Interventional Radiology Procedures Research Articles

CLINTERVENTIONAL protocol: a randomized controlled trial to evaluate clinical consultations and audiovisual tools for interventional radiology

Interventional radiology (IR) has evolved rapidly, but the clinical integration of interventional radiologists has not kept pace with technical advancements. This trial will address a gap in the literature by providing a robust investigation into specific measures for enhancing the clinical role of interventional radiologists, with potential implications for improving patient experiences and outcomes. The single-center randomized controlled trial will include 428 patients undergoing IR procedures. The control group will receive information about the procedure from the ordering physician, while the experimental group will have an additional consultation with an interventional radiologist and be shown procedure-specific explanatory videos. The primary outcomes are patients’ knowledge, satisfaction with the information and communication, and anxiety. Data collection will involve specific questionnaires and scales. This trial is designed to investigate the importance of proactive clinical roles in patient care within IR. The study explores the potential of consultations and audiovisual tools, highlighting their role in educating patients about procedures. The results may help foster a more widespread acceptance of clinical responsibilities in IR and underscore the pivotal role of audiovisual aids in patient education and satisfaction.Trial registrationNCT05461482 at clinicaltrials.gov.Relevance statementThis randomized controlled trial will assess the impact of clinical consultations and explanatory audiovisual tools on patient understanding, satisfaction, and anxiety in interventional radiology. The findings could help establish a more proactive clinical role for interventional radiologists and improve the overall quality of patient-centered care.Key PointsWe describe the protocol of an interventional radiology randomized clinical trial.The control group will receive procedure information from the referring physician and the experimental group receives additional consultation with interventionalists and views a video.Knowledge, satisfaction with information, and patient anxiety will be evaluated.This study will provide insights about the benefits of consultations and videos in interventional radiology.Graphical

Short-term Postoperative Complications of Lymphatic Malformation Surgical Excision: A 20-Year Institutional Review.

To evaluate outcomes and postoperative complications following surgical resection of lymphatic malformations (LMs) at a single multidisciplinary vascular anomalies center. A single-center retrospective review of all patients ≤21 years old who underwent surgical resection of a lymphatic malformation at a quaternary referral center with a multidisciplinary vascular anomalies team from 2004 to 2024. Data pertaining to postoperative outcomes and treatments was abstracted. A total of 109 surgical procedures were included and examined. The most common 30-day postoperative complications included: seroma (18.3%), superficial surgical site infection (18.3%), and wound dehiscence (12.8%), with lower rates of nerve palsy/injury (5.5%), lymphedema (2.8%), hematomas (3.7%), and abscesses (4.6%). An interventional radiology procedure within 30-days postoperatively was required for management of seroma in 8 patients (7.3%), while 7 (6.4%) patients required reoperation. Among patients who underwent attempted complete resection, recurrence of the LM was documented in 32.0% (16/50). Subjective quality of life improvement was noted in 69.7%. There was no difference in incidence of postoperative complications reported in patients who underwent preoperative sclerotherapy vs those that did not (p=0.980). Seroma and surgical site infection were the most reported short-term postoperative complications followed by wound dehiscence with low rates of other complications in surgical resection of LMs. Few patients required postoperative procedural intervention. Despite a relatively high rate of short-term complications, patients reported high satisfaction and symptom improvement following LM resection, which underscores the important role for surgical management of LMs in select patients. III. Cohort study.

External Validation of SHA2PE Score: A Score to Predict Low-Risk Lower Gastrointestinal Bleeding in the Emergency Department.

Introduction: Lower gastrointestinal bleeding (LGIB) frequently leads to emergency department (ED) visits and hospitalizations, encompassing a spectrum of outcomes from spontaneous resolution to intrahospital mortality. Aim: The purpose of this study was to validate a scoring system designed to identify cases of low-risk LGIB, allowing for safe discharge from the ED. Methods: A retrospective analysis of all gastrointestinal bleeding cases presented at three EDs in 2020 was conducted, focusing specifically on patients with LGIB. The SHA2PE score incorporates factors such as systolic blood pressure, hemoglobin levels, use of antiplatelet or anticoagulant medications, pulse rate, and episodes of bright blood per rectum. Results: Out of 1112 patients presenting with LGIB to the ED, 55 were hospitalized, 20 required blood transfusions, 15 underwent colonoscopies, one underwent interventional radiology procedures, and two patients died. Employing a SHA2PE score with a cutoff value of 1 yielded a specificity of 78.5% (95% CI (confidence interval) [75.8-81.0]), sensitivity of 76.8% (95% CI [63.6-87.0]), positive predictive value (PPV) of 17.0% (95% CI [12.6-22.2]), and negative predictive value (NPV) of 98.3% (95% CI [97.2-99.1]) for predicting the need for hospitalization and intrahospital intervention. When considering return visits to the ED within 7 days with the same presentation, the score demonstrated a specificity of 78.8% (95% CI [76.0-81.3]), sensitivity of 68.6% (95% CI [56.4-79.1]), PPV of 19% (95% CI [14.3-24.4]), and NPV of 97.2% (95% CI [95.8-98.2]). Conclusions: The SHA2PE score demonstrates potential in predicting cases of low-risk LGIB, offering a high NPV for hospitalization, the need for intrahospital intervention, and return visits to the ED. However, these findings should be interpreted cautiously given the low prevalence of interventions and limitations in the study's population and design.

