chronic myelogenous leukaemia) incidence has been estimated through the software RADRISK. This software is based on a transport model from epidemiological studies of population exposed to external low-LET ionizing radiation [1]. Other non-solid carcinomas have not been considered due to their low statistical power, such as myeloid and non-Hodgkin lymphomas. The discrepancies observed between the physically recorded doses and biological estimated doses could indicate that exposed workers did not always wear their dosimeters or these dosimeters were not always exposed to the radiation field.

  9. Monte Carlo calculations on extremity and eye lens dosimetry for medical staff at interventional radiology procedures.

    PubMed

    Carinou, E; Ferrari, P; Koukorava, C; Krim, S; Struelens, L

    2011-03-01

    There are many factors that can influence the extremity and eye lens doses of the medical staff during interventional radiology and cardiology procedures. Numerical simulations can play an important role in evaluating extremity and eye lens doses in correlation with many different parameters. In the present study, the first results of the ORAMED (Optimisation of Radiation protection of MEDical staff) simulation campaign are presented. The parameters investigated for their influence on eye lens, hand, wrist and leg doses are: tube voltage, filtration, beam projection, field size and irradiated part of the patient's body. The tube voltage ranged from 60 to 110 kV(p), filtration from 3 to 6 mm Al and from 0 to 0.9 mm Cu. For all projections, the results showed that doses received by the operator decreased with increasing tube voltage and filtration. The magnitude of the influence of the tube voltage and the filtration on the doses depends on the beam projection and the irradiated part of the patient's body. Finally, the influence of the field size is significant in decreasing the doses.

  10. British Society of Interventional Radiology: Biliary Drainage and Stenting Registry (BDSR)

    SciTech Connect

    Uberoi, R. Das, N.; Moss, J.; Robertson, I.

    2012-02-15

    Objectives: This study was designed to audit current practice in percutaneous biliary drainage and stenting in the United Kingdom. Methods: In 2006, the British Society of Interventional Radiology set up the first web-based Biliary Drainage and Stenting Registry (BDSR). This consisted of a series of tick sheets, which were completed online. Data collection included technical and clinical success of the procedures and outcomes at discharge with a separate form for any follow-up visits. Two months before data analysis, all contributors were asked via email to complete any outstanding data. This paper reports on data collected between November 1, 2006 and August 18, 2009. Results: A total of 833 procedures were recorded and were entered by 62 operators from 44 institutions within the United Kingdom. There were 455 men and 378 women with a median age of 69 (range 20-101) years.The majority of procedures were performed by a consultant. Successful drainage of the biliary tree was achieved in 98.7%. Partial or complete relief of symptoms was seen in 65% of patients. Minor complications, predominantly pain (14.3%), were seen in 26% and major complications, predominantly sepsis (3.5%), were seen in 7.9% of patients. Conclusions: These figures provide an essential benchmark for both audit and patient information. Identifying areas of good practice and those that require improvement will ultimately result in better patient care.

  11. [Estimation of personal dose based on the dependent calibration of personal dosimeters in interventional radiology].

    PubMed

    Mori, Hiroshige; Koshida, Kichiro; Ichikawa, Katsuhiro

    2007-08-20

    The purpose of present study is, in interventional radiology (IVR), to elucidate the differences between each personal dosimeter, and the dependences and calibrations of area or personal dose by measurement with electronic dosimeters in particular. We compare space dose rate distributions measured by an ionization survey meter with the value measured by personal dosimeter: an optically stimulated luminescence, two fluoroglass, and two electronic dosimeters. Furthermore, with electronic dosimeters, we first measured dose rate, energy, and directional dependences. Secondly, we calibrated the dose rate measured by electronic dosimeters with the results, and estimated these methods with coefficient of determination and Akaike's Information Criterion (AIC). The results, especially in electronic dosimeters, revealed that the dose rate measured fell by energy and directional dependences. In terms of methods of calibration, the method is sufficient for energy dependence, but not for directional dependence, because of the lack of stable calibration. This improvement poses a question for the future. The study suggested that these dependences of the personal dosimeter must be considered when area or personal dose is estimated in IVR.

  12. A structured light system to guide percutaneous punctures in interventional radiology

    NASA Astrophysics Data System (ADS)

    Nicolau, S. A.; Brenot, J.; Goffin, L.; Graebling, P.; Soler, L.; Marescaux, J.

    2008-04-01

    Interventional radiology is a new medical field which allows percutaneous punctures on patients for tumoral destruction or tissue analysis. The patient lies on a CT or MRI table and the practitioner guides the needle insertion iteratively using repetitive acquisitions (2D slices). We aim at designing a guidance system to reduce the number of CT/MRI acquisitions, and therefore decrease the irradiation and shorten the duration of intervention. We propose a system composed of two calibrated cameras and a structured light videoprojector. The cameras track at 15Hz the needle manipulated by the practitioner and a software displays the needle position with respect to a preoperative segmented image of the patient. To register the preoperative image in the camera frame, we firstly reconstruct the patient skin in 3D using the structured light. Then, the surfacic registration between the reconstructed skin and the segmented skin from the preoperative image is performed using the Iterative Closest Point (ICP) algorithm. Ensuring the quality of this registration is the most challenging task of the system. Indeed, a surfacic registration cannot correctly converge if the surfaces to be registered are too smooth. The main contribution of our work is the evaluation on patients of the conditions that can ensure a correct registration of the preoperative skin surface with the reconstructed one. Furthermore, in case of unfavourable conditions, we propose a method to create enough singularities on the patient abdomen so that the convergence is guaranteed. In the coming months, we plan to evaluate the full system during standard needle insertion on patients.

  13. Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures.

    PubMed

    Erden, I Aydin; Pamuk, A Gulsun; Akinci, Seda B; Koseoglu, Ayhan; Aypar, Ulku

    2009-05-01

    With an increase in the frequency of interventional radiology procedures in pediatrics, there has been a corresponding increase in demand for procedural sedation to facilitate them. The purpose of our study was to compare the frequency of adverse effects, sedation level, patient recovery characteristics in pediatric patients receiving intravenous propofol fentanyl combination with or without ketamine for interventional radiology procedures. Our main hypothesis was that the addition of ketamine would decrease propofol/fentanyl associated desaturation. Sixty consenting American Society of Anesthesia physical status I-III pediatric patients undergoing interventional radiology procedures under sedation were studied according to a randomized, double-blinded, institutional review board approved protocol. Group 1 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + ketamine 0.5 mg.kg(-1), and group 2 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + same volume of %0.9 NaCl intravenously. While apnea was not observed in any of the groups, there were three cases (10%) in group 1, and nine cases (30%) in group 2 with oxygen desaturation (P = 0.052). In group 1, 12 (40%) patients and, in group 2, 21 (70%) patients required supplemental propofol during the procedure (P = 0.021). There was no evidence for difference between groups in terms of other side effects except nystagmus. In conclusion, addition of low dose ketamine to propofol-fentanyl combination decreased the risk of desaturation and it also decreased the need for supplemental propofol dosage in pediatric patients at interventional radiology procedures.

  14. The effects of expanding outpatient and inpatient evaluation and management services in a pediatric interventional radiology practice.

    PubMed

    Edalat, Faramarz; Lindquester, Will S; Gill, Anne E; Simoneaux, Stephen F; Gaines, Jennifer; Hawkins, C Matthew

    2017-03-01

    Despite a continuing emphasis on evaluation and management clinical services in adult interventional radiology (IR) practice, the peer-reviewed literature addressing these services - and their potential economic benefits - is lacking in pediatric IR practice. To measure the effects of expanding evaluation and management (E&M) services through the establishment of a dedicated pediatric interventional radiology outpatient clinic and inpatient E&M reporting system. We collected and analyzed E&M current procedural terminology (CPT) codes from all patients seen in a pediatric interventional radiology outpatient clinic between November 2014 and August 2015. We also calculated the number of new patients seen in the clinic who had a subsequent procedure (procedural conversion rate). For comparison, we used historical data comprising pediatric patients seen in a general interventional radiology (IR) clinic for the 2 years immediately prior. An inpatient E&M reporting system was implemented and all inpatient E&M (and subsequent procedural) services between July 2015 and September 2015 were collected and analyzed. We estimated revenue for both outpatient and inpatient services using the Medicare Physician Fee Schedule global non-facility price as a surrogate. Following inception of a pediatric IR clinic, the number of new outpatients (5.5/month; +112%), procedural conversion rate (74.5%; +19%), estimated E&M revenue (+158%), and estimated procedural revenue from new outpatients (+228%) all increased. Following implementation of an inpatient clinic reporting system, there were 8.3 consults and 7.3 subsequent hospital encounters per month, with a procedural conversion rate of 88%. Growth was observed in all meaningful metrics following expansion of outpatient and inpatient pediatric IR E&M services.

  15. Femoral fractures in children, is early interventional treatment beneficial?

    PubMed

    Sturdee, S W; Templeton, P A; Dahabreh, Z; Cullen, E; Giannoudis, P V

    2007-08-01

    A protocol of early intervention (flexible intramedullary nails, early hip spica, and external fixation) was started in 1999 and during a 3-year period there were 25 children who sustained a femoral shaft fracture (early intervention group). These were prospectively reviewed with a minimum follow up of 24 months (Range 24-35 months). A historical control group of 41 children was used. These children were injured between February 1996 and February 1999 and were retrospectively reviewed. They had traditional in patient treatments with either Gallows or Thomas splint traction (traditional treatment group). Over the 6-year period from 1996 to 2002 there were a total of 66 femoral shaft fractures in the study that presented to our hospital. The mean length of hospital stay was 29 nights in the traditional group and 10 nights in the early intervention group. This difference is significant (p<0.001). The malunion rate was slightly higher in the early active group at radiological union but most of these remodelled over the 2 years of follow up. The protocol of early intervention used in our institution, of flexible nails, early hip spica or external fixation depended on the age of the child, and has resulted in a shorter hospital stay for the children. This has benefits for the child, the family and the hospital.

  16. Professional development for radiographers and post graduate nurses in radiological interventions: Building teamwork and collaboration through drama.

    PubMed

    Lundén, M; Lundgren, S M; Morrison-Helme, M; Lepp, M

    2017-11-01

    The rapid development within Interventional Radiology presents new challenges. Hybrid operating rooms consist of interventional radiology, open surgery, computed tomography, magnetic resonance imaging and other techniques. This means that several disciplines and professionals need to work in new constellations creating a multidisciplinary team around the patient. In accordance with this development, higher professional education must provide new pedagogic strategies to successfully address the knowledge expected in today's complex working life. To explore the use of Applied Drama as a learning medium, focusing on the use of Forum Theatre, to foster team work and collaboration in the field of radiography and learning. A qualitative approach, closely related to Ethnography, was utilized. The Drama Workshop utilising Forum Theatre created a dynamic learning environment and enabled the participants from three professions to understand each other's priorities better. The use of drama within health care education allows the students to take different roles in order to find the best way to co-operate. Forum Theatre is a useful learning medium in order to promote teamwork and collaboration in the radiological intervention field. By choosing a personal working experience, Forum Theatre seem to engage the participants at a deeper level and to experience various communication strategies and how the outcome changed depending on the approach. This can lead to improved teamwork and collaboration. Copyright © 2017 The College of Radiographers. All rights reserved.

  17. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia

    PubMed Central

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Bardhan, Pradip Kumar; Faruque, Abu S. G.; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

    2015-01-01

    Background Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM) children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO) recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children. Methods We prospectively enrolled SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) or Acute Respiratory Infection (ARI) ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111) and without WHO defined danger signs of severe pneumonia (n = 296). The outcomes of interest were treatment failure (if a child required changing of antibiotics) and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths. Results SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001) and fatal outcome (21% vs. 4%; p<0.001) compared to those without danger signs. Only 6/111 (5.4%) SAM children with danger signs of severe pneumonia and 12/296 (4.0%) without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01). Conclusion and Significance The result suggests that SAM children with cough or

  18. The Role of Interventional Radiology in the Management of Deep Venous Thrombosis: Advanced Therapy

    SciTech Connect

    O'Sullivan, Gerard J.

    2011-06-15

    Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This 'usual treatment' is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical thrombectomy was once the only option in severe cases in which limbs were threatened, but thrombus removal is no longer restricted to emergency cases. Interventional radiologists are now using advanced endovascular techniques to achieve thrombus removal in a minimally invasive manner in a very short treatment time, thereby quickly restoring patency, relieving acute symptoms, and potentially limiting the subsequent development of postthrombotic syndrome when followed with anticoagulation and compression regimens. This article provides an overview of the interventions available for treating DVT. One of the newer 'single-session' techniques is isolated pharmacomechanical thrombolysis, which is described here in detail with supporting cases.

  19. Current radiology. Volume 5

    SciTech Connect

    Wilson, G.H.; Hanafee, W.N.

    1984-01-01

    This book contains 10 selections. They are: Nuclear Magnetic Resonance Imaging, Interventional Vascular Radiology, Genitourinary Radiology, Skeletal Radiology, Digital Subtraction Angiography, Neuroradiology, Computed Tomographic Evaluation of Degenerative Diseases of the Lumbar Spine, The Lung, Otolaringology and Opthalmology, and Pediatric Radiology: Cranial, Facial, Cervical, Vertebral, and Appendicular.

  20. Identifying the Learning Curve for Uterine Artery Embolisation in an Interventional Radiological Training Unit

    SciTech Connect

    Das, Raj E-mail: raj.das@stgeorges.nhs.uk; Lucatelli, Pierleone Wang, Haofan Belli, Anna-Maria

    2015-08-15

    AimA clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill.MethodsTen IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to three groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters).ResultsMean fluoroscopy time was 18.4 (±8.1), 17.3 (±9.0), 16.3 (±8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4 %.ConclusionUAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.

  1. A Leadership Intervention to Further the Training of Female Faculty (LIFT-OFF) in Radiology.

    PubMed

    Spalluto, Lucy B; Spottswood, Stephanie E; Deitte, Lori A; Chern, Alexander; Dewey, Charlene M

    2017-06-01

    Women are under-represented in the field of radiology, occupy a minority of leadership positions, and, at our institution, have not achieved the same level of academic success as their male counterparts. Consequently, the authors designed, implemented, and evaluated the Leadership Intervention to Further the Training of Female Faculty (LIFT-OFF) program to (1) improve access to opportunities for women's faculty development and advancement, and (2) improve clarification of expectations about the role and path of advancement. LIFT-OFF was developed based on the results of a needs assessment survey. The results generated 14 priority topics, which served as the basis for educational modules conducted by expert speakers. Module effectiveness was assessed with pre- and postsurveys to elicit participant knowledge about the targeted subject matter. A formative program evaluation was performed at the completion of year 1 of 2 to assess outcomes and impacts to date. Seventeen of 55 (31%) educational module post-survey questions demonstrated a statistically significant (P < 0.05) increase in "yes" responses, indicating an improved understanding of targeted information. At year 1, 75% of the participants indicated that the program improved access to faculty development opportunities and 62% reported improved access to career advancement opportunities. Satisfaction with pace of professional advancement increased from 25% to 46% for junior women faculty (P = 0.046). Faculty development programs such as LIFT-OFF can provide career development opportunities and executive skills necessary for women to achieve academic career success and assume leadership positions. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  2. British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry

    SciTech Connect

    Uberoi, Raman Tapping, Charles Ross; Chalmers, Nicholas; Allgar, Victoria

    2013-12-15

    Purpose: The British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry was produced to provide an audit of current United Kingdom (UK) practice regarding placement and retrieval of IVC filters to address concerns regarding their safety. Methods: The IVC filter registry is a web-based registry, launched by the BSIR on behalf of its membership in October 2007. This report is based on prospectively collected data from October 2007 to March 2011. This report contains analysis of data on 1,434 IVC filter placements and 400 attempted retrievals performed at 68 UK centers. Data collected included patient demographics, insertion and retrieval data, and patient follow-up. Results: IVC filter use in the majority of patients in the UK follows accepted CIRSE guidelines. Filter placement is usually a low-risk procedure, with a low major complication rate (<0.5 %). Cook Gunther Tulip (560 filters: 39 %) and Celect (359 filters: 25 %) filters constituted the majority of IVC filters inserted, with Bard G2, Recovery filters, Cordis Trapease, and OptEase constituting most of the remainder (445 filters: 31 %). More than 96 % of IVC filters deployed as intended. Operator inexperience (<25 procedure) was significantly associated with complications (p < 0.001). Of the IVC filters initially intended for temporary placement, retrieval was attempted in 78 %. Of these retrieval was technically successful in 83 %. Successful retrieval was significantly reduced for implants left in situ for >9 weeks versus those with a shorter dwell time. New lower limb deep vein thrombosis (DVT) and/or IVC thrombosis was reported in 88 patients following filter placement, there was no significant difference of incidence between filter types. Conclusions: This registry report provides interventional radiologists and clinicians with an improved understanding of the technical aspects of IVC filter placement to help improve practice, and the potential consequences of IVC filter

  3. Evaluation of radiation dose to patients undergoing interventional radiology procedures at Ramathibodi Hospital, Thailand

    PubMed Central

    Urairat, J; Asavaphatiboon, S; Singhara Na Ayuthaya, S; Pongnapang, N

    2011-01-01

    Purpose: This study was carried out to assess the radiation dose to patients undergoing interventional radiology procedures at Ramathibodi Hospital, Bangkok, Thailand. Methods: Data were collected from 60 patients under transarterial oily-chemoembolisation (TOCE) and femoral angiography performed with the Toshiba Infinix model VC-i FPD single plane system. Data were also collected from 60 patients who underwent brain arteriovenous malformations (AVM) and dural-arteriovenous fistula (DAVF) embolisation, performed with the Toshiba Infinix model VF-i bi-plane systems. A built-in air kerma area product (KAP) meter calibrated in situ was used for the skin dose calculation. Results: The calibration coefficient of air kerma area product meter at tube voltage between 50 kV and 100 kV was found to vary within ± 5.07%, ± 7.2%, ± 4.86 % from calibration coefficient of 80 kV for a single-plane, tube 1 and tube 2 of bi-plane x-ray system, respectively. Mean air kerma area product values were 90.99 ± 52.89, 31.02 ± 17.92, 33.11 ± 23.99 (Frontal), 35.01 ± 19.10 (Lateral), 50.15 ± 44.76 (Frontal), 97.31 ± 44.12 (Lateral) Gy-cm2 for transarterial oily-chemoembolisation, femoral angiography, diagnostic cerebral angiography, therapeutic cerebral angiography, respectively. The therapeutic cerebral angiography procedure was found to give the highest entrance dose, number of images and fluoroscopy time: 362.63 cGy (Lateral), 1015 images (Lateral) and 126 minutes, respectively. However, the highest air kerma area product value was from transarterial oily-chemoembolisation with 264.37 Gy-cm2. There were 2 cases of therapeutic cerebral angiography, where the patient entrance dose was higher than 3 Gy in the frontal view, which reached the deterministic threshold for temporary epilation. Conclusion: Very wide variationswere found in patient dose from different interventional procedures. There is a need for a dose record system to provide feedback to radiologists who perform the

  4. Exercise interventions during cancer treatment: biopsychosocial outcomes.

    PubMed

    Courneya, K S

    2001-04-01

    More than 1.2 million Americans are diagnosed with cancer each year, and many receive intensive medical treatments. Currently, exercise is not considered a standard quality-of -life intervention for cancer patients. In this article, 11 studies are reviewed that have examined exercise interventions concurrent with cancer treatment. The key conclusion is that exercise improves a wide range of biopsychosocial outcomes in cancer patients, but much more reserch is needed.

  5. Benefits of an automatic patient dose registry system for interventional radiology and cardiology at five hospitals of the Madrid area.

    PubMed

    Fernandez-Soto, J M; Ten, J I; Sanchez, R M; España, M; Pifarre, X; Vano, E

    2015-07-01

    The purpose of this article is to present the results of connecting the interventional radiology and cardiology laboratories of five university hospitals to a unique server using an automatic patient dose registry system (Dose On Line for Interventional Radiology, DOLIR) developed in-house, and to evaluate its feasibility more than a year after its introduction. The system receives and stores demographic and dosimetric parameters included in the MPPS DICOM objects sent by the modalities to a database. A web service provides a graphical interface to analyse the information received. During 2013, the system processed 10 788 procedures (6874 cardiac, 2906 vascular and 1008 neuro interventional). The percentages of patients requiring clinical follow-up due to potential tissue reactions before and after the use of DOLIR are presented. The system allowed users to verify in real-time, if diagnostic (or interventional) reference levels are fulfilled. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Red emission phosphor for real-time skin dosimeter for fluoroscopy and interventional radiology

    SciTech Connect

    Nakamura, Masaaki Chida, Koichi; Zuguchi, Masayuki

    2014-10-15

    Purpose: There are no effective real-time direct skin dosimeters for interventional radiology. Such a scintillation dosimeter would be available if there was a suitable red emission phosphor in the medical x-ray range, since the silicon photodiode is a highly efficient device for red light. However, it is unknown whether there is a suitable red emission phosphor. The purpose of this study is to find a suitable red emission phosphor that can be used in x-ray dosimeters. Methods: Five kinds of phosphors which emit red light when irradiated with electron beams or ultraviolet rays in practical devices were chosen. For the brightness measurement, phosphor was put into transparent plastic cells or coated onto plastic sheets. The phosphors were irradiated with medical range x-rays [60–120 kV(peak), maximum dose rate of 160 mGy min{sup −1}], and the emission was measured by a luminance meter. Several characteristics, such as brightness, dose rate dependence, tube voltage dependence, and brightness stability, were investigated. Results: The luminescence of Y V O{sub 4}:Eu, (Y,Gd,Eu) BO{sub 3}, and Y{sub 2}O{sub 3}:Eu significantly deteriorated by 5%–10% when irradiated with continuous 2 Gy x-rays. The 0.5MgF{sub 2}⋅3.5MgO⋅GeO{sub 2}:Mn phosphor did not emit enough. Only the Y{sub 2}O{sub 2}S:Eu,Sm phosphor had hardly any brightness deterioration, and it had a linear relationship so that the x-ray dose rate could be determined from the brightness with sufficient accuracy. For the tube voltage dependence of the Y{sub 2}O{sub 2}S:Eu,Sm phosphor, the brightness per unit dose rate with 120 kV(peak) x-rays was 30% higher than that with 60 kV(peak) x-rays. Conclusions: Five kinds of phosphors were chosen as an x-ray scintillator for a real-time direct skin dosimeter. The Y V O{sub 4}:Eu, (Y,Gd,Eu)BO{sub 3}, and Y{sub 2}O{sub 3}:Eu phosphors had brightness deterioration caused by the x-rays. Only the Y{sub 2}O{sub 2}S:Eu,Sm phosphor had hardly any brightness deterioration

  7. A new brace treatment similar for adolescent scoliosis and kyphosis based on restoration of thoracolumbar lordosis. Radiological and subjective clinical results after at least one year of treatment

    PubMed Central

    2012-01-01

    Study design A prospective treatment study with a new brace was conducted Objective. To evaluate radiological and subjective clinical results after one year conservative brace treatment with pressure onto lordosis at the thoracolumbar joint in children with scoliosis and kyphosis. Summary of background data Conservative brace treatment of adolescent scoliosis is not proven to be effective in terms of lasting correction. Conservative treatment in kyphotic deformities may lead to satisfactory correction. None of the brace or casting techniques is based on sagittal forces only applied at the thoracolumbar spine (TLI= thoracolumbar lordotic intervention). Previously we showed in patients with scoliosis after forced lordosis at the thoracolumbar spine a radiological instantaneous reduction in both coronal curves of double major scoliosis. Methods A consecutive series of 91 children with adolescent scoliosis and kyphosis were treated with a modified symmetric 30 degrees Boston brace to ensure only forced lordosis at the thoracolumbar spine. Scoliosis was defined with a Cobb angle of at least one of the curves [greater than or equal to] 25 degrees and kyphosis with or without a curve <25 degrees in the coronal plane. Standing radiographs were made i) at start, ii) in brace at beginning and iii) after one year treatment without brace. Results Before treatment start ‘in brace’ radiographs showed a strong reduction of the Cobb angles in different curves in kyphosis and scoliosis groups (sagittal n = 5 all p < 0.001, pelvic obliquity p < 0.001). After one year of brace treatment in scoliosis and kyphosis group the measurements on radiographs made without brace revealed an improvement in 3 Cobb angles each. Conclusion Conservative treatment using thoracolumbar lordotic intervention in scoliotic and kyphotic deformities in adolescence demonstrates a marked improvement after one year also in clinical and postural criteria. An effect not obtained with current brace techniques

  8. Electromagnetic heating of breast tumors in interventional radiology: in vitro and in vivo studies in human cadavers and mice.

    PubMed

    Hilger, I; Andrä, W; Hergt, R; Hiergeist, R; Schubert, H; Kaiser, W A

    2001-02-01

    To assess relevant parameters for the minimally invasive elimination of breast tumors by using a selective application of magnetite and exposure of the breast to an alternating magnetic field. The specific absorption rate (SAR) of different magnetite samples was determined calorimetrically. Temperature elevations based on magnetite mass (7-112 mg) and magnetic field amplitude (1.2-6.5 kA/m frequency, 400 kHz) were investigated by using human breast tissue. Parameter combinations (21 mg +/- 9 [SD], 242-second magnetic field exposure, 6.5-kA/m amplitude) were tested in 10 immunodeficient mice bearing human adenocarcinomas (MX-1 cells). Histologic sections of heated tumor tissue were analyzed. SAR data of different magnetite particle types ranged from 3 to 211 W/g. Temperature elevation (DeltaT) as a function of the magnetite mass increased linearly up to 28 mg; at higher masses, a saturation of DeltaT was observed at nearly 88 degrees C. The dependence of DeltaT on magnetic field amplitude (H) revealed a third-order power law: DeltaT = 0.26 degrees C/(kA/m)(3). H(3), with r(2) = 0.95. A mean temperature of 71 degrees C +/- 8 was recorded in the tumor region at the end of magnetic field exposure of the mice. Typical macroscopic findings included tumor shrinkage after heating. Histologically nuclear degenerations were observed in heated malignant cells. Magnetic heating of breast tumors is a promising technique for future interventional radiologic treatments.

  9. Impact of Treatment Integrity on Intervention Effectiveness

    ERIC Educational Resources Information Center

    Fryling, Mitch J.; Wallace, Michele D.; Yassine, Jordan N.

    2012-01-01

    Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity…

  10. Impact of Treatment Integrity on Intervention Effectiveness

    ERIC Educational Resources Information Center

    Fryling, Mitch J.; Wallace, Michele D.; Yassine, Jordan N.

    2012-01-01

    Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity…

  11. Trichotillomania: Behavioral Assessment and Treatment Interventions

    ERIC Educational Resources Information Center

    Kell, Brandy L.; Kress, Victoria E.

    2006-01-01

    This article examines the behavioral treatment of Trichotillomania. A brief overview of the diagnosis and assessment of Trichotillomania is provided. Guidelines for a structured clinical evaluation when working with people diagnosed with Trichotillomania are supplied. The most effective behavioral interventions and treatments for working with…

  12. Technical Basis for Radiological Emergency Plan Annex for WTD Emergency Response Plan: West Point Treatment Plant

    SciTech Connect

    Hickey, Eva E.; Strom, Daniel J.

    2005-08-01

    Staff of the King County Wastewater Treatment Division (WTD) have concern about the aftermath of a radiological dispersion event (RDE) leading to the introduction of significant quantities of radioactive material into the combined sanitary and storm sewer system in King County, Washington. Radioactive material could come from the use of a radiological dispersion device (RDD). RDDs include "dirty bombs" that are not nuclear detonations but are explosives designed to spread radioactive material (National Council on Radiation Protection and Measurements (NCRP) 2001). Radioactive material also could come from deliberate introduction or dispersion of radioactive material into the environment, including waterways and water supply systems. This document, Volume 3 of PNNL-15163 is the technical basis for the Annex to the West Point Treatment Plant (WPTP) Emergency Response Plan related to responding to a radiological emergency at the WPTP. The plan primarily considers response to radioactive material that has been introduced in the other combined sanitary and storm sewer system from a radiological dispersion device, but is applicable to any accidental or deliberate introduction of materials into the system.

  13. EAU Guidelines on Interventional Treatment for Urolithiasis.

    PubMed

    Türk, Christian; Petřík, Aleš; Sarica, Kemal; Seitz, Christian; Skolarikos, Andreas; Straub, Michael; Knoll, Thomas

    2016-03-01

    Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. To evaluate the optimal measures for treatment of urinary stone disease. Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence. Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates. Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques. For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  14. Membrane treatment of liquid wastes from radiological decontamination operations.

    PubMed

    Svittsov, A A; Khubetsov, S B; Volchek, K

    2011-01-01

    The paper focuses on the evaluation of membrane filtration for the treatment of liquid radioactive streams generated in area decontamination operations. In this work, semi-permeable membranes were demonstrated to be effective reducing the volume of wastewater containing cesium and cobalt by two orders of a magnitude. The efficiency of membrane separation was enhanced by employing additives that enlarged the size of target radionuclide species and improved their rejection by the membranes. This was achieved by chelation with synthetic water-soluble polymers and by adsorption on micro particles of adsorbent coupled with micelle formation. The effect of wastewater composition and that of the radionuclide-binding additives on the volume reduction was investigated. Membrane treatment is expected to help simplify further processing and decrease disposal costs.

  15. Differences in Pediatric Non-Interventional Radiology Procedural Sedation Practices and Adverse Events by Registered Nurses and Physicians.

    PubMed

    Crego, Nancy; Baernholdt, Marianne; Merwin, Elizabeth

    The purpose of this study was to determine differences in sedation-related adverse events according to the type of provider monitoring and delivering sedation. A retrospective, cross-sectional, correlational design using secondary data from the Pediatric Sedation Research Consortium database was used for this study. A sample of 36,352 cases (0-14 years of age) sedated and monitored for diagnostic radiology procedures by three types of providers (registered nurses [RNs] alone, physicians (MDs) alone, or registered nurse + physician [RN+MD sedation teams]) were compared. Patients sedated by RNs alone or MDs alone had lower odds of unanticipated adverse events (odds ratios 0.46 and 0.53, respectively; p<0.0001) compared with RN+MD sedation provider teams. Team skills may be an important competency for RN+MD sedation teams in the non-interventional radiology setting. This study can inform clinicians, administrators, and quality-improvement managers of the differences in adverse event outcomes of pediatric radiology procedures when RN+MD teams provide sedation compared with RNs or MDs alone. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Radiological and chemical characterization report for the planned Quarry Construction Staging Area and Water Treatment Plant: Revision 1

    SciTech Connect

    Not Available

    1989-03-01

    The Quarry Construction Staging Area and Water Treatment Plant (QCSA) will be used in the support of the bulk waste removal of the Weldon Spring Quarry. Radiological and chemical characterization was performed on a 12 acre site where the QCSA will be constructed. The characterization revealed approximately .5 acres of radiologically contaminated land. No chemical contamination was found. 8 refs., 5 figs., 7 tabs.

  17. Interventional radiology and the use of metal stents in nonvascular clinical practice: a systematic overview.

    PubMed

    Pron, G; Common, A; Simons, M; Ho, C S

    1999-05-01

    The intent of this systematic overview was to describe the clinical role of metal stents in nonvascular health care interventions and the level of evidence supporting their use. Structured searches of Medline were conducted and limited to original peer-reviewed articles published in English. Clinical practice involving metal stents was reported in more than 109 clinical series involving 4,753 patients. Stents were placed mainly for palliation of malignant biliary, esophageal, and airway obstruction in patients who were untreatable or had surgically unresectable lesions. Assessment of these interventions has so far centered on safety and technical success. Efficacy, quality of life, and costing factors were not routinely reported. Randomized trial evidence was available but limited; six randomized trials involving metal stents have been reported. Three trials involved biliary malignant obstruction, and all three reported metal stent (132 patients) palliation to be superior to plastic stent palliation (136 patients) based on longer patency and lower reintervention costs. Safety and complication differences between stents, however, were inconsistent across trials. In three trials involving esophageal malignant obstruction, metal stent (82 patients) palliation was reported to be superior to plastic stent (41 patients), based on lower complication and reintervention rates, and superior to laser therapy (18 patients), based on better dysphagia relief. Use of metal stents has been reported for obstructed ducts and passageways of most body systems. There is, however, limited controlled trial evidence confirming the advantages of their use over plastic stents or other forms of treatment.

  18. TSD-DOSE : a radiological dose assessment model for treatment, storage, and disposal facilities.

    SciTech Connect

    Pfingston, M.

    1998-12-23

    In May 1991, the U.S. Department of Energy (DOE), Office of Waste Operations, issued a nationwide moratorium on shipping slightly radioactive mixed waste from DOE facilities to commercial treatment, storage, and disposal (TSD) facilities. Studies were subsequently conducted to evaluate the radiological impacts associated with DOE's prior shipments through DOE's authorized release process under DOE Order 5400.5. To support this endeavor, a radiological assessment computer code--TSD-DOSE (Version 1.1)--was developed and issued by DOE in 1997. The code was developed on the basis of detailed radiological assessments performed for eight commercial hazardous waste TSD facilities. It was designed to utilize waste-specific and site-specific data to estimate potential radiological doses to on-site workers and the off-site public from waste handling operations at a TSD facility. The code has since been released for use by DOE field offices and was recently used by DOE to evaluate the release of septic waste containing residual radioactive material to a TSD facility licensed under the Resource Conservation and Recovery Act. Revisions to the code were initiated in 1997 to incorporate comments received from users and to increase TSD-DOSE's capability, accuracy, and flexibility. These updates included incorporation of the method used to estimate external radiation doses from DOE's RESRAD model and expansion of the source term to include 85 radionuclides. In addition, a detailed verification and benchmarking analysis was performed.

  19. The value of radiology in predicting gallstone type when selecting patients for medical treatment.

    PubMed Central

    Bell, G D; Dowling, R H; Whitney, B; Sutor, D J

    1975-01-01

    Since medical treatment of gallstones is confined to cholesterol-rich stones, the ability of clinical radiographs to predict gallstone type was tested prospectively by comparing the preoperative radiological appearance of gallstones from 57 unselected patients with cholelithiasis coming to cholecystectomy with the subsequent analysis of the stones both by X-ray diffraction and by chemical techniques. Fifty-two per cent of the patients had 'non-functioning' gallbladders which failed to opacify after at least two contrast examinations and 25 out of 50 had radioopaque stones. Of the 25 patients with radiolucent stones, the stones in 20 ((80%) were predominantly cholesterol in type but radiology was misleading in five; three contained 40-55% calcium salts but were still radiolucent while two were amorphous and contained less than 10% cholesterol by weight on chemical analysis. While radiology was sometimes misleading when the stones were small and irregular, large radiolucent stones with a smooth profile were invariably cholesterol-rich stones. The results also show that in men calcified stones were commoner than in women and that in older women the gallstones contained more calcium salts and less cholesterol than in younger women less than 50 yr). This paper analyses critically the value and limitations of clinical radiology in predicting gallstone type. PMID:1140634

  20. Anticipated Supply and Demand for Independent Interventional Radiology Residency Positions: A Survey of Department Chairs.

    PubMed

    Herwald, Sanna E; Spies, James B; Yucel, E Kent

    2017-02-01

    The first participants in the independent interventional radiology (IR) residency match will begin prerequisite diagnostic radiology (DR) residencies before the anticipated launch of the independent IR programs in 2020. The aim of this study was to estimate the competitiveness level of the first independent IR residency matches before these applicants have already committed to DR residencies and possibly early specialization in IR (ESIR) programs. The Society of Chairs of Academic Radiology Departments (SCARD) Task Force on the IR Residency distributed a survey to all active SCARD members using SurveyMonkey. The survey requested the number of planned IR residency and ESIR positions. The average, minimum, and maximum of the range of planned independent IR residency positions were compared with the average, maximum, and minimum, respectively, of the range of planned ESIR positions, to model matches of average, high, and low competitiveness. Seventy-four active SCARD members (56%) answered at least one survey question. The respondents' programs planned to fill, in total, 98 to 102 positions in integrated IR residency programs, 61 to 76 positions in independent IR residency programs, and 50 to 77 positions in ESIR DR residency programs each year. The ranges indicate the uncertainty of some programs regarding the number of positions. The survey suggests that participating programs will fill sufficient independent IR residency positions to accommodate all ESIR applicants in a match year of average or low competitiveness, but not in a match year of high competitiveness. This suggestion does not account for certain difficult-to-predict factors that may affect the independent IR residency match. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. Treatment options for low-level radiologically contaminated ORNL filtercake

    SciTech Connect

    Lee, Hom-Ti; Bostick, W.D.

    1996-04-01

    Water softening sludge (>4000 stored low level contaminated drums; 600 drums per year) generated by the ORNL Process Waste Treatment Plant must be treated, stabilized, and placed in safe storage/disposal. The sludge is primarily CaCO{sub 3} and is contaminated by low levels of {sup 90}Sr and {sup 137}Cs. In this study, microwave sintering and calcination were evaluated for treating the sludge. The microwave melting experiments showed promise: volume reductions were significant (3-5X), and the waste form was durable with glass additives (LiOH, fly ash). A commercial vendor using surrogate has demonstrated a melt mineralization process that yields a dense monolithic waste form with a volume reduction factor (VR) of 7.7. Calcination of the sludge at 850-900 C yielded a VR of 2.5. Compaction at 4500 psi increased the VR to 4.2, but the compressed form is not dimensionally stable. Addition of paraffin helped consolidate fines and yielded a VR of 3.5. In conclusion, microwave melting or another form of vitrification is likely to be the best method; however for immediate implementation, the calculation/compaction/waxing process is viable.