Lumen-Apposing Metal Stents in the Management of Complex Pelvic Abscesses.

Lumen-apposing metal stents (LAMS) are utilized in a wide range of therapeutic gastrointestinal applications. We present our experience with LAMS-assisted drainage of complex pelvic abscesses at a large safety-net hospital. EUS-guided LAMS placements for pelvic abscesses from July 2020 to June 2024 were analyzed. Data were collected on patient demographics, procedure indications, fluid collection size, stent characteristics, stent dwell time, and complications. All cases underwent multidisciplinary review with Surgery and Interventional Radiology (IR) prior to LAMS-assisted drainage; all were deemed not amenable to drainage by IR. Eleven patients underwent EUS-guided drainage of complex pelvic abscesses with cautery-enhanced LAMS. Diverticulitis was the most common cause of abscesses (n = 6; 55%). The average time from presentation to drainage was 7 days (1-18). The average abscess size was 7.2 cm (3.9-12.0 cm). The most common LAMS size was 15 mm × 10 mm; each was placed through the left colon and rectum with both technical and clinical success. All abscesses completely resolved with a mean stent dwell time of 28 days (17-42 days). After stent removal, the fistula was not routinely closed. No complications such as stent migration, bleeding, or perforation occurred. There were no recurrences and no patients required additional surgical or IR procedures with a mean follow-up of 25 weeks (SD 35.6). Adequate drainage is the cornerstone of pelvic abscess management, but IR or surgical access can be challenging, with inadequate drainage and prolonged hospitalization leading to significant morbidity. In our experience, EUS-guided, LAMS-assisted drainage provides a safe and effective alternative for managing pelvic abscesses.

Robust solutions via optimisation and predictive process monitoring for the scheduling of the interventional radiology procedures

AbstractInterventional radiology (IR) is an increasingly used medical specialty relying on the possibilities offered by medical imaging guidance technologies to perform minimally invasive procedures (both diagnostic and therapeutic) through very small incisions or body orifices. Although the operative context is quite similar to that of the classical operating room (OR) literature, to the best of our knowledge management problems arising in the IR operative context never appeared in the healthcare management literature. This is even more true for studies that combine the OR approach with automatic extraction of information from real hospital health record data as in the present study. Two specific features characterise our case study with respect to the traditional OR literature: due to the Italian legislation, the anaesthetist (usually in a very limited number) must be present for the entire duration of the procedure (), and the IR does not have its own ward but receives inpatients from different wards (). The aim of this paper is to introduce a novel approach to determine a robust solution for our case study problem addressing both features and . Our approach is based on the interplay between optimisation and predictive process monitoring (PPM) models. The obtained results show that the proposed approach produces schedules that achieve higher usage rate, lower overtime and more patients operated on than the original schedule. We also show that the integration of PPM models within the optimisation workflow improves the quality of the output schedule with respect to the standard one‐shot optimisation.

Association of anaesthesia-directed sedation with unplanned discharge to a nursing home following non-ambulatory interventional radiology and endoscopic procedures: a retrospective cohort study.

Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non-anaesthetists should provide procedural sedation. We studied adult patients who previously lived independently and underwent a non-ambulatory interventional radiology or gastroenterology procedure under anaesthetist-directed or non-anaesthetist-directed sedation at a large healthcare network. The primary outcomes were postprocedural adverse discharge to a nursing home and postprocedural duration of hospital stay. Among 22,868 patients included, 15,168 (66.3%) and 7700 (33.7%) underwent anaesthetist-directed sedation and non-anaesthetist-directed sedation, respectively. Of all patients receiving anaesthetist-directed sedation, 9.2% experienced adverse discharge to a nursing home compared with 21.3% undergoing non-anaesthetist-directed sedation. Anaesthetist-directed sedation was associated with reduced risk of adverse discharge to a nursing home (adjusted relative risk 0.54, 95%CI 0.45-0.63, p < 0.001, adjusted risk difference -4.6%, 95%CI -5.8 to -3.4, p < 0.001) and a shorter postprocedural duration of hospital stay (median (IQR [range]) 2 (1-6 [0-315]) days vs. 5 (2-12 [0-268]) days; adjusted model estimate 0.84, 95%CI 0.79-0.89, p < 0.001). The lower risk of adverse discharge to a nursing home and shorter duration of hospital stay in patients undergoing anaesthetist-directed sedation was reproduced in an instrumental variable analysis (adjusted risk difference -4.3%, 95%CI -8.4 to -0.1, p = 0.043; and -1.41 days, 95%CI -1.43 to -1.41 days, p < 0.001, respectively). Among patients undergoing anaesthetist-directed sedation the mean (SD) proportion of missing blood pressure measurements was lower (0.7 (4.9) % vs. 8.0 (14.6) %, p < 0.001), which mediated the effect of anaesthetist-directed sedation on adverse discharge. Among patients undergoing a non-ambulatory interventional radiology procedure or a gastrointestinal endoscopy, anaesthetist-directed sedation is associated with a reduced risk of adverse discharge to a nursing home and a shorter duration of hospital stay.