  2. Clinical and radiological aspects of idiopathic diabetic muscle infarction. Rational approach to diagnosis and treatment.

    PubMed

    Aboulafia, A J; Monson, D K; Kennon, R E

    1999-03-01

    The systemic effects of diabetes mellitus are well recognised. The heart, kidney, central and peripheral nervous systems, and the distal parts of the limbs are often the site of end-organ damage resulting from ischaemia. Infarction of large muscle groups in the limb, not associated with gangrene, is uncommon. There have been few reported cases other than radiological descriptions of diabetic muscle infarcts. While previous reports have illustrated some of the clinical and radiological characteristics of this condition, the paucity of published cases makes it difficult to determine the most appropriate methods of diagnosis and treatment. During a five-year period we treated 14 patients with diabetes mellitus, aged from 32 to 59 years, who were referred to a musculoskeletal oncology service for suspected soft-tissue sarcoma, but were subsequently found to have a diabetic muscle infarct. Closed needle biopsy was performed in 13 without complications. In 12 patients, the symptoms resolved without surgical treatment.

  3. Radiation shielding materials and radiation scatter effects for interventional radiology (IR) physicians.

    PubMed

    McCaffrey, J P; Tessier, F; Shen, H

    2012-07-01

    To measure the attenuation effectiveness and minimize the weight of new non-Pb radiation shielding materials used for radiation protection by interventional radiology (IR) physicians, to compare the accuracy of the different standard measurement geometries of these materials, and to determine x-ray qualities that correspond to the scattered radiation that IR physicians typically encounter. Radiation attenuation capabilities of non-Pb materials were investigated. Typically, most studies of non-Pb materials have focused on the attenuating properties of metal powders. In this study, layers of materials incorporating non-Pb powdered compounds such as Bi(2)O(3), Gd(2)O(3), and BaSO(4) were measured individually, as bilayers, and as a Bi(2)O(3)-loaded hand cream. Attenuation measurements were performed in narrow-beam (fluorescence excluded) and broad beam (fluorescence included) geometries, demonstrating that these different geometries provided significantly different results. The Monte Carlo (MC) program EGSnrc was used to calculate the resulting spectra after attenuation by radiation shielding materials, and scattered x-ray spectra after 90° scattering of eight ASTM Standard primary x-ray beams. Surrogate x-ray qualities that corresponded to these scattered spectra were tabulated. Radiation shielding materials incorporating Bi(2)O(3) were found to provide equivalent or superior attenuation compared with commercial Pb-based and non-Pb materials across the 60-130 kVp energy range. Measurements were made for single layers of the Bi(2)O(3) compound and for bilayers where the ordering was low atomic number (Z) layer closest to x-ray source∕high Z (Bi(2)O(3)) layer farthest from the x-ray source. Narrow-beam Standard test methods which do not include the contribution from fluorescence overestimated the attenuating capabilities of Pb and non-Pb materials. Measurements of a newly developed, quick-drying, and easily removable Bi(2)O(3)-loaded hand cream demonstrated better

  4. Radiation shielding materials and radiation scatter effects for interventional radiology (IR) physicians.

    PubMed

    McCaffrey, J P; Tessier, F; Shen, H

    2012-07-01

    To measure the attenuation effectiveness and minimize the weight of new non-Pb radiation shielding materials used for radiation protection by interventional radiology (IR) physicians, to compare the accuracy of the different standard measurement geometries of these materials, and to determine x-ray qualities that correspond to the scattered radiation that IR physicians typically encounter. Radiation attenuation capabilities of non-Pb materials were investigated. Typically, most studies of non-Pb materials have focused on the attenuating properties of metal powders. In this study, layers of materials incorporating non-Pb powdered compounds such as Bi2 O3 , Gd2 O3 , and BaSO4 were measured individually, as bilayers, and as a Bi2 O3 -loaded hand cream. Attenuation measurements were performed in narrow-beam (fluorescence excluded) and broad beam (fluorescence included) geometries, demonstrating that these different geometries provided significantly different results. The Monte Carlo (MC) program EGSnrc was used to calculate the resulting spectra after attenuation by radiation shielding materials, and scattered x-ray spectra after 90° scattering of eight ASTM Standard primary x-ray beams. Surrogate x-ray qualities that corresponded to these scattered spectra were tabulated. Radiation shielding materials incorporating Bi2 O3 were found to provide equivalent or superior attenuation compared with commercial Pb-based and non-Pb materials across the 60-130 kVp energy range. Measurements were made for single layers of the Bi2 O3 compound and for bilayers where the ordering was low atomic number (Z) layer closest to x-ray source/high Z (Bi2 O3 ) layer farthest from the x-ray source. Narrow-beam Standard test methods which do not include the contribution from fluorescence overestimated the attenuating capabilities of Pb and non-Pb materials. Measurements of a newly developed, quick-drying, and easily removable Bi2 O3 -loaded hand cream demonstrated better attenuation

  5. Visualizing research themes in radiological applications for breast cancer detection, diagnosis and treatment.

    PubMed

    Li, Guisu; McCain, Katherine W

    2008-11-06

    We present a visualization of basic and clinical research in radiological detection, diagnosis and treatment of breast cancer based on an analysis of almost 14,000 articles indexed in the Web of Science from 1997 to 2006. Using bibliometric and network visualization software, we identified highly cited key papers linked to seven visible, persistent research themes spanning detection, diagnosis, and radiotherapy for breast cancer.

  6. Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment.

    PubMed

    Suwatanapongched, Thitiporn; Sangsatra, Wasinan; Boonsarngsuk, Viboon; Watcharananan, Siriorn P; Incharoen, Pimpin

    2013-01-01

    We aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. We retrospectively reviewed the medical records, initial and follow-up chest computed tomography scans and/or radiographs for initial clinical and radiologic manifestations and outcomes following antifungal treatment of 12 immunocompetent patients diagnosed with pulmonary cryptococcosis between 1990 and 2012. Twelve patients (age range, 21-62 years; males, eight patients [66.7%]) were included. Nine (75%) patients were symptomatic, eight of whom had disseminated infection with central nervous system involvement. Initial pulmonary abnormalities consisted of single nodules/masses (n=5), single segmental or lobar mass-like consolidation (n=3), multiple cavitary and noncavitary nodules (n=1), and multifocal consolidation plus nodules (n=3). These lesions ranged from less than 1 cm to 15 cm in greatest diameter. Distinct subpleural and lower lung predominance was observed. Seven patients (58.3%) had one or more atypical/aggressive findings, namely endobronchial obstruction (n=4), calcified (n=1) or enlarged (n=4) mediastinal/hilar lymph nodes, vascular compression (n=1), pericardial involvement (n=1), and pleural involvement (n=2). Following antifungal therapy, radiologic resolution was variable within the first six months of eight nonsurgical cases. Substantial (>75%) improvement with some residual abnormalities, bronchiectasis, cavitation, and/or fibrotic changes were frequently observed after 12-24 months of treatment (n=6). Pulmonary cryptococcosis in immunocompetent patients frequently causes disseminated infection with atypical/aggressive radiologic findings that are gradually and/or incompletely resolved after treatment. The presence of nonenhanced low-attenuation areas within subpleural consolidation or mass and the absence of tree-in-bud appearance should raise concern for pulmonary cryptococcosis

  7. Economically affordable anatomical kidney phantom with calyxes for puncture and drainage training in interventional urology and radiology.

    PubMed

    Ristolainen, Asko; Ross, Peeter; Gavšin, Juri; Semjonov, Eero; Kruusmaa, Maarja

    2014-06-01

    Trends in interventional radiology and urology training are orientated towards reducing costs and increasing efficiency. In order to comply with the trends, we propose training on inexpensive patient-specific kidney phantoms. To develop a new kidney phantom for puncture and drainage training in interventional urology and radiology, and to evaluate their anatomical correctness and suitability for training compared to the traditional way of training on home-made phantoms. A CASE STUDY FOR VALIDATION OF KIDNEY PHANTOMS WAS CONDUCTED WITH NINE RADIOLOGY STUDENTS DIVIDED INTO TWO GROUPS: one trained on standard home-made training phantom (n = 4) and the other on our kidney phantoms (n = 5). Another test phantom was used to evaluate the effectiveness of the training of the two groups. The tests were video recorded and analyzed. Duration of the procedure was used as the primary indicator of procedure's quality. Comparison tests were also conducted with professional radiologists. Anatomical correctness of the kidney phantom was evaluated by comparing the post mortem kidney scans with reconstructed models from CT scans. Subjective feedback was also collected from the participants. Wider use of kidney phantoms was analyzed. The average volumetric difference between post mortem kidney scans and reconstructed CT kidney models was 4.70 ± 3.25%. All five students practicing on the kidney phantom improved their performance and the results were almost equal to the results of the professional radiologist while in the other group two students out of four trained on standard home-made training phantoms failed to improve their performance. However, the small number of test subjects prevents us from drawing general conclusions about the efficiency of the new practice. The kidney phantoms were found usable also for nephrostomy catheter placement training under fluoroscopy. The feedback from radiologists showed that the anatomically correct features of the phantom is an

  8. Early experience using an online reporting system for interventional radiology procedure-related complications integrated with a digital dictation system.

    PubMed

    Gupta, Sanjay; Patel, Jay; McEnery, Kevin; Wallace, Michael J; Ahrar, Kamran; Suitor, Chuck; Hicks, Marshall E

    2011-08-01

    The absence of user-friendly systems for reporting complications is a major barrier to improving quality assurance (QA) programs in interventional radiology (IR) services. We describe the implementation of a QA application that is completely integrated with the radiology dictation system. We implemented an IR QA process as a module within the electronic medical record and radiologist dictation system applications used at our institution. After a radiologist completes a dictation, he or she must select from a drop-down list of complications before proceeding to the next case. Delayed QA events can be entered using the same applications. All complication entries are sent to a database, which is queried to run reports. During the study period, all the 20,034 interventional procedures were entered in the QA database, 1,144 complications were reported, 110 (9.6%) of which were classified as major. Although majority of the complications (996) were entered at the time of dictation, 148 complications (12.9%) were entered afterwards. All major complications were referred to the IR peer review committee, and 30 of these were discussed in the morbidity and mortality meetings. We studied post-lung-biopsy pneumothorax and chest tube rates and initiated a quality improvement process based on the results.The integration of the IR QA reporting system into the workflow process and the mandatory requirements for completion has the potential to minimize the work effort required to enter complication data, and improve participation in the QA process.

  9. A study of inventiveness among Society of Interventional Radiology members and the impact of their social networks.

    PubMed

    Murphy, Kieran J; Elias, Gavin; Jaffer, Hussein; Mandani, Rashesh

    2013-07-01

    To investigate the nature of inventiveness among members of the Society of Interventional Radiology (SIR) and learn what influenced the inventors and assisted their creativity. The membership directory of the SIR was cross-referenced with filings at the United States Patent and Trademark Organization (USPTO) and the Patent Cooperation Treaty (PCT). The inventors were queried with an online survey to illuminate their institutions of training and practice as well as enabling or inhibiting factors to their inventiveness. Responses were analyzed through the construction of social network maps and thematic and graphical analysis. It was found that 457 members of the SIR held 2,492 patents or patent filings. After 1986, there was a marked and sustained increase in patent filings. The online survey was completed by 73 inventors holding 470 patents and patent filings. The social network maps show the key role of large academic interventional radiology departments and individual inventors in the formation of interconnectivity among inventors and the creation of the intellectual property (IP). Key inhibitors of the inventive process include lack of mentorship, of industry contacts, and of legal advice. Key enablers include mentorship, motivation, and industry contacts. Creativity and inventiveness in SIR members stem from institutions that are hubs of innovation and networks of key innovators; inventors are facilitated by personal motivation, mentorship, and strong industry contacts. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  10. Vascular Access Tracking System: a Web-Based Clinical Tracking Tool for Identifying Catheter Related Blood Stream Infections in Interventional Radiology Placed Central Venous Catheters.

    PubMed

    Morrison, James; Kaufman, John

    2016-12-01

    Vascular access is invaluable in the treatment of hospitalized patients. Central venous catheters provide a durable and long-term solution while saving patients from repeated needle sticks for peripheral IVs and blood draws. The initial catheter placement procedure and long-term catheter usage place patients at risk for infection. The goal of this project was to develop a system to track and evaluate central line-associated blood stream infections related to interventional radiology placement of central venous catheters. A customized web-based clinical database was developed via open-source tools to provide a dashboard for data mining and analysis of the catheter placement and infection information. Preliminary results were gathered over a 4-month period confirming the utility of the system. The tools and methodology employed to develop the vascular access tracking system could be easily tailored to other clinical scenarios to assist in quality control and improvement programs.

  11. Multiparametric and Multimodality Functional Radiological Imaging for Breast Cancer Diagnosis and Early Treatment Response Assessment.

    PubMed

    Jacobs, Michael A; Wolff, Antonio C; Macura, Katarzyna J; Stearns, Vered; Ouwerkerk, Ronald; El Khouli, Riham; Bluemke, David A; Wahl, Richard

    2015-05-01

    Breast cancer is the second leading cause of cancer death among US women, and the chance of a woman developing breast cancer sometime during her lifetime is one in eight. Early detection and diagnosis to allow appropriate locoregional and systemic treatment are key to improve the odds of surviving its diagnosis. Emerging data also suggest that different breast cancer subtypes (phenotypes) may respond differently to available adjuvant therapies. There is a growing understanding that not all patients benefit equally from systemic therapies, and therapeutic approaches are being increasingly personalized based on predictive biomarkers of clinical benefit. Optimal use of established and novel radiological imaging methods, such as magnetic resonance imaging and positron emission tomography, which have different biophysical mechanisms can simultaneously identify key functional parameters. These methods provide unique multiparametric radiological signatures of breast cancer, that will improve the accuracy of early diagnosis, help select appropriate therapies for early stage disease, and allow early assessment of therapeutic benefit.

  12. Multiparametric and Multimodality Functional Radiological Imaging for Breast Cancer Diagnosis and Early Treatment Response Assessment

    PubMed Central

    Wolff, Antonio C.; Macura, Katarzyna J.; Stearns, Vered; Ouwerkerk, Ronald; El Khouli, Riham; Bluemke, David A.; Wahl, Richard

    2015-01-01

    Breast cancer is the second leading cause of cancer death among US women, and the chance of a woman developing breast cancer sometime during her lifetime is one in eight. Early detection and diagnosis to allow appropriate locoregional and systemic treatment are key to improve the odds of surviving its diagnosis. Emerging data also suggest that different breast cancer subtypes (phenotypes) may respond differently to available adjuvant therapies. There is a growing understanding that not all patients benefit equally from systemic therapies, and therapeutic approaches are being increasingly personalized based on predictive biomarkers of clinical benefit. Optimal use of established and novel radiological imaging methods, such as magnetic resonance imaging and positron emission tomography, which have different biophysical mechanisms can simultaneously identify key functional parameters. These methods provide unique multiparametric radiological signatures of breast cancer, that will improve the accuracy of early diagnosis, help select appropriate therapies for early stage disease, and allow early assessment of therapeutic benefit. PMID:26063885

  13. SU-D-209-03: Radiation Dose Reduction Using Real-Time Image Processing in Interventional Radiology

    SciTech Connect

    Kanal, K; Moirano, J; Zamora, D; Stewart, B

    2016-06-15

    Purpose: To characterize changes in radiation dose after introducing a new real-time image processing technology in interventional radiology systems. Methods: Interventional radiology (IR) procedures are increasingly complex, at times requiring substantial time and radiation dose. The risk of inducing tissue reactions as well as long-term stochastic effects such as radiation-induced cancer is not trivial. To reduce this risk, IR systems are increasingly equipped with dose reduction technologies.Recently, ClarityIQ (Philips Healthcare) technology was installed in our existing neuroradiology IR (NIR) and vascular IR (VIR) suites respectively. ClarityIQ includes real-time image processing that reduces noise/artifacts, enhances images, and sharpens edges while also reducing radiation dose rates. We reviewed 412 NIR (175 pre- and 237 post-ClarityIQ) procedures and 329 VIR (156 preand 173 post-ClarityIQ) procedures performed at our institution pre- and post-ClarityIQ implementation. NIR procedures were primarily classified as interventional or diagnostic. VIR procedures included drain port, drain placement, tube change, mesenteric, and implanted venous procedures. Air Kerma (AK in units of mGy) was documented for all the cases using a commercial radiation exposure management system. Results: When considering all NIR procedures, median AK decreased from 1194 mGy to 561 mGy. When considering all VIR procedures, median AK decreased from 49 to 14 mGy. Both NIR and VIR exhibited a decrease in AK exceeding 50% after ClarityIQ implementation, a statistically significant (p<0.05) difference. Of the 5 most common VIR procedures, all median AK values decreased, but significance (p<0.05) was only reached in venous access (N=53), angio mesenteric (N=41), and drain placement procedures (N=31). Conclusion: ClarityIQ can reduce dose significantly for both NIR and VIR procedures. Image quality was not assessed in conjunction with the dose reduction.

  14. [Promising directions of optimization of providing radiological safety in large-scale treatment-and-preventive institutions].

    PubMed

    Tsvetkov, S V; Petreev, I V; Greben'kov, S V

    2011-09-01

    The article contains results of fulfilled studies that allowed finding main features of radiology safety, working out academic and research recommendations to perfect radiology safety in treatment-and-preventive institutions (TPI) and creating a method of calculation of authorized staffing needed by radiological safety services. It was established that the following actions are least fulfilled: radiation control, organization of radiation safety education, authorization for work with ionizing radiation both for military men and civil staff, maintenance of documentation. We suggest that promising direction of optimization of providing radiological safety in large-scale TPI is the following: allotment of special structure that will provide comprehensive fulfillment of regulatory documents demands, it may be, e. g. radiological safety service.

  15. TSD-DOSE: A radiological dose assessment model for treatment, storage, and disposal facilities

    SciTech Connect

    Pfingston, M.; Arnish, J.; LePoire, D.; Chen, S.-Y.

    1998-10-14

    Past practices at US Department of Energy (DOE) field facilities resulted in the presence of trace amounts of radioactive materials in some hazardous chemical wastes shipped from these facilities. In May 1991, the DOE Office of Waste Operations issued a nationwide moratorium on shipping all hazardous waste until procedures could be established to ensure that only nonradioactive hazardous waste would be shipped from DOE facilities to commercial treatment, storage, and disposal (TSD) facilities. To aid in assessing the potential impacts of shipments of mixed radioactive and chemically hazardous wastes, a radiological assessment computer model (or code) was developed on the basis of detailed assessments of potential radiological exposures and doses for eight commercial hazardous waste TSD facilities. The model, called TSD-DOSE, is designed to incorporate waste-specific and site-specific data to estimate potential radiological doses to on-site workers and the off-site public from waste-handling operations at a TSD facility. The code is intended to provide both DOE and commercial TSD facilities with a rapid and cost-effective method for assessing potential human radiation exposures from the processing of chemical wastes contaminated with trace amounts of radionuclides.

  16. SCATTERED X-RAY ENERGY DATA FROM INTEGRATED MULTI-FILTER PERSONAL DOSEMETERS WORN BY INTERVENTIONAL RADIOLOGY STAFF.

    PubMed

    Mori, Hiroshige

    2016-11-01

    The accuracy and usability of scattered X-ray energy data obtained from multi-filter dosemeters were investigated by comparing the data with results obtained via Monte Carlo simulation. The energy data, which were read from integrated personal dosemeters used by interventional radiology (IR) staff in individual monitoring, were plotted against relative frequency and statistically assessed. The effective energy obtained from the multi-filter dosemeters was inversely proportional to detector size and lower than the results of the Monte Carlo simulation. All distributions of scattered X-ray energy to which the IR staff were exposed had only one peak value, which corresponded with the effective energy measured using a water phantom. For abdominal IR, there was a significant difference in the distributions between IR staff (p < 0.01). The results suggest that rectifying systematic errors resulting from oblique incidence of X-rays against the filters would make the energy data usable for optimisation of radiological protection. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Interventional treatment for unresectable hepatocellular carcinoma

    PubMed Central

    Murata, Satoru; Mine, Takahiko; Sugihara, Fumie; Yasui, Daisuke; Yamaguchi, Hidenori; Ueda, Tatsuo; Onozawa, Shiro; Kumita, Shin-ichiro

    2014-01-01

    Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies (TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC. PMID:25309076

  18. Radiologically hyperdense zones of the patella seem to be partial osteonecroses subsequent to fracture treatment.

    PubMed

    Schüttrumpf, Jan Philipp; Behzadi, Cyrus; Balcarek, Peter; Walde, Tim Alexander; Frosch, Stephan; Wachowski, Martin Michael; Stürmer, Klaus Michael; Frosch, Karl-Heinz

    2013-10-01

    The blood supply to the proximal patella is provided primarily via intraosseous vessels from the inferior patella. Two vascular systems within the patella are distinguished: Tiny arteries penetrate the middle third of the anterior patellar surface via vascular foramina and continue in a proximal direction. Additional vessels enter the patella at its distal pole, between the patellar ligament and the articular surface, and also run proximally. As a result of the double vascular supply to the distal portion and the vulnerable blood supply to the proximal part, localized osteonecroses subsequent to fracture may occur within the patella and nearly exclusively affect the upper portion of the patella. Such focal regions of osteonecrosis may appear radiographically as localized regions of hyperdensity within the patella. The aim of this study was to investigate the extent to which radiologically hyperdense areas, possibly representing localized osteonecrosis, may occur subsequent to surgical treatment of a patella fracture and the influence that they have on the outcome of the fracture. Retrospective analysis of 100 patients who had been treated operatively for a patella fracture from January 1998 to December 2008 was conducted. The subjective pain rating, clinical scores, and patient satisfaction scores were recorded. Existing X-rays were assessed with regard to possible increased radiological dense areas. After an average of 60.61 ( ± 33.88) months, it was possible to perform a clinical follow-up on 60 patients aged 45.48 ( ± 18.51) years. Radiographic follow-up of all patients revealed that nine patients (9%) exhibited a hyperdense area in the proximal patella portion. X-rays showed radiopaque areas between 1 and 2 months after surgery. In seven cases, the radiological finding disappeared after six months. In two patients with persisting radiologically dense areas, bone necrosis was verified by means of magnetic resonance imaging (MRI) examination and a histological

  19. Reducing Blood-borne Exposure in Interventional Radiology: What the IR Should Know

    SciTech Connect

    Tso, David K.; Athreya, Sriharsha

    2013-08-01

    Interventional radiologists are at risk of exposure to blood-borne pathogens in their day-to-day practice. Percutaneous exposure from unsafe sharps handling, mucocutaneous exposure from body fluid splashes, and glove perforation from excessive wear can expose the radiologist to potentially infectious material. The increasing prevalence of blood-borne pathogens, including hepatitis B and C, and human immunodeficiency virus, puts nurses, residents, fellows, and interventional radiologists at risk for occupational exposure. This review outlines suggestions to establish a culture of safety in the interventional suite.

  20. Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee.

    PubMed

    Khalilzadeh, Omid; Baerlocher, Mark O; Shyn, Paul B; Connolly, Bairbre L; Devane, A Michael; Morris, Christopher S; Cohen, Alan M; Midia, Mehran; Thornton, Raymond H; Gross, Kathleen; Caplin, Drew M; Aeron, Gunjan; Misra, Sanjay; Patel, Nilesh H; Walker, T Gregory; Martinez-Salazar, Gloria; Silberzweig, James E; Nikolic, Boris

    2017-10-01

    To develop a new adverse event (AE) classification for the interventional radiology (IR) procedures and evaluate its clinical, research, and educational value compared with the existing Society of Interventional Radiology (SIR) classification via an SIR member survey. A new AE classification was developed by members of the Standards of Practice Committee of the SIR. Subsequently, a survey was created by a group of 18 members from the SIR Standards of Practice Committee and Service Lines. Twelve clinical AE case scenarios were generated that encompassed a broad spectrum of IR procedures and potential AEs. Survey questions were designed to evaluate the following domains: educational and research values, accountability for intraprocedural challenges, consistency of AE reporting, unambiguity, and potential for incorporation into existing quality-assurance framework. For each AE scenario, the survey participants were instructed to answer questions about the proposed and existing SIR classifications. SIR members were invited via online survey links, and 68 members participated among 140 surveyed. Answers on new and existing classifications were evaluated and compared statistically. Overall comparison between the two surveys was performed by generalized linear modeling. The proposed AE classification received superior evaluations in terms of consistency of reporting (P < .05) and potential for incorporation into existing quality-assurance framework (P < .05). Respondents gave a higher overall rating to the educational and research value of the new compared with the existing classification (P < .05). This study proposed an AE classification system that outperformed the existing SIR classification in the studied domains. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  1. Economically affordable anatomical kidney phantom with calyxes for puncture and drainage training in interventional urology and radiology

    PubMed Central

    Ross, Peeter; Gavšin, Juri; Semjonov, Eero; Kruusmaa, Maarja

    2014-01-01

    Background Trends in interventional radiology and urology training are orientated towards reducing costs and increasing efficiency. In order to comply with the trends, we propose training on inexpensive patient-specific kidney phantoms. Purpose To develop a new kidney phantom for puncture and drainage training in interventional urology and radiology, and to evaluate their anatomical correctness and suitability for training compared to the traditional way of training on home-made phantoms. Material and Methods A case study for validation of kidney phantoms was conducted with nine radiology students divided into two groups: one trained on standard home-made training phantom (n = 4) and the other on our kidney phantoms (n = 5). Another test phantom was used to evaluate the effectiveness of the training of the two groups. The tests were video recorded and analyzed. Duration of the procedure was used as the primary indicator of procedure’s quality. Comparison tests were also conducted with professional radiologists. Anatomical correctness of the kidney phantom was evaluated by comparing the post mortem kidney scans with reconstructed models from CT scans. Subjective feedback was also collected from the participants. Wider use of kidney phantoms was analyzed. Results The average volumetric difference between post mortem kidney scans and reconstructed CT kidney models was 4.70 ± 3.25%. All five students practicing on the kidney phantom improved their performance and the results were almost equal to the results of the professional radiologist while in the other group two students out of four trained on standard home-made training phantoms failed to improve their performance. However, the small number of test subjects prevents us from drawing general conclusions about the efficiency of the new practice. The kidney phantoms were found usable also for nephrostomy catheter placement training under fluoroscopy. Conclusion The feedback from radiologists showed

  2. Clinical and Radiological Classification of the Jawbone Anatomy in Endosseous Dental Implant Treatment

    PubMed Central

    Kubilius, Marius

    2013-01-01

    ABSTRACT Objectives The purpose of present article was to review the classifications suggested for assessment of the jawbone anatomy, to evaluate the diagnostic possibilities of mandibular canal identification and risk of inferior alveolar nerve injury, aesthetic considerations in aesthetic zone, as well as to suggest new classification system of the jawbone anatomy in endosseous dental implant treatment. Material and Methods Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandible; mandibular canal; alveolar nerve, inferior; anatomy, cross-sectional; dental implants; classification. The search was restricted to English language articles, published from 1972 to March 2013. Additionally, a manual search in the major anatomy and oral surgery books were performed. The publications there selected by including clinical and human anatomy studies. Results In total 109 literature sources were obtained and reviewed. The classifications suggested for assessment of the jawbone anatomy, diagnostic possibilities of mandibular canal identification and risk of inferior alveolar nerve injury, aesthetic considerations in aesthetic zone were discussed. New classification system of the jawbone anatomy in endosseous dental implant treatment based on anatomical and radiologic findings and literature review results was suggested. Conclusions The classification system proposed here based on anatomical and radiological jawbone quantity and quality evaluation is a helpful tool for planning of treatment strategy and collaboration among specialists. Further clinical studies should be conducted for new classification validation and reliability evaluation. PMID:24422030

  3. Early intervention critical to autism treatment.

    PubMed

    Butter, Eric M; Wynn, Jacqueline; Mulick, James A

    2003-10-01

    It is still not universally accepted within the scientific community that the habilitation of autistic children is possible, or that their ability to function without supports in regular education by third, fourth, or fifth grade happens as a direct result of EIBI. However, using the outcome studies that have been reported, the rate of children reaching a best-outcome status appears to be between about 10% and 47%. There is a more global way to look at the effects of EIBI or behavioral intervention. Even if the child retains many characteristics of autism, the usual outcome of treatment is that the child learns useful skills. Behavioral intervention results in effective and efficient learning, which is precisely what it aims to accomplish and what behavioral techniques have been developed to do. Children and families have been able to achieve much more than many would ever have believed before EIBI became a realistic possibility.

  4. Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom

    SciTech Connect

    Wiersema, Arno M.; Vos, Jan-Albert; Bruijninckx, Cornelis M. A.; Delden, Otto M. van; Reijnen, Michel M. P. J.; Vahl, Anco; Zeebregts, Clark J.; Moll, Frans L.

    2013-12-15

    Purpose: The use of prophylactic antithrombotic drugs to prevent arterial thrombosis during the periprocedural period during (percutaneous) peripheral arterial interventions (PAIs) is still a matter of dispute, and clear evidence-based guidelines are lacking. To create those guidelines, a study group was formed in the Netherlands in cooperation with the Dutch Society of Vascular Surgery and the Society of Interventional Radiology. The study group is called 'Consensus on Arterial PeriProcedural Anticoagulation (CAPPA).' Materials and Methods: The CAPPA study group devised and distributed a comprehensive questionnaire amongst Dutch interventional radiologists (IRs). Results: One hundred forty-two IRs responded (68 %) to the questionnaire. Almost no IR stopped acetyl salicylic acid before interventions, and 40 % stopped clopidogrel before PAI but not before carotid artery stenting (CAS). A flushing solution on the sideport of the sheath was used routinely by 30 % of IRs in PAI and by 50 % of IRs during CAS. A minority of IRs used a heparinised flushing solution (28 %). Unfractionated heparin was used by 95 % of IRs as bolus; 5000 IU was the most used dosage. Timing of administration varied widely. A majority of IRs (75 %) repeated heparin administration after 1 h. Conclusion: A substantial variety exists amongst IRs in the Netherlands regarding the use of prophylactic periprocedural antithrombotic drugs to prevent arterial thrombosis during PAI. When compared with varying results regarding the use of heparin in the United Kingdom, the variety in the Netherlands showed a different pattern. The proven variety in these countries, and also between these countries, emphasises the need for authoritative studies to develop evidence-based practical guidelines.

  5. Interventional treatment of sialoliths in main salivary glands.

    PubMed

    Salerno, S; Cannizzaro, F; Lo Casto, A; Lombardo, F; Barresi, B; Speciale, R; Lagalla, R

    2002-04-01

    The aim of our study was to demonstrate the effectiveness of interventional radiology in the treatment of sialolithiasis, as the first-choice treatment for the removal of stones located in the middle and proximal tracts of the main salivary ducts, and to assess its limitations and contraindications. Between February 1998 and May 2001 eleven interventional removals of sialoliths were performed for recurrent obstruction of the main salivary duct associated with chronic sialadenitis. Patients were selected on the basis of a preliminary sialogram, designed to determine the location and size of the stone. Exclusion criteria were location of the stone in the gland hilum or intraglandular stone, maximum stone diameter >20% of the duct calibre, signs of adherence of the stone to the duct wall. Stone removal, performed after obtaining informed consent, involved administering antibiotic therapy and local anaesthesia, and dilatating the duct ostium to enable introduction of the basket catheter. The basket was then advanced along the duct under fluoroscopic guidance and suitably manoeuvred so as to capture and extract the stone. On completing the procedure a sialogram was taken to ensure the complete patency of the duct. Patients were prescribed a short course of antibiotics and were followed up at 1, 3 and 6 months. In 10/11 patients the stone was located in Wharton's duct and in 1/11 in Stensen's duct. Removal of the calculus was successful in 10/11 patients; in 2 of these it was necessary to reintroduce the basket after extraction of the stone, in order to eliminate small stone fragments and salivary sand; in 1 patient a preliminary balloon-catheter sialoplasty was performed prior to the procedure to dilatate a distal stenosis caused by chronic sialadenitis; in 3 patients it was necessary to make a small incision in the orifice to introduce the dilator. Removal of the sialolith was unsuccessful in 1/11 of the patients treated, as it proved impossible to capture the calculus

  6. [Interventional treatment methods in atrial fibrillation].

    PubMed

    Osswald, S

    1996-10-12

    Currently, interventional treatment modalities for atrial fibrillation chiefly comprise experimental techniques. Among the rate-control procedures, AV-nodal ablation in conjunction with permanent pacemaker implantation and transcatheter radiofrequency modulation of the AV-node are clinically accepted techniques. In contrast, the original corridor operation--which electrically isolates the left and right atrium from the sinus- and AV-node--has been changed over time and ultimately led to the development of the MAZE procedure. Among the procedures for maintenance of sinus rhythm, permanent atrial pacing and bi-atrial pacing may offer an effective--though still experimental--treatment modality in selected patients with vagally mediated or bradycardia-induced atrial fibrillation. Despite the fact that the MAZE procedure is highly effective in restoring sinus rhythm and associated with a reasonably low surgical mortality, the morbidity and complication rate of this procedure are high. Automated transvenous low-energy atrioversion may offer an interesting alternative in the future. However, there remain some significant limitations, such as the pain associated with low-energy shocks, the risk of ventricular fibrillation induction and the cost-benefit issue which needs to be solved before this technique can become clinically applicable. Last but not least, transcatheter radio frequency ablation of atrial fibrillation, a still highly investigational technique, may have the potential to revolutionize interventional therapy of atrial fibrillation in the future. For this to occur, however, the technique still needs significant improvement. In conclusion, although their current impact on clinical practice is rather small, interventional techniques for treatment of atrial fibrillation are rapidly developing and will certainly change our therapeutic strategies in the near future.

  7. The role of radiology in the diagnosis and treatment of mesenteric ischaemia.

    PubMed

    Upponi, Sara; Harvey, John Julian; Uberoi, Raman; Ganeshan, Arul

    2013-03-01

    Clinicians working in any acute medical/surgical unit need an understanding of mesenteric ischaemia. Acute mesenteric ischaemia is a life-threatening vascular emergency associated with high morbidity and mortality. However, prompt diagnosis with the use of contrast-enhanced CT, more specifically CT angiography, has replaced catheter angiography as the new standard and is readily available in many emergency departments. Similarly, new hybrid open surgery endovascular treatment can minimise the surgical insult to these often critically ill elderly patients. Together, these changes can change the previously grim prognosis associated with this condition. By contrast, chronic mesenteric ischaemia (CMI) is an insidious disease and often a diagnosis of exclusion. However, it can cause a significant reduction in a patient's quality of life, due to 'mesenteric angina' and food avoidance, yet can potentially be treated simply and effectively. Recognition of the typical clinical history and imaging findings is key to making the diagnosis in a timely fashion. Radiology plays a significant role in the diagnosis and increasingly in the treatment of mesenteric ischaemia. Other clinicians should have a basic understanding of what radiology can and cannot offer. The advantages and limitations of commonly used imaging modalities-plain films, CT, MRI and ultrasound, are examined. The significance of findings, such as pneumatosis coli and portal gas are explained. Finally, the different endovascular management of both acute and CMI is discussed, which have emerged as minimally invasive options to complement open revascularisation surgery.

  8. Interventions to increase adherence to acne treatment

    PubMed Central

    Moradi Tuchayi, Sara; Alexander, Tiffany M; Nadkarni, Anish; Feldman, Steven R

    2016-01-01

    Background Adherence to acne medication is poor and is a major reason why treatment plans are ineffective. Recognizing solutions to nonadherence is critical. Objective The purpose of this study is to describe the hurdles associated with acne nonadherence and to provide mechanisms on how to ameliorate them. Methods PubMed database was searched. Of the 419 search results, 29 articles were reviewed to identify hurdles to adherence and corresponding solutions. Results Hurdles to primary nonadherence where the medication is not even started, include lack of knowledge, confusion about usage, weak physician–patient relationship, fear of adverse reactions, and cost. Secondary nonadherence hurdles where the medication is started but is not taken as directed include lack of results, complex regimens, side effects, busy lifestyle, forgetfulness, inconvenience, and psychiatric comorbidity. Solutions to these hurdles include treatment simplification, technology, and dynamic education. Limitations Adherence is affected by numerous factors, but available literature analyzing acne adherence and interventions to improve adherence to treatment is limited. Conclusion There are several hurdles in adhering to acne treatment. Recognition of these hurdles and finding appropriate solutions may be as important to treatment outcomes as choosing the right medication to prescribe. PMID:27784999

  9. Fast and Efficient Radiological Interventions via a Graphical User Interface Commanded Magnetic Resonance Compatible Robotic Device

    PubMed Central

    Özcan, Alpay; Christoforou, Eftychios; Brown, Daniel; Tsekos, Nikolaos

    2011-01-01

    The graphical user interface for an MR compatible robotic device has the capability of displaying oblique MR slices in 2D and a 3D virtual environment along with the representation of the robotic arm in order to swiftly complete the intervention. Using the advantages of the MR modality the device saves time and effort, is safer for the medical staff and is more comfortable for the patient. PMID:17946067

  10. Pseudomyxoma Peritonei: Symptom Control and Objective Radiological Response after Treatment with Lanreotide Autogel.

    PubMed

    Zafra, Gema Marín; Luque, Pedro Segura

    2016-01-01

    Peritoneal mucinous carcinomatosis is an aggressive subtype of pseudomyxoma peritonei, which often leads to inoperable bowel obstruction and, ultimately, death. Due to the poor prognosis, treatment is often symptomatic and aimed at alleviating the symptoms - pain, nausea, and vomiting - associated with gastrointestinal obstruction. Due to their antisecretory activity, somatostatin analogues are commonly prescribed in such cases. In the case presented here, a patient diagnosed with disseminated peritoneal mucinous carcinomatosis of appendiceal origin responded well to symptomatic treatment with lanreotide Autogel(®) at a dose of 120 mg/28 days. More importantly, radiological evidence of a reduction in peritoneal ascites, indicative of antiproliferative activity, was observed. These findings are important, particularly given the negative impact of this disease on both quality of life and survival. This case adds to the growing body of evidence supporting the antiproliferative and antisecretory activity of lanreotide Autogel.

  11. Role of Interventional Radiology in the Management of Chylothorax: A Review of the Current Management of High Output Chylothorax

    SciTech Connect

    Lyon, Stuart Mott, Nigel Koukounaras, Jim; Shoobridge, Jen; Hudson, Patricio Vargas

    2013-06-15

    Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the more invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.

  12. Calculation of conversion factors for effective dose for various interventional radiology procedures

    SciTech Connect

    Compagnone, Gaetano; Giampalma, Emanuela; Domenichelli, Sara; Renzulli, Matteo; Golfieri, Rita

    2012-05-15

    Purpose: To provide dose-area-product (DAP) to effective dose (E) conversion factors for complete interventional procedures, based on in-the-field clinical measurements of DAP values and using tabulated E/DAP conversion factors for single projections available from the literature. Methods: Nine types of interventional procedures were performed on 84 patients with two angiographic systems. Different calibration curves (with and without patient table attenuation) were calculated for each DAP meter. Clinical and dosimetric parameters were recorded in-the-field for each projection and for all patients, and a conversion factor linking DAP and effective doses was derived for each complete procedure making use of published, Monte Carlo calculated conversion factors for single static projections. Results: Fluoroscopy time and DAP values for the lowest-dose procedure (biliary drainage) were approximately 3-fold and 13-fold lower, respectively, than those for the highest-dose examination (transjugular intrahepatic portosystemic shunt, TIPS). Median E/DAP conversion factors from 0.12 (abdominal percutaneous transluminal angioplasty) to 0.25 (Nephrostomy) mSvGy{sup -1} cm{sup -2} were obtained and good correlations between E and DAP were found for all procedures, with R{sup 2} coefficients ranging from 0.80 (abdominal angiography) to 0.99 (biliary stent insertion, Nephrostomy and TIPS). The DAP values obtained in this study showed general consistency with the values provided in the literature and median E values ranged from 4.0 mSv (biliary drainage) to 49.6 mSv (TIPS). Conclusions: Values of E/DAP conversion factors were derived for each procedure from a comprehensive analysis of projection and dosimetric data: they could provide a good evaluation for the stochastic effects. These results can be obtained by means of a close cooperation between different interventional professionals involved in patient care and dose optimization.

  13. Radiation doses in interventional radiology procedures: the RAD-IR study: part I: overall measures of dose.

    PubMed

    Miller, Donald L; Balter, Stephen; Cole, Patricia E; Lu, Hollington T; Schueler, Beth A; Geisinger, Michael; Berenstein, Alejandro; Albert, Robin; Georgia, Jeffrey D; Noonan, Patrick T; Cardella, John F; St George, James; Russell, Eric J; Malisch, Tim W; Vogelzang, Robert L; Miller, George L; Anderson, Jon

    2003-06-01

    To determine patient radiation doses for interventional radiology and neuroradiology procedures, to identify procedures associated with higher radiation doses, and to determine the effects of various parameters on patient doses. A prospective observational study was performed at seven academic medical centers. Each site contributed demographic and radiation dose data for subjects undergoing specific procedures in fluoroscopic suites equipped with built-in cumulative dose (CD) and dose-area-product (DAP) measurement capability compliant with International Electrotechnical Commission standard 60601-2-43. The accuracy of the dosimetry was confirmed by comprehensive measurements and by frequent consistency checks performed over the course of the study. Data were collected on 2,142 instances of interventional radiology procedures, 48 comprehensive physics evaluations, and 581 periodic consistency checks from the 12 fluoroscopic units in the study. There were wide variations in dose and statistically significant differences in fluoroscopy time, number of images, DAP, and CD for different instances of the same procedure, depending on the nature of the lesion, its anatomic location, and the complexity of the procedure. For the 2,142 instances, observed CD and DAP correlate well overall (r = 0.83, P <.000001), but correlation in individual instances is poor. The same is true for the correlation between fluoroscopy time and CD (r = 0.79, P <.000001). The correlation between fluoroscopy time and DAP (r = 0.60, P <.000001) is not as good. In 6% of instances (128 of 2,142), which were principally embolization procedures, transjugular intrahepatic portosystemic shunt (TIPS) procedures, and renal/visceral artery stent placements, CD was greater than 5 Gy. Most procedures studied can result in clinically significant radiation dose to the patient, even when performed by trained operators with use of dose-reducing technology and modern fluoroscopic equipment. Embolization procedures

  14. RESULTS FROM CLINICAL AND RADIOLOGICAL FOLLOW-UP, AFTER SURGICAL TREATMENT OF CHONDROBLASTOMA

    PubMed Central

    Penna, Valter; Toller, Eduardo Areas; Ferreira, Adriano Jander; Dias, Dante Palloni Costa

    2015-01-01

    Objectives: To evaluate the long-term clinical and radiological results from patients who underwent surgical treatment of chondroblastoma, between 2003 and 2009, by the same surgical team, using the same operative technique. Methods: A retrospective study was conducted on 12 patients with histological diagnoses of chondroblastoma, who were attended between 2003 and 2009 at the Pius XII Foundation (Barretos Cancer Hospital, Barretos, State of São Paulo). These patients underwent surgical treatment with intralesional resection of the tumor, adjuvant electrocauterization and replacement with methyl methacrylate (11 cases) or an autologous graft from the iliac crest (one case). The preoperative evaluation included physical examination, plain radiographs of the site, magnetic resonance imaging, computed axial tomography and bone scintigraphy. The patients were assessed clinically and radiologically according to a predefined protocol, with a series of plain radiographs, and a functional assessment in accordance with the Enneking functional score. Results: The average age at the time of diagnosis was 14 years and 4 months. The most frequent location affected was the distal femoral epiphysis (75%), followed by the proximal tibial epiphysis (16.6%) and the calcaneus (8.4%). There was higher prevalence among the female patients than among the male patients (3:1). In three cases, preoperative biopsy was necessary. During the follow-up, there was no evidence of local tumor recurrence, and all the patients presented an excellent functional result from the surgical technique used, with Enneking scores ranging from 20 to 30. Conclusion: Surgical treatment of chondroblastoma, using intralesional resection, adjuvant electrocauterization and replacement with methyl methacrylate or bone graft produced good results. PMID:27027054

  15. Radiological evolution of porcine neurocysticercosis after combined antiparasitic treatment with praziquantel and albendazole.

    PubMed

    Cangalaya, Carla; Bustos, Javier A; Calcina, Juan; Vargas-Calla, Ana; Mamani, Javier; Suarez, Diego; Arroyo, Gianfranco; Gonzalez, Armando E; Chacaltana, Juan; Guerra-Giraldez, Cristina; Mahanty, Siddhartha; Nash, Theodore E; García, Héctor H

    2017-06-01

    The onset of anthelmintic treatment of neurocysticercosis (NCC) provokes an acute immune response of the host, which in human cases is associated with exacerbation of neurological symptoms. This inflammation can occur at the first days of therapy. So, changes in the brain cysts appearance may be detected by medical imaging. We evaluated radiological changes in the appearance of brain cysts (enhancement and size) on days two and five after the onset of antiparasitic treatment using naturally infected pigs as a model for human NCC. Contrast T1-weighted magnetic resonance imaging with gadolinium was performed before and after antiparasitic treatment. Eight NCC-infected pigs were treated with praziquantel plus albendazole and euthanized two (n = 4) and five (n = 4) days after treatment; another group of four infected pigs served as untreated controls. For each lesion, gadolinium enhancement intensity (GEI) and cyst volume were measured at baseline and after antiparasitic treatment. Volume and GEI quantification ratios (post/pre-treatment measures) were used to appraise the effect of treatment. Cysts from untreated pigs showed little variations between their basal and post treatment measures. At days 2 and 5 there were significant increases in GEI ratio compared with the untreated group (1.32 and 1.47 vs 1.01, p = 0.021 and p = 0.021). Cyst volume ratios were significantly lower at days 2 and 5 compared with the untreated group (0.60 and 0.22 vs 0.95, p = 0.04 and p = 0.02). Cysts with lower cyst volume ratios showed more marked post-treatment inflammation, loss of vesicular fluid and cyst wall wrinkling. A significant and drastic reduction of cyst size and increased pericystic enhancement occur in the initial days after antiparasitic treatment as an effect of acute perilesional immune response. These significant changes showed that early anthelmintic efficacy (day two) can be detected using magnetic resonance imaging.

  16. Radiological evolution of porcine neurocysticercosis after combined antiparasitic treatment with praziquantel and albendazole

    PubMed Central

    Bustos, Javier A.; Calcina, Juan; Vargas-Calla, Ana; Mamani, Javier; Suarez, Diego; Arroyo, Gianfranco; Gonzalez, Armando E.; Chacaltana, Juan; Guerra-Giraldez, Cristina; Mahanty, Siddhartha; Nash, Theodore E.; García, Héctor H.

    2017-01-01

    Background The onset of anthelmintic treatment of neurocysticercosis (NCC) provokes an acute immune response of the host, which in human cases is associated with exacerbation of neurological symptoms. This inflammation can occur at the first days of therapy. So, changes in the brain cysts appearance may be detected by medical imaging. We evaluated radiological changes in the appearance of brain cysts (enhancement and size) on days two and five after the onset of antiparasitic treatment using naturally infected pigs as a model for human NCC. Methods and results Contrast T1-weighted magnetic resonance imaging with gadolinium was performed before and after antiparasitic treatment. Eight NCC-infected pigs were treated with praziquantel plus albendazole and euthanized two (n = 4) and five (n = 4) days after treatment; another group of four infected pigs served as untreated controls. For each lesion, gadolinium enhancement intensity (GEI) and cyst volume were measured at baseline and after antiparasitic treatment. Volume and GEI quantification ratios (post/pre-treatment measures) were used to appraise the effect of treatment. Cysts from untreated pigs showed little variations between their basal and post treatment measures. At days 2 and 5 there were significant increases in GEI ratio compared with the untreated group (1.32 and 1.47 vs 1.01, p = 0.021 and p = 0.021). Cyst volume ratios were significantly lower at days 2 and 5 compared with the untreated group (0.60 and 0.22 vs 0.95, p = 0.04 and p = 0.02). Cysts with lower cyst volume ratios showed more marked post-treatment inflammation, loss of vesicular fluid and cyst wall wrinkling. Conclusion/Significance A significant and drastic reduction of cyst size and increased pericystic enhancement occur in the initial days after antiparasitic treatment as an effect of acute perilesional immune response. These significant changes showed that early anthelmintic efficacy (day two) can be detected using magnetic resonance

  17. A randomised crossover simulation study comparing the impact of chemical, biological, radiological or nuclear substance personal protection equipment on the performance of advanced life support interventions.

    PubMed

    Schumacher, J; Arlidge, J; Garnham, F; Ahmad, I

    2017-03-02

    Recent incidents involving chemical, biological, radiological and nuclear substances have stressed the importance of sufficient personal protection equipment for medical first-responders. Modern lightweight, battery-independent, suit ensembles may prove superior to the current protective suit used in the UK. This study compared the powered respiratory protective suit (PRPS ensemble) with a lightweight suit consisting of a SARATOGA(®) Multipurpose CBRN Protective Coverall Polyprotect 12 in conjunction with the Avon C50 Respirator/Avon CBRNF12CE filter canister and butyl rubber protective gloves (Polyprotect 12 ensemble). Thirty anaesthetists carried out a standardised resuscitation scenario either unprotected (control) or wearing the PRPS or Polyprotect 12 ensembles in a randomised, crossover simulation study. Treatment times for five simulated advanced life support interventions (application of monitoring; bag/mask ventilation; tracheal intubation; drug and fluid administration; and external pacing) were measured. Wearer comfort was also assessed for the two protective suits by questionnaire. All participants accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) completion time for the five interventions was significantly longer for the PRPS compared with the Polyprotect 12 ensemble (204 (53) s vs. 149 (36) s, respectively; p < 0.0001). Participants rated mobility, noise, heat, vision, dexterity and speech intelligibility significantly better in the Polyprotect 12 ensemble compared with the PRPS ensemble. The combination of a lightweight Polyprotect 12 suit and an Avon C50 air-purifying respirator is preferable to the powered respiratory protective suit during simulated emergency life support, due to a combination of shorter task completion times and improved mobility, communication and dexterity.

  18. Evidence-based medical oncology and interventional radiology paradigms for liver-dominant colorectal cancer metastases

    PubMed Central

    Sag, Alan Alper; Selcukbiricik, Fatih; Mandel, Nil Molinas

    2016-01-01

    Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is (limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population. PMID:27003990

  19. Evidence-based medical oncology and interventional radiology paradigms for liver-dominant colorectal cancer metastases.

    PubMed

    Sag, Alan Alper; Selcukbiricik, Fatih; Mandel, Nil Molinas

    2016-03-21

    Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is (limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.

  20. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

    PubMed Central

    Venkatesh, Hosur Ananthashayana; Gamanagatti, Shivanand; Garg, Pramod; Srivastava, Deep Narayan

    2016-01-01

    Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks. PMID:27134524

  1. Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents

    PubMed Central

    Ramesh, Aruna C.; Kumar, S.

    2010-01-01

    In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury. PMID:21829319

  2. Hospital Organization and Importance of an Interventional Radiology Inpatient Admitting Service: Italian Single-Center 3-Year Experience

    SciTech Connect

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore

    2009-03-15

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of Euro 1,009,095.35. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  3. Physician-received scatter radiation with angiography systems used for interventional radiology: comparison among many X-ray systems.

    PubMed

    Chida, Koichi; Morishima, Yoshiaki; Inaba, Youhei; Taura, Masaaki; Ebata, Ayako; Takeda, Ken; Shimura, Hirotaka; Zuguchi, Masayuki

    2012-05-01

    Radiation protection for interventional radiology (IR) physicians is very important. Current IR X-ray systems tend to use flat-panel detectors (FPDs) rather than image intensifiers (IIs). The purpose of this study is to test the hypothesis that there is no difference in physician-received scatter radiation (PRSR) between FPD systems and II systems. This study examined 20 X-ray systems in 15 cardiac catheterisation laboratories (11 used a FPD and 9 used an II). The PRSR with digital cineangiography and fluoroscopy were compared among the 20 X-ray systems using a phantom and a solid-state-detector electronic pocket dosemeter. The maximum PRSR exceeded the minimum PRSR by ~12-fold for cineangiography and ~9-fold for fluoroscopy. For both fluoroscopy and digital cineangiography, the PRSR had a statistically significant positive correlation with the entrance surface dose (fluoroscopy, r = 0.87; cineangiography, r = 0.86). There was no statistically significant difference between the average PRSR of FPDs and IIs during either digital cineangiography or fluoroscopy. There is a wide range of PRSR among the radiography systems evaluated. The PRSR correlated well with the entrance surface dose of the phantom in 20 X-ray units used for IR. Hence, decreasing the dose to the patient will also decrease the dose to staff.

  4. Hospital organization and importance of an interventional radiology inpatient admitting service: Italian single-center 3-year experience.

    PubMed

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore

    2009-03-01

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of 1,009,095.35 euros. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  5. Clinical and Radiologic Responses to Cladribine for the Treatment of Erdheim-Chester Disease.

    PubMed

    Goyal, Gaurav; Shah, Mithun V; Call, Timothy G; Litzow, Mark R; Hogan, William J; Go, Ronald S

    2017-09-01

    While cladribine is best known for the treatment of hairy cell leukemia and other lymphoid cancers, it also has activity against myeloid neoplasms, such as Erdheim-Chester disease (ECD). To assess the efficacy of cladribine (2-chloro-2'-deoxyadenosine) in the treatment of ECD. This study was a single-institution retrospective medical record review from January 1, 1998, to April 6, 2016, at a tertiary academic medical center. In all eligible cases, the diagnosis of ECD was made using clinical criteria in conjunction with histopathologic findings. Cladribine therapy in first-line treatment or later. Two response criteria were used, clinical and radiological. For clinical response, the following criteria were used: complete response (complete resolution of symptoms attributed to ECD), partial response (partial resolution of symptoms attributed to ECD), stable disease (no change in symptoms attributed to ECD), and progressive disease (worsening of symptoms attributed to ECD). For radiological response, the following categories were used: complete response (complete resolution of proven or suspected lesion due to ECD), partial response (partial resolution of proven or suspected lesion due to ECD), stable disease (no significant change in proven or suspected lesion due to ECD for ≥3 months), and progressive disease (progression or worsening of proven or suspected lesion due to ECD). A total of 63 adult patients with confirmed ECD were identified. Their median age at diagnosis of ECD was 54 years (age range, 18-80 years), and 67% (42 of 63) were male. Cladribine was the most commonly used chemotherapeutic agent and was administered in 21 of 63 patients (33%). Their median age at the time of cladribine therapy was 62 years (age range, 40-78 years). Cladribine was used as the first-line treatment in 9 patients and as later-line treatment in the remaining 12 patients. The median number of cycles of cladribine administered was 2.5 (range, 1-6). The overall clinical response

  6. Prevention of Contrast-Induced Nephropathy (CIN) in Interventional Radiology Practice

    PubMed Central

    Gupta, Rajan K.; Bang, Tami J.

    2010-01-01

    Contrast-induced nephropathy (CIN) is a widely recognized and clinically significant problem in patients undergoing an increasing number of minimally invasive procedures that require contrast administration. Contrast-induced nephropathy is the third most common cause of hospital-acquired renal failure and has significant prognostic implications on patient outcomes. Interventional practitioners are faced with challenging decisions regarding prophylaxis and patient management. The major risk factor for developing CIN is preexisting renal dysfunction, particularly in association with diabetes. Patients are considered to be at risk when estimated glomerular filtration rate (eGFR) or estimated creatinine clearance (eCCr) is less than 60. The cornerstone of prevention of CIN is appropriate risk stratification, intravenous hydration with normal saline or sodium bicarbonate, appropriate withholding of nephrotoxic medications, use of low or iso-osmolar contrast media, and various intraprocedural methods for iodinated contrast dose reduction. Although N-acetylcysteine administration is popular, it remains unproven. Practitioners must be familiar with prevention strategies and diagnosis of CIN to minimize its clinical impact. PMID:22550376

  7. [Process-oriented cost calculation in interventional radiology. A case study].

    PubMed

    Mahnken, A H; Bruners, P; Günther, R W; Rasche, C

    2012-01-01

    Currently used costing methods such as cost centre accounting do not sufficiently reflect the process-based resource utilization in medicine. The goal of this study was to establish a process-oriented cost assessment of percutaneous radiofrequency (RF) ablation of liver and lung metastases. In each of 15 patients a detailed task analysis of the primary process of hepatic and pulmonary RF ablation was performed. Based on these data a dedicated cost calculation model was developed for each primary process. The costs of each process were computed and compared with the revenue for in-patients according to the German diagnosis-related groups (DRG) system 2010. The RF ablation of liver metastases in patients without relevant comorbidities and a low patient complexity level results in a loss of EUR 588.44, whereas the treatment of patients with a higher complexity level yields an acceptable profit. The treatment of pulmonary metastases is profitable even in cases of additional expenses due to complications. Process-oriented costing provides relevant information that is needed for understanding the economic impact of treatment decisions. It is well suited as a starting point for economically driven process optimization and reengineering. Under the terms of the German DRG 2010 system percutaneous RF ablation of lung metastases is economically reasonable, while RF ablation of liver metastases in cases of low patient complexity levels does not cover the costs.

  8. How to Interpret Thyroid Biopsy Results: A Three-Year Retrospective Interventional Radiology Experience

    SciTech Connect

    Oppenheimer, Jason D. Kasuganti, Deepa; Nayar, Ritu; Chrisman, Howard B.; Lewandowski, Robert J.; Nemcek, Albert A.; Ryu, Robert K.

    2010-08-15

    Results of thyroid biopsy determine whether thyroid nodule resection is appropriate and the extent of thyroid surgery. At our institution we use 20/22-gauge core biopsy (CBx) in conjunction with fine-needle aspiration (FNA) to decrease the number of passes and improve adequacy. Occasionally, both ultrasound (US)-guided FNA and CBx yield unsatisfactory specimens. To justify clinical recommendations for these unsatisfactory thyroid biopsies, we compare rates of malignancy at surgical resection for unsatisfactory biopsy results against definitive biopsy results. We retrospectively reviewed a database of 1979 patients who had a total of 2677 FNA and 663 CBx performed by experienced interventional radiologists under US guidance from 2003 to 2006 at a tertiary-care academic center. In 451 patients who had surgery following biopsy, Fisher's exact test was used to compare surgical malignancy rates between unsatisfactory and malignant biopsy cohorts as well as between unsatisfactory and benign biopsy cohorts. We defined statistical significance at P = 0.05. We reported an overall unsatisfactory thyroid biopsy rate of 3.7% (100/2677). A statistically significant higher rate of surgically proven malignancies was found in malignant biopsy patients compared to unsatisfactory biopsy patients (P = 0.0001). The incidence of surgically proven malignancy in unsatisfactory biopsy patients was not significantly different from that in benign biopsy patients (P = 0.8625). In conclusion, an extremely low incidence of malignancy was associated with both benign and unsatisfactory thyroid biopsy results. The difference in incidence between these two groups was not statistically significant. Therefore, patients with unsatisfactory biopsy specimens can be reassured and counseled accordingly.

  9. Interventional oncology in multidisciplinary cancer treatment in the 21(st) century.

    PubMed

    Adam, Andreas; Kenny, Lizbeth M

    2015-02-01

    Interventional oncology is an evolving branch of interventional radiology, which relies on rapidly evolving, highly sophisticated treatment tools and precise imaging guidance to target and destroy malignant tumours. The development of this field has important potential benefits for patients and the health-care system, but as a new discipline, interventional oncology has not yet fully established its place in the wider field of oncology; its application does not have a comprehensive evidence base, or a clinical or quality-assurance framework within which to operate. In this regard, radiation oncology, a cornerstone of modern cancer care, has a lot of important information to offer to interventional oncologists. A strong collaboration between radiation oncology and interventional oncology, both of which aim to cure or control tumours or to relieve symptoms with as little collateral damage to normal tissue as possible, will have substantial advantages for both disciplines. A close relationship with radiation oncology will help facilitate the development of a robust quality-assurance framework and accumulation of evidence to support the integration of interventional oncology into multidisciplinary care. Furthermore, collaboration between interventional oncology and radiation oncology fields will have great benefits to practitioners, people affected by cancer, and to the wider field of oncology.

  10. Percutaneous BioOrganic Sealing of Duodenal Fistulas: Case Report and Review of Biological Sealants with Potential Use in Interventional Radiology

    SciTech Connect

    Wadhwa, Vibhor; Leeper, William R.; Tamrazi, Anobel

    2015-08-15

    Biological sealants are being increasingly used in a variety of surgical specialties for their hemostatic and sealing capabilities. However, their use in interventional radiology has not been widely reported. The authors describe a case of duodenal perforation occurring after 15 years of gastric bypass surgery, in whom surgical diversion was unsuccessfully attempted and the leakage was successfully controlled using percutaneous administration of a combination of biological and organic sealants.

  11. Establishment of an inferior vena cava filter database and interventional radiology led follow-up - retrieval rates and patients lost to follow-up.

    PubMed

    Klinken, Sven; Humphries, Charlotte; Ferguson, John

    2017-10-01

    To evaluate the rates of inferior vena cava (IVC) filter retrieval and the number of patient's lost to follow-up, before and after the establishment of an IVC filter database and interventional radiology (inserting physician) led follow-up. On the 1st of June 2012, an electronic interventional radiology database was established at our Institution. In addition, the interventional radiology team took responsibility for follow-up of IVC filters. Data were prospectively collected from the database for all patients who had an IVC filter inserted between the 1st June 2012 and the 31st May 2014. Data on patients who had an IVC filter inserted between the 1st of June 2009 to the 31st of May 2012 were retrospectively reviewed. Patient demographics, insertion indications, filter types, retrieval status, documented retrieval decisions, time in situ, trackable events and complications were obtained in the pre-database (n = 136) and post-database (n = 118) cohorts. Attempted IVC filter retrieval rates were improved from 52.9% to 72.9% (P = 0.001) following the establishment of the database. The number of patients with no documented decision (lost to follow-up) regarding their IVC filter reduced from 31 of 136 (23%) to 0 of 118 patients (P = < 0.001). There was a non-significant reduction in IVC filter dwell time in the post-database group (113 as compared to 137 days, P = 0.129). Following the establishment of an IVC filter database and interventional radiology led follow-up, we demonstrate a significant improvement in the attempted retrieval rates of IVC filters and the number of patient's lost to follow-up. © 2017 The Royal Australian and New Zealand College of Radiologists.

  12. Radiological diagnosis in lung disease: factoring treatment options into the choice of diagnostic modality.

    PubMed

    Wielpütz, Mark O; Heußel, Claus P; Herth, Felix J F; Kauczor, Hans-Ulrich

    2014-03-14

    Chest X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) each have characteristic advantages and disadvantages that need to be considered in clinical decision-making. This point is discussed in reference to the main types of lung disease that are encountered in practice. A selective literature search was performed in the PubMed and Google Scholar databases. Existing clinical guidelines on the main types of lung disease and studies concerning radiological diagnosis were also con - sidered in this review. There have been no more than a few large-scale, controlled comparative trials of different radiological techniques. Chest X-ray provides general orientation as an initial diagnostic study and is especially useful in the diagnosis of pneumonia, cancer, and chronic obstructive pulmonary disease (COPD). Multi-detector CT affords nearly isotropic spatial resolution at a radiation dose of only 0.2-5 mSv, much lower than before. Its main indications, according to current guidelines, are tumors, acute pulmonary embolism, pulmonary hypertension, pulmonary fibrosis, advanced COPD, and pneumonia in a high-risk patient. MRI is used in the diagnosis of cystic fibrosis, pulmonary embolism, pulmonary hypertension, and bronchial carcinoma. The positive predictive value (PPV) of a chest X-ray in outpatients with pneumonia is only 27% (gold standard, CT); in contrast, an initial, non-randomized trial of MRI in nosocomial pneumonia revealed a PPV of 95%. For the staging of mediastinal lymph nodes in bronchial carcinoma, MRI has a PPV of 88% and positron emission tomography with CT (PET/CT) has a PPV of 79%, while CT alone has a PPV of 41% (gold standard, histology). The choice of radiologicalal technique for the detection, staging, follow-up, and quantification of lung disease should be based on the individual clinical options, so that appropriate treatment can be provided without excessive use of diagnostic testing.

  13. Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists: A single–emergency center experience

    PubMed Central

    Tsurukiri, Junya; Ohta, Shoichi; Mishima, Shiro; Homma, Hiroshi; Okumura, Eitaro; Akamine, Itsuro; Ueno, Masahito; Oda, Jun; Yukioka, Tetsuo

    2017-01-01

    INTRODUCTION Comprehensive treatment of a patient in acute medicine and surgery requires the use of both surgical techniques and other treatment methods. Recently, acute vascular interventional radiology techniques (AVIRTs) have become increasingly popular, enabling adequately trained in-house experts to improve the quality of on-site care. METHODS After obtaining approval from our institutional ethics committee, we conducted a retrospective study of AVIRT procedures performed by acute care specialists trained in acute medicine and surgery over a 1-year period, including those conducted out of hours. Trained acute care specialists were required to be certified by the Japanese Association of Acute Medicine and to have completed at least 1 year of training as a member of the endovascular team in the radiology department of another university hospital. The study was designed to ensure that at least one of the physicians was available to perform AVIRT within 1 h of a request at any time. Femoral sheath insertion was usually performed by the resident physicians under the guidance of trained acute care specialists. RESULTS The study sample comprised 77 endovascular procedures for therapeutic AVIRT (trauma, n = 29, and nontrauma, n = 48) among 62 patients (mean age, 64 years; range, 9–88 years), of which 55% were male. Of the procedures, 47% were performed out of hours (trauma, 52%; and nontrauma, 44%). Three patients underwent resuscitative endovascular balloon occlusion of the aorta in the emergency room. No major device-related complications were encountered, and the overall mortality rate within 60 days was 8%. The recorded causes of death included exsanguination (n = 2), pneumonia (n = 2), sepsis (n = 1), and brain death (n = 1). CONCLUSION When performed by trained acute care specialists, AVIRT seems to be advantageous for acute on-site care and provides good technical success. Therefore, a standard training program should be established for acute care specialists

  14. Optimal scan parameters for CT fluoroscopy in lung interventional radiologic procedures: relationship between radiation dose and image quality.

    PubMed

    Yamao, Yoshikazu; Yamakado, Koichiro; Takaki, Haruyuki; Yamada, Tomomi; Murashima, Shuichi; Uraki, Junji; Kodama, Hiroshi; Nagasawa, Naoki; Takeda, Kan

    2010-04-01

    To evaluate the relationship between radiation doses and lung computed tomographic (CT) fluoroscopic scan parameters and to determine optimal scan parameters for performance of lung interventional radiologic (IR) procedures. The institutional review board approved this prospective study, which included 32 patients with a single lung tumor; written informed consent was obtained. CT fluoroscopic images were obtained with three tube voltages (80,120,135 kV) and three tube currents (10, 20, 30 mA) in each patient. The signal-to-noise ratios (SNRs) and the contrast-to-noise ratios (CNRs) were measured quantitatively. To evaluate the feasibility of performing lung IR procedures, four readers visually scored the image quality. Acceptable CT fluoroscopic images were determined by using agreement of at least three of the four readers. The weighted CT dose index for each CT scan parameter was measured. A piecewise linear regression equation was obtained from the relationship between radiation doses and visual image scores. Both the SNR and the CNR improved as the radiation dose increased, leading to improvement in the image quality. Acceptable image quality was achieved in 94% (30 of 32) of patients when the radiation dose was 1.18 mGy/sec (120 kV, 10 mA) and in all patients when it was greater than 1.48 mGy/sec (135 kV, 10 mA). The piecewise linear curve showed rapid improvement in image quality until the radiation dose increased to 1.48 mGy/sec (135 kV, 10 mA). When the radiation dose was increased greater than 1.48 mGy/sec, improvement in the image quality became more gradual. Results of this study can be used to guide the determination of optimal scan parameters in lung CT fluoroscopy. RSNA, 2010

  15. Importance of dose settings in the x-ray systems used for interventional radiology: a national survey.

    PubMed

    Vano, E; Sanchez, R; Fernandez, J M; Rosales, F; Garcia, M A; Sotil, J; Hernandez, J; Carrera, F; Ciudad, J; Soler, M M; Ballester, T

    2009-01-01

    The purpose of this work was to investigate the differences in dose settings among the X-ray units involved in a national survey of patient doses in interventional radiology (IR). The survey was promoted by the National Society of IR and involved 10 centers. As part of the agreed quality control for the survey, entrance doses were measured in a 20-cm-thick acrylic phantom simulating a medium-sized patient. A standard digital subtraction angiography (DSA) imaging protocol for the abdomen was used at the different centers. The center of the phantom was placed at the isocenter of the C-arm system during the measurements to simulate clinical conditions. Units with image intensifiers and flat detectors were involved in the survey. Entrance doses for low, medium, and high fluoroscopy modes and DSA acquisitions were measured for a field of view of 20 cm (or closest). A widespread range of entrance dose values was obtained: 4.5-18.6, 9.2-28.4, and 15.4-51.5 mGy/min in low, medium, and high fluoroscopy mode, respectively, and 0.7-5.0 mGy/DSA image. The ratios between the maximum and the minimum values measured (3-4 for fluoroscopy and 7 for DSA) suggest an important margin for optimization. The calibration factor for the dose-area product meter was also included in the survey and resulted in a mean value of 0.73, with a standard deviation of 0.07. It seems clear that the dose setting for the X-ray systems used in IR requires better criteria and approaches.

  16. Importance of Dose Settings in the X-Ray Systems Used for Interventional Radiology: A National Survey

    SciTech Connect

    Vano, E. Sanchez, R.; Fernandez, J. M.; Rosales, F.; Garcia, M. A.; Sotil, J.; Hernandez, J.; Carrera, F.; Ciudad, J.; Soler, M. M.; Ballester, T.

    2009-01-15

    The purpose of this work was to investigate the differences in dose settings among the X-ray units involved in a national survey of patient doses in interventional radiology (IR). The survey was promoted by the National Society of IR and involved 10 centers. As part of the agreed quality control for the survey, entrance doses were measured in a 20-cm-thick acrylic phantom simulating a medium-sized patient. A standard digital subtraction angiography (DSA) imaging protocol for the abdomen was used at the different centers. The center of the phantom was placed at the isocenter of the C-arm system during the measurements to simulate clinical conditions. Units with image intensifiers and flat detectors were involved in the survey. Entrance doses for low, medium, and high fluoroscopy modes and DSA acquisitions were measured for a field of view of 20 cm (or closest). A widespread range of entrance dose values was obtained: 4.5-18.6, 9.2-28.4, and 15.4-51.5 mGy/min in low, medium, and high fluoroscopy mode, respectively, and 0.7-5.0 mGy/DSA image. The ratios between the maximum and the minimum values measured (3-4 for fluoroscopy and 7 for DSA) suggest an important margin for optimization. The calibration factor for the dose-area product meter was also included in the survey and resulted in a mean value of 0.73, with a standard deviation of 0.07. It seems clear that the dose setting for the X-ray systems used in IR requires better criteria and approaches.

  17. Dental radiology.

    PubMed

    Woodward, Tony M

    2009-02-01

    Dental radiology is the core diagnostic modality of veterinary dentistry. Dental radiographs assist in detecting hidden painful pathology, estimating the severity of dental conditions, assessing treatment options, providing intraoperative guidance, and also serve to monitor success of prior treatments. Unfortunately, most professional veterinary training programs provide little or no training in veterinary dentistry in general or dental radiology in particular. Although a technical learning curve does exist, the techniques required for producing diagnostic films are not difficult to master. Regular use of dental x-rays will increase the amount of pathology detected, leading to healthier patients and happier clients who notice a difference in how their pet feels. This article covers equipment and materials needed to produce diagnostic intraoral dental films. A simplified guide for positioning will be presented, including a positioning "cheat sheet" to be placed next to the dental x-ray machine in the operatory. Additionally, digital dental radiograph systems will be described and trends for their future discussed.

  18. A case of astroblastoma: Radiological and histopathological characteristics and a review of current treatment options

    PubMed Central

    Samples, Derek C.; Henry, James; Bazan, Carlos; Tarasiewicz, Izabela

    2016-01-01

    Background: Astroblastoma is a rare neuroepithelial tumor that often originates in the cerebral hemisphere of children and young adults. Diagnosis of this obscure neoplasm can be difficult because these tumors are so infrequently encountered and share common radiological and neuropathological features of other glial neoplasms. As such, it should be included in the differential diagnosis of astrocytoma and ependymoma if the clinical and radiographic features suggest it. Standardized treatment of astroblastomas remains under dispute because of the lack of knowledge regarding the tumor and a paucity of studies in the literature. Case Description: We present a case of a low-grade astroblastoma diagnosed in a 30-year-old female with seizures, headache, and vision changes. She underwent gross total resection and, without evidence of high-grade features, adjuvant therapy was not planned postoperatively. Post-operative surveillance suggested early recurrence, warranting referral to radiation therapy. Patient ended up expiring despite adjuvant therapy secondary to extensive recurrence and tumor metastasis. Conclusions: Astroblastoma must be considered in the differential of supratentorial tumors in children and young adults. Treatment of such, as suggested by most recent literature, includes gross total resection and adjuvant radiotherapy for lesions exhibiting high-grade features. PMID:28144474

  19. Web-based remote psychological intervention improves cancer treatment.

    PubMed

    Wang, Ping; Yu, Tao; Yang, Lin

    2017-08-01

    Web-based-remote (WBR) intervention is a new approach that incorporates smart control technology and modern medicine to monitor patient compliance. It is based on computer control and communication technology. This study is to explore the benefits of WBR psychological intervention for cancer treatment. 128 patients diagnosed with cancer by Pathology Department of our hospital between 1 February 2013 and 1 August 2013 were included. Patients were randomly assigned to intervention and control group (n = 64). The Questionnaire-Core 30 (QLQ-C30) was used for the survey. Intervention group received WBR psychological intervention in addition to regular clinical follow-up care. Control group only received regular clinical follow-up care. The QLQ-C30 score was significantly better in the intervention group than the control group when the intervention and control groups were followed for three months. In conclusion, WBR psychological intervention substantially improves the quality of life in patients during cancer treatment.