Complications in interventional radiology: early detection and effective intervention strategies.

This narrative review provides a comprehensive overview of complications in interventional radiology (IR), focusing on their aetiology, recognition, and management. As IR procedures continue to evolve and expand, understanding potential adverse events is crucial for improving patient safety and outcomes. The review will summarise various common complications associated with IR-based procedures, including their presentation, aetiology, and management. By consolidating current knowledge on these issues, the review offers valuable insights into minimising risks and enhancing procedural success. This synthesis will aid practitioners' knowledge and ultimately try and ensure safer IR practices and aftercare of patients.

Long-Term Reoperation Rates Following Pancreatoduodenectomy for Pancreatic Adenocarcinoma.

Short-term outcomes after pancreatoduodenectomy (PD) are well-studied, but long-term reoperation rates and their indications remain poorly characterized. A single-center retrospective chart review was performed on patients who underwent PD for pancreatic adenocarcinoma between 1/2011 and 12/2021. Reoperations occurring >90days after PD were dichotomized to being related or unrelated to the index PD or pancreatic adenocarcinoma. The Kaplan-Meier analysis estimated the incidence of long-term reoperation at 1 and 5years postoperatively. Six-hundred twenty-eight patients were included. The 5-year incidence of any additional operation >90days after PD was 30.0% (95% CI 23.2-36.2%), and the 5-year incidence of any long-term related reoperation was 21.2% (95% CI 15.0-26.8%). The most common indications for reoperations by 5-year incidence were cancer recurrence (12.8%, 95% CI 7.6-17.7%), incisional hernia (6.2%, 95% CI 2.6-9.7%), small bowel obstruction (1.3%, 95% CI 0.2-2.4%), and leak, fistula, or infection (1.0%, 95% CI 0.1-2.0%). Of the examined risk factors, only 90-day reoperation was found to be predictive of long-term related reoperations (P = 0.02). Additionally, the 5-year incidence of endoscopic or interventional radiology procedures was 20.2% (95% CI 14.5-25.4%). However, 40.9% (95% CI 33.6-47.3%) of patients required additional surgery or procedures of any kind between 90 days and 5years after PD. Within 5years of PD, one in three patients required additional surgery, and one in five had operations for related indications. Related reoperative indications included recurrence, hernia, PD-specific complications, and small bowel obstruction. However, the rates of each of these reoperations were relatively low.

Large language model doctor: assessing the ability of ChatGPT-4 to deliver interventional radiology procedural information to patients during the consent process

PurposeThe study aims to evaluate how current interventional radiologists view ChatGPT in the context of informed consent for interventional radiology (IR) procedures.MethodsChatGPT-4 was instructed to outline the risks, benefits, and alternatives for IR procedures. The outputs were reviewed by IR physicians to assess if outputs were 1) accurate, 2) comprehensive, 3) easy to understand, 4) written in a conversational tone, and 5) if they were comfortable providing the output to the patient. For each criterion, outputs were measured on a 5-point scale. Mean scores and percentage of physicians rating output as sufficient (4 or 5 on 5-point scale) were measured. A linear regression correlated mean rating with number of years in practice. Intraclass correlation coefficient (ICC) measured agreement among physicians.ResultsThe mean rating of the ChatGPT responses was 4.29, 3.85, 4.15, 4.24, 3.82 for accuracy, comprehensiveness, readability, conversational tone, and physician comfort level, respectively. Percentage of physicians rating outputs as sufficient was 84%, 71%, 85%, 85%, and 67% for accuracy, comprehensiveness, readability, conversational tone, and physician comfort level, respectively. There was an inverse relationship between years in training and output score (coeff = -0.03413, p = 0.0128); ICC measured 0.39 (p = 0.003).ConclusionsGPT-4 produced outputs that were accurate, understandable, and in a conversational tone. However, GPT-4 had a decreased capacity to produce a comprehensive output leading some physicians to be uncomfortable providing the output to patients. Practicing IRs should be aware of these limitations when counseling patients as ChatGPT-4 continues to develop into a clinically usable AI tool.