  20. Society of Interventional Radiology

    MedlinePlus

    ... Fibroid Embolization Varicose Veins Vascular Screening Venous disease Women's health Find a Doctor SIR Blog: The Vision to Heal SIR’s blog, Vision to Heal, provides timely in depth discourse from SIR leadership and senior management that explores practice-changing topics. ...

  1. Society of Interventional Radiology

    MedlinePlus

    ... Members Medical Professionals Patients Media Fellows • Residents • Students Corporate International Join About Us Meetings and Education Doctor Finder/Patient information Select a State: Choose ...

  2. Interventional Radiology: Stroke

    MedlinePlus

    ... MEMBERSHIP DIRECTORY DIVERSITY AND INCLUSIVENESS I AM IR LEADERSHIP DEVELOPMENT ACADEMY Meetings and Education Meetings and Education ... INTERNATIONAL SCHOLARSHIP PROGRAM MEDIA ARCHIVE GOVERNMENT AFFAIRS GRASSROOTS LEADERSHIP PROGRAM ADVOCACY TOOLKIT Publications ... PUBLICATIONS ANNUAL REPORT ...

  3. Treatment Acceptability of Interventions Published in Six School Psychology Journals

    ERIC Educational Resources Information Center

    Villarreal, Victor; Ponce, Christopher; Gutierrez, Heveli

    2015-01-01

    Treatment acceptability (TA) is critical when selecting and implementing an intervention, as TA is associated with treatment outcomes. The significance of TA is reflected in school psychology models for services that state that school psychologists should address TA during development, implementation, and evaluation of interventions. However, the…

  4. Does Smoking Intervention Influence Adolescent Substance Use Disorder Treatment Outcomes?

    ERIC Educational Resources Information Center

    Myers, Mark G.; Prochaska, Judith J.

    2008-01-01

    Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking…

  5. Does Smoking Intervention Influence Adolescent Substance Use Disorder Treatment Outcomes?

    ERIC Educational Resources Information Center

    Myers, Mark G.; Prochaska, Judith J.

    2008-01-01

    Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking…

  6. Treatment Acceptability of Interventions Published in Six School Psychology Journals

    ERIC Educational Resources Information Center

    Villarreal, Victor; Ponce, Christopher; Gutierrez, Heveli

    2015-01-01

    Treatment acceptability (TA) is critical when selecting and implementing an intervention, as TA is associated with treatment outcomes. The significance of TA is reflected in school psychology models for services that state that school psychologists should address TA during development, implementation, and evaluation of interventions. However, the…

  7. A synthetic radiological study of brain treatment in ancient Egyptian mummies.

    PubMed

    Wade, Andrew D; Nelson, Andrew J; Garvin, Greg J

    2011-08-01

    Variability in brain treatment, as a part of the Egyptian mummification process, is poorly appreciated in the literature, as variability in the details of excerebration have not been addressed comprehensively nor with respect to social, geographic, and temporal variation. The description of Egyptian mummification commonly used in the popular and academic literature is derived largely from accounts by Herodotus and Diodorus Siculus. However, this normative description does not acknowledge the existence of a wide range of mummification techniques practiced and so stifles the study of geographic and chronological changes in the practice and their causes. Therefore, the goal of this study is to use the classical description as a hypothesis for empirical testing, using published literature and primary radiographic data, with a specific focus on the practice of excerebration. Three primary treatments of the brain in mummification, and their variation over time and across social strata, are discussed in relation to their treatment in the literature, their radiological indicators, and their technical considerations. In order to examine Egyptian mummy excerebration, this study makes use of two samples: (1) a literature-based sample of 125 mummies, and (2) a sample of 6 mummies examined directly using computed tomography. In spite of an apparent high degree of variability, the literature continues to focus on modern and classical stereotypes rather than the rich variability in the Egyptian mummification tradition. Detailed, large-scale examination of this and other mummification traditions, and their meanings, is required to further our understanding of this important early complex society. Copyright © 2011 Elsevier GmbH. All rights reserved.

  8. Infantile hepatic hemangiomas. Clinical features, radiologic investigations, and treatment of 20 patients

    SciTech Connect

    Stanley, P.; Geer, G.D.; Miller, J.H.; Gilsanz, V.; Landing, B.H.; Boechat, I.M. )

    1989-08-15

    The clinical features, radiologic investigation, and treatment of 20 infants with hepatic hemangiomas are presented. Palpable abdominal mass (n = 18) and cardiac failure (n = 11) were the common presenting features. Nine patients had hyperconsumptive coagulopathy. Seven patients had other hemangiomas. Ultrasound (n = 15) showed the number and distribution of the hemangiomas within the liver. Hypoechoic and hyperechoic elements were present in addition to prominent vascular channels and diminished caliber of the distal aorta. Radionuclide sulfur colloid (n = 12) and labeled red blood cell (n = 7) studies showed the distribution and vascularity of the hemangiomas. Computed tomography (n = 8) revealed central hypointensity with marked peripheral enhancement after contrast. Arteriography now performed only as a prelude to therapeutic embolization demonstrated hypervascularity in each patient, contrast pooling in six and early draining veins in five. Magnetic resonance scanning (n = 3) showed decreased signal intensity on T1 images and high intensity signal on T2. In two patients, there was resolution or improvement of the hemangiomas without therapy. Four patients had surgery (lobectomy (2), trisegmentectomy (1), and surgical evacuation of a central hematoma (1)). Steroids and radiation were given to seven patients, and one patient also required therapeutic embolization. Steroids were the initial therapy in five patients, one of whom later required therapeutic embolization and another cyclophosphamide. Two patients were treated initially with radiation therapy, one of whom also needed emergency hepatic artery ligation. Seventeen of the 20 patients are alive and well from 6 months to 14 years after diagnosis.

  9. Biomimetic hydroxyapatite used in the treatment of periodontal intrabony pockets: clinical and radiological analysis

    PubMed Central

    Figliuzzi, Michele Mario; Giudice, Amerigo; Pileggi, Settimia; Scordamaglia, Francesco; Marrelli, Massimo; Tatullo, Marco; Fortunato, Leonzio

    2016-01-01

    Summary Aim Hydroxyapatite (PA) has a chemical composition and physical structure very similar to natural bone and therefore it has been considered to be the ideal biomaterial able to ensure a biomimetic scaffold to use in bone tissue engineering. The aim of this study is to clinically test hydroxyapatite used as osteoconductive biomaterial in the treatment of periodontal bone defects. Clinical and radiological evaluations were conducted at 6, 12 and 18 months after the surgery. Materials and methods Forty patients with 2- and 3-wall intrabony pockets were enrolled in this study. PPD, CAL, radiographic depth (RD) and angular defects were preoperatively measured. After surgery, patients were re-evaluated every 6 months for 18 months. Statistical analyses were also performed to investigate any differences between preoperative and postoperative measurements. Results Paired t-test samples conducted on the data obtained at baseline and 18 months after, showed significant (p<0.01) differences in each measurement performed. The role of preoperative RD was demonstrated to be a significant key factor (p<0.01). A relevant correlation between preoperative PPD and CAL gain was also found. Conclusions Within the limitations of this study, the absence of anatomical variables, except the morphology of the bone defect, emphasizes the importance of the proper surgical approach and the graft material used. PMID:27486507

  10. [Difference in the level of patient treatment safety analysed by the years of experience of the radiological technologists].

    PubMed

    Doi, Tsukasa; Kawamoto, Kiyosumi; Yamaguchi, Kazuya

    2012-01-01

    According to the report of the reporting project of medical accidents (from July 2010 to March 2011) which was issued by the Ministry of Health, Labour, and Welfare, a lot of incidents involving radiological technologists occurred among young ages or experienced ages; therefore, we focused on this matter. We carried out questionnaires for the radiological technologists at the radiology department of our hospital to see how concerned they are about the patient treatment safety. We examined the causal relationship between years of their experience and their concerns about the patient treatment safety. As a result, we found that their concerns about the patient treatment safety are characteristically different depending on the years of experience. The results showed that the new technologists were on a low level of caring with a similar philosophy to the saying "To err is human". They also lack a positive attitude. Moreover, they stated that the causes of the errors were neither the devices nor the system of the devices. Mid-career technologists stated that the most common cause of errors is the liability of the person concerned. They are concerned that education to improve individual abilities is important. Experienced technologists stated that the cause of the error is excluding the person concerned, but due to the devices, patients, or advanced specialization of the examinations. However, they also had the positive attitude to promote the patient treatment safety.

  11. A new approach to the treatment of nasal bone fracture: radiologic classification of nasal bone fractures and its clinical application.

    PubMed

    Han, Daniel Seung Youl; Han, Yea Sik; Park, Jin Hyung

    2011-11-01

    A radiologic examination is required in the treatment of nasal bone fracture to determine the fracture condition. Thus, there is an increasing need for radiologic classification of nasal bone fractures that can be applied to clinical practice. Computed tomography was performed in 125 patients with nasal bone fractures to determine which axial view best showed the entire nasal view. The obtained axial view was then used as a reference for classification. The length from the top to the base of the nasal bone was divided into upper, middle, and lower levels, after which the fracture location was determined. If the fracture spanned the boundaries of these levels, it was classified as the total level. Subsequently, the fracture was subclassified based on the fracture direction and pattern and the concurrent fracture. Radiologic examination of patients with nasal bone fracture showed that nasal bone fracture was frequently found at the total, middle, upper, and lower levels, in that order. Nasal bone fractures at the upper level showed lower frequencies of complication and reoperation than the fractures at the other levels, whereas nasal bone fractures at the total level showed the highest frequencies of complication and reoperation. Radiologic classification can be useful for preoperative and postoperative evaluations of nasal bone fractures and can be helpful in understanding such fractures because it can efficiently predict the prognosis of a fracture. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  12. The development of Operational Intervention Levels (OILs) for Soils - A decision support tool in nuclear and radiological emergency response

    NASA Astrophysics Data System (ADS)

    Lee Zhi Yi, Amelia; Dercon, Gerd; Blackburn, Carl; Kheng, Heng Lee

    2017-04-01

    In the event of a large-scale nuclear accident, the swift implementation of response actions is imperative. For food and agriculture, it is important to restrict contaminated food from being produced or gathered, and to put in place systems to prevent contaminated produce from entering the food chain. Emergency tools and response protocols exist to assist food control and health authorities but they tend to focus on radioactivity concentrations in food products as a means of restricting the distribution and sale of contaminated produce. Few, if any, emergency tools or protocols focus on the food production environment, for example radioactivity concentrations in soils. Here we present the Operational Intervention Levels for Soils (OIL for Soils) concept, an optimization tool developed at the IAEA to facilitate agricultural decision making and to improve nuclear emergency preparedness and response capabilities. Effective intervention relies on the prompt availability of radioactivity concentration data and the ability to implement countermeasures. Sampling in food and agriculture can be demanding because it may involve large areas and many sample types. In addition, there are finite resources available in terms of manpower and laboratory support. Consequently, there is a risk that timely decision making will be hindered and food safety compromised due to time taken to sample and analyse produce. However, the OILs for Soils concept developed based on experience in Japan can help in this situation and greatly assist authorities responsible for agricultural production. OILs for Soils - pre-determined reference levels of air dose rates linked to radionuclide concentrations in soils - can be used to trigger response actions particularly important for agricultural and food protection. Key considerations in the development of the OILs for Soils are: (1) establishing a pragmatic sampling approach to prioritize and optimize available resources and data requirements for

  13. Cryptogenic organizing pneumonia: clinical and radiological features, treatment outcomes of 17 patients, and review of the literature.

    PubMed

    Niksarlıoğlu, Elif Yelda; Özkan, Gülcihan Zehra; Bakan, Nur Dilek; Yurt, Sibel; Kılıç, Lütfiye; Çamsarı, Güngör

    2016-12-20

    We evaluated patients with cryptogenic organizing pneumonia (COP) who attended our clinic. We retrospectively investigated the clinical and radiological findings, diagnostic methods, treatment, and follow-up outcomes of 17 patients who had been histopathologically diagnosed with COP. The mean age of the patients was 49.8 ± 10.4 years. The most common symptom was cough (n = 15; 88.2%) and the most common radiological finding (n = 10) was consolidation in the inferior lobes on thoracic computed tomography. The diagnosis of COP was made by open lung biopsy in 11 (64.7%) patients, transbronchial biopsy in 5 (29.4%), and video-assisted thoracoscopic surgery biopsy in 1 (5.9%). The mean follow-up period was 28.7 ± 25.0 (range: 3-85) months. Twelve patients received oral corticosteroid therapy and seven of them improved without any fibrotic changes. One patient refused treatment; a chest radiography of that patient was found to be normal at the end of the 20-month follow-up period. Three patients received no other therapy, as the lesion had been completely excised. Common symptoms included cough and dyspnea, while the main radiological presentation of COP was consolidation. Corticosteroids are a good treatment option in general, but relapse may occur.

  14. Improving Treatment Integrity through a Functional Approach to Intervention Support

    ERIC Educational Resources Information Center

    Liaupsin, Carl J.

    2015-01-01

    A functional approach to intervention planning has been shown to be effective in reducing problem behaviors and promoting appropriate behaviors in children and youth with behavior disorders. When function-based intervention plans are not successful, it is often due to issues of treatment integrity in which teachers omit or do not sufficiently…

  15. A Treatment Integrity Analysis of Function-Based Intervention

    ERIC Educational Resources Information Center

    Wood, Brenna K.; Umbreit, John; Liaupsin, Carl J.; Gresham, Frank M.

    2007-01-01

    This study examined whether direct, interval-by-interval measures of treatment integrity would make it possible to distinguish whether equivocal intervention results could be attributed to the intervention itself, or to poor implementation. Josh, an eight-year-old 3rd grader, performed at or slightly above his peers' academically, yet engaged in…

  16. Research-Based Family Interventions for the Treatment of Schizophrenia.

    ERIC Educational Resources Information Center

    Gingerich, Susan L.; Bellack, Alan S.

    1996-01-01

    Well-controlled clinical trials have established the efficacy of a number of family-based psychosocial interventions for the treatment of schizophrenia. Reviews seven studies with long term follow-up. (Author)

  17. Acute behavioral interventions and outpatient treatment strategies with suicidal adolescents

    PubMed Central

    O’Brien, Kimberly H. McManama; Singer, Jonathan B.; LeCloux, Mary; Duarté-Vélez, Yovanska; Spirito, Anthony

    2015-01-01

    Despite the prevalence of suicidal thoughts and behaviors among adolescents, there is limited knowledge of effective interventions to use with this population. This paper reviews the findings of studies on behavioral interventions for adolescents who are at acute suicide risk, as well as outpatient treatment and risk management strategies with suicidal adolescents. The importance of addressing comorbid behaviors and enhancing protective factors are discussed. Cultural considerations in working with suicidal adolescents and strategies for conducting culturally competent treatment are explored. PMID:26279646

  18. Battlefield radiology

    PubMed Central

    Graham, R N J

    2012-01-01

    With the increasing tempo of military conflicts in the last decade, much has been learnt about imaging battlefield casualties in the acute setting. Ultrasound in the form of focused abdominal sonography in trauma (FAST) has proven invaluable in emergency triage of patients for immediate surgery. Multidetector CT allows accurate determination of battlefield trauma injuries. It permits the surgeons and anaesthetists to plan their interventions more thoroughly and to be made aware of clinically occult injuries. There are common injury patterns associated with blast injury, gunshot wounds and blunt trauma. While this body of knowledge is most applicable to the battlefield, there are parallels with peacetime radiology, particularly in terrorist attacks and industrial accidents. This pictorial review is based on the experiences of a UK radiologist deployed in Afghanistan in 2010. PMID:22806621

  19. Medical treatment in carotid artery intervention.

    PubMed

    Kolkert, J L; Meerwaldt, R; Lefrandt, J D; Geelkerken, R H; Zeebregts, C J

    2011-12-01

    Medical treatment has a pivotal role in the treatment of patients with occlusive carotid artery disease. Large trials have provided the justification for operative treatment besides medical treatment in patients with recent significant carotid artery stenosis two decades ago. Since then, medical therapy has evolved tremendously. Next to aspirin, antiplatelet regimens acting on a different level in the modulation of platelet aggregation have made their entry. Moreover, statin therapy has been introduced. These changes among others in secondary stroke prevention, along with better understanding in life-style adjustments and perioperative medical management, have led to a decrease in stroke recurrence. Secondary prevention is therefore now the most important pillar of medical therapy. It consists of antiplatelet therapy, statins and blood pressure lowering agents in all patients. Small adjustments are recommended for those patients referred for invasive treatment. Moreover, long-term medical treatment is imperative. In this article, we summarize current evidence in literature regarding medical management in patients with previous stroke or TIA.

  20. Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures.

    PubMed

    Hoshino, Masatoshi; Tsujio, Tadao; Terai, Hidetomi; Namikawa, Takashi; Kato, Minori; Matsumura, Akira; Suzuki, Akinobu; Takayama, Kazushi; Takaoka, Kunio; Nakamura, Hiroaki

    2013-05-15

    examination scores at enrollment were associated with SF-36 PCS ≤ 40 and reduced activities of daily living. The previous use of steroids was associated with SF-36 MCS ≤ 40, prolonged back pain, and vertebral collapse. No other examined variables were significant risk factors for patient outcomes. These results showed that treatment intervention factors did not affect patient outcomes 6 months after OVF. Middle-column injury was a significant risk factor for both clinical and radiological outcomes. In the future, establishing systematic treatments for cases with middle-column injuries is needed. 2.

  1. [Controlling instruments in radiology].

    PubMed

    Maurer, M

    2013-10-01

    Due to the rising costs and competitive pressures radiological clinics and practices are now facing, controlling instruments are gaining importance in the optimization of structures and processes of the various diagnostic examinations and interventional procedures. It will be shown how the use of selected controlling instruments can secure and improve the performance of radiological facilities. A definition of the concept of controlling will be provided. It will be shown which controlling instruments can be applied in radiological departments and practices. As an example, two of the controlling instruments, material cost analysis and benchmarking, will be illustrated.

  2. Young Children and Trauma: Intervention and Treatment

    ERIC Educational Resources Information Center

    Osofsky, Joy D., Ed.

    2004-01-01

    Recent years have seen significant advances in knowledge about the effects of exposure to psychological trauma on young children from birth to age 5. This volume brings together leading experts to address practical considerations in working with traumatized young children and their caregivers. State-of-the-art assessment and treatment approaches…

  3. Young Children and Trauma: Intervention and Treatment

    ERIC Educational Resources Information Center

    Osofsky, Joy D., Ed.

    2004-01-01

    Recent years have seen significant advances in knowledge about the effects of exposure to psychological trauma on young children from birth to age 5. This volume brings together leading experts to address practical considerations in working with traumatized young children and their caregivers. State-of-the-art assessment and treatment approaches…

  4. Radiological assessment of the PRF/BMSC efficacy in the treatment of aseptic nonunions: A retrospective study on 90 subjects.

    PubMed

    Dallari, D; Rani, N; Sabbioni, G; Mazzotta, A; Cenacchi, A; Savarino, L

    2016-11-01

    Nonunion is a major orthopaedic concern because of treatment difficulty, high costs and devastating effects on the patients' life quality. Therefore, there is interest in the use of bone substitutes and cell-based strategies to augment fracture repair. We aimed to verify if Platelet Rich Fibrin (PRF) added with bone marrow stromal cells (BMSC) was able to improve the reparative process in the aseptic nonunion, and to establish whether it was worthwhile with atrophic nonunion. The primary outcome was radiological union. As secondary endpoint, the healing time was assessed, and the radiological consolidation grade at each follow-up. We identified 113 subjects with tibia or femur nonunion and retrospectively created two groups. Group A was constituted by 56 subjects who underwent the standard procedure, i.e. Judet decortication with/out internal fixation devices, and opposite cortical homoplastic stick. In 57 patients, the standard procedure was modified by adding PRF and BMSC carried by homologous lyophilised bone chips (group B). The same surgeon performed all the operations. To our knowledge, no data are reported in the literature about such application. Since a "gold standard" for healing quantification does not exist, a new scoring radiological system was applied, at 1.5, 3, 6, 12 and 24 months after treatment. At the final 24-month follow-up, the radiological union percentage was 94,12 in group B and 95,12% in group A. A decreased healing time was demonstrated in the presence of PRF/BMSC in comparison with the standard procedure. When we compared the radiological scores at each follow-up, we found that the PRF/BMSC combination significantly improved the consolidation grade at 1.5-, 3- and 6-month follow-up in femurs and at 1.5-month follow-up in tibiae. Furthermore, an improved consolidation grade was demonstrated in the atrophic subjects treated with adjuvants compared to atrophic patients treated with the standard procedure at 1.5-month follow-up. This study

  5. [Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology].

    PubMed

    Ferreirós, J; Cabeza, B; Gayete, Á; Sánchez, M; Torres, M I; Cobo, M; Isla, D; Puente, J; Reguart, N; de Castro, J

    2015-01-01

    The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM) have therefore produced a national consensus statement in order to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography (MDCT) as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only Response Evaluation Criteria in Solid Tumours (RECIST 1.1) but also Immune-Related Response Criteria (irRC).

  6. Cangrelor for treatment during percutaneous coronary intervention.

    PubMed

    Oestreich, Julie H; Dobesh, Paul P

    2014-03-01

    Dual antiplatelet therapy consisting of aspirin and a P2Y12-receptor antagonist is important for preventing major adverse cardiovascular events in patients managed with percutaneous coronary intervention (PCI). The current P2Y12-receptor antagonists are only available for oral administration and exhibit a delayed onset of action. Furthermore, several days are required for platelet function to return to normal following cessation of therapy. Cangrelor is an intravenous ATP analog that directly, selectively and reversibly inhibits P2Y12 receptors on platelets. A 30-μg/kg bolus dose followed by a 4-μg/kg per minute continuous infusion of cangrelor achieves peak concentration and maximal platelet inhibition within minutes of administration. Cangrelor also demonstrates a fast offset as normal platelet function is restored 1-2 h after cessation of the infusion. Three large, double-blind, randomized trials - CHAMPION PLATFORM, CHAMPION PCI and CHAMPION PHOENIX - assessed the efficacy and safety of cangrelor compared with clopidogrel (during or immediately after PCI) or placebo in the setting of PCI. In the most recent CHAMPION PHOENIX trial, cangrelor was superior to clopidogrel for preventing adverse cardiovascular events with no significant increase in major bleeding. Based on the clinical trial results combined with unique properties such as intravenous administration and fast onset and offset, cangrelor may provide benefit in certain patients undergoing PCI.

  7. Neurodevelopmental Treatment (NDT): Therapeutic Intervention and Its Efficacy.

    ERIC Educational Resources Information Center

    Stern, Francine Martin; Gorga, Delia

    1988-01-01

    Use of neurodevelopmental treatment, also known as the Bobath method, is discussed, including its history, philosophy, goals, and treatment emphasis with infants and children with movement disorders. Examples of children before and after therapeutic intervention illustrate use of the technique, and controversies in measuring therapy efficacy are…

  8. Neurodevelopmental Treatment (NDT): Therapeutic Intervention and Its Efficacy.

    ERIC Educational Resources Information Center

    Stern, Francine Martin; Gorga, Delia

    1988-01-01

    Use of neurodevelopmental treatment, also known as the Bobath method, is discussed, including its history, philosophy, goals, and treatment emphasis with infants and children with movement disorders. Examples of children before and after therapeutic intervention illustrate use of the technique, and controversies in measuring therapy efficacy are…

  9. Use of digital panoramic radiology in presurgical implant treatment planning to accurately assess bone density.

    PubMed

    Chugh, Niranjan Kumar; Bhattacharyya, Jayanta; Das, Samiran; Ghosh, Soumitra; Dutta, Kaushik; Goel, Preeti

    2016-08-01

    No cost-effective method of ascertaining bone density from 2-dimensional radiographic images is currently available for dental implants before surgery. The purpose of this in vivo study was to use digital panoramic radiology and dental computed tomography (CT) to evaluate the bone density of specific points in the jaw near the tooth-bearing areas. The objective was to determine whether digital panoramic radiology can be used in assessing bone density as an alternative to a more expensive and complex dental CT. This study involved determining bone densities at predetermined anatomic landmarks near tooth-bearing areas of the jaws of 20 participants, using digital panoramic radiology in gray-level scale with a lead step wedge. Subsequently, the bone densities of the same points were determined in Hounsfield units (Hu) with dental CT. The data collected after interpretation of the panoramic radiograph and CT were tabulated and analyzed statistically. Bone density measured using CT correlated with the first 3 steps of (A, B, and C) the digital scale of gray. Further analysis conducted using the Mann-Whitney U test showed a significant association between step A to detect D4 bone, step B to detect D3 bone, and step C to detect D2 type bone. The digital scale of gray obtained from a lead step wedge can be effectively used with digital orthopanoramic radiology to assess bone density before the placement of implants, but with certain restrictions. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  10. Combined radiologic and endoscopic treatment (using the "rendezvous technique") of a biliary fistula following left hepatectomy.

    PubMed

    Gracient, Aurélien; Rebibo, Lionel; Delcenserie, Richard; Yzet, Thierry; Regimbeau, Jean-Marc

    2016-08-14

    Despite the ongoing decrease in the frequency of complications after hepatectomy, biliary fistulas still occur and are associated with high morbidity and mortality rates. Here, we report on an unusual technique for managing biliary fistula following left hepatectomy in a patient in whom the right posterior segmental duct joined the left hepatic duct. The biliary fistula was treated with a combined radiologic and endoscopic procedure based on the "rendezvous technique". The clinical outcome was good, and reoperation was not required.

  11. Clinical pharmacist interventions on an assertive community treatment team.

    PubMed

    Gable, Kelly N; Stunson, Mary Janet

    2010-08-01

    Assertive Community Treatment (ACT) is a community-based treatment approach intended to help in the recovery and rehabilitation of clients with severe and persistent mental illnesses. A clinical pharmacist is not routinely a member of an ACT team. The purpose of this study is to demonstrate the role of a pharmacist by reviewing recommendations and interventions made by a clinical pharmacist on an ACT team. Information was gathered through a chart review of clients at Community Alternatives in St. Louis, Missouri. All recommendations and interventions performed by the clinical pharmacist between February 1, 2008 and July 31, 2008 were recorded. A total of 341 interventions and recommendations for 29 clients were completed by the pharmacist. Medication management, medication adjustment recommendations, and mental health assessments were the most frequent interventions. This study suggests a clinical pharmacist can be beneficial to an ACT team and provide diverse services to both clients and other team members.

  12. Interventional neuroradiology.

    PubMed Central

    Barnwell, S L

    1993-01-01

    A wide variety of diseases affecting the central nervous system and head and neck can be treated using interventional neuroradiologic techniques. These new treatments have depended on advances in radiologic imaging, catheter technology, and the development of new embolic agents. These procedures may be an adjunct to other therapy, palliative or curative. Diseases for which interventional neuroradiologic techniques have been major advances in treatment include cerebral aneurysms, vasospasm after subarachnoid hemorrhage, cerebral arteriovenous malformations, dural arteriovenous fistulas, dural sinus thrombosis, atherosclerosis, scalp arteriovenous fistulas, carotid-cavernous fistulas, and stroke. This field is rapidly evolving as advances are made in catheter technology and new embolic agents are developed. Images PMID:8434468

  13. Behavioral Lifestyle Intervention in the Treatment of Obesity

    PubMed Central

    Looney, Shannon M.; Raynor, Hollie A.

    2013-01-01

    This article provides an overview of research regarding adult behavioral lifestyle intervention for obesity treatment. We first describe two trials using a behavioral lifestyle intervention to induce weight loss in adults, the Diabetes Prevention Program (DPP) and the Look AHEAD (Action for Health in Diabetes) trial. We then review the three main components of a behavioral lifestyle intervention program: behavior therapy, an energy- and fat-restricted diet, and a moderate- to vigorous-intensity physical activity prescription. Research regarding the influence of dietary prescriptions focusing on macronutrient composition, meal replacements, and more novel dietary approaches (such as reducing dietary variety and energy density) on weight loss is examined. Methods to assist with meeting physical activity goals, such as shortening exercise bouts, using a pedometer, and having access to exercise equipment within the home, are reviewed. To assist with improving weight loss outcomes, broadening activity goals to include resistance training and a reduction in sedentary behavior are considered. To increase the accessibility of behavioral lifestyle interventions to treat obesity in the broader population, translation of efficacious interventions such as the DPP, must be undertaken. Translational studies have successfully altered the DPP to reduce treatment intensity and/or used alternative modalities to implement the DPP in primary care, worksite, and church settings; several examples are provided. The use of new methodologies or technologies that provide individualized treatment and real-time feedback, and which may further enhance weight loss in behavioral lifestyle interventions, is also discussed. PMID:25114557

  14. SU-C-18C-06: Radiation Dose Reduction in Body Interventional Radiology: Clinical Results Utilizing a New Imaging Acquisition and Processing Platform

    SciTech Connect

    Kohlbrenner, R; Kolli, KP; Taylor, A; Kohi, M; Fidelman, N; LaBerge, J; Kerlan, R; Gould, R

    2014-06-01

    Purpose: To quantify the patient radiation dose reduction achieved during transarterial chemoembolization (TACE) procedures performed in a body interventional radiology suite equipped with the Philips Allura Clarity imaging acquisition and processing platform, compared to TACE procedures performed in the same suite equipped with the Philips Allura Xper platform. Methods: Total fluoroscopy time, cumulative dose area product, and cumulative air kerma were recorded for the first 25 TACE procedures performed to treat hepatocellular carcinoma (HCC) in a Philips body interventional radiology suite equipped with Philips Allura Clarity. The same data were collected for the prior 85 TACE procedures performed to treat HCC in the same suite equipped with Philips Allura Xper. Mean values from these cohorts were compared using two-tailed t tests. Results: Following installation of the Philips Allura Clarity platform, a 42.8% reduction in mean cumulative dose area product (3033.2 versus 1733.6 mGycm∧2, p < 0.0001) and a 31.2% reduction in mean cumulative air kerma (1445.4 versus 994.2 mGy, p < 0.001) was achieved compared to similar procedures performed in the same suite equipped with the Philips Allura Xper platform. Mean total fluoroscopy time was not significantly different between the two cohorts (1679.3 versus 1791.3 seconds, p = 0.41). Conclusion: This study demonstrates a significant patient radiation dose reduction during TACE procedures performed to treat HCC after a body interventional radiology suite was converted to the Philips Allura Clarity platform from the Philips Allura Xper platform. Future work will focus on evaluation of patient dose reduction in a larger cohort of patients across a broader range of procedures and in specific populations, including obese patients and pediatric patients, and comparison of image quality between the two platforms. Funding for this study was provided by Philips Healthcare, with 5% salary support provided to authors K. Pallav

  15. Treatment of cachexia: melanocortin and ghrelin interventions.

    PubMed

    Steinman, Jeremy; DeBoer, Mark Daniel

    2013-01-01

    Cachexia is a condition typified by wasting of fat and LBM caused by anorexia and further endocrinological modulation of energy stores. Diseases known to cause cachectic symptoms include cancer, chronic kidney disease, and chronic heart failure; these conditions are associated with increased levels of proinflammatory cytokines and increased resting energy expenditure. Early studies have suggested the central melanocortin system as one of the main mediators of the symptoms of cachexia. Pharmacological and genetic antagonism of these pathways attenuates cachectic symptoms in laboratory models; effects have yet to be studied in humans. In addition, ghrelin, an endogenous orexigenic hormone with receptors on melanocortinergic neurons, has been shown to ameliorate symptoms of cachexia, at least in part, by an increase in appetite via melanocortin modulation, in addition to its anticatabolic and anti-inflammatory effects. These effects of ghrelin have been confirmed in multiple types of cachexia in both laboratory and human studies, suggesting a positive future for cachexia treatments.

  16. Occupational exposure to the whole body, extremities and to the eye lens in interventional radiology in Poland, as based on personnel dosimetry records at IFJ PAN

    NASA Astrophysics Data System (ADS)

    Szumska, Agnieszka; Budzanowski, M.; Kopeć, R.

    2014-11-01

    We report results of measurements of Hp(10) from whole body dosimeters (about 53 thousand readouts), of Hp(0.07) from finger ring dosimeters (23 thousand readouts) and of Hp(3) from eye lens dosimeters (100 readouts), issued in the years 2010-12 to over 150 medical departments in Poland which apply X-rays in radiology, interventional radiology (haemodynamic, angiology, cardiac surgery), urology, orthopaedics, electrophysiology or electro-cardiology. In all measurements thermoluminescence detectors (TLD) were used: the well-known standard MTS-N (LiF:Mg, Ti) for whole body and extremity dosimetry, and the high-sensitivity MCP-N (LiF:Mg, Cu, P) for eye lens dosimetry and environmental monitoring. We analysed the data base of the accredited Laboratory of Individual and Environmental Dosimetry (LADIS) at the Institute of Nuclear Physics PAN which offers its dosimetry service to these departments on a regular basis. We found that in the population of radiation workers that studied over the years 2010-2012 in 84%, 87%, and 34% of Hp(10), Hp(0.07) and Hp(3) measurements, respectively, the level of 0.1 mSv/quarter did not exceed, indicating lack of their occupational exposure. In the remaining 16%, 13% and 66% of individual cases, the 0.1 mSv/quarter exceeded, occasionally reaching several hundreds of mSv/quarter.

  17. Comparative study of clinico-bacterio-radiological profile and treatment outcome of smokers and nonsmokers suffering from pulmonary tuberculosis

    PubMed Central

    Rathee, Deepti; Arora, Piyush; Meena, Manoj; Sarin, Rohit; Chakraborty, Pitambar; Jaiswal, Anand; Goyal, Mukesh

    2016-01-01

    Introduction: Tuberculosis (TB) is one of the leading causes of death and disease worldwide. Tobacco smoking has been linked as a risk factor for TB. This study was aimed to affirm the strength of association between smoking and pulmonary TB. Materials and Methods: Pulmonary TB patients aged between 18 and 65 years were enrolled and followed-up until treatment completion. Two consecutive sputum smears were examined from each patient for the presence of acid-fast bacilli (AFB) using Ziehl–Neelsen technique. Radiological severity of disease was assessed using guidelines of National TB Association of USA. Sputum smears for AFB were graded for positivity as per WHO Revised National TB Control Programme criteria. Response was determined in terms of sputum conversion at the end of intensive phase and final treatment outcomes. Results: Sputum smear grading of 3+ increased from 12.5% to 68.18% and 66.66% as smoking index increased from <100 to 100–299 and >300 (P < 0.05). In nonsmokers, 79.2% patients had minimal disease while only 4.2% had advanced disease as compared to smokers where 52.4% had moderate disease, 26.2% advanced disease, and 21.4% minimal disease (P < 0.01). Smokers had significantly lower treatment success rate (69%) as against nonsmokers and former smokers (93.8% and 90.9%, respectively, P = 0.001) owing to a higher default rate among smokers (28.5%) than nonsmokers (6.3%) and former smokers (9.1%). Conclusion: Smokers during initial presentation, as well as at end of the treatment demonstrate more radiological findings, cavitary disease, and worse sputum AFB smear grading. Smokers also have a poorer treatment success rate largely due to high percentage of default rate thus suggesting noncompliance as a main confounder to treatment success. Focus needs to be made to reduce defaulters which are more common among smokers. PMID:27625444

  18. Interventional treatment for low back pain: general risks.

    PubMed

    Hartog, Arthur

    2010-11-01

    The commonly performed spinal procedures, such as epidural injections, spinal nerve blocks, zygapophysial joint (z-joint) interventions, and discography, are reported to be safe. However, diagnostic and therapeutic spinal interventions can lead to serious complications, although their incidence seems to be low. Knowledge of potential complications is still required to minimize risks. This article describes the risks associated with the most commonly performed procedures, precautions that can be taken to minimize these risks, and treatment options available once complications have occurred. This article describes the risks associated with the most commonly performed procedures, precautions that can be taken to minimize these risks, and treatment options available once complications have occurred.

  19. [Measurement of effective energy and entrance surface dose using fluorescent glass dosimeter in interventional radiology procedures: make of half-value layer measurement instrument and IVR-phantom].

    PubMed

    Iida, Hiroji; Noto, Kimiya; Takata, Tadanori; Chabatake, Mitsuhiro; Yamamoto, Tomoyuki

    2010-05-20

    In interventional radiology (IVR) procedures, automatic brightness control (ABC) is helpful in maintaining good image quality by adjusting kV and/or mA based on the subject's thickness. However, it was difficult to measure effective energy using half-value layer (HVL). We investigated the usefulness of measuring effective energy and entrance surface dose using a fluorescent glass dosimeter in IVR procedures, and we made an HVL folder and IVR-phantom for that purpose. Effective energy measured using the HVL folder correlated well with reference ionization dosimeter (y=0.992x, r=0.963). The result indicated that the present method using an HVL folder and IVR-phantom provides accurate measurements of effective energy and entrance surface dose in IVR procedures. In conclusion, the present measurement method may be useful for quality control of IVR equipment. In addition, the development of this measurement technique may be useful for comparisons of exposure levels in different hospitals.

  20. Proposed method to calculate FRMAC intervention levels for the assessment of radiologically contaminated food and comparison of the proposed method to the U.S. FDA's method to calculate derived intervention levels

    SciTech Connect

    Kraus, Terrence D.; Hunt, Brian D.

    2014-02-01

    This report reviews the method recommended by the U.S. Food and Drug Administration for calculating Derived Intervention Levels (DILs) and identifies potential improvements to the DIL calculation method to support more accurate ingestion pathway analyses and protective action decisions. Further, this report proposes an alternate method for use by the Federal Emergency Radiological Assessment Center (FRMAC) to calculate FRMAC Intervention Levels (FILs). The default approach of the FRMAC during an emergency response is to use the FDA recommended methods. However, FRMAC recommends implementing the FIL method because we believe it to be more technically accurate. FRMAC will only implement the FIL method when approved by the FDA representative on the Federal Advisory Team for Environment, Food, and Health.

  1. Strategies in treatment of suicidality: identification of common and treatment-specific interventions in empirically supported treatment manuals.

    PubMed

    Weinberg, Igor; Ronningstam, Elsa; Goldblatt, Mark J; Schechter, Mark; Wheelis, Joan; Maltsberger, John T

    2010-06-01

    Many reports of treatments for suicidal patients claim effectiveness in reducing suicidal behavior but fail to demonstrate which treatment interventions, or combinations thereof, diminish suicidality. In this study, treatment manuals for empirically supported psychological treatments for suicidal patients were examined to identify which interventions they had in common and which interventions were treatment-specific. Empirically supported treatments for suicidality were identified through a literature search of PsychLit and MEDLINE for the years 1970-2007, employing the following search strategy: [suicide OR parasuicide] AND [therapy OR psychotherapy OR treatment] AND [random OR randomized]. After identifying the reports on randomized controlled studies that tested effectiveness of different treatments, the reference list of each report was searched for further studies. Only reports published in English were included. To ensure that rated manuals actually correspond to the delivered and tested treatments, we included only treatment interventions with explicit adherence rating and scoring and with adequate adherence ratings in the published studies. Five manualized treatments demonstrating efficacy in reducing suicide risk were identified and were independently evaluated by raters using a list of treatment interventions. The common interventions included a clear treatment framework; a defined strategy for managing suicide crises; close attention to affect; an active, participatory therapist style; and use of exploratory and change-oriented interventions. Some treatments encouraged a multimodal approach and identification of suicidality as an explicit target behavior, and some concentrated on the patient-therapist relationship. Emphasis on interpretation and supportive interventions varied. Not all methods encouraged systematic support for therapists. This study identified candidate interventions for possible effectiveness in reducing suicidality. These interventions

  2. Primary Chronic Osteomyelitis of the Jaws in Children: An Update on Pathophysiology, Radiological Findings, Treatment Strategies, and Prospective Analysis of Two Cases

    PubMed Central

    Berglund, Caroline; Ekströmer, Karin; Abtahi, Jahan

    2015-01-01

    Objective. Primary chronic osteomyelitis (PCO) of the jaws in children is associated with pain, trismus, and swelling. In children, temporomandibular joint involvement is rare and few studies have been published due to the relatively low incidence. This paper presents two cases of mandibular PCO in children with the involvement of the collum mandibulae. In addition, a review of the literature regarding demographic data, histological, radiological, and laboratory findings, and treatment strategies of PCO was also performed. Material and Methods. Prospective analyses of two PCO cases. A PubMed search was used and the articles were sorted according to their corresponding key area of focus. Results. Review of the literature revealed twenty-four cases of PCO with two cases of mandibular condyle involvement. The mean age was 18 years; the male to female ratio was 1 : 3. Most of the patients were treated with anti-inflammatory drugs in combination with decortication. Clinical recurrence was seen in 7 cases. Conclusion. A combination of anti-inflammatory drugs and surgical intervention appears to be the first choice of treatment. However, surgical removal of necrotic tissue adjacent to collum mandibulae has its limitations in children. Further investigations are of utmost importance in order to increase our knowledge and understanding of this disease. PMID:26435856

  3. Effects of exercise interventions during different treatments in breast cancer

    PubMed Central

    Fairman, Ciaran M; Focht, Brian C; Lucas, Alexander R; Lustberg, Maryam B

    2017-01-01

    Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors. To date, most research has focused on post-treatment interventions. However, given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment, and that the effects are substantially more pronounced during treatment, an assessment of the safety and efficacy of exercise during treatment is warranted. In this review, we present and evaluate the results of randomized controlled trials (RCTs) conducted during breast cancer treatment. We conducted literature searches to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation. Data were extracted on physiological and psychosocial outcomes. Cohen’s d effect sizes were calculated for each outcome. A total of 17 studies involving 1,175 participants undergoing active cancer therapy met the inclusion criteria. Findings revealed that, on average, exercise interventions resulted in moderate to large improvements in muscular strength: resistance exercise (RE, d = 0.86), aerobic exercise (AE, d = 0.55), small to moderate improvements in cardiovascular functioning (RE, d = 0.45; AE, d = 0.17, combination exercise (COMB, d = 0.31) and quality of life (QoL; RE, d = 0.30; AE, d = 0.50; COMB, d = 0.63). The results of this review suggest that exercise is a safe, feasible, and efficacious intervention in breast cancer patients who are undergoing different types of treatment. Additional research addressing the different modes of exercise during each type of treatment is warranted to assess the comparable efficacy of the various exercise modes during established breast cancer treatments. PMID:27258052

  4. Effects of exercise interventions during different treatments in breast cancer.

    PubMed

    Fairman, Ciaran M; Focht, Brian C; Lucas, Alexander R; Lustberg, Maryam B

    2016-05-01

    Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors. To date, most research has focused on post-treatment interventions. However, given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment, and that the effects are substantially more pronounced during treatment, an assessment of the safety and efficacy of exercise during treatment is warranted. In this review, we present and evaluate the results of randomized controlled trials (RCTs) conducted during breast cancer treatment. We conducted literature searches to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation. Data were extracted on physiological and psychosocial outcomes. Cohen's d effect sizes were calculated for each outcome. A total of 17 studies involving 1,175 participants undergoing active cancer therapy met the inclusion criteria. Findings revealed that, on average, exercise interventions resulted in moderate to large improvements in muscular strength: resistance exercise (RE, = 0.86), aerobic exercise (AE, = 0.55), small to moderate improvements in cardiovascular functioning (RE, = 0.45; AE, = 0.17, combination exercise (COMB, = 0.31) and quality of life (QoL; RE, = 0.30; AE, = 0.50; COMB, = 0.63). The results of this review suggest that exercise is a safe, feasible, and efficacious intervention in breast cancer patients who are undergoing different types of treatment. Additional research addressing the different modes of exercise during each type of treatment is warranted to assess the comparable efficacy of the various exercise modes during established breast cancer treatments. ©2016 Frontline Medical Communications.

  5. Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes

    PubMed Central

    Khatri, Kavin; Sharma, Vijay; Farooque, Kamran; Tiwari, Vivek

    2016-01-01

    Background Unstable distal end radius fractures are difficult to manage and so various treatment modalities have been described. The use of variable-angle locking plates is promoted for the management of these fractures. Objectives This study aimed to evaluate the functional and radiological outcomes in unstable distal end radius fractures treated with variable-angle locking plates. Patients and Methods We reviewed 23 unstable distal end radius fractures that were treated at our institution with volar variable-angle locking plates. The mean age of the patients was 32.82 ± 11.81 years (range 19 to 62) and the mean duration of follow-up was 11.04 ± 2.47 months (range 6 to 15). All of the patients underwent open reduction and internal fixation with a variable-angle locking plate. Radiological parameters such as radial inclination, length, tilt, and ulnar variance were measured at six weeks and at the final follow-up. The functional evaluation was conducted by measuring the range of motion at the wrist joint as well as the grip strength. Gartland and Werley’s demerit scoring system was used to assess the final outcome. Results There were two cases of superficial infection that responded to oral antibiotics. One patient had developed a hypertrophic scar, while another had carpal tunnel syndrome that was conservatively managed. There was a significant improvement in the functional indices from six weeks to the final follow-up, while the radiological parameters were maintained. According to Gartland and Werley, excellent results were reported in 65.2% cases, while good results were present in 35% cases. Conclusions The use of variable-angle locking plates in treating unstable distal end radius fractures is associated with excellent to good functional outcomes with minimal complications. PMID:27679785

  6. Mexico's methamphetamine precursor chemical interventions: impacts on drug treatment admissions.

    PubMed

    Cunningham, James K; Bojorquez, Ietza; Campollo, Octavio; Liu, Lon-Mu; Maxwell, Jane Carlisle

    2010-11-01

    To help counter problems related to methamphetamine, Mexico has implemented interventions targeting pseudoephedrine and ephedrine, the precursor chemicals commonly used in the drug's synthesis. This study examines whether the interventions impacted methamphetamine treatment admissions-an indicator of methamphetamine consequences. Quasi-experiment: autoregressive integrated moving average (ARIMA)-based intervention time-series analysis. precursor chemical restrictions implemented beginning November 2005; major rogue precursor chemical company closed (including possibly the largest single drug-cash seizure in history) March 2007; precursor chemicals banned from Mexico (North America's first precursor ban) August 2008. Mexico and Texas (1996-2008). Monthly treatment admissions for methamphetamine (intervention series) and cocaine, heroin and alcohol (quasi-control series). The precursor restriction was associated with temporary methamphetamine admissions decreases of 12% in Mexico and 11% in Texas. The company closure was associated with decreases of 56% in Mexico and 48% in Texas; these decreases generally remained to the end of the study period. Neither intervention was associated with significant changes in the Mexico or Texas quasi-control series. The analysis of Mexico's ban was indeterminate due largely to a short post-ban series. This study, one of the first quasi-experimental analyses of an illicit-drug policy in Mexico, indicates that the country's precursor interventions were associated with positive impacts domestically and in one of the Unites States' most populous states--Texas. These interventions, coupled with previous US and Canadian interventions, amount to a new, relatively cohesive level of methamphetamine precursor control across North America's largest nations, raising the possibility that the impacts found here could continue for an extended period. © 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction.

  7. [Forensic radiology].

    PubMed

    Stein, K M; Grünberg, K

    2009-01-01

    Forensic radiology includes both clinical and postmortem forensic radiology. Clinical forensic radiology deals with imaging of healthy people from a legal point of view, such as for determining age or to prove and document injuries in victims of crime. Postmortem forensic radiology deals with the application of modern radiological methods in order to optimise post-mortem diagnosis. X-ray examination has for decades been routinely used in postmortem diagnosis. Newer developments include the application of postmortem computer tomography and magnetic resonance imaging; these are the methods with the greatest information potential but also with the greatest deviations from diagnostics in living persons. Application of radiological methods for securing evidence in criminal procedures is still in its infancy. Radiologists' technical understanding and forensic doctors' knowledge of postmortem changes in a corpse must be synergised.

  8. Interventional modalities in the treatment of complex regional pain syndrome.

    PubMed

    Nambi-Joseph, Pushpa; Stanton-Hicks, Michael; Sferra, James J

    2004-06-01

    Complex regional pain syndrome (CRPS) applies to a variety of conditions in which symptoms such as allodynia and hyperalgesia predominate along with hyperpathia and vasomotor/sudomotor disturbances. The incidence of CRPS in the chronic pain population varies and is difficult to determine, though it appears to affect women more than men. Treatment is multidisciplinary, and recovery of function and the reduction of pain are the main goals of treatment;this article addresses some of the interventional modalities that are used.

  9. Dilemma-focused intervention for unipolar depression: a treatment manual.

    PubMed

    Feixas, Guillem; Compañ, Victoria

    2016-07-12

    This article introduces a new treatment protocol for depression. Based on previous research which indicated the presence of cognitive conflicts in depression, this study created an intervention manual to address these conflicts. The therapy manual for depressive patients followed the guideline for inclusion in clinical trials (stage II), which has received high recognition. A preliminary version (stage I) of this manual was formulated based on other, more general dilemma-focused therapy publications, inspired by personal construct theory (PCT), and input from clinical experience. The resulting version was then applied during the 8-session format of a pilot study with patients diagnosed with major depressive disorder or dysthymia. Finally, feedback was requested from seasoned and highly respected therapists, some of whom were familiar with PCT. According to the mentioned guideline, the intervention manual selected the theoretical framework, in this case PCT, to include its conceptualization of depression and resolution of dilemmas (to foster clinical improvement) as a main treatment goal. The manual was then contrasted with psychoanalytic psychotherapy, cognitive-behavior therapy (CBT), motivational interviewing (MI), and other similar approaches such as cognitive-analytic therapy and coherence therapy. Following these conceptual clarifications, the specific interventions included in the manual were defined according to both categories: their unique and essential components and those conceived as common psychotherapeutic factors. Next, the general structure and content for each session were presented. The structure consisted of seven well-defined individual sessions with an additional session, which could complement any of the former sessions to address the patient's issues in greater depth, if needed. This Dilemma-Focused Intervention manual aimed to improve the treatment outcome for depression by offering an intervention that could be combined with other general

  10. A Comparison of Treatment Integrity Assessment Methods for Behavioral Intervention

    ERIC Educational Resources Information Center

    Koh, Seong A.

    2010-01-01

    The purpose of this study was to examine the similarity of outcomes from three different treatment integrity (TI) methods, and to identify the method which best corresponded to the assessment of a child's behavior. Six raters were recruited through individual contact via snowball sampling. A modified intervention component list and 19 video clips…

  11. Asperger Syndrome: Treatment and Intervention. Some Guidelines for Parents.

    ERIC Educational Resources Information Center

    Klin, Ami; Volkmar, Fred R.

    This guide provides assessment, education, and treatment strategies for children with Asperger syndrome. It discusses assessment, and provides guidelines for securing and implementing services and determines appropriate placement. The following recommendations are also provided for general intervention strategies: (1) skills, concept, appropriate…

  12. A Comparison of Treatment Integrity Assessment Methods for Behavioral Intervention

    ERIC Educational Resources Information Center

    Koh, Seong A.

    2010-01-01

    The purpose of this study was to examine the similarity of outcomes from three different treatment integrity (TI) methods, and to identify the method which best corresponded to the assessment of a child's behavior. Six raters were recruited through individual contact via snowball sampling. A modified intervention component list and 19 video clips…

  13. Novel Interventional Strategies for the Treatment of Atrial Fibrillation

    PubMed Central

    Siontis, Konstantinos C; Oral, Hakan

    2016-01-01

    The landscape of the invasive management of atrial fibrillation, the most common sustained arrhythmia in humans, has changed dramatically in the last decade owing to numerous advances in arrhythmia mapping and ablation technologies. The current review critically appraises novel interventional strategies for the treatment of atrial fibrillation with a focus on clinical effectiveness and safety. PMID:27403294

  14. Rehabilitation treatment taxonomy and the international classification of health interventions.

    PubMed

    Sykes, Catherine R

    2014-01-01

    This commentary provides some reactions to the rehabilitation treatment taxonomy project in relation to work already underway to develop an International Classification of Health Interventions. This commentary also includes some comments in response to questions posed by the authors. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Amoebic liver abscess with hepatic artery pseudoaneurysm: successful treatment by interventional radiology.

    PubMed

    Yadav, Ajit K; Gupta, Saumya; Hariprasad, Sudarsan; Kumar, Ashish; Ghuman, Samarjit S; Gupta, Arun

    2015-03-01

    Amoebic liver abscess is most common extra-intestinal presentation of amoebiasis. It is rarely complicated with vascular involvement including thrombosis of hepatic vein or IVC and pseudo-aneurysm of hepatic artery. We describe a case of hepatic artery pseudo-aneurysm as a complication of amoebic liver abscess treated with percutaneous embolization.

  16. Intervention in the Context of Development: Pathways Toward New Treatments

    PubMed Central

    Veenstra-VanderWeele, Jeremy; Warren, Zachary

    2015-01-01

    Neuropsychiatric disorders vary substantially in age of onset but are best understood within the context of neurodevelopment. Here, we review opportunities for intervention at critical points in developmental trajectories. We begin by discussing potential opportunities to prevent neuropsychiatric disorders. Once symptoms begin to emerge, a number of interventions have been studied either before a diagnosis can be made or shortly after diagnosis. Although some of these interventions are helpful, few are based upon an understanding of pathophysiology, and most ameliorate rather than resolve symptoms. As such, in the next portion of the review, we turn our discussion to genetic syndromes that are rare phenocopies of common diagnoses such as autism spectrum disorder or schizophrenia. Cellular or animal models of these syndromes point to specific regulatory or signaling pathways. As examples, findings from the mouse models of Fragile X and Rett syndromes point to potential treatments now being tested in randomized clinical trials. Paralleling oncology, we can hope that our treatments will move from nonspecific, like chemotherapies thrown at a wide range of tumor types, to specific, like the protein kinase inhibitors that target molecularly defined tumors. Some of these targeted treatments later show benefit for a broader, yet specific, array of cancers. We can hope that medications developed within rare neurodevelopmental syndromes will similarly help subgroups of patients with disruptions in overlapping signaling pathways. The insights gleaned from treatment development in rare phenocopy syndromes may also teach us how to test treatments based upon emerging common genetic or environmental risk factors. PMID:25182180

  17. Role of radiology in geriatric care

    PubMed Central

    O’Brien, Jeremy; Baerlocher, Mark O.; Asch, Murray; Myers, Andy

    2009-01-01

    Abstract OBJECTIVE To present family physicians with the options available for diagnosing and treating a selection of common diseases in the elderly using diagnostic and interventional radiology. QUALITY OF EVIDENCE Articles providing level I or II evidence were included in our review. Most articles presented results from randomized or other case-controlled studies. MAIN MESSAGE Geriatric care has become a complicated, multidisciplinary effort, with the family physician often leading the team. The expanding cohort of patients is not only better informed than their predecessors, but also more demanding of better care through cutting-edge technology and treatment. Specifically, the role of radiology has expanded quickly in geriatric medicine. Because of complex clinical presentations and rising costs, it is essential for primary care physicians to understand the appropriate use of imaging and radiological intervention. CONCLUSION There are a number of new and innovative radiological techniques and procedures available for elderly patients. This review aims to inform primary care physicians of a selected number of these techniques. PMID:19155363

  18. The 1985 year book of diagnostic radiology

    SciTech Connect

    Bragg, D.G.

    1984-01-01

    This book provides reviews of 343 significant articles from 79 journals. Topics include the following: expanding use of nuclear magnetic resonance imaging; sonography and pediatric radiology; radiographic evaluation of skeletal stress injuries; cost effectiveness of radiographic procedures; radiologic manifestations of iatrogenic complications; breast cancer diagnosis; interventional radiology and underutilization; and computed tomography in diagnosis and staging of neoplasms.

  19. Chest radiology

    SciTech Connect

    Austin, J.H.M.

    1982-01-01

    This review of chest radiology reexamines normal findings on plain chest radiographs, and presents a new plain film view for detecting metastases in the lungs, and describes new findings on acute and chronic inflammatory diseases. Various chest radiologic procedures are examined. (KRM)

  20. Orthopaedic radiology

    SciTech Connect

    Park, W.M.; Hughes, S.P.F.

    1987-01-01

    This book is an account of the principles of modern diagnostic imaging techniques and their applications in orthopedics. The aim is to show radiology as a dynamic subject. Orthopaedic Radiology is divided into two sections with the first part focusing on the principles of diagnostic imaging and interpretation and the second applying this information to practical clinical problems.

  1. Treatment Utilization and Unmet Treatment Need among Hispanics Following Brief Intervention

    PubMed Central

    Cochran, Gerald; Caetano, Raul

    2012-01-01

    Background In a large randomized trial examining ethnic differences in response to a brief alcohol intervention following an alcohol related injury, we showed that Hispanics, but not non-Hispanics, were more likely to reduce alcohol intake in comparison to treatment as usual (Field et al, 2010). The current study evaluates whether the observed improvements in drinking outcomes previously reported among Hispanics following brief intervention might be related to prior or subsequent treatment utilization. . Methods The present study is a secondary analysis of data collected in a randomized clinical trial that evaluated ethnic differences in the effect of a brief motivational intervention (BMI) on alcohol use among medical inpatients admitted for alcohol related injury. For the current study, statistical analyses were carried out to compare alcohol use, alcohol problems, treatment utilization and unmet treatment need between Hispanic (n=539) and White, non-Hispanic (n=667). In addition, we examined the relationship between prior treatment utilization and unmet treatment need and alcohol use outcomes following brief intervention and the impact of brief intervention on subsequent treatment utilization and unmet treatment need. Results In comparison to White, non-Hispanics, Hispanics at baseline reported heavier drinking, more alcohol problems, greater unmet treatment need and lower rates of treatment utilization. Among Hispanics, multilevel analyses showed that prior treatment utilization or unmet treatment need did not moderate the effect of BMI on alcohol outcomes. Furthermore, BMI did not significantly impact subsequent treatment utilization or unmet treatment need among Hispanics. Finally, treatment utilization and unmet treatment need at six-months were not significant mediators between BMI and alcohol use outcomes at follow up. Conclusion The benefits of brief intervention among Hispanics do not appear to be better explained by subsequent engagement in mutual help

  2. Evaluation of Core Vocabulary Intervention for Treatment of Inconsistent Phonological Disorder: Three Treatment Case Studies

    ERIC Educational Resources Information Center

    McIntosh, Beth; Dodd, Barbara

    2009-01-01

    Children with unintelligible speech differ in severity, underlying deficit, type of surface error patterns and response to treatment. Detailed treatment case studies, evaluating specific intervention protocols for particular diagnostic groups, can identify best practice for children with speech disorder. Three treatment case studies evaluated the…

  3. Evaluation of Core Vocabulary Intervention for Treatment of Inconsistent Phonological Disorder: Three Treatment Case Studies

    ERIC Educational Resources Information Center

    McIntosh, Beth; Dodd, Barbara

    2008-01-01

    Children with unintelligible speech differ in severity, underlying deficit, type of surface error patterns and response to treatment. Detailed treatment case studies, evaluating specific intervention protocols for particular diagnostic groups, can identify best practice for children with speech disorder. Three treatment case studies evaluated the…

  4. Evaluation of Core Vocabulary Intervention for Treatment of Inconsistent Phonological Disorder: Three Treatment Case Studies

    ERIC Educational Resources Information Center

    McIntosh, Beth; Dodd, Barbara

    2008-01-01

    Children with unintelligible speech differ in severity, underlying deficit, type of surface error patterns and response to treatment. Detailed treatment case studies, evaluating specific intervention protocols for particular diagnostic groups, can identify best practice for children with speech disorder. Three treatment case studies evaluated the…

  5. Evaluation of Core Vocabulary Intervention for Treatment of Inconsistent Phonological Disorder: Three Treatment Case Studies

    ERIC Educational Resources Information Center

    McIntosh, Beth; Dodd, Barbara

    2009-01-01

    Children with unintelligible speech differ in severity, underlying deficit, type of surface error patterns and response to treatment. Detailed treatment case studies, evaluating specific intervention protocols for particular diagnostic groups, can identify best practice for children with speech disorder. Three treatment case studies evaluated the…

  6. Interventional sialendoscopy for treatment of juvenile recurrent parotitis

    PubMed Central

    Gary, Celeste; Kluka, Evelyn A.; Schaitkin, Barry; Walvekar, Rohan R.

    2011-01-01

    Objective: To evaluate our preliminary experience with interventional sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis (JRP). Materials and Methods: Three consecutive pediatric patients with JRP who underwent interventional sialendoscopy were identified. Interventional sialendoscopy consisted of serial dilation of the Stenson's duct, endoscopy of the ductal system and saline irrigation followed by instillation of triamcinolone acetate. Clinical, demographic, procedure-related data and complications were documented. End points of the study were technical success, defined as completion of the procedure, subjective improvement in symptoms as indicated by the patients or their parents and assessment of safety in terms of complications. Results: Three male patients with a mean age of 9 years (range 6–11 years) underwent interventional sialendoscopy for JRP. Endoscopic findings included a blanched stenotic duct with intraductal debris in those who were symptomatic. Technical success was 100%. The mean number of episodes of JRP in the year prior to presenting to our service among the three patients was 5 (range 4–6 per year). There were no new episodes of JRP reported at the last follow-up. There were no major complications. Conclusion: Our preliminary experience concurs with the current literature and suggests that interventional sialendoscopy is effective for the management of JRP and can be considered for patients who fail conservative medical management. PMID:22121310

  7. Aptitude-treatment interaction effects in psychooncological interventions.

    PubMed

    Stulz, Niklaus; Künzler, Alfred; Barth, Jürgen; Hepp, Urs

    2014-01-01

    To examine aptitude-treatment interaction (ATI) effects in cancer patients receiving psychooncological interventions (POIs). N=36 cancer patients were treated with POI. Hierarchical linear regression was used to test two interaction effects between patient baseline characteristics (aptitudes) and process analyses of therapy sessions (treatment) on change in mental health during POI. Patients with high emotional distress did best when their therapy reduced arousal, and patients with lower emotional distress benefited most if therapists emphasized arousal induction. The interaction between the coping style of the patient (internalizing vs. externalizing) and the focus of the treatment (emotion vs. behavior) did not predict POI outcomes. The ATI effect of patient's distress and therapist's arousal induction/reduction may help therapists to make differential treatment decisions in POI. Tailoring treatments to cancer patients based on their personal characteristics may enhance the effectiveness of POI. © 2014.

  8. Non-pharmacological interventions for alleviating pain during orthodontic treatment.

    PubMed

    Fleming, Padhraig S; Strydom, Hardus; Katsaros, Christos; MacDonald, Lci; Curatolo, Michele; Fudalej, Piotr; Pandis, Nikolaos

    2016-12-23

    Pain is prevalent during orthodontics, particularly during the early stages of treatment. To ensure patient comfort and compliance during treatment, the prevention or management of pain is of major importance. While pharmacological means are the first line of treatment for alleviation of orthodontic pain, a range of non-pharmacological approaches have been proposed recently as viable alternatives. To assess the effects of non-pharmacological interventions to alleviate pain associated with orthodontic treatment. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 9), MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016) and EThOS (to 6 October 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) comparing a non-pharmacological orthodontic pain intervention to a placebo, no intervention or another non-pharmacological pain intervention were eligible for inclusion. We included any type of orthodontic treatment but excluded trials involving the use of pre-emptive analgesia or pain relief following orthognathic (jaw) surgery or dental extractions in combination with orthodontic treatment. We excluded split-mouth trials (in which each participant receives two or more treatments, each to a separate section of the mouth) and cross-over trials. At least two review authors independently assessed risk of bias and extracted data. We used the random-effects model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors. We included 14

  9. Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions

    PubMed Central

    Terplan, Mishka; Ramanadhan, Shaalini; Locke, Abigail; Longinaker, Nyaradzo; Lui, Steve

    2016-01-01

    Background Illicit drug use in pregnancy is a complex social and public health problem. The consequences of drug use in pregnancy are high for both the woman and her child. Therefore, it is important to develop and evaluate effective treatments. There is evidence for the effectiveness of psychosocial interventions in drug treatment but it is unclear whether they are effective in pregnant women. This is an update of a Cochrane review originally published in 2007. Objectives To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in illicit drug treatment programmes on birth and neonatal outcomes, on attendance and retention in treatment, as well as on maternal and neonatal drug abstinence. In short, do psychosocial interventions translate into less illicit drug use, greater abstinence, better birth outcomes, or greater clinic attendance? Search methods We conducted the original literature search in May 2006 and performed the search update up to January 2015. For both review stages (original and update), we searched the Cochrane Drugs and Alcohol Group Trial's register (May 2006 and January 2015); the Cochrane Central Register of Trials (CENTRAL; the Cochrane Library 2015, Issue 1); PubMed (1996 to January 2015); EMBASE (1996 to January 2015); and CINAHL (1982 to January 2015). Selection criteria We included randomized controlled trials comparing any psychosocial intervention vs. a control intervention that could include pharmacological treatment, such as methadone maintenance, a different psychosocial intervention, counselling, prenatal care, STD counselling and testing, transportation, or childcare. Data collection and analysis We used standard methodological procedures expected by the Cochrane Collaboration. We performed analyses based on three comparisons: any psychosocial intervention vs. control, contingency management (CM) interventions vs. control, and motivational interviewing based (MIB) interventions vs. control. Main results

  10. Radiological, physical, and chemical characterization of additional alpha contaminated and mixed low-level waste for treatment at the advanced mixed waste treatment project

    SciTech Connect

    Hutchinson, D.P.

    1995-07-01

    This document provides physical, chemical, and radiological descriptive information for a portion of mixed waste that is potentially available for private sector treatment. The format and contents are designed to provide treatment vendors with preliminary information on the characteristics and properties for additional candidate portions of the Idaho National Engineering Laboratory (INEL) and offsite mixed wastes not covered in the two previous characterization reports for the INEL-stored low-level alpha-contaminated and transuranic wastes. This report defines the waste, provides background information, briefly reviews the requirements of the Federal Facility Compliance Act (P.L. 102-386), and relates the Site Treatment Plans developed under the Federal Facility Compliance Act to the waste streams described herein. Each waste is summarized in a Waste Profile Sheet with text, charts, and tables of waste descriptive information for a particular waste stream. A discussion of the availability and uncertainty of data for these waste streams precedes the characterization descriptions.

  11. A Review of Spasticity Treatments: Pharmacological and Interventional Approaches

    PubMed Central

    Chang, Eric; Ghosh, Nilasha; Yanni, Daniel; Lee, Sujin; Alexandru, Daniela; Mozaffar, Tahseen

    2015-01-01

    Spasticity is a velocity-dependent increase in muscle tone and uncontrolled, repetitive, involuntary contractions of skeletal muscles. Spasticity presents as upper motor neuron symptoms in patients with central nervous system pathology such as stroke, spinal cord injury, brain injury, or multiple sclerosis. As a result, a patient can have significant pain and limited mobility, which can lead to decreased quality of life and difficulty maintaining personal care. In this article we discuss mechanisms, indications, efficacy, and side effects of the most accepted current treatments. Currently available treatment options include oral medications and interventional procedures. Oral medications comprise centrally acting agents, such as baclofen, clonidine, and tizanidine, as well as anticonvulsants such as benzodiazepines and gabapentin and peripherally acting dantrolene. Interventional procedures include focal injections of botulinum toxin, phenol or alcohol, and an intrathecal baclofen pump. Surgical treatments include selective dorsal rhizotomy and neurectomy. We found that there are several treatments available with data to support their use, but many still need further research to prove their efficacy and develop optimal utilization. PMID:25750484

  12. [Interventional Bronchoscopy for the Treatment of Pulmonary Sarcoma].

    PubMed

    Wang, Hongwu; Zhang, Nan; Li, Dongmei; Zou, Hang; Zhang, Jieli; Zhou, Yunzhi; Bai, Xiuyun

    2016-09-20

    Pulmonary sarcoma is a rare malignant tumor in soft tissues. Resection is the preferred option to treat this tumor. The aim of this study is to explore the effect of interventional bronchoscopies in the treatment of pulmonary sarcoma if the patient is inoperable. Sixteen cases with pulmonary sarcoma were retrospectively reviewed in our hospital from November 2008 to July 2014. The mean age was (53.1±5.4) years old. Rigid bronchoscopy was applied for the first procedure with general anesthesia, and electronic bronchoscopy was used for the second procedure or slight patients. Sixteen cases, which include 10 sarcomatoid carcinoma, 2 fibrosarcoma, 2 sarcoma, 1 fibromucoid sarcoma, and 1 spindle cell synovial sarcoma, were collected in this study. Eleven cases (68.8%) were peripheral and mainly located in the right upper lobe and left lower lobe. Five cases (31.2%) were central. Of these cases, 82% (9/11) were mixed and primary tumors in pulmonary tumor. Meanwhile, 56% (9/16) were intraluminal and 69% (11/16) were metastatic in central airway. All of the four cases with whole atelectasis were completely relieved through postbronchoscopic interventions. Three of the seven cases with segment atelectasis were completely reopened; two of them were partially relieved; and the remaining two had no response. The obstructive degree, Karnofsky performance status (KPS), and shortness of breathless score improved significantly after the treatment. Interventional bronchoscopy could rapidly and efficiently remove endobronchial tumor, relieve airway obstruction, and improve clinical symptoms.

  13. Towards the estimation of the scattered energy spectra reaching the head of the medical staff during interventional radiology: A Monte Carlo simulation study

    NASA Astrophysics Data System (ADS)

    Zagorska, A.; Bliznakova, K.; Buchakliev, Z.

    2015-09-01

    In 2012, the International Commission on Radiological Protection has recommended a reduction of the dose limits to the eye lens for occupational exposure. Recent studies showed that in interventional rooms is possible to reach these limits especially without using protective equipment. The aim of this study was to calculate the scattered energy spectra distribution at the level of the operator's head. For this purpose, an in-house developed Monte Carlo-based computer application was used to design computational phantoms (patient and operator), the acquisition geometry as well as to simulate the photon transport through the designed system. The initial spectra from 70 kV tube voltage and 8 different filtrations were calculated according to the IPEM Report 78. An experimental study was carried out to verify the results from the simulations. The calculated scattered radiation distributions were compared to the initial incident on the patient spectra. Results showed that there is no large difference between the effective energies of the scattered spectra registered in front of the operator's head obtained from simulations of all 8 incident spectra. The results from the experimental study agreed well to simulations as well.

  14. CT-fluoroscopy in chest interventional radiology: sliding scale of imaging parameters based on radiation exposure dose and factors increasing radiation exposure dose.

    PubMed

    Yamao, Yoshikazu; Yamakado, K; Takaki, H; Yamada, T; Kodama, H; Nagasawa, N; Nakatsuka, A; Uraki, J; Takeda, K

    2013-02-01

    To verify the usefulness of a sliding scale of imaging parameters to reduce radiation exposure during chest interventional radiology (IR), and to identify factors that increase radiation exposure in order to obtain acceptable computed tomography (CT)-fluoroscopy image quality. The institutional review board approved this retrospective study, for which the need for informed consent was waived. Interventional radiologists determined the optimal CT-fluoroscopy imaging parameters using the sliding scale based on the radiation exposure dose. The imaging parameters were changed from those generating low radiation (120 kV/10 mA, 1.2 mGy/s) to others generating higher radiation exposure until acceptable image quality was obtained for each procedure. Validation of the imaging parameter sliding scale was done using regression analysis. Factors that increase radiation exposure were identified using multiple regression analysis. In 125 patients, 217 procedures were performed, of which 72 procedures (33.2%, 72/217) were performed with imaging parameters of minimum radiation exposure, but increased radiation exposure was necessary in 145 (66.8%, 145/217). Significant correlation was found between the radiation exposure dose and the percentage achievement of acceptable image quality (R(2) = 0.98). Multivariate regression analysis showed that high body weight (p < 0.0001), long device passage (p < 0.0001), and lesions above the aortic arch (p = 0.04) were significant independent factors increasing radiation exposure. Although increased radiation exposure dose might be necessary to obtain acceptable chest CT-fluoroscopy images depending on the patient, lesion, and procedure characteristics, a sliding scale of imaging parameters helps to reduce radiation exposure. Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  15. Impact on Patient Safety and Satisfaction of Implementation of an Outpatient Clinic in Interventional Radiology (IPSIPOLI-Study): A Quasi-Experimental Prospective Study

    SciTech Connect

    Lutjeboer, Jacob Burgmans, Mark Christiaan E-mail: mburgmans@hotmail.com; Chung, Kaman Erkel, Arian Robert van

    2015-06-15

    PurposeInterventional radiology (IR) procedures are associated with high rates of preparation and planning errors. In many centers, pre-procedural consultation and screening of patients is performed by referring physicians. Interventional radiologists have better knowledge about procedure details and risks, but often only get acquainted with the patient in the procedure room. We hypothesized that patient safety (PS) and patient satisfaction (PSAT) in elective IR procedures would improve by implementation of a pre-procedural visit to an outpatient IR clinic.Material and MethodsIRB approval was obtained and informed consent was waived. PS and PSAT were measured in patients undergoing elective IR procedures before (control group; n = 110) and after (experimental group; n = 110) implementation of an outpatient IR clinic. PS was measured as the number of process deviations. PSAT was assessed using a questionnaire measuring Likert scores of three dimensions: interpersonal care aspects, information/communication, and patient participation. Differences in PS and PSAT between the two groups were compared using an independent t test.ResultsThe average number of process deviations per patient was 0.39 in the control group compared to 0.06 in the experimental group (p < 0.001). In 9.1 % patients in the control group, no legal informed consent was obtained compared to 0 % in the experimental group. The mean overall Likert score was significantly higher in the experimental group compared to the control group: 2.68 (SD 0.314) versus 2.48 (SD 0.381) (p < 0.001).ConclusionPS and PSAT improve significantly if patients receive consultation and screening in an IR outpatient clinic prior to elective IR procedures.

  16. Personnel dose reduction in (90)Y microspheres liver-directed radioembolization: from interventional radiology suite to patient ward.

    PubMed

    Law, Martin; Wong, K K; Tso, W K; Lee, Victor; Luk, M Y; Tong, C C; Chu, Ferdinand

    2017-03-01

    To describe a method to reduce the external radiation exposure emitted from the patient after liver-directed radioembolization using (90)Y glass microspheres, to quantitatively estimate the occupational dose of medical personnel providing patient care to the patient radioembolized with the use of the method and to discuss radiation exposure to patients who are adjacent if the patient radioembolized needs hospitalization. A lead-lined blanket of lead equivalence of 0.5 mm was used to cover the patient abdomen immediately after the (90)Y radioembolization procedure, in order to reduce the radiation emitted from the patient. The interventional radiologist used a rod-type puncture site compressor for haemostasis to avoid direct contact with possible residual radioactivity at the puncture site. Dose rates were measured at the interventional radiologist chest and hand positions during puncture site pressing for haemostasis with and without the use of the blanket. The measurement results were applied to estimate the occupational dose of colleagues performing patient care to the patient radioembolized. The exposure to patients adjacent in the ward was estimated if the patient radioembolized was hospitalized. The radiation exposures measured at the radiologist chest and hand positions have been significantly reduced with the lead-lined blanket in place. The radiologist, performing puncture site pressing at the end of radioembolization procedure, would receive an average hand dose of 1.95 μSv and body dose under his own lead apron of 0.30 μSv for an average (90)Y microsphere radioactivity of 2.54 GBq. Other medical personnel, nurses and porters, would receive occupational doses corresponding to an hour of background radiation. If the patient radioembolized using (90)Y needs hospitalization in a common ward, using the lead-lined blanket to cover the abdomen of the patient and keeping a distance of 2 m from the patient who is adjacent would reduce the exposure by 0

  17. Anti-tumor necrosis factor treatment in cherubism--clinical, radiological and histological findings in two children.

    PubMed

    Hero, M; Suomalainen, A; Hagström, J; Stoor, P; Kontio, R; Alapulli, H; Arte, S; Toiviainen-Salo, S; Lahdenne, P; Mäkitie, O

    2013-01-01

    Cherubism is a rare and disfiguring genetic disorder with excessive bone resorption and multilocular lesions in the mandible and/or maxilla. The disease-causing gain-of-function mutations in the SH3-binding protein 2 (SH3BP2) gene result in increased myeloid cell responses to macrophage colony stimulating factor and RANK ligand, formation of hyperactive osteoclasts (giant cells), and hyper-reactive macrophages that produce excessive amounts of the inflammatory cytokine tumor necrosis factor α (TNF-α). Recent findings in the cherubism mouse model suggest that TNF-α plays a major role in disease pathogenesis and that removal of TNF-α prevents development of the bone phenotype. We treated two children with cherubism with the TNF-α antagonist adalimumab for approximately 2.5 years and collected extensive clinical, radiological and histological follow-up data during the treatment. Histologically the treatment resulted in a significant reduction in the number of multinucleated giant cells and TNF-α staining positivity in both patients. As evaluated by computed tomography and magnetic resonance imaging, the lesions in Patient 1 showed either moderate enlargement (mandibular symphysis) or remained stable (mandibular rami and body, the maxilla). In Patient 2, the lesions in mandibular symphysis showed enlargement during the first 8 months of treatment, and thereafter the lesions remained unchanged. Bone formation and resorption markers remained unaffected. The treatment was well tolerated. Based on our findings, TNF-α antagonist may decrease the formation of pathogenic giant cells, but does not result in lesion regression or prevent lesion expansion in active cherubism. TNF-α modulator treatment thus does not appear to provide sufficient amelioration for patients suffering from cherubism. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Lifestyle interventions for the treatment of women with gestational diabetes.

    PubMed

    Brown, Julie; Alwan, Nisreen A; West, Jane; Brown, Stephen; McKinlay, Christopher Jd; Farrar, Diane; Crowther, Caroline A

    2017-05-04

    Gestational diabetes (GDM) is glucose intolerance, first recognised in pregnancy and usually resolving after birth. GDM is associated with both short- and long-term adverse effects for the mother and her infant. Lifestyle interventions are the primary therapeutic strategy for many women with GDM. To evaluate the effects of combined lifestyle interventions with or without pharmacotherapy in treating women with gestational diabetes. We searched the Pregnancy and Childbirth Group's Trials Register (14 May 2016), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (14th May 2016) and reference lists of retrieved studies. We included only randomised controlled trials comparing a lifestyle intervention with usual care or another intervention for the treatment of pregnant women with GDM. Quasi-randomised trials were excluded. Cross-over trials were not eligible for inclusion. Women with pre-existing type 1 or type 2 diabetes were excluded. We used standard methodological procedures expected by the Cochrane Collaboration. All selection of studies, data extraction was conducted independently by two review authors. Fifteen trials (in 45 reports) are included in this review (4501 women, 3768 infants). None of the trials were funded by a conditional grant from a pharmaceutical company. The lifestyle interventions included a wide variety of components such as education, diet, exercise and self-monitoring of blood glucose. The control group included usual antenatal care or diet alone. Using GRADE methodology, the quality of the evidence ranged from high to very low quality. The main reasons for downgrading evidence were inconsistency and risk of bias. We summarised the following data from the important outcomes of this review. Lifestyle intervention versus control groupFor the mother:There was no clear evidence of a difference between lifestyle intervention and control groups for the risk of hypertensive disorders of pregnancy (pre-eclampsia) (average

  19. Haemostasis with the FISH Vascular Closure Device after 6 French Transfemoral Accesses in Interventional Radiology: Clinical Results

    PubMed Central

    Kamusella, Peter C.; Lüdtke, Christopher W.; Scheer, Fabian; Andresen, Reimer

    2017-01-01

    Introduction Endovascular procedures have increased for different indications over the recent years. To achieve a safe haemostasis after arterial puncture and for more comfort for the patients different vascular closure devices have been developed. Aim To evaluate the effectiveness and safety of a percutaneous closure system based on a matrix patch for achieving haemostasis. Materials and Methods In this study from 2014 to 2015 a percutaneous vascular closure system Femoral Introducer Sheath and Haemostasis (FISH) was used in 54 patients (mean age 69.0±10.7 years), in an antegrade and retrograde technique within the context of an angiographic intervention. The system was used in conjunction with transfemoral approaches with a sheath size of 6F. Postinterventionally (on the following day and after 6 weeks), follow-up was conducted clinically and using colour coded ultrasound. Results Immediate haemostasis was achieved in 50/54 patients (92.6 %). In 4 cases, an immediate haemostasis was not achieved. In these cases, manual compression was successful. There was one major complication, a retroperitoneal bleeding requiring transfusion. Minor complications were not observed. Conclusion Safe and effective haemostasis is possible with the percutaneous FISH closure system at puncture sizes of 6 F. An immediate re-puncture after using FISH is possible. PMID:28384956

  20. Web-based platform for patient dose surveys in diagnostic and interventional radiology in Bulgaria: Functionality testing and optimisation.

    PubMed

    Simeonov, F; Palov, N; Ivanova, D; Kostova-Lefterova, D; Georgiev, E; Zagorska, A; Madzharova, R; Vassileva, J

    2017-09-01

    In the period 2013-2016 the National Centre of Radiobiology and Radiation Protection (NCRRP) at the Ministry of Health of Bulgaria has developed a web based platform for performing national patient dose surveys and establishing Diagnostic Reference Levels (DRLs). It is accessible via internet browser, allowing the users to submit data remotely. Electronic questionnaires, specific for radiography, fluoroscopy, image guided interventional procedures, mammography and CT, were provided. Short and clear manuals were added to guide users and minimise human errors. The web-based data collection platform is functional and is currently being used for performing the third national dose survey in Bulgaria, launched in 2016. Data analysis is facilitated due to the standardisation of collected data and their storing. Using the platform, the participating facilities can establish their typical dose levels based on the median value, and compare them to DRLs. A disadvantage of the platform is the need to enter data manually, but it is opened for future upgrades for automatic data harvesting and analysis. Various practical approaches were used to overcome the lack of qualified human resources and insufficient understanding of the DRL and dose tracking concept and to motivate facilities to submit data. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  1. Evaluation of a physiotherapeutic treatment intervention in "Bell's" facial palsy.

    PubMed

    Cederwall, Elisabet; Olsén, Monika Fagevik; Hanner, Per; Fogdestam, Ingemar

    2006-01-01

    The aim of this study was to evaluate a physiotherapeutic treatment intervention in Bell's palsy. A consecutive series of nine patients with Bell's palsy participated in the study. The subjects were enrolled 4-21 weeks after the onset of facial paralysis. The study had a single subject experimental design with a baseline period of 2-6 weeks and a treatment period of 26-42 weeks. The patients were evaluated using a facial grading score, a paresis index and a written questionnaire created for this study. Every patient was taught to perform an exercise program twice daily, including movements of the muscles surrounding the mouth, nose, eyes and forehead. All the patients improved in terms of symmetry at rest, movement and function. In conclusion, patients with remaining symptoms of Bell's palsy appear to experience positive effects from a specific training program. A larger study, however, is needed to fully evaluate the treatment.

  2. Radiologic Career Ladder

    DTIC Science & Technology

    1992-09-01

    reliable radiological support in the diagnosis, treatment , and prevention of injuries/ diseases affecting the health and welfare of USAF personnel...unit depends on the medical treatment facility it supports. The USAF Surgeon General designates categories of medical treatment facilities based upon the...staff and adequacy of medical facilities. The occupied patient bed rate further delineates medical treatment facilities, such that average ranges (as

  3. Praziquantel treatment of porcine brain and muscle Taenia solium cysticercosis. 1. Radiological, physiological and histopathological studies.

    PubMed

    Flisser, A; Gonzalez, D; Shkurovich, M; Madrazo, I; Correa, D; Rodriguez-Carbajal, J; Cohen, S; Rodriguez-del-Rosal, E; Collado, M; Fernandez, B

    1990-01-01

    Porcine Taenia solium cysticercosis, recognized as a model of the human disease, was used to analyze the effect of the anthelminthic drug praziquantel on hosts and parasites. The drug (50 mg/kg daily) was given over 15 days in the feed of 13 cysticercotic and 9 control pigs. Changes in the number, size and appearance of brain parasites were seen by computerized tomography immediately after the last dose of praziquantel, although not all cysticerci had disappeared by day 47 following the end of the treatment. Muscle parasites became small and hyperdense shortly after treatment and disappeared from tomographic images afterwards. No alterations were found in EEGs or in brain-stem auditory and somatosensory evoked potentials. Muscle cysticerci showed increasing degrees of degeneration with time after treatment, and an augmented inflammatory reaction was concomitantly observed. In contrast, more heterogeneous results were obtained in parasites lodged in the brain, since viable cysts and less intense inflammatory reactions were found in the brain at different times after treatment. Physiological evaluation of the parasites showed that evagination was inhibited immediately after treatment and that oxygen consumption decreased with time. The results of this investigation suggest that praziquantel damages cysticerci and that the inflammatory reaction destroys and eliminates them.

  4. Compliance therapy: an intervention to improve inpatients' attitudes toward treatment.

    PubMed

    Tay, Sim-Eng Clara

    2007-06-01

    Nonadherence to prescription medication is the leading cause of relapse or recurrence of psychotic illness. Literature has shown that compliance therapy, a brief intervention based on motivational interviewing and cognitive approaches, can lead to improved attitudes, adherence to treatment, and insight. This descriptive study aimed to examine the effectiveness of compliance therapy on treatment adherence. The 69 participants were patients of the same ward, either referred for patient education by the psychiatrist or selected from a convenience sample of patients on the clinical pathway of relapsed schizophrenia or major depression. Compliance therapy was conducted individually or in small groups of 2 to 3 patients. The shortened version of the Drug Attitude Inventory (DAI-10), along with a rating scale adapted from another study, was used to measure attitude and the rate of adherence before and after therapy. Patients in both individual and group sessions showed significant improvements in attitude. Those with six or more admissions had slightly less significant improvement, and those with personality disorder or substance abuse showed no significant improvement. Compliance therapy benefits patients and improves their attitude toward treatment. Psychiatric nurses could be trained in this clinical intervention to enable them to conduct compliance therapy in the hospital or in the community.

  5. Time issues in multilevel interventions for cancer treatment and prevention.

    PubMed

    Alexander, Jeffrey; Prabhu Das, Irene; Johnson, Timothy P

    2012-05-01

    The concept of time introduces important complexities in estimating intervention effects, program and evaluation design, and measurement and analysis of individual change in multilevel interventions (MLIs). Despite growing recognition that time is a critical element for assessing both individual-level outcomes and higher-level changes in organizational, community, and policy contexts, most MLI designs and evaluations have not addressed these issues. In this chapter we discuss 1) conceptualizing disease life-course and treatment theory in MLIs, 2) approaches to incorporating time in research and program design for MLIs in cancer treatment and prevention, 3) analysis of time-varying multilevel data in the context of cancer treatment and prevention, and 4) resource considerations and trade-offs of incorporating time as a dimension of MLIs and analysis. Although analytic techniques for analyzing time-related phenomena are becoming more available and powerful, there has not been corresponding progress made in the development of theory to guide the application of these techniques in program design and implementation.

  6. Peri-implant diseases: a review of treatment interventions.

    PubMed

    Romanos, Georgios E; Javed, Fawad; Delgado-Ruiz, Rafael Arcesio; Calvo-Guirado, José Luis

    2015-01-01

    The ideal management of peri-implant diseases focuses on infection control, detoxification of implant surfaces, regeneration of lost tissues, and plaque-control regimens via mechanical debridement (with or without raising a surgical flap). However, a variety of other therapeutic modalities also have been proposed for the management of peri-implantitis. These treatment strategies encompass use of antiseptics and/or antibiotics, laser therapy, guided bone regeneration, and photodynamic therapy. The aim of this article was to review indexed literature with reference to the various therapeutic interventions proposed for the management of peri-implant diseases. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Divine intervention and the treatment of chemical dependency.

    PubMed

    Ellis, A; Schoenfeld, E

    1990-01-01

    Alcoholics Anonymous and related 12-step programs are the predominant influence on chemical dependency treatment programs in the United States today. 12-step programs have a strong religious orientation, despite rationalizations that Higher Power need not mean the traditional definition of God. The teaching of religious beliefs is not a proper function of therapists treating addictions in a general population. Moreover, teaching patients they can only recover through the intervention of a Higher Power locks them into a pattern of dependence on something outside themselves in order to function. 12-step programs have helped millions of people. Even more could be helped were they to eliminate the concept of needing a Higher Power.

  8. Comparison of Explicit Forgiveness Interventions with an Alternative Treatment: A Randomized Clinical Trial

    ERIC Educational Resources Information Center

    Wade, Nathaniel G.; Worthington, Everett L.; Haake, Shawn

    2009-01-01

    Forgiveness interventions can help people forgive past offenses. However, few studies have compared forgiveness interventions with genuine alternative treatments. The authors compared forgiveness interventions with a therapeutic alternative treatment. Participants reduced unforgiveness and increased forgiveness regardless of treatment condition.…

  9. Surrogate formulations for thermal treatment of low-level mixed waste. Part 1: Radiological surrogates

    SciTech Connect

    Stockdale, J.A.D.; Bostick, W.D.; Hoffmann, D.P.; Lee, H.T.

    1994-01-01

    The evaluation and comparison of proposed thermal treatment systems for mixed wastes can be expedited by tests in which the radioactive components of the wastes are replaced by surrogate materials chosen to mimic, as far as is possible, the chemical and physical properties of the radioactive materials of concern. In this work, sponsored by the Mixed Waste Integrated Project of the US Department of Energy, the authors have examined reported experience with such surrogates and suggest a simplified standard list of materials for use in tests of thermal treatment systems. The chief radioactive nuclides of concern in the treatment of mixed wastes are {sup 239}Pu, {sup 238}U, {sup 235}U, {sup 137}Cs, {sup 103}Ru, {sup 99}Tc, and {sup 90}Sr. These nuclides are largely by-products of uranium enrichment, reactor fuel reprocessing, and weapons program activities. Cs, Ru, and Sr all have stable isotopes that can be used as perfect surrogates for the radioactive forms. Technetium exists only in radioactive form, as do plutonium and uranium. If one wishes to preclude radioactive contamination of the thermal treatment system under trial burn, surrogate elements must be chosen for these three. For technetium, the authors suggest the use of natural ruthenium, and for both plutonium and uranium, they recommend cerium. The seven radionuclides listed can therefore be simulated by a surrogate package containing stable isotopes of ruthenium, strontium, cesium, and cerium.

  10. Interventions for replacing missing teeth: treatment of perimplantitis.

    PubMed

    Esposito, M; Worthington, H V; Coulthard, P

    2004-10-18

    One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 28 June 2004. All RCTs of oral implants comparing agents or interventions for treating perimplantitis around dental implants. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two reviewers. We contacted the authors for missing information. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Only two eligible trials were identified, but one was excluded due to insufficient data presented. The included study compared the use of locally applied metronidazole gel versus ultrasonic debridement in patients affected possibly

  11. [Project REMISSION(PLUS): clinical and radiological remission : new treatment goals in the management of rheumatoid arthritis].

    PubMed

    Ostendorf, B; Scherer, A; Kellner, H; Backhaus, M

    2008-12-01

    In a large number of patients with rheumatoid arthritis (RA), chronic inflammatory processes cause joint changes and loss of function even in the early stages of disease. Early, targeted use of disease-modifying antirheumatic drugs [DMARDs and TNF-alpha blockers ("biologicals")] can significantly reduce the risk of aggressive progression and irreversible joint damage. Hence, early identification of disease-specific processes of joint inflammation and erosion - at the onset of disease or later - is of key importance for the patient's prognosis and therapeutic strategy. This can be achieved today with great precision and reliability through the use of modern imaging methods like arthrosonography and magnetic resonance imaging (MRI). The REMISSION(PLUS) initiative aspire to integrate modern imaging technologies as standard methods in the care and management of RA patients. The main areas on which this initiative will be focusing are the conceptualization and implementation of educational programs and training seminars on sonography and MRI, the development and establishment of case report forms for standardized documentation of findings, and the systematic monitoring of patients on treatment, with the aim of producing very precise documentation of structural change processes in RA and also, if possible, to document radiological remission or even progression. The REMISSION(PLUS) project also includes the setting up of specialized centers of excellence, which will network to support the implementation and access to the various imaging procedures at hospitals, rheumatology clinics and rheumatology practices nationwide.

  12. Radiological assessment of water treatment processes in a water treatment plant in Saudi Arabia: Water and sludge radium content, radon air concentrations and dose rates.

    PubMed

    Al-Jaseem, Q Kh; Almasoud, Fahad I; Ababneh, Anas M; Al-Hobaib, A S

    2016-09-01

    There is an increase demand for clean water sources in Saudi Arabia and, yet, renewable water resources are very limited. This has forced the authorities to explore deep groundwater which is known to contain large concentrations of radionuclides, mainly radium isotopes. Lately, there has been an increase in the number of water treatment plants (WTPs) around the country. In this study, a radiological assessment of a WTP in Saudi Arabia was performed. Raw water was found to have total radium activity of 0.23Bq/L, which exceeds the international limit of 0.185Bq/L (5pCi/L). The WTP investigated uses three stages of treatment: flocculation/sedimentation, sand filtration and reverse osmosis. The radium removal efficiency was evaluated for each stage and the respective values were 33%, 22% and 98%. Moreover, the activity of radium in the solid waste generated from the WTP in the sedimentation and sand filtrations stages were measured and found to be 4490 and 6750Bq/kg, respectively, which exceed the national limit of 1000Bq/kg for radioactive waste. A radiological assessment of the air inside the WTP was also performed by measuring the radon concentrations and dose rates and were found in the ranges of 2-18Bq/m(3) and 70-1000nSv/h, respectively. The annual effective dose was calculated and the average values was found to be 0.3mSv which is below the 1mSv limit. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology.

    PubMed

    Miura, Fumihiko; Asano, Takehide; Amano, Hodaka; Yoshida, Masahiro; Toyota, Naoyuki; Wada, Keita; Kato, Kenichiro; Yamazaki, Eriko; Kadowaki, Susumu; Shibuya, Makoto; Maeno, Sawako; Furui, Shigeru; Takeshita, Koji; Kotake, Yutaka; Takada, Tadahiro

    2009-01-01

    Intra-abdominal arterial hemorrhage is still one of the most serious complications after pancreato-biliary surgery. We retrospectively analyzed our experiences with 15 patients in order to establish a therapeutic strategy for postoperative arterial hemorrhage following pancreato-biliary surgery. Between August 1981 and November 2007, 15 patients developed massive intra-abdominal arterial bleeding after pancreato-biliary surgery. The initial surgery of these 15 patients were pylorus-preserving pancreatoduodenectomy (PPPD) (7 patients), hemihepatectomy and caudate lobectomy with extrahepatic bile duct resection or PPPD (4 patients), Whipple's pancreatoduodenectomy (PD) (3 patients), and total pancreatectomy (1 patient). Twelve patients were managed by transcatheter arterial embolization and three patients underwent re-laparotomy. Patients were divided into two groups according to the site of bleeding: SMA group, superior mesenteric artery (4 patients); HA group, stump of gastroduodenal artery, right hepatic artery, common hepatic artery, or proper hepatic artery (11 patients). In the SMA group, re-laparotomy and coil embolization for pseudoaneurysm were performed in three and one patients, respectively, but none of the patients survived. In the HA group, all 11 patients were managed by transcatheter arterial embolization. None of four patients who had major hepatectomy with extrahepatic bile duct resection survived. Six of seven patients (85.7%) who had pancreatectomy survived, although hepatic infarction occurred in four. Management of postoperative arterial hemorrhage after pancreato-biliary surgery should be done according to the site of bleeding and the initial operative procedure. Careful consideration is required for indication of interventional radiology for bleeding from SMA after pancreatectomy and hepatic artery after major hepatectomy with bilioenteric anastomosis.

  14. The influence of operator position, height and body orientation on eye lens dose in interventional radiology and cardiology: Monte Carlo simulations versus realistic clinical measurements.

    PubMed

    Principi, S; Farah, J; Ferrari, P; Carinou, E; Clairand, I; Ginjaume, M

    2016-09-01

    This paper aims to provide some practical recommendations to reduce eye lens dose for workers exposed to X-rays in interventional cardiology and radiology and also to propose an eye lens correction factor when lead glasses are used. Monte Carlo simulations are used to study the variation of eye lens exposure with operator position, height and body orientation with respect to the patient and the X-ray tube. The paper also looks into the efficiency of wraparound lead glasses using simulations. Computation results are compared with experimental measurements performed in Spanish hospitals using eye lens dosemeters as well as with data from available literature. Simulations showed that left eye exposure is generally higher than the right eye, when the operator stands on the right side of the patient. Operator height can induce a strong dose decrease by up to a factor of 2 for the left eye for 10-cm-taller operators. Body rotation of the operator away from the tube by 45°-60° reduces eye exposure by a factor of 2. The calculation-based correction factor of 0.3 for wraparound type lead glasses was found to agree reasonably well with experimental data. Simple precautions, such as the positioning of the image screen away from the X-ray source, lead to a significant reduction of the eye lens dose. Measurements and simulations performed in this work also show that a general eye lens correction factor of 0.5 can be used when lead glasses are worn regardless of operator position, height and body orientation. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  15. A rare case of recurrent hematuria from right kidney: radiologic diagnosis and treatment.

    PubMed

    Venetucci, Pietro; Quarantelli, Mario; Iaccarino, Vittorio

    2011-01-01

    We report the case of a young woman admitted because of several and recurring episodes of macroscopic hematuria beginned after her first pregnancy. Contrast-enhanced multidetector computed tomography images showed dilated ovarian veins due to a typical pelvic varicocele. We supposed to be a right ovarian vein syndrome, a rare clinical situation characterized by an anomalous compression of the lumbar ureter by the ectasic ovarian vein; this condition may cause a chronic inflammatory stimulus above the urothelial mucosa with a following hematuria. All symptoms were solved by an endovascular treatment through the sclero-embolisation of the pelvic varicocele. After eighteen months the patient didn't present hematuria anymore and she no longer complained about her right side lumbar pain.

  16. A Rare Case of Recurrent Hematuria from Right Kidney: Radiologic Diagnosis and Treatment

    PubMed Central

    Venetucci, Pietro; Quarantelli, Mario; Iaccarino, Vittorio

    2011-01-01

    We report the case of a young woman admitted because of several and recurring episodes of macroscopic hematuria beginned after her first pregnancy. Contrast-enhanced multidetector computed tomography images showed dilated ovarian veins due to a typical pelvic varicocele. We supposed to be a right ovarian vein syndrome, a rare clinical situation characterized by an anomalous compression of the lumbar ureter by the ectasic ovarian vein; this condition may cause a chronic inflammatory stimulus above the urothelial mucosa with a following hematuria. All symptoms were solved by an endovascular treatment through the sclero-embolisation of the pelvic varicocele. After eighteen months the patient didn't present hematuria anymore and she no longer complained about her right side lumbar pain. PMID:22084790

  17. Comparison of clinical and radiologic treatment outcomes of Kienböck's disease.

    PubMed

    Stahl, Stéphane; Hentschel, Pascal J H; Santos Stahl, Adelana; Meisner, Christoph; Schaller, Hans-Eberhard; Manoli, Theodora

    2015-08-27

    The clinical outcomes of scaphotrapeziotrapezoid (STT) arthrodesis were compared to radial shortening osteotomy (RSO) to determine if any of the treatment methods was superior. The impact of RSO and vascularized bone grafts (VBG) on disease progression were measured based on X-rays to evaluate if a difference in Kienböck's disease (KD) progression exists. Out of 98 consecutive patients treated between 1991 and 2013, 46 had STT arthrodesis, 21 had RSO, 7 had VBG, and 3 had VBG and RSO. Patients treated with STT arthrodesis were compared to RSO regarding post-operative range of motion (ROM), wrist pain on the Numeric Rating Scale (NRS), grip strength, duration of incapacity for work, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Modified Mayo Wrist scores (MMWS). Radiographic assessment (Nattrass index, radioscaphoid angle, and Ståhl index) was performed to determine disease progression following RSO or VBG. Baseline patient characteristics were comparable in all treatment groups. There were no significant differences in post-operative ROM, wrist pain, grip strength, duration of incapacity, DASH score, or MMWS score following STT arthrodesis (n = 27) or RSO (n = 14). The Ståhl index, the Nattrass index, and the radioscaphoid angle suggested disease progression following RSO (n = 14) and/or VBG (n = 6) although the changes were not significant. The study failed to demonstrate clinically relevant differences between STT arthrodesis compared to RSO. No evidence was found that decompression or revascularization, or the combination of the two, can reverse or halt the course of the disease. Therapy, level III, retrospective comparative study with prospectively collected data.

  18. Implementation Planning to Promote Parents' Treatment Integrity of Behavioral Interventions for Children with Autism

    ERIC Educational Resources Information Center

    Fallon, Lindsay M.; Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Feinberg, Adam B.; Kratochwill, Thomas R.

    2016-01-01

    Behavioral interventions delivered across home and school settings can promote positive outcomes for youth with autism spectrum disorders (ASD). Yet, stakeholders who deliver these interventions may struggle to implement interventions as intended. Low levels of treatment integrity can undermine potentially positive intervention outcomes. One way…

  19. Implementation Planning to Promote Parents' Treatment Integrity of Behavioral Interventions for Children with Autism

    ERIC Educational Resources Information Center

    Fallon, Lindsay M.; Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Feinberg, Adam B.; Kratochwill, Thomas R.

    2016-01-01

    Behavioral interventions delivered across home and school settings can promote positive outcomes for youth with autism spectrum disorders (ASD). Yet, stakeholders who deliver these interventions may struggle to implement interventions as intended. Low levels of treatment integrity can undermine potentially positive intervention outcomes. One way…

  20. Orthopaedic radiology

    SciTech Connect

    Park, W.M.; Hughes, S.P.F.

    1985-01-01

    This book provides an account of the principles of modern diagnostic imaging techniques and their applications in orthopedics. The aim of the book is to show radiology as a dynamic subject which can help clinicians, while at the same time assisting radiologists to understand the needs of the orthopedic surgeon.

  1. Combination ibandronate and radiotherapy for the treatment of bone metastases: Clinical evaluation and radiologic assessment

    SciTech Connect

    Vassiliou, Vassilios; Kalogeropoulou, Christine; Christopoulos, Christos; Solomou, Ekaterini; Leotsinides, Michael; Kardamakis, Dimitrios . E-mail: kardim@med.upatras.gr

    2007-01-01

    Purpose: Ibandronate is a single-nitrogen, noncyclic bisphosphonate with proven efficacy for reducing metastatic bone pain. In this study, we assessed the palliative effects of combined ibandronate and radiotherapy. Methods and Materials: Forty-five patients with bone metastases from various solid tumors received external-beam radiotherapy, 30-40 Gy over 3-4.5, weeks combined with 10 cycles of monthly intravenous ibandronate, 6 mg. Results: After combined therapy, mean bone pain scores (graded from 0 to 10) were reduced from 6.3 at baseline to 0.8 after 3 months, with further reductions at later time points (all p < 0.001). Opioid use decreased from 84% of patients at baseline (38/45) to 24% (11/45) at 3 months, with further subsequent reductions (all p < 0.001). Mean performance status and functioning scores also significantly improved. Bone density (assessed by computed tomography scan) increased by 20% vs. baseline at 3 months, 46% at 6 months, and 73% at 10 months (all p < 0.001). Lesion improvement was also demonstrated by magnetic resonance imaging. Treatment was well tolerated with no renal toxicity. Conclusions: In this pilot study, combined radiotherapy and ibandronate provided substantial bone pain relief and increased bone density. Computed tomography-based or magnetic resonance imaging-based evaluations offer objective methods for assessing therapeutic outcomes.

  2. Prediction of treatment outcome in soft tissue sarcoma based on radiologically defined habitats

    NASA Astrophysics Data System (ADS)

    Farhidzadeh, Hamidreza; Chaudhury, Baishali; Zhou, Mu; Goldgof, Dmitry B.; Hall, Lawrence O.; Gatenby, Robert A.; Gillies, Robert J.; Raghavan, Meera

    2015-03-01

    Soft tissue sarcomas are malignant tumors which develop from tissues like fat, muscle, nerves, fibrous tissue or blood vessels. They are challenging to physicians because of their relative infrequency and diverse outcomes, which have hindered development of new therapeutic agents. Additionally, assessing imaging response of these tumors to therapy is also difficult because of their heterogeneous appearance on magnetic resonance imaging (MRI). In this paper, we assessed standard of care MRI sequences performed before and after treatment using 36 patients with soft tissue sarcoma. Tumor tissue was identified by manually drawing a mask on contrast enhanced images. The Otsu segmentation method was applied to segment tumor tissue into low and high signal intensity regions on both T1 post-contrast and T2 without contrast images. This resulted in four distinctive subregions or "habitats." The features used to predict metastatic tumors and necrosis included the ratio of habitat size to whole tumor size and components of 2D intensity histograms. Individual cases were correctly classified as metastatic or non-metastatic disease with 80.55% accuracy and for necrosis ≥ 90 or necrosis <90 with 75.75% accuracy by using meta-classifiers which contained feature selectors and classifiers.

  3. Treatment interventions for early childhood obesity: a systematic review

    PubMed Central

    Foster, Byron A; Farragher, Jill; Parker, Paige; Sosa, Erica T.

    2015-01-01

    Context With 25% of pre-school age children in the United States being overweight or obese, effective interventions for these children would have significant public health implications. Randomized trials targeting this age group have been done since the last systematic review. Objective To systematically review the literature on treatment interventions for overweight or obesity in pre-school age children. Data Sources Medline (1948–July 2014), the Cochrane Central Registry (1991–July 2014), CINAHL (1990–July2014) and PAS abstracts (2000–2014). Study Selection Inclusion criteria were children age 0–6 in the study and adiposity as an outcome. Exclusions were having normal weight children in the trial and not having a comparison group. Data Extraction Data were extracted independently by two authors using a template. Results The initial search yielded 1,981 results, narrowed to 289 abstracts after initial review. Further analysis and cross-referencing led to the selection of six randomized controlled trials representing 1222 children. Two studies used systems changes and motivational interviewing and showed no significant effect on adiposity. Two studies used an intensive, multi-disciplinary approach over six months and demonstrated significant decreases in adiposity. One study tested parental coaching and showed a significant reduction in adiposity at six months. One study used education on a dairy-rich diet and showed a possible effect on adiposity. Limitations The study designs were too heterogeneous for meta-analysis; few ethnic minority subjects were included. Conclusions Multi-disciplinary, intensive interventions have some evidence of efficacy in reducing adiposity in pre-school children. PMID:26142067

  4. Lifestyle interventions for the treatment of urinary incontinence in adults.

    PubMed

    Imamura, Mari; Williams, Kate; Wells, Mandy; McGrother, Catherine

    2015-12-02

    Low cost, non-invasive alterations in lifestyle are frequently recommended by healthcare professionals or those presenting with incontinence. However, such recommendations are rarely based on good evidence. The objective of the review was to determine the effectiveness of specific lifestyle interventions (i.e. weight loss; dietary changes; fluid intake; reduction in caffeinated, carbonated and alcoholic drinks; avoidance of constipation; stopping smoking; and physical activity) in the management of adult urinary incontinence. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process, and handsearching of journals and conference proceedings (searched 3 July 2013), and the reference lists of relevant articles. We incorporated the results of these searches fully in the review. We undertook an updated search of the Specialised Register, which now includes searches of ClinicalTrials.gov and WHO ICTRP, on 27 October 2014; potentially eligible studies from this search are currently awaiting classification. Randomised and quasi-randomised studies of community-based lifestyle interventions compared with no treatment, other conservative therapies, or pharmacological interventions for the treatment of urinary incontinence in adults. Two authors independently assessed study quality and extracted data. We collected information on adverse effects from the trials. Data were combined in a meta-analysis when appropriate. We assessed the quality of the evidence using the GRADE approach. We included 11 trials in the review, involving a total of 5974 participants.Four trials involving 4701 women compared weight loss programmes with a control intervention. Low quality evidence from one trial suggested that more women following weight loss programmes reported improvement in symptoms of incontinence at six months (163/214 (76%) versus 49/90 (54

  5. Influence of surface treatment on osseointegration of dental implants: histological, histomorphometric and radiological analysis in vivo.

    PubMed

    Calvo-Guirado, José Luis; Satorres-Nieto, Marta; Aguilar-Salvatierra, Antonio; Delgado-Ruiz, Rafael Arcesio; Maté-Sánchez de Val, José Eduardo; Gargallo-Albiol, Jordi; Gómez-Moreno, Gerardo; Romanos, Georgios E

    2015-03-01

    The aim of this article is to compare the influence of surface treatment on the integration (at 2, 4 and 8 weeks) of 120 dental implants inserted in 60 tibiae of rabbits. Four different surfaces were double-blind tested: blasted, acid-etched and discrete crystal deposition (DCD) (group A); blasted (group B); acid-etched (group C) and blasted and acid-etched (group D). Bone-to-implant contact plus reverse torque and bone level were measured at the time of implant insertion and at 14, 28 and 56 days of healing. Group A showed the highest early and late bone-to-implant contact (BIC) values: 40.8 ± 2.3 % at 14 days decreasing to 27.7 ± 1.1 % after 28 days and 39.4 ± 1.4 % at 56 days. For group B, the average BIC values at 14, 28 and 56 days were 23.34 ± 2.1, 23.77 ± 1.9 and 29.47 ± 1.7 %, respectively. Group C showed a value of 25.72 ± 2.3 % after 14 days of integration, 34.92 ± 2.2 % at 28 days and 32.91 ± 1.6 % at 56 days. Group D showed a BIC value of 32 ± 2.5 % at 14 days, 32.85 ± 1.4 % at 28 days and 34.04 ± 2.3 % at 56 days. In the scanning electron microscopy (SEM) analysis, no statistically significant differences were found. The Ca/P ratio values were 1.762 for surface A, 1.625 for surface B, 1.663 for surface C and finally 1.722 for surface D. Therefore, we conclude that even if there seems to be a tendency to obtain better BIC results with surface A (blasted-etched and covered with hydroxyapatite (HA)), no statistical differences were obtained in this study. The study shows the influence of different implant surfaces in increasing osseointegation for immediate loading implants.

  6. MO-D-BRD-02: Radiological Physics and Surface Lesion Treatments with Electronic Brachytherapy

    SciTech Connect

    Fulkerson, R.

    2015-06-15

    Electronic brachytherapy (eBT) has seen an insurgence of manufacturers entering the US market for use in radiation therapy. In addition to the established interstitial, intraluminary, and intracavitary applications of eBT, many centers are now using eBT to treat skin lesions. It is important for medical physicists working with electronic brachytherapy sources to understand the basic physics principles of the sources themselves as well as the variety of applications for which they are being used. The calibration of the sources is different from vendor to vendor and the traceability of calibrations has evolved as new sources came to market. In 2014, a new air-kerma based standard was introduced by the National Institute of Standards and Technology (NIST) to measure the output of an eBT source. Eventually commercial treatment planning systems should accommodate this new standard and provide NIST traceability to the end user. The calibration and commissioning of an eBT system is unique to its application and typically entails a list of procedural recommendations by the manufacturer. Commissioning measurements are performed using a variety of methods, some of which are modifications of existing AAPM Task Group protocols. A medical physicist should be familiar with the different AAPM Task Group recommendations for applicability to eBT and how to properly adapt them to their needs. In addition to the physical characteristics of an eBT source, the photon energy is substantially lower than from HDR Ir-192 sources. Consequently, tissue-specific dosimetry and radiobiological considerations are necessary when comparing these brachytherapy modalities and when making clinical decisions as a radiation therapy team. In this session, the physical characteristics and calibration methodologies of eBt sources will be presented as well as radiobiology considerations and other important clinical considerations. Learning Objectives: To understand the basic principles of electronic

  7. Human toxocariasis: current advances in diagnostics, treatment, and interventions.

    PubMed

    Moreira, Gustavo Marçal Schmidt Garcia; Telmo, Paula de Lima; Mendonça, Marcelo; Moreira, Angela Nunes; McBride, Alan John Alexander; Scaini, Carlos James; Conceição, Fabricio Rochedo

    2014-09-01

    Toxocariasis is a neglected zoonosis caused by the nematodes Toxocara canis and Toxocara cati. This disease is widespread in many countries, reaching high prevalence independently of the economic conditions. However, the true number of cases of toxocariasis is likely to be underestimated owing to the lack of adequate surveillance programs. Although some diagnostic tests are available, their sensitivity and specificity need to be improved. In addition, treatment options for toxocariasis are limited and are non-specific. Toxocariasis is listed as one of the five most important neglected diseases by the CDC. This review presents recent advances related to the control of toxocariasis, including new immunodiagnostics, therapies, and drug formulations, as well as novel interventions using DNA vaccines, immunomodulators, and probiotics.

  8. Successful combination of interventional and surgical treatment of left atrium perforation.

    PubMed

    Bahcivan, Muzaffer; Doyurgan, Onur; Urkmez, Melih; Keceligil, Hasan Tahsin

    2009-04-01

    Percutaneous interventions are increasingly used in the treatment of cardiac diseases which are resistant to medical treatment. However, the complications caused by these interventions can lead to serious results. In this article, we present a case of a successful combination of interventional and surgical treatment methods, following the development of left atrial perforation during radiofrequency catheter ablation (RFA), in a patient with atrial fibrillation resistant to medical treatment.

  9. Individualizing treatment choices in the systolic blood pressure intervention trial.

    PubMed

    Ferreira, João Pedro; Gregson, John; Duarte, Kévin; Gueyffier, François; Rossignol, Patrick; Zannad, Faiez; Pocock, Stuart

    2017-08-30

    Any treatment decision should be tailored to the individual patients' characteristics. A personalized approach aims to help better selecting the patients who are likely to benefit most from a treatment decision. In the systolic blood pressure intervention trial, intensive treatment reduced the rate of major cardiovascular events, but increased the rate of serious adverse events (SAEs). To assess the trade-off between efficacy and safety to simultaneously quantify an individual patient's absolute benefit and absolute harm, helping clinicians making better therapeutic choices in daily practice. Multivariable Poisson regression models were used to identify independent risk factors for: primary composite cardiovascular outcome and major SAEs = safety. Estimates from the models were used to quantify each individual risk. Subclinical cardiovascular disease, number of antihypertensive agents, current smoking, age, urine albumin-to-creatinine ratio, and serum creatinine were associated with increased risk of both primary outcome events and SAEs. Triglycerides were associated with increased primary outcome events only, and chronic kidney disease and female sex with SAEs only. The models were well calibrated and showed good performance (c-index for safety = 0.69 and c-index for efficacy = 0.72). For the primary outcome, there is a steep gradient in risk by fifths of the predicted model and a similar gradient exists for the safety outcome predicted model. Mortality within 1 year of an efficacy outcome (as assessed by the Kaplan-Meier method) was nearly three-fold higher than following a safety outcome (21.9 vs. 7.5%). If one judges the clinical importance of efficacy and safety outcomes based on their 1-year mortality, then there is a net benefit of intensive therapy for almost all patients. Antihypertensive treatment intensification is associated with lower cardiovascular event rates; however, it increases the risk of adverse events. However, having adverse

  10. Clinical and Radiological Comparison of Femur and Fibular Allografts for the Treatment of Cervical Degenerative Disc Diseases

    PubMed Central

    Oh, Hyeong-Seok; Shim, Chan Shik; Lee, Sang-Ho

    2013-01-01

    Objective This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. Methods A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with a femur allograft, and 51 patients (64 segments) were treated with a fibular allograft. The mean follow-up period was 16.0 (range, 12-25) months in the femur group and 19.5 (range, 14-39) months in the fibular group. Cage fracture and breakage, subsidence rate, fusion rate, segmental angle and height and disc height were assessed by using radiography. Clinical outcomes were assessed using a visual analog scale and neck disability index. Results At 12 months postoperatively, cage fracture and breakage had occurred in 3.4% (2/58) and 7.4% (4/58) of the patients in the femur group, respectively, and 21.9% (14/64) and 31.3% (20/64) of the patients in the fibular group, respectively (p<0.05). Subsidence was noted in 43.1% (25/58) of the femur group and in 50.5% (32/64) of the fibular group. No difference in improvements in the clinical outcome between the two groups was observed. Conclusion The femur allograft showed good results in subsidence and radiologic parameters, and sustained the original cage shape more effectively than the fibular allograft. The present study suggests that the femur allograft may be a good choice as a fusion substitute for the treatment of cervical DDD. PMID:23439721

  11. Clinical and radiological comparison of femur and fibular allografts for the treatment of cervical degenerative disc diseases.

    PubMed

    Oh, Hyeong-Seok; Shim, Chan Shik; Kim, Jin-Sung; Lee, Sang-Ho

    2013-01-01

    This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with a femur allograft, and 51 patients (64 segments) were treated with a fibular allograft. The mean follow-up period was 16.0 (range, 12-25) months in the femur group and 19.5 (range, 14-39) months in the fibular group. Cage fracture and breakage, subsidence rate, fusion rate, segmental angle and height and disc height were assessed by using radiography. Clinical outcomes were assessed using a visual analog scale and neck disability index. At 12 months postoperatively, cage fracture and breakage had occurred in 3.4% (2/58) and 7.4% (4/58) of the patients in the femur group, respectively, and 21.9% (14/64) and 31.3% (20/64) of the patients in the fibular group, respectively (p<0.05). Subsidence was noted in 43.1% (25/58) of the femur group and in 50.5% (32/64) of the fibular group. No difference in improvements in the clinical outcome between the two groups was observed. The femur allograft showed good results in subsidence and radiologic parameters, and sustained the original cage shape more effectively than the fibular allograft. The present study suggests that the femur allograft may be a good choice as a fusion substitute for the treatment of cervical DDD.

  12. Development of the triage, monitoring and treatment Handbook for Members of the Public Affected by Radiological Terrorism - A European Response

    SciTech Connect

    Kruse, P.; Rojas-Palma, C.

    2007-07-01

    European national emergency response plans have long been focused on accidents at nuclear power plants. Recently, the possible threats by disaffected groups have shifted the focus to being prepared also for malevolent use of radiation that are aimed at creating disruption and panic in the society. The casualties will most likely be members of the public. According to the scenario, the number of affected people can vary from a few to mass casualties. The radiation exposure can range from very low to substantial, possibly combined with conventional injuries. There is a need to develop practicable tools for the adequate response to such acts and more specifically to address European guidelines for triage, monitoring and treatment of exposed people. Although European countries have developed emergency response plans for nuclear accidents they have not all made plans for handling malevolent use of radioactive material. Indeed, there is a need to develop practical guidance on emergency response and medical treatment of the public affected by malevolent acts. Generic guidance on this topic has been published by international organisations. They are, however, not operational documents to be used in emergency situations. The Triage, Monitoring and Treatment (TMT) Handbook aims to strengthen the European ability to efficiently respond to malevolent acts in terms of protecting and treating exposed people. Part of the Handbook is also devoted to public information and communication issues which would contribute to public reassurance in emergency situations. The Handbook will be drafted by European and international experts before it is circulated to all emergency response institutions in Europe that would be a part of the handling of malevolent acts using radioactive material. The institutions would be given a 6 months consultation time with encouragement to test the draft Handbook in national exercises. A workshop will allow feedback from these end users on the content

  13. Risk management in radiology departments

    PubMed Central

    Craciun, Horea; Mankad, Kshitij; Lynch, Jeremy

    2015-01-01

    Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients. PMID:26120383

  14. Risk management in radiology departments.

    PubMed

    Craciun, Horea; Mankad, Kshitij; Lynch, Jeremy

    2015-06-28

    Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients.

  15. Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals.

    PubMed

    Danielsson, A J; Nachemson, A L

    2001-03-01

    This study is a follow-up investigation for a consecutive series of patients with adolescent idiopathic scoliosis treated between 1968 and 1977. In this series, 156 patients underwent surgery with distraction and fusion using Harrington rods, and 127 were treated with brace. To determine the long-term outcome in terms of radiologic findings and curve progression at least 20 years after completion of the treatment. Radiologic appearance is important in comparing the outcome of different treatment options and in evaluating clinical results. Earlier studies have shown a slight increase of the Cobb angle in brace-treated patients with time, but not in fused patients. Of 283 patients, 252 attended a clinical and radiologic follow-up assessment by an unbiased observer (91% of the surgically treated and 87% of the brace-treated patients). This evaluation included chart reviews, validated questionnaires, clinical examination, and full-length standing frontal and lateral roentgenographs. Curve size was measured by the Cobb method on anteroposterior roentgenograms as well as by sagittal contour and balance on lateral films. The occurrence of any degenerative changes or other complications was noted. An age- and gender-matched control group of 100 individuals was randomly selected and subjected to the same examinations. The mean follow-up times were 23 years for surgically treated group and 22 years for brace-treated group. The deterioration of the curves was 3.5 degrees for all the surgically treated curves and 7.9 degrees for all the brace-treated curves (P < 0.001). Five patients, all brace-treated, had a curve increase of 20 degrees or more. The overall complication rate after surgery was low: Pseudarthrosis occurred in three patients, and flat back syndrome developed in four patients. Eight of the patients treated with fusion (5.1%) had undergone some additional curve-related surgical procedure. The lumbar lordosis was less in the surgically treated than in the brace

  16. Interventions for replacing missing teeth: treatment of perimplantitis.

    PubMed

    Esposito, Marco; Grusovin, Maria Gabriella; Tzanetea, Eleni; Piattelli, Adriano; Worthington, Helen V

    2010-06-16

    One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 7th January 2010. All RCTs comparing agents or interventions for treating perimplantitis around dental implants. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Twelve eligible trials were identified, but five were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual

  17. Interventions for replacing missing teeth: treatment of perimplantitis.

    PubMed

    Esposito, M; Grusovin, M G; Coulthard, P; Worthington, H V

    2006-07-19

    One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 15 March 2006. All RCTs of oral implants comparing agents or interventions for treating perimplantitis around dental implants. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Seven eligible trials were identified, but two were excluded. The following procedures were tested: 1) use of local antibiotics versus ultrasonic debridement; 2) benefits of adjunctive local antibiotics to debridement; 3

  18. Cancer treatment-induced diarrhea: interventions to minimize the roller coaster ride.

    PubMed

    2004-01-01

    This program used a case-study approach to discuss interventions that nurses can implement in their daily clinical environment to minimize cancer treatment-induced diarrhea. Manifestations of cancer treatment-induced diarrhea, medical treatment options, and nutritional interventions were covered.

  19. Radiology today. Volume 4

    SciTech Connect

    Heuck, F.H.W.; Donner, M.W.

    1987-01-01

    The book discusses the following contents: Advances in Cardiovascular Imaging: Digital Arteriography: Ongoing Developments. Magnetic Resonance Imaging of the Cardiovascular System. Comparison of Vascular CT and MRI. Characterization of Vascular Lesions by Ultrasound - Progress in Vascular Interventions: Laser Angioplasty: A Review. Fibrinolytic Therapy Combined with Clot Extraction. Drugs Useful in Angioplasty. Developments in Cardiovascular Imaging: Blood Flow Measurements with Digital Arteriography. Selection of Imaging Techniques for Venous Thromboembolic Disease. Clinical Usefulness of High-Verus Low-Osmolality Contrast Agents. Developments in Angiographic and Interventional Instrumentation. Progress in Cardiovascular Interventions. Inferior Vena Cava Filters: Types, Placement, and Efficiency. Transluminal Vascular Stenting and Grafting. Venography and Sclerotherapy of Varioceles in Children and Adolescents. A New Catheter System - Important Hip Problems: Radiologic and Pathologic Correlation and Hip Disease. Comparison of Imaging Modalities in Femoral Head Necrosis. Osteoartrosis and Arthritis (Synovitis) of the Hip. Hip Anthrography.

  20. Interventions for replacing missing teeth: treatment of perimplantitis.

    PubMed

    Esposito, M; Grusovin, M G; Kakisis, I; Coulthard, P; Worthington, H V

    2008-04-16

    One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 9 January 2008. All RCTs comparing agents or interventions for treating perimplantitis around dental implants. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Ten eligible trials were identified, but three were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different

  1. Alzheimer's disease and language impairments: social intervention and medical treatment.

    PubMed

    Klimova, Blanka; Maresova, Petra; Valis, Martin; Hort, Jakub; Kuca, Kamil

    2015-01-01

    Communication is very important for people to be successfully integrated into social environment and make and maintain relationship. Particularly, language difficulties lead to social exclusion of the people affected with Alzheimer's disease (AD) and contribute to a significant decrease in the quality of their life and also have a big impact on their family members who in most cases become their caregivers who need to communicate with their loved ones in order to meet their needs. Therefore, the goal of this study is to describe language impairments in the individual phases of AD and discuss their improvement with respect to AD on the basis of literature review. The authors of this article use traditional research methods in order to achieve the goal set mentioned earlier. First, a method of literature review of available sources describing language impairments in the individual phases of AD is exploited. Second, to show how informal caregivers and relevant drugs can successfully intervene in the improvement of these language impairments, a method of comparison of different research studies exploring such social intervention and medical treatment is used.

  2. A Meta-Analysis of Treatment Interventions for Internet Addiction Among Korean Adolescents.

    PubMed

    Chun, JongSerl; Shim, HaiSun; Kim, Soyoun

    2017-04-01

    This study comprehensively examined the effects of treatment interventions for Internet addiction among adolescents in South Korea through a meta-analysis. We analyzed 70 domestic master's theses and journal articles that reported on controlled studies and involved pre- and post-test analyses in the design. The dates of these publications fall between 2000 and 2015. The total effect size, calculated by random-effect analysis (g), revealed that interventions for the treatment of Internet addiction were effective (ES = 1.838). Meta-ANOVAs revealed differences between groups based on a theoretical model, intervention group size, and intervention duration. Integrative therapy produced larger effect sizes (ES = 2.794) compared to other treatment models such as cognitive behavioral therapy and reality therapy. Effect sizes for interventions, including nine to 12 people (ES = 2.178), were larger than those of interventions including more or fewer participants. Finally, treatment interventions that lasted 8 or more weeks revealed larger effect sizes (ES = 2.294) compared to shorter interventions. The study findings suggest directions for the development and effective operation of future Internet addiction interventions among Korean adolescents. Increasing the effectiveness of these interventions requires an integrative theoretical model, an intervention group size of nine to 12 participants, and a long-term intervention.

  3. Establishing Treatment Fidelity in a Web-Based Behavioral Intervention Study

    PubMed Central

    Eaton, Linda H.; Doorenbos, Ardith Z.; Schmitz, KrisAnn L.; Carpenter, Kelly M.; McGregor, Bonnie A.

    2011-01-01

    Background Treatment fidelity pertains to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Approaches to establishing treatment fidelity in Web-based interventions differ from those used in interventions that are delivered in person. Objective To describe a methodology for ensuring treatment fidelity in a Web-based cognitive behavioral stress management intervention. Methods The intervention Coping with Cancer Workbook, adapted for Web-based delivery from an in-person intervention, was tested in a randomized controlled trial with 123 breast cancer survivors. Strategies for ensuring treatment fidelity were implemented and assessed. Results The National Institutes of Health Behavior Change Consortium Treatment Fidelity Guidelines were relevant to establishing treatment fidelity for the Web-based intervention. Discussion Web-based delivery of behavioral interventions is both a strength and a threat to treatment fidelity. Investigators must be cognizant of the elements of treatment fidelity and implement strategies to monitor and improve the reliability and validity of Web-based interventions. PMID:22048559

  4. Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach

    PubMed Central

    Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

    2013-01-01

    Background Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. Objective The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. Methods We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. Results The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels

  5. Interventions for the treatment of borderline ovarian tumours

    PubMed Central

    Faluyi, Olusola; Mackean, Melanie; Gourley, Charlie; Bryant, Andrew; Dickinson, Heather O

    2014-01-01

    Background The safety of conservative surgery and the benefit of additional interventions after surgery for borderline ovarian tumours are unknown. Objectives To evaluate the benefits and harm of different treatment modalities offered for borderline ovarian tumours. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register to 2009, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE to 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies. Selection criteria Randomised controlled trials (RCTs) that compared different interventions in adult women diagnosed with borderline ovarian tumours of any histological variant. Data collection and analysis Two review authors independently abstracted data and assessed risk of bias. Main results We identified seven RCTs that enrolled 372 women. We could not pool results of trials as the treatment comparisons differed. Six RCTs (n = 340) conducted over 15 years ago, evaluated adjuvant therapy (chemotherapy, pelvic external irradiation or intraperitoneal radioactive isotope therapy) after radical surgery; over 87% of participants had Stage I tumours. Most participants were followed up for over 10 years. Overall and recurrence-free survival were similar between both arms of these trials, except that one trial (n = 66) showed a significantly lower survival (P = 0.03) in women who received chemotherapy (thio-TEPA). Adverse effects of treatment were incompletely reported and all six trials were at high risk of bias. One further trial (n = 32) that recruited participants with bilateral serous tumours who were wishing fertility preservation, revealed a significantly increased chance of pregnancy (hazard ratio (HR) = 3.3, 95% CI 1.4 to 8.0) but non-significantly earlier disease recurrence (HR = 1.5, 95% CI 0.6 to 3.8) in the women who had ultra-conservative surgery (bilateral

  6. Psychological interventions in the treatment of childhood obesity: what we know and need to find out.

    PubMed

    Bogle, Vanessa; Sykes, Catherine

    2011-10-01

    This review aims to assess the effectiveness of psychological interventions for treating childhood obesity. Firm conclusions about the effectiveness of psychological interventions to treat childhood obesity remain unclear. Based on current knowledge, the review suggests that a number of interventions may be effective including: multi-component family-based behavioural interventions, interventions aimed at reducing sedentary behaviour and/or increasing physical activity levels as a component of family-based behavioural treatments, in addition to population-based school-wide treatment for girls. Further investment is needed to improve current research and find new, more imaginative ways to research childhood obesity.

  7. Treatment of child abuse: a review of the behavioral interventions.

    PubMed

    Isaacs, C D

    1982-01-01

    Child abuse has probably existed as a social problem as long as parents and children have lived under the same roof, and in recent years it has received tremendous attention. Most of the research has focused on etiology rather than treatment, leaving large gaps in our knowledge about remediating abuse. Behavioral scientists have only begun to formulate a conceptual framework from which to work. Many theoretical questions are yet unanswered, particularly the question of what constitutes abuse. Burgess (1978) believes that conceptual problems exist because abuse falls along a continuum of parent-child relationships--a continuum that at one end might include verbal punishment (e.g., threats, ridicule) or milder forms of physical punishment (e.g., slap on the hand, spanking), and at the other end include extreme forms of physical punishment that exceed community mores (for example, hitting a child with a closed fist, scalding a child in hot water, torturing or killing a child). Thus, the question-- where does discipline stop and abuse begin?-- faces every researcher who must operationally define abuse. Identifying the consequences of abuse in a child's development is another area of inquiry that remains untreated. Most of the literature is filled with the subjective impressions of professionals speculating that abused children become the juvenile delinquents and the child abusers of the future; however, as yet no longitudinal studies have been conducted that compare the developmental outcomes of abused and non-abused children from early childhood to later adulthood. What if there were no differences? How might this influence our approaches to the treatment of abuse? Answers to these and other questions will take years of study. Increased awareness of the problem of child abuse has led to greater efforts to remediate the problem. Treatment efforts with abusive families are still in the initial stages, but, undoubtedly, information from these early programs can be the

  8. Behavioral outcomes of AIDS educational interventions for drug users in short-term treatment.

    PubMed Central

    McCusker, J; Stoddard, A M; Zapka, J G; Lewis, B F

    1993-01-01

    This paper reports the behavioral outcomes of informational vs enhanced small-group educational interventions for drug users among 407 subjects in a short-term drug treatment program. Logistic regression was used to analyze drug use and sexual behaviors at the final follow-up visit. Among lower risk subjects, the enhanced intervention was more effective in reducing injection practices that produced risks in terms of human immunodeficiency virus infection; among those at highest risk, the informational interventions were more effective. The enhanced intervention was more effective than the informational interventions in reducing cocaine use at follow-up. No differential intervention effect on sexual risk behaviors was found. PMID:8214241

  9. Image-guided elbow interventions: a literature review of interventional treatment options

    PubMed Central

    Sorani, Alan

    2016-01-01

    Over the years, a wide range of image-guided interventional therapies have been used in treating different elbow pathologies, many of which are predominantly based on anecdotal and low-level study findings. This article critically assesses the existing literature and discusses the efficacy of the most commonly utilized interventional procedures for elbow pathology. PMID:26206415

  10. Treatment Approach, Autism Severity and Intervention Outcomes in Young Children

    ERIC Educational Resources Information Center

    Zachor, Ditza A.; Itzchak, Esther Ben

    2010-01-01

    The current study examined the relation between autism severity at baseline, type of intervention employed and outcomes in young children with autism spectrum disorder (ASD). Seventy-eight children with ASD, aged 15-35 months (M=25.4, SD=4.2), received either applied behavioral analysis (ABA) or integration of several intervention approaches…

  11. Psychological Interventions with AIDS and HIV: Prevention and Treatment.

    ERIC Educational Resources Information Center

    Kelly, Jeffrey A.; Murphy, Debra A.

    1992-01-01

    Notes that research to date has yielded important findings for primary prevention efforts for Acquired Immune Deficiency Syndrome (AIDS) and has identified psychological dimensions relevant to mental health interventions for persons with human immunodeficiency virus (HIV). Sees pressing need for more systematic intervention outcome research in…

  12. Treatment Approach, Autism Severity and Intervention Outcomes in Young Children

    ERIC Educational Resources Information Center

    Zachor, Ditza A.; Itzchak, Esther Ben

    2010-01-01

    The current study examined the relation between autism severity at baseline, type of intervention employed and outcomes in young children with autism spectrum disorder (ASD). Seventy-eight children with ASD, aged 15-35 months (M=25.4, SD=4.2), received either applied behavioral analysis (ABA) or integration of several intervention approaches…

  13. Test Driving Interventions to Increase Treatment Integrity and Student Outcomes

    ERIC Educational Resources Information Center

    Dart, Evan H.; Cook, Clayton R.; Collins, Tai A.; Gresham, Frank M.; Chenier, Jeffrey S.

    2012-01-01

    Behavioral consultation has been shown to be an effective way for school psychologists to work with teachers in implementing interventions for student problem behavior. Some teachers are resistant to the behavioral consultation process and thereby fail to implement agreed upon interventions with integrity, which is problematic considering the…

  14. Advanced medical countermeasures for radiological accidents and nuclear disasters: prevention, prophylaxis, treatment and pre- and post-exposure management.

    NASA Astrophysics Data System (ADS)

    Popov, Dmitri; Maliev, Slava; Jones, Jeffrey

    Countermeasures against nuclear terrorism to prevent or limit the number of irradiated human population or radiation intoxications include early identification of the nuclear terrorism event and all persons which exposed by radiation, decontamination program and procedures, radiation control, and medical countermeasures which include medical diagnosis,differential diagnosis of Acute Radiation Syndromes by Immune Enzyme Assay , pre-exposure vaccination with Human Antiradiation Vaccine, post-exposure specific treatment - de-intoxication with Radiation Antidote IgG (blocking Antiradiation Antibodies). Our Advanced Medical Technology elaborated as a part of effective countermeasure include Plan of Action.Countermeasures against nuclear terrorism to prevent or limit the number of high level of lethality and severe forms of radiation illness or intoxications include A.early identification of the nuclear terrorism event and persons exposed,b. appropriate decontamination, c. radiation control, and d.medical countermeasures and medical management of ARS. Medical countermeasures, which include medical interventions such as active immuneprophylaxis with Human Antiradiation Vaccine , passive immune-prophylaxis with Antiradiation Antitoxins immune-globulins IgG , and chemoprophylaxis - post-exposure antioxidants prophylaxis and antibioticprophylaxis. Medical countermeasures with Antiradiation Vaccine should be initiated before an exposure (if individuals are identified as being at high risk for exposure)but after a confirmed exposure event Antiradiation Vaccine not effective and Antiradiation Antidot IgG must be applyed for treatment of Acute Radiation Syndromes.

  15. Reinventing radiology reimbursement.

    PubMed

    Marshall, John; Adema, Denise

    2005-01-01

    Lee Memorial Health System (LMHS), located in southwest Florida, consists of 5 hospitals, a home health agency, a skilled nursing facility, multiple outpatient centers, walk-in medical centers, and primary care physician offices. LMHS annually performs more than 300,000 imaging procedures with gross imaging revenues exceeding dollar 350 million. In fall 2002, LMHS received the results of an independent audit of its IR coding. The overall IR coding error rate was determined to be 84.5%. The projected net financial impact of these errors was an annual reimbursement loss of dollar 182,000. To address the issues of coding errors and reimbursement loss, LMHS implemented its clinical reimbursementspecialist (CRS) system in October 2003, as an extension of financial services' reimbursement division. LMHS began with CRSs in 3 service lines: emergency department, cardiac catheterization, and radiology. These 3 CRSs coordinate all facets of their respective areas' chargemaster, patient charges, coding, and reimbursement functions while serving as a resident coding expert within their clinical areas. The radiology reimbursement specialist (RRS) combines an experienced radiologic technologist, interventional technologist, medical records coder, financial auditor, reimbursement specialist, and biller into a single position. The RRS's radiology experience and technologist knowledge are key assets to resolving coding conflicts and handling complex interventional coding. In addition, performing a daily charge audit and an active code review are essential if an organization is to eliminate coding errors. One of the inherent effects of eliminating coding errors is the capturing of additional RVUs and units of service. During its first year, based on account level detail, the RRS system increased radiology productivity through the additional capture of just more than 3,000 RVUs and 1,000 additional units of service. In addition, the physicians appreciate having someone who "keeps up

  16. Technology in radiology: advances in diagnostic imaging & therapeutics.

    PubMed

    Stern, S M

    1993-01-01

    Nearly 100 years from its birth, radiology continues to grow as though still in adolescence. Although some radiologic technologies have matured more than others, new applications and techniques appear regularly in the literature. Radiology has evolved from purely diagnostic devices to interventional technologies. New contrast agents in MRI, X ray and ultrasound enable physicians to make diagnoses and plan therapies with greater precision than ever before. Techniques are less and less invasive. Advances in computer technology have given supercomputer-like power to high-end nuclear medicine and MRI systems. Imaging systems in most modalities are now designed with upgrades in mind instead of "planned obsolescence." Companies routinely upgrade software and other facets of their products, sometimes at no additional charge to existing customers. Hospitals, radiology groups and imaging centers will face increasing demands to justify what they do according to patient outcomes and management criteria. Did images make the diagnosis or confirm it? Did the images determine optimal treatment strategies or confirm which strategies might be appropriate? Third-party payers, especially the government, will view radiology in those terms. The diagnostic imaging and therapy systems of today require increasingly sophisticated technical support for maintenance and repair. Hospitals, radiology groups and imaging centers will have to determine the most economic and effective ways to guarantee equipment up-time. Borrowing from the automotive industry, some radiology manufacturers have devised transtelephonic software systems to facilitate remote troubleshooting. To ensure their fiscal viability, hospitals continue to acquire new imaging and therapy technologies for competitive and access-to-services reasons.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Crisis intervention program: an alternative to inpatient psychiatric treatment for children.

    PubMed

    Blumberg, Samuel H

    2002-03-01

    This study evaluated the impact of a Crisis Intervention program as an alternative to use of psychiatric treatment beds for young children. A multidisciplinary community-based intervention was utilized, including family therapy, psychiatric intervention, and school consultations. The impact of the service was evaluated in relation to the use of psychiatric treatment beds by the population of children eligible for Medicaid or uninsured. In comparison to an historical control group, the program resulted in a 23% reduction in the use of psychiatric treatment beds. A cost-minimization analysis indicated that in addition to the program reducing the use of psychiatric treatment beds, the cost of treatment was also slightly reduced.

  18. Predictors of Treatment Use among Foster Mothers in an Attachment-Based Intervention Program

    PubMed Central

    Bick, Johanna; Dozier, Mary; Moore, Shannon

    2012-01-01

    The current study examined predictors of treatment use among 56 foster mothers who participated in an attachment-based intervention program for foster infants. Foster mothers’ levels of treatment use were coded at early, middle, and late phases of the intervention program. Foster mothers’ states of mind with regard to attachment predicted their understanding of the intervention session concepts. Specifically, autonomous foster mothers showed higher levels of understanding at the start of the intervention program, when compared with non-autonomous foster mothers. State of mind with regard to attachment also predicted foster mothers’ levels of reflective functioning during the intervention sessions. Autonomous foster mothers showed higher levels of reflective functioning at early, middle, and late stages of the intervention program, when compared with non-autonomous foster mothers. We discuss the relevance of these findings for both treatment effectiveness and treatment delivery. PMID:22856617

  19. Radiology of congenital heart disease

    SciTech Connect

    Amplatz, K.

    1986-01-01

    This is a text on the radiologic diagnosis of congenital heart disease and its clinical manifestations. The main thrust of the book is the logical approach which allows an understanding of the complex theory of congenital heart disease. The atlas gives a concise overview of the entire field of congenital heart disease. Emphasis is placed on the understanding of the pathophysiology and its clinical and radiological consequences. Surgical treatment is included since it provides a different viewpoint of the anatomy.

  20. ACR appropriateness criteria radiologic management of infected fluid collections.

    PubMed

    Lorenz, Jonathan M; Al-Refaie, Waddah B; Cash, Brooks D; Gaba, Ron C; Gervais, Debra A; Gipson, Matthew G; Kolbeck, Kenneth J; Kouri, Brian E; Marshalleck, Francis E; Nair, Ajit V; Ray, Charles E; Hohenwalter, Eric J

    2015-08-01

    The best management of infected fluid collections depends on a careful assessment of clinical and anatomic factors as well as an up-to-date review of the published literature, to be able to select from a host of multidisciplinary treatment options. This article reviews conservative, radiologic, endoscopic, and surgical options and their best application to infected fluid collections as determined by the ACR Appropriateness Criteria Expert Panel on Interventional Radiology. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application, by the panel, of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  1. Screening, brief intervention, and referral to treatment for opioid and other substance use during infertility treatment.

    PubMed

    Wright, Tricia E

    2017-08-01

    Opioid use and misuse have reached epidemic proportions in the United States, especially in women of childbearing age, some of whom seek infertility treatments. Substance use is much more common than many of the conditions routinely screened for during the preconception period, and it can have devastating consequences for the woman and her family. Substance use can worsen infertility, complicate pregnancy, increase medical problems, and lead to psychosocial difficulties for the woman and her family. The reproductive endocrinologist thus has an ethical and medical duty to screen for substance use, provide initial counseling, and refer to specialized treatment as needed. This article provides an overview of screening, brief intervention, and referral to treatment (SBIRT), a public health approach shown to be effective in ameliorating the harms of substance use. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Characterization of a cable-free system based on p-type MOSFET detectors for 'in vivo' entrance skin dose measurements in interventional radiology

    SciTech Connect

    Falco, Maria Daniela; D'Andrea, Marco; Strigari, Lidia; D'Alessio, Daniela; Quagliani, Francesco; Santoni, Riccardo; Bosco, Alessia Lo

    2012-08-15

    Purpose: During radiological interventional procedures (RIP) the skin of a patient under examination may undergo a prolonged x-ray exposure, receiving a dose as high as 5 Gy in a single session. This paper describes the use of the OneDose{sup TM} cable-free system based on p-type MOSFET detectors to determine the entrance skin dose (ESD) at selected points during RIP. Methods: At first, some dosimetric characteristics of the detector, such as reproducibility, linearity, and fading, have been investigated using a C-arc as a source of radiation. The reference setting (RS) was: 80 kV energy, 40 cm Multiplication-Sign 40 cm field of view (FOV), current-time product of 50 mAs and source to skin distance (SSD) of 50 cm. A calibrated PMX III solid state detector was used as the reference detector and Gafchromic{sup Registered-Sign} films have been used as an independent dosimetric system to test the entire procedure. A calibration factor for the RS and correction factors as functions of tube voltage and FOV size have been determined. Results: Reproducibility ranged from 4% at low doses (around 10 cGy as measured by the reference detector) to about 1% for high doses (around 2 Gy). The system response was found to be linear with respect to both dose measured with the PMX III and tube voltage. The fading test has shown that the maximum deviation from the optimal reading conditions (3 min after a single irradiation) was 9.1% corresponding to four irradiations in one hour read 3 min after the last exposure. The calibration factor in the RS has shown that the system response at the kV energy range is about four times larger than in the MV energy range. A fifth order and fourth order polynomial functions were found to provide correction factors for tube voltage and FOV size, respectively, in measurement settings different than the RS. ESDs measured with the system after applying the proper correction factors agreed within one standard deviation (SD) with the corresponding ESDs

  3. Conservative and radiological management of simple renal cysts: a comprehensive review.

    PubMed

    Skolarikos, Andreas; Laguna, M Pilar; de la Rosette, Jean J M C H

    2012-07-01

    What's known on the subject? and What does the study add? Simple renal cysts are a common entity, which may need observation and follow-up or treatment. The study, for the first time, systematically reviews the indications for follow-up or radiological treatment of simple renal cysts. To review the conservative and radiological management of simple renal cysts a systematic literature review was performed. Simple renal cysts are commonly found in the adult population. Increasing age is highly associated with its incidence. When they remain asymptomatic they require neither treatment nor follow-up. When the shape of the cyst is slightly irregular follow-up is mandatory to exclude malignant progression. Symptomatic cysts require intervention. Ultrasound or computed tomography guidance have been effectively used for cyst puncture. However, simple fluid aspiration is ineffective leading to cyst recurrence. Aspiration should be accompanied with the injection of a sclerosing agent to destroy renal cyst epithelium. Several issues such as the ultimate technique and agent remain to be clarified. High rates of cyst disappearance and long-lasting cyst volume reduction have been reported with the use of various sclerosants. Ethanol in high concentrations and multiple injections is more commonly used with new agents showing similar efficacy and better complication profile. Studies comparing radiological intervention to surgical excision are lacking. Simple renal cysts may not require treatment when asymptomatic. Radiological intervention with the use of sclerosants needs further evaluation and comparison with other treatment methods. © 2012 BJU INTERNATIONAL.

  4. Behavioral Interventions in the Treatment of Pathological Gambling: A Review of Activity Scheduling and Desensitization

    ERIC Educational Resources Information Center

    Dowling, Nicki; Jackson, Alun C.; Thomas, Shane A.

    2008-01-01

    Cognitive and behavioral interventions have been cautiously recommended as "best practice" in the treatment of pathological gambling. Behavioral interventions, using a range of techniques, have been the most commonly evaluated approach to the psychological treatment of pathological gambling. The recent literature evaluating behavioral treatments…

  5. Impact of Treatment Adherence Intervention on a Social Skills Program Targeting Criticism Behaviours.

    ERIC Educational Resources Information Center

    Piccinin, Serge; And Others

    1992-01-01

    Investigated effect of cognitive-behavioral treatment adherence intervention in course of criticism skill group training program. Assigned 86 participants to treatment condition with or without adherence intervention or to control. Results suggest that adherence activities facilitated arousal optimal to greater program attendance and outcome gains…

  6. Treatment Effects of a Relationship-Strengthening Intervention for Economically Disadvantaged New Parents

    ERIC Educational Resources Information Center

    Charles, Pajarita; Jones, Anne; Guo, Shenyang

    2014-01-01

    Objective: The purpose of the present study was to evaluate the treatment effects of a relationship skills and family strengthening intervention for n = 726 high-risk, disadvantaged new parents. Method: Hierarchical linear modeling and regression models were used to assess intervention treatment effects. These findings were subsequently verified…

  7. Treatment Effects of a Relationship-Strengthening Intervention for Economically Disadvantaged New Parents

    ERIC Educational Resources Information Center

    Charles, Pajarita; Jones, Anne; Guo, Shenyang

    2014-01-01

    Objective: The purpose of the present study was to evaluate the treatment effects of a relationship skills and family strengthening intervention for n = 726 high-risk, disadvantaged new parents. Method: Hierarchical linear modeling and regression models were used to assess intervention treatment effects. These findings were subsequently verified…

  8. Organizational-skills interventions in the treatment of ADHD.

    PubMed

    Langberg, Joshua M; Epstein, Jeffery N; Graham, Amanda J

    2008-10-01

    Children with attention-deficit/hyperactivity disorder (ADHD) often experience problems with temporal and materials organization. These difficulties remain prominent throughout development. For children, organizational problems are most apparent in the school setting and result in impairments such as lost and forgotten homework assignments and inadequate planning for tests. Temporal aspects of organization tend to be most salient for adults with ADHD and manifest as procrastination and missed appointments and deadlines. Skills and strategy training interventions have been developed to address the organizational problems of children and adults with ADHD. Patients are taught systems for managing their time and materials more effectively. Contingency management is often used in conjunction with organizational skills training to promote the use of organizational skills and their generalization. Organizational skills interventions have been evaluated as standalone interventions and part of multicomponent interventions for children, adolescents and adults with ADHD. These interventions are associated with significant improvements in the organization of materials, homework management, time management and planning. There is also some evidence to suggest that organizational improvements lead to reductions in ADHD symptoms and gains in academic functioning. Additional research using randomized controlled research designs and long-term follow-up evaluation is necessary before organizational interventions may be considered established evidence-based interventions for patients with ADHD.

  9. Decommoditizing radiology.

    PubMed

    Reiner, Bruce I; Siegel, Eliot L

    2009-03-01

    The current focus on the economic bottom line in health care creates the potential for radiology to become a commodity, devoid of qualitative differentiation. This trend toward commoditization has been accelerated by the globalization of imaging services (teleradiology), increased information exchange (eg, Digital Imaging and Communications in Medicine, Integrating the Healthcare Enterprise), and new technology development (eg, picture archiving and communication systems, computer-aided diagnosis). The optimum strategy for avoiding commoditization is the creation of objective quality metrics and standards throughout the medical imaging practice, which will provide a reproducible and objective means with which to differentiate imaging service deliverables on the basis of quality and clinical outcomes. These quality measures can in turn be directly tied to economic incentives (pay for performance), providing further incentive for proactive quality assurance, qualitative differentiation, and technology development centered on quality.

  10. Radiological diagnosis of fractures

    SciTech Connect

    Finlay, D.B.L.; Allen, M.J.

    1984-01-01

    This book is about radiology of fractures. While it contains sections of clinical features it is not intended that readers should rely entirely upon these for the diagnosis and management of the injured patient. As in the diagnosis and treatment of all medical problems, fracture management must be carried out in a logical step-by-step fashion - namely, history, examination, investigation, differential diagnosis, diagnosis and then treatment. Each section deals with a specific anatomical area and begins with line drawings of the normal radiographs demonstrating the anatomy. Accessory views that may be requested, and the indications for these, are included. Any radiological pitfalls for the area in general are then described. The fractures in adults are then examined in turn, their radiological features described, and any pitfalls in their diagnosis discussed. A brief note of important clinical findings is included. A brief mention is made of pediatric fractures which are of significance and their differences to the adult pattern indicated. Although fractures can be classified into types with different characteristics, in life every fracture is individual. Fractures by and large follow common patterns, but many have variations.

  11. Interventions for Children and Youth with Autism: Prudent Choices in a World of Exaggerated Claims and Empty Promises. Part I: Intervention and Treatment Option Review.

    ERIC Educational Resources Information Center

    Heflin, L. Juane; Simpson, Richard L.

    1998-01-01

    Discusses intervention and treatment options being used with the population of children and youth who have autism spectrum disorders. The discussion includes interventions based on relationship formation (including holding therapy, gentle teaching, options, and floor time), skill-based treatments, physiologically oriented intervention, and…

  12. [Emphysematous pyelonephritis: radiologic diagnosis].

    PubMed

    Kably, M I; Elamraoui, F; Chikhaoui, N

    2003-10-01

    Emphysematous pyelonephritis (EPN) is a rare and severe form of acute pyelonephritis. Escherichia coli accounts for 60% of the cases. Predisposing factors are: diabetus mellitus, recent urinary tract infection and obstruction. There is a female predominance (2/1). Conventional radiography reveals the renal emphysema in 85% of the cases. Ultrasonography shows hyperechoic areas corresponding to the gaz. CT scan is the best technique, allowing the exact localization of the gaz inside the renal parenchyma. The natural course of the disease allows its radiologic classification in 4 grades. EPN has a poor prognosis if only a medical treatment is initiated. Every urinary tract infection, in a diabetic patient must be treated, and must lead to a radiologic exploration, which allows an early detection of severe forms of the disease.

  13. Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention.

    PubMed

    Weidt, Steffi; Bruehl, Annette Beatrix; Delsignore, Aba; Zai, Gwyneth; Kuenburg, Alexa; Klaghofer, Richard; Rufer, Michael

    2017-01-01

    Many patients suffering from trichotillomania (TTM) have never undergone treatment. Without treatment, TTM often presents with a chronic course. Characteristics of TTM individuals who have never been treated (untreated) remain largely unknown. Whether treatment history impacts Internet-based interventions has not yet been investigated. We aimed to answer whether Internet-based interventions can reach untreated individuals and whether treatment history is associated with certain characteristics and impacts on the outcome of an Internet-based intervention. We provided Internet-based interventions. Subjects were characterized at three time points using the Massachusetts General Hospital Hairpulling Scale, Hamilton Depression Rating Scale, and the World Health Organization Quality of Life questionnaire. Of 105 individuals, 34 were untreated. Health-related quality of life (HRQoL) was markedly impaired in untreated and treated individuals. Symptom severity did not differ between untreated and treated individuals. Nontreatment was associated with fewer depressive symptoms (P=0.002). Treatment history demonstrated no impact on the outcome of Internet-based interventions. Results demonstrate that Internet-based interventions can reach untreated TTM individuals. They show that untreated individuals benefit as much as treated individuals from such interventions. Future Internet-based interventions should focus on how to best reach/support untreated individuals with TTM. Additionally, future studies may examine whether Internet-based interventions can reach and help untreated individuals suffering from other psychiatric disorders.

  14. Fluid Retention Associated with Imatinib Treatment in Patients with Gastrointestinal Stromal Tumor: Quantitative Radiologic Assessment and Implications for Management

    PubMed Central

    Shinagare, Atul B.; Krajewski, Katherine M.; Pyo, Junhee; Tirumani, Sree Harsha; Jagannathan, Jyothi P.; Ramaiya, Nikhil H.

    2015-01-01

    Objective We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management. Materials and Methods In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores. Results The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction. Conclusion Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management. PMID:25741192

  15. Combined radiologic and endoscopic treatment (using the “rendezvous technique”) of a biliary fistula following left hepatectomy

    PubMed Central

    Gracient, Aurélien; Rebibo, Lionel; Delcenserie, Richard; Yzet, Thierry; Regimbeau, Jean-Marc

    2016-01-01

    Despite the ongoing decrease in the frequency of complications after hepatectomy, biliary fistulas still occur and are associated with high morbidity and mortality rates. Here, we report on an unusual technique for managing biliary fistula following left hepatectomy in a patient in whom the right posterior segmental duct joined the left hepatic duct. The biliary fistula was treated with a combined radiologic and endoscopic procedure based on the “rendezvous technique”. The clinical outcome was good, and reoperation was not required. PMID:27570431

  16. mHealth interventions for weight loss: a guide for achieving treatment fidelity

    PubMed Central

    Shaw, Ryan J; Steinberg, Dori M; Zullig, Leah L; Bosworth, Hayden B; Johnson, Constance M; Davis, Linda L

    2014-01-01

    mHealth interventions have shown promise for helping people sustain healthy behaviors such as weight loss. However, few have assessed treatment fidelity, that is, the accurate delivery, receipt, and enactment of the intervention. Treatment fidelity is critical because the valid interpretation and translation of intervention studies depend on treatment fidelity assessments. We describe strategies used to assess treatment fidelity in mobile health (mHealth) interventions aimed at sustaining healthy behaviors in weight loss. We reviewed treatment fidelity recommendations for mHealth-based behavioral interventions and described how these recommendations were applied in three recent weight loss studies. We illustrate how treatment fidelity can be supported during study design, training of providers, treatment delivery, receipt of treatment, and enactment of treatment skills. Pre-planned strategies to ensure the treatment fidelity of mHealth interventions will help counter doubts concerning valid conclusions about their effectiveness and allow investigators and clinicians to implement robustly efficacious mobile health programs. Trial registration number 1F31 NR012599. PMID:24853065

  17. Evaluating Treatment Participation in an Internet-Based Behavioral Intervention for Pediatric Chronic Pain

    PubMed Central

    Murphy, Lexa K.; Palermo, Tonya M.

    2012-01-01

    Objective Little is known about how participation in internet-based behavioral interventions influences outcomes in youth with health conditions. This study describes participation in an online behavioral pain management intervention for families of adolescents with chronic pain. Methods 26 adolescent–parent dyads were randomized to the intervention arm of a controlled trial evaluating a cognitive–behavioral pain intervention. Participation was measured by the number of logins, messages, completion of interactive fields, and behavioral assignments. Associations between content of messages from participants and treatment outcomes were evaluated. Results Most participants (92.3%) logged in and completed assignments. Over half of participants initiated messages to the online coach. A greater number of messages sent by adolescents containing rapport or treatment content predicted positive treatment outcomes. Conclusions Most families actively participated in the intervention. Interaction with an online coach may increase the benefit of this Internet behavioral pain management treatment program for adolescents. PMID:22511033

  18. Alternatives for the treatment of salivary duct obstruction.

    PubMed

    McGurk, Mark; Brown, Jackie

    2009-12-01

    Minimally invasive alternatives for treatment of salivary duct obstruction are discussed. Radiologically- and endoscopically-guided interventions using wire baskets and dilating balloons, including cutting balloons, are covered as are combined endoscopic and open approaches.

  19. Effect of Depression on Risky Drinking and Response to a Screening, Brief Intervention, and Referral to Treatment Intervention.

    PubMed

    Montag, Annika C; Brodine, Stephanie K; Alcaraz, John E; Clapp, John D; Allison, Matthew A; Calac, Dan J; Hull, Andrew D; Gorman, Jessica R; Jones, Kenneth Lyons; Chambers, Christina D

    2015-08-01

    We assessed alcohol consumption and depression in 234 American Indian/Alaska Native women (aged 18-45 years) in Southern California. Women were randomized to intervention or assessment alone and followed for 6 months (2011-2013). Depression was associated with risk factors for alcohol-exposed pregnancy (AEP). Both treatment groups reduced drinking (P < .001). Depressed, but not nondepressed, women reduced drinking in response to SBIRT above the reduction in response to assessment alone. Screening for depression may assist in allocating women to specific AEP prevention interventions.

  20. The Survival Benefit of a Novel Trauma Workflow that Includes Immediate Whole-body Computed Tomography, Surgery, and Interventional Radiology, All in One Trauma Resuscitation Room: A Retrospective Historical Control Study.

    PubMed

    Kinoshita, Takahiro; Yamakawa, Kazuma; Matsuda, Hiroki; Yoshikawa, Yoshiaki; Wada, Daiki; Hamasaki, Toshimitsu; Ono, Kota; Nakamori, Yasushi; Fujimi, Satoshi

    2017-09-26

    The aim of this study was to evaluate the impact of a novel trauma workflow, using an interventional radiology (IVR)-computed tomography (CT) system in severe trauma. In August 2011, we installed an IVR-CT system in our trauma resuscitation room. We named it the Hybrid emergency room (ER), as it enabled us to perform all examinations and treatments required for trauma in a single place. This retrospective historical control study conducted in Japan included consecutive severe (injury severity score ≥16) blunt trauma patients. Patients were divided into 2 groups: Conventional (from August 2007 to July 2011) or Hybrid ER (from August 2011 to July 2015). We set the primary endpoint as 28-day mortality. The secondary endpoints included cause of death and time course from arrival to start of CT and surgery. Multivariable logistic regression analysis adjusted for clinically important variables was performed to evaluate the clinical outcomes. We included 696 patients: 360 in the Conventional group and 336 in the Hybrid ER group. The Hybrid ER group was significantly associated with decreased mortality [adjusted odds ratio (OR), 0.50 (95% confidence interval, 95% CI, 0.29-0.85); P = 0.011] and reduced deaths from exsanguination [0.17 (0.06-0.47); P = 0.001]. The time to CT initiation [Conventional 26 (21 to 32) minutes vs Hybrid ER 11 (8 to 16) minutes; P < 0.0001] and emergency procedure [68 (51 to 85) minutes vs 47 (37 to 57) minutes; P < 0.0001] were both shorter in the Hybrid ER group. This novel trauma workflow, comprising immediate CT diagnosis and rapid bleeding control without patient transfer, as realized in the Hybrid ER, may improve mortality in severe trauma.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without

  1. Cognitive Counselling Intervention: Treatment Effectiveness in an Italian University Centre

    ERIC Educational Resources Information Center

    Strepparava, Maria Grazia; Bani, Marco; Zorzi, Federico; Corrias, Deborah; Dolce, Rossella; Rezzonico, Giorgio

    2016-01-01

    Offering counselling to students is increasingly considered as a key academic service. However, the reduction of resources allocated to Italian universities emphasises the need to assess the quality of interventions. This paper presents data reporting the effectiveness of a university counselling service. A sample of 45 undergraduate students…

  2. Cognitive Counselling Intervention: Treatment Effectiveness in an Italian University Centre

    ERIC Educational Resources Information Center

    Strepparava, Maria Grazia; Bani, Marco; Zorzi, Federico; Corrias, Deborah; Dolce, Rossella; Rezzonico, Giorgio

    2016-01-01

    Offering counselling to students is increasingly considered as a key academic service. However, the reduction of resources allocated to Italian universities emphasises the need to assess the quality of interventions. This paper presents data reporting the effectiveness of a university counselling service. A sample of 45 undergraduate students…

  3. Musical "Tune-Ups" for Couples: Brief Treatment Interventions

    ERIC Educational Resources Information Center

    Duba, Jill D.; Roseman, Christopher

    2012-01-01

    Some couples seek counseling to address warning signs. They may not be facing a relationship crisis but may be more concerned about where they are headed. Hence, a marriage makeover may not necessarily be needed, but instead couples in counseling may benefit from something rejuvenating. In such cases, brief interventions or techniques may be…

  4. Overcoming Barriers to HIV Treatment Adherence: A Brief Cognitive Behavioral Intervention for HIV-Positive Adults on Antiretroviral Treatment

    PubMed Central

    Olem, David; Sharp, Kelly M.; Taylor, Jonelle M.; Johnson, Mallory O.

    2014-01-01

    Maximizing HIV treatment adherence is critical in efforts to optimize health outcomes and to prevent further HIV transmission. The Balance Project intervention uses cognitive behavioral approaches to improve antiretroviral medication adherence through promoting adaptive coping with medication side effect and distress related to HIV. This 5-session intervention has been documented to prevent nonadherence among persons living with HIV who experience high levels of distress associated with their antiretroviral medication side effects. We describe the theoretical underpinnings of the intervention, provide details of the training and session protocols with a case example, and discuss implications for future applications of the intervention in both research and clinical settings. PMID:24855332

  5. Systematic Review of Interventions Supported by ICT for the Prevention Treatment of Occupational Stress.

    PubMed

    Narváez, Santiago; Tobar, Angela M; López, Diego M

    2014-01-01

    Stress-related disorders have become one of the main problems of public health in many countries and of worldwide organizations, and they are expected to become more common in the forthcoming decades. This article aims at providing a systematic review and a descriptive evaluation of the interventions supported by ICT for the prevention and treatment of occupational stress. A systematic review of five databases (EBSCO, The Cochrane Library, PubMed, ScienceDirect and IEEEXplorer) was carried out. This article provides a quantitative and qualitative description of 21 studies about occupational stress interventions supported by ICT. The following factors were considered for the analysis: impact of the intervention, design of the study, type of intervention, purpose of the intervention, type of instrument for the measurement of occupational stress, and type of ICT used. The systematic review demonstrated that interventions supported by ICT for the prevention and treatment of occupational stress are scarce but effective.

  6. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review.

    PubMed

    Agerwala, Suneel M; McCance-Katz, Elinore F

    2012-01-01

    Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT.

  7. Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review

    PubMed Central

    Agerwala, Suneel M.; McCance-Katz, Elinore F.

    2013-01-01

    Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT. PMID:23210379

  8. Consumer perceptions of trauma assessment and intervention in substance abuse treatment.

    PubMed

    Sanford, Ashley; Donahue, Megan; Cosden, Merith

    2014-09-01

    Substance abuse treatment programs are increasing their use of integrated interventions for trauma and substance abuse. While positive behavioral outcomes have been associated with this model, the purpose of this study was to determine consumers' satisfaction with it. Participants were 51 men and 102 women who received trauma assessments and interventions through a drug treatment court. Satisfaction with treatment was measured through the Consumer Perception of Care (CPC). Participants were generally satisfied with the trauma assessments and interventions they received. Number of traumatic experiences, measured by the Adverse Childhood Experiences (ACE) scale, and level of distress, as assessed on the Trauma Symptom Inventory (TSI), were significantly associated with assessment and treatment satisfaction. Gender differences were noted, with men reporting fewer traumatic experiences and trauma-symptoms and less satisfaction with trauma assessment. Implications for the integration of trauma and substance abuse interventions in drug treatment courts and other programs are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Radiological Control Manual

    SciTech Connect

    Not Available

    1993-04-01

    This manual has been prepared by Lawrence Berkeley Laboratory to provide guidance for site-specific additions, supplements, and clarifications to the DOE Radiological Control Manual. The guidance provided in this manual is based on the requirements given in Title 10 Code of Federal Regulations Part 835, Radiation Protection for Occupational Workers, DOE Order 5480.11, Radiation Protection for Occupational Workers, and the DOE Radiological Control Manual. The topics covered are (1) excellence in radiological control, (2) radiological standards, (3) conduct of radiological work, (4) radioactive materials, (5) radiological health support operations, (6) training and qualification, and (7) radiological records.

  10. Treatment Compliance in Group Therapy: Issues and Interventions

    ERIC Educational Resources Information Center

    Hunnicutt Hollenbaugh, Karen Michelle

    2011-01-01

    In this manuscript, research on treatment compliance and dropout in group therapy is reviewed. A number of variables found to be related to the compliance and dropout are identified including client characteristics, treatment characteristics, and therapist perceptions and behavior. Implications of these results for increasing treatment compliance…

  11. Greening radiology.

    PubMed

    Prasanna, Prasanth M; Siegel, Eliot; Kunce, Amy

    2011-11-01

    Reducing energy consumption has increased in importance with rising energy prices and funding cutbacks. With the introduction of electronic medical records on the rise in all fields of medicine, there will be a large jump in the number of computers in health care. Radiologist have the unique opportunity, as technological leaders, to direct energy efficiency measures as a means of cost savings and the reduction of airborne by-products from energy production to improve patients' lives. The aim of this study was to assess the many workstations and monitors throughout the authors' department to determine their electrical consumption and cost. Equipment was monitored using an electricity meter during both active and standby states. Cost per kilowatt-hour was calculated at $0.11, not including taxes and fees. Any given monitor left on 24/7 would annually consume between 49.5 and 1,399.84 kWh, costing from $5.45 to $153.98. A single workstation left on 24/7 would use 455.65 to 2,358.72 kWh, costing from $59.91 to $259.46. In aggregate, all workstations and monitors would use approximately 137,759.54 kWh, costing $15,153.55. If all equipment were shut down after an 8-hour workday, the department would consume about 32,633.64 kWh, costing $3,589.70 thereby saving 83,866.6 kWh and $9,225.33. Although computers in the remainder of the hospital may use less energy than workstations, this serves as a predictive model for potential energy consumption and cost. With the increasing necessity of cost savings and energy reduction, this small and simple step, implemented hospital-wide, will lead to much larger cost savings across institutions. Copyright © 2011 American College of Radiology. All rights reserved.

  12. Increasing the treatment of hypertension through primary intervention

    SciTech Connect

    Fair, M.D.

    1994-12-31

    South Carolina is one of the leading states in stroke mortality. Hypertension is one of the major risk factors that lead to strokes. Unfortunately, many people who are hypertensive do not treat their disease properly due to lack of medical education. The specific objectives of this project are to access geographic areas to determine the level of medical representation available; to identify areas of medical needs based on race, income and health status; and, to structure an intervention plan to target areas that are in the highest hypertension at-risk category. The methods used are to identify medical coverage by geographic areas. Health in poor areas is identified and mapped. Implementation of intervention strategies is prioritized based on areas of need.

  13. The treatment of perinatal addiction. Identification, intervention, and advocacy.

    PubMed Central

    Jessup, M

    1990-01-01

    Women of reproductive age who use and abuse psychoactive drugs and alcohol present a special challenge to primary care physicians. There are compelling medical reasons for identifying and intervening with pregnant women who are addicted or have alcoholism. The teratogenicity of all drugs of abuse and alcohol, the risk of infection with the acquired immunodeficiency syndrome (AIDS), and the potential for full recovery of a pregnant woman from addiction are some of the reasons that identification and intervention in the problem are indicated. Whether encountered in the clinic setting or in private practice, chemically dependent pregnant or postpartum women are usually responsive to appropriate physician interventions that include a detailed and caring confrontation- and advocacy-oriented support. Complex legal and ethical issues surround perinatal addiction including the role of toxicologic screening, reports to child welfare services, issues in noncompliance, and interdisciplinary case management. PMID:2349799

  14. Early Intervention and Treatment Acceptability: Multiple Perspectives for Improving Service Delivery in Home Settings.

    ERIC Educational Resources Information Center

    Paget, Kathleen D.

    1991-01-01

    This article examines issues related to treatment acceptability in early intervention programs, by applying concepts pertaining to collaboration, cultural difference, compliance and freedom of choice, family life cycles, and systems theory. A paradigm for designing home-based intervention plans with families of preschoolers with behavior disorders…

  15. Psychotherapeutic Orientations: A Comparison of Conceptualizations, Interventions, and Treatment Plan Costs.

    ERIC Educational Resources Information Center

    Kopta, Stephen Mark; And Others

    1986-01-01

    Delineated patterns of conceptualization and intervention of four psychotherapeutic orientations (psychodynamic, cognitive-behavioral, family systems, eclectic) and then determined how these patterns related to treatment plan costs. Conceptualization and intervention categories given more focus by the psychodynamic group correlated positively with…

  16. Treatment Integrity of Interventions with Children in the School Psychology Literature from 1995 to 2008

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Gritter, Katie L.; Dobey, Lisa M.

    2011-01-01

    Increased accountability in education has resulted in a focus on implementing interventions with strong empirical support. Both student outcome and treatment integrity data are needed to draw valid conclusions about intervention effectiveness. Reviews of the literature in other fields (e.g., applied behavior analysis, prevention science) suggest…

  17. Effects of Professional Group Membership, Intervention Type, and Diagnostic Label on Treatment Acceptability.

    ERIC Educational Resources Information Center

    Fairbanks, Larry D.; Stinnett, Terry A.

    1997-01-01

    Investigates professionals' ratings of treatment acceptability for two interventions. Teachers, school psychologists, and school social workers (N=97) viewed a vignette of a student exhibiting disruptive behavior and then rated the intervention's acceptability. Results show that professional group membership produced a significant interaction…

  18. Treatment Integrity of Interventions with Children in the School Psychology Literature from 1995 to 2008

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Gritter, Katie L.; Dobey, Lisa M.

    2011-01-01

    Increased accountability in education has resulted in a focus on implementing interventions with strong empirical support. Both student outcome and treatment integrity data are needed to draw valid conclusions about intervention effectiveness. Reviews of the literature in other fields (e.g., applied behavior analysis, prevention science) suggest…

  19. A Cognitive Therapy Intervention for Suicide Attempters: An Overview of the Treatment and Case Examples

    ERIC Educational Resources Information Center

    Berk, Michele S.; Henriques, Gregg R.; Warman, Debbie M.; Brown, Gregory K.; Beck, Aaron T.

    2004-01-01

    Although suicidal behavior is a serious public health problem, few effective treatments exist to treat this population. This article describes a new cognitive therapy intervention that has been developed for treating recent suicide attempters. The intervention is based on general principles of cognitive therapy and targets the automatic thoughts…

  20. A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery

    ERIC Educational Resources Information Center

    Prochaska, Judith J.; Delucchi, Kevin; Hall, Sharon M.

    2004-01-01

    This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (? 6 months) were summarized with random effects models. Intervention effects for smoking…

  1. A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery

    ERIC Educational Resources Information Center

    Prochaska, Judith J.; Delucchi, Kevin; Hall, Sharon M.

    2004-01-01

    This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (? 6 months) were summarized with random effects models. Intervention effects for smoking…

  2. Pancreatoduodenectomy: imaging and image-guided interventional treatment.

    PubMed

    Singh, Ajay K; Gervais, Debra; Mueller, Peter

    2004-06-01

    Though the mortality of pancreatoduodenectomy (Whipple surgery) is under 4%, the morbidity continues to be high. The interventional radiologist plays an important role in the management of postoperative complications, such as abdominal abscess, bilomas, liver abscess, biliary obstruction, pseudocyst, and hemorrhage. Identification of the normal postoperative anatomy is crucial to correctly interpreting CT scans for short-term complications and long-term tumor recurrence.

  3. Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial.

    PubMed

    Rouchy, R C; Moreau-Gaudry, A; Chipon, E; Aubry, S; Pazart, L; Lapuyade, B; Durand, M; Hajjam, M; Pottier, S; Renard, B; Logier, R; Orry, X; Cherifi, A; Quehen, E; Kervio, G; Favelle, O; Patat, F; De Kerviler, E; Hughes, C; Medici, M; Ghelfi, J; Mounier, A; Bricault, I

    2017-07-06

    Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator's instruments, meaning the position and progression of the instruments are visualised in real time on the patient's images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and

  4. [Effect of early surgical interventions on results of burn treatment].

    PubMed

    Fistal', N M

    2009-01-01

    Results of treatment of 160 adults which were treated in the department of thermal defeats and plastic surgery of IURS named by V. K. Gusak AMS of Ukraine in 2005-2007 were analysed. 110 men in age 34.82 +/- 1.22 entered a basic group. All patients of this group were operated in early terms 1-2 days after a trauma. The group of comparison is made from 50 men in the same age with identical on an area and depth defeats. The patients of this group had prolongation of the specialized treatment, therefore primary surgical treatment began later. At the analysis of treatment results we found out that early surgical treatment of the burned adult brought to the decline burn disease, reduce the terms of treatment and amount of operative interferences, prevents formation of rough scars and deformations.

  5. Quality of Life, Psychological Interventions and Treatment Outcome in Tuberculosis Patients: The Indian Scenario

    PubMed Central

    Peddireddy, Vidyullatha

    2016-01-01

    Objective: Psychological distress is being recognized in individuals affected with many diseases since it affects quality of life (QOF) and has gained importance in the clinical settings. Psychological interventions and their effect on the treatment outcome have yielded encouraging results in many diseased conditions. Tuberculosis (TB) ranks as a deadly disease resulting in millions of deaths worldwide. However, the effect of TB on the psychological status of patients and interventions to improve treatment outcome is neglected, especially in underdeveloped and developing countries. Methods: Systematic review of research papers that published on the QOF in TB and the effect of psychological interventions on treatment outcome were conducted. Results: Tuberculosis patients experience high levels of stress and decreased QOF. In the Indian scenario, TB patients undergo immense psychological stress similar to what is reported in other locations. Psychological interventions renewed hope on life and adherence to medication and treatment outcomes. Such psychological interventions are not practiced in Indian clinical settings. Conclusion: There is an urgent need for both governmental and non-governmental organizations to devise strategies to include psychological interventions mandatory during TB treatments. In the absence of such interventions, the fight against TB in India will remain incomplete. PMID:27833578

  6. A systematic review of nonpharmacologic interventions for treatment-related symptoms in women with ovarian cancer.

    PubMed

    Davis, Lorie L; Carpenter, Janet S

    2015-10-01

    Women with ovarian cancer have a continued high symptom burden in comparison to other cancer survivors secondary to ongoing chemotherapy treatment. Prolonged or ineffective management of treatment-related symptoms can contribute to treatment noncompliance, worsening of symptoms, and reduced health-related quality of life. This review of the literature was conducted to describe experimental and quasi-experimental research addressing nonpharmacologic interventions for the treatment-related symptoms of sleep disturbance, pain, anxiety, depression, and low energy or fatigue in women with ovarian cancer and to critique the quality of interventions. A systematic search of the literature was conducted in PubMed and yielded 136 articles. Eight articles met the inclusion criteria and were evaluated. Nonpharmacologic interventions for treatment-related symptoms were complex, with an average of 4.4 components. Intervention delivery, setting, and exposure varied widely across studies. Only three studies contained details sufficient to replicate the intervention. Lack of clarity in intervention reporting may explain perceptions of clinically inefficacious symptom management in this context. Greater attention to reporting would facilitate better translation of interventions into practice and when addressing complex cancer symptom clusters.

  7. Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study

    PubMed Central

    Akdemir, Gülşah; Verheul, Marije K; Heimans, Lotte; Wevers-de Boer, Kirsten V C; Goekoop-Ruiterman, Yvonne P M; van Oosterhout, Maikel; Harbers, Joop B; Bijkerk, Casper; Steup-Beekman, Gerda M; Lard, Leroy R; Huizinga, Tom W J; Trouw, Leendert A; Allaart, Cornelia F

    2016-01-01

    Objectives To identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment. Methods In the IMPROVED study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (disease activity score (DAS) <1.6 after 4 months) tapered prednisone to zero. Patients not in early remission were randomised to arm 1: MTX plus hydroxychloroquine, sulfasalazine and prednisone, or to arm 2: MTX plus adalimumab. Predictors of radiological progression (≥0.5 Sharp/van der Heijde score; SHS) after 2 years were assessed using logistic regression analysis. Results Median (IQR) SHS progression in 488 patients was 0 (0–0) point, without differences between RA or UA patients or between treatment arms. In only 50/488 patients, the SHS progression was ≥0.5: 33 (66%) were in the early DAS remission group, 9 (18%) in arm 1, 5 (10%) in arm 2, 3 (6%) in the outside of protocol group. Age (OR (95% CI): 1.03 (1.00 to 1.06)) and the combined presence of anticarbamylated protein antibodies (anti-CarP) and anticitrullinated protein antibodies (ACPA) (2.54 (1.16 to 5.58)) were independent predictors for SHS progression. Symptom duration <12 weeks showed a trend. Conclusions After 2 years of remission steered treatment in early arthritis patients, there was limited SHS progression in only a small group of patients. Numerically, patients who had achieved early DAS remission had more SHS progression than other patients. Positivity for both anti-CarP and ACPA and age were independently associated with SHS progression. Trial registration numbers ISRCTN Register number 11916566 and EudraCT number 2006 06186-16. PMID:26925251

  8. Educational interventions for knowledge on the disease, treatment adherence and control of diabetes mellitus.

    PubMed

    Figueira, Ana Laura Galhardo; Boas, Lilian Cristiane Gomes Villas; Coelho, Anna Claudia Martins; Freitas, Maria Cristina Foss de; Pace, Ana Emilia

    2017-04-20

    to assess the effect of educational interventions for knowledge on the disease, medication treatment adherence and glycemic control of diabetes mellitus patients. evaluation research with "before and after" design, developed in a sample of 82 type 2 diabetes mellitus patients. To collect the data, the Brazilian version of the Diabetes Knowledge Scale (DKN-A), the Measure of Adherence to Treatments and the electronic system at the place of study were used. The data were collected before and after the end of the educational interventions. The educational activities were developed within 12 months, mediated by the Diabetes Conversation Maps, using the Cognitive Social Theory to conduct the interventions. the knowledge on the disease (p<0.001), the medication treatment (oral antidiabetics) (p=0.0318) and the glycated hemoglobin rates (p=0.0321) improved significantly. the educational interventions seem to have positively contributed to the participants' knowledge about diabetes mellitus, the medication treatment adherence and the glycated hemoglobin rates.

  9. Developing and implementing a positive behavioral reinforcement intervention in prison-based drug treatment: Project BRITE.

    PubMed

    Burdon, William M; St De Lore, Jef; Prendergast, Michael L

    2011-09-01

    Within prison settings, the reliance on punishment for controlling inappropriate or noncompliant behavior is self-evident. What is not so evident is the similarity between this reliance on punishment and the use of positive reinforcements to increase desired behaviors. However, seldom do inmates receive positive reinforcement for engaging in prosocial behaviors or, for inmates receiving drug treatment, behaviors that are consistent with or support their recovery. This study provides an overview of the development and implementation of a positive behavioral reinforcement intervention in male and female prison-based drug treatment programs. The active involvement of institutional staff, treatment staff, and inmates enrolled in the treatment programs in the development of the intervention along with the successful branding of the intervention were effective at promoting support and participation. However, these factors may also have ultimately impacted the ability of the randomized design to reliably demonstrate the effectiveness of the intervention.

  10. Seeking to reduce nonbeneficial treatment in the ICU: an exploratory trial of proactive ethics intervention*.

    PubMed

    Andereck, William S; McGaughey, J Westly; Schneiderman, Lawrence J; Jonsen, Albert R

    2014-04-01

    To investigate whether the proactive intervention of a clinical ethicist in cases of prolonged lengths of stay in a critical care setting reduces nonbeneficial treatment while increasing perceived patient/surrogate and provider satisfaction and reducing associated costs. Nonbeneficial treatment is defined here as the use of life-sustaining treatments delivered to patients who had been in the ICU for 5 days and did not survive to discharge. Prospective randomized exploratory trial from October 2007 to February 2010 in the adult ICU of a large, urban, not-for-profit community hospital. Medical/surgical ICU of California Pacific Medical Center, a large tertiary not-for-profit hospital in San Francisco, CA. Three hundred eighty-four patients with ICU lengths of stay of five days or greater. Patients were randomized to either an intervention arm (Proactive Ethics Intervention) (n = 174) or control arm (n = 210). There were 56 patients in the intervention arm and 52 patients in the control arm who did not survive to discharge. Proactive ethics intervention involves a trained bioethicist in the care of all ICU patients with a length of stay greater than or equal to 5 days. The intervention used a nine step process model designed to look for manifest or latent ethics conflicts and address them. The primary outcome measures were days in the ICU; overall length of hospital stay; mortality; nonbeneficial treatments, for example, provision of nutritional support; surrogate and survivor satisfaction, and cost. The intervention and control arms showed no significant difference in mortality. Proactive Ethics Intervention, at the 95% CI, was not associated with reductions of overall length of stay (23 d for intervention and 21 d for control, p = 0.74), ICU days (11 in each arm, p = 0.91), life-sustaining treatments (days on ventilator: intervention, 14.6; control, 13.7; p = 0.74; days receiving artificial nutrition and hydration: intervention, 16.5; control, 15.9; p = 0.85), or

  11. Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome

    PubMed Central

    Flik, Carla E; Bakker, Laura; Laan, Wijnand; van Rood, Yanda R; Smout, André J P M; de Wit, Niek J

    2017-01-01

    AIM To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome. METHODS Randomized controlled trials comparing psychological interventions (stress management/relaxation therapy (cognitive) behavioral therapy, short-term psychodynamic therapy, and hypnotherapy) for the treatment of adult patients with irritable bowel syndrome (IBS) diagnosed with the Manning or Rome criteria with an adequate placebo control treatment and reporting data on IBS symptom severity were identified by searching PubMed, Embase, the Cochrane Library, CINAHL and PsycINFO databases. Full-text articles that were written in English and published between 1966 and February 2016 in peer-reviewed journals were selected for the present review. Placebo interventions were considered to be adequate if the number of sessions and the amount of time spent with the therapist were the same as in the active treatment. The placebo response rate (PRR) was computed for IBS symptom severity (primary outcome measure) as well as for anxiety, depression and quality of life (secondary outcome measures). RESULTS Six studies, with a total of 555 patients met the inclusion criteria. Four studies used an educational intervention, whereas two studies used a form of supportive therapy as the placebo intervention. The PRR for IBS symptom severity ranged from 25% to 59%, with a pooled mean of 41.4%. The relative PRR for the secondary outcome measures ranged from 0% to 267% for anxiety, 6% to 52% for depression 20% to 125% for quality of life. The PRR associated with pharmacological treatments, treatment with dietary bran and complementary medicine ranged from 37.5% to 47%. Contrary to our expectations, the PRR in studies on psychological interventions was comparable to that in studies on pharmacological, dietary and alternative medical interventions. CONCLUSION The PRR is probably determined to a larger extent by

  12. A review of electronic interventions for prevention and treatment of overweight and obesity in young people.

    PubMed

    Nguyen, B; Kornman, K P; Baur, L A

    2011-05-01

    The objective of this systematic review is to provide a qualitative comparison of interactive electronic media interventions for the prevention or treatment of obesity and/or obesity-related behaviours in children and adolescents. Literature searches of 12 databases from the earliest publication date until March 2010 were conducted. Twenty-four studies in which children and/or adolescents interacted with electronic interventions delivered as adjunct or sole interventions for the prevention or treatment of obesity and/or obesity-related behaviours met the inclusion criteria. Fifteen focussed on obesity prevention and nine on treatment interventions. The average study quality design score was 45%. Most studies demonstrated some form of significant outcome (e.g. reported changes in dietary and/or physical activity behaviours) in participants receiving interactive electronic interventions, with 11 out of 15 studies leading to positive changes in measured or reported adiposity outcomes. In 87% of studies, the effects of interactive electronic interventions were not separately evaluated from other intervention components. These results should be viewed with caution because of the overall poor quality of the studies. Studies were mostly conducted in the USA, largely in minority populations, and the direct transferability of interventions to other populations is unclear. Further high quality research is needed in this area to accurately inform the evidence base. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

  13. American diagnostic radiology residency and fellowship programmes.

    PubMed

    Rumack, Carol Masters

    2011-03-01

    American Diagnostic Radiology Residency and Fellowship programmes are Graduate Medical Education programmes in the United States (US) equivalent to the Postgraduate Medical Education programmes in Singapore. Accreditation Council for Graduate Medical Education (ACGME) accredited diagnostic radiology residency programmes require 5 years total with Post Graduate Year (PGY) 1 year internship in a clinical specialty, e.g. Internal Medicine following medical school. PGY Years 2 to 5 are the core years which must include Radiology Physics, Radiation Biology and rotations in 9 required subspecialty rotations: Abdominal, Breast, Cardiothoracic, Musculoskeletal, Neuroradiology, Nuclear and Paediatric Radiology, Obstetric & Vascular Ultrasound and Vascular