Estimating occupational exposure in interventional radiology through Air Kerma Area Product - calculation of Effective Dose conversion factors

During interventional radiology procedures, interventionists are positioned close to the patient and directly exposed to ionizing radiation. This study presents a methodology to estimate the effective dose of interventionists through Air Kerma Area Product (PKA) in three interventional procedure modalities: coronary, cerebral, and peripheral. Optically stimulated luminescence dosimeters were used in several body regions (thyroid, eye lens, abdomen, feet, and hands) to assess equivalent doses and to convert external to internal doses – leading to effective doses related to each modality. These effective doses were then correlated to the total PKA given by the equipment. Thus, an effective dose estimate factor was calculated to represent the conversion between equipment parameters and the effective dose obtained from dosimeters, resulting in a novel methodology. The agreement between the methods was in the range of ± 0.13 μSv for angiographies and -8.3 to 5.3 μSv for angioplasties. These findings underscore the reliability of PKA as a predictor of effective dose, facilitating a rapid and precise assessment of occupational exposure in IR. This novel approach has the potential to enhance radiation safety protocols and optimize protection strategies for IR professionals, ensuring more accurate monitoring and control of radiation exposure in clinical settings.

EGS SO32 - Management of Spontaneous Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Spontaneous Oesophageal Perforation (SOP) is a rare gastro-intestinal surgical emergency with devastating morbidity and mortality. Given the rarity of the entity, there is no up-to-date evidence on outcomes in the context of centralized esophagogastric services neither consensus guidelines nor standardized treatment algorithms on how these should be optimally managed. Endoscopic Vacuum Therapy (EVT) has emerged as safe and effective option particularly in cases where major invasive surgery would otherwise be deferred. Herein, we sought to explore the effectiveness, patient benefit and related morbidity/mortality by exploring the strategy outcomes in SOPs prior to and during periods where EVT was available. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=72) presented or transferred to our tertiary oesophagogastric unit for SOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or perforation secondary to malignancy, iatrogenic, traumatic or food bolus were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day, 1-year mortality. Results In 2009-2017 pre-EVT period, 25/72 patients were managed a) 18/25 surgically with thoracotomy and T-tube, b) non-surgical 7/25, four were palliated. 30-day, 90-day mortality were 4/25 and 2/25, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 14/25 (56%), 90-day reintervention 8/25 (32%), median LOS 27 days. In 2018-2023 EVT period , 47/72 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 18/47, b) non-surgical 15/47, c) endoscopy 6/47, d) EVT in 14/47. 30-day mortality was 6/47, 90-day mortality 2/47, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 32/47 (68%), 90-day reintervention 26/47 (55.3%), median LOS 34 days. 1-year mortality was 5/25 and 3/47 respectively. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of spontaneous oesophageal perforations. Optimal patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is recommended as soon as such a diagnosis is confirmed.

EGS SO30 - Management of Iatrogenic Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass non-operative for early perforation without sepsis, endoscopic with endoclip/stent and surgical including primary repair, exclusion and diversion or oesophagectomy. Recently, Endoscopic Vacuum Therapy (EVT) has been introduced as safe and effective alternative approach. We sought to assess treatment outcomes in patients with IOPs prior to and during periods where EVT was available as treatment option. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=30) presented or transferred to our tertiary oesophagogastric unit for IOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or spontaneous perforation secondary to malignancy or benign pathology were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day and 1-year mortality. Results In 2009-2017 pre-EVT period, 11/30 patients were managed a) non-surgically 7/11, b) endoclip 3/11 and stenting 1/11. 30-day and 90-day mortality were 1/11, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 3/11 (27.3%), 90-day reintervention 8/11 (72.7%), median LOS 27 days. In 2018-2023 EVT period, 19/30 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 5/19, b) non-surgical 7/19, c) IR NJT, stent or PEG in 6/19 d) EVT in 4/19. 30-day mortality was 0/19, 90-day mortality 1/19 (5.2%), 90-day morbidity Clavien-Dindo &amp;gt;IIIa 7/19 (36.8%), 90-day reintervention 9/19 (47.4%), median LOS 61 days. 1-year mortality was 0/19 for both. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of iatrogenic oesophageal perforations. Careful patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is a sine qua non.

Peritoneal Catheters Malposition/Dysfunction and Their Approach with Catheterography and Radiologic Manipulation in Peritoneal Dialysis: A Minireview and Case Series.

Peritoneal catheter dysfunction is one of the most frequent complications of peritoneal dialysis. The malposition of a peritoneal catheter may cause one- or two-way obstruction with fluid outflow or inflow problems, large residual volumes, and, therefore, reduced ultrafiltration and sometimes abdominal pain. Standard procedures may often fail to solve the dysfunction. Catheterography is an interventional radiologic procedure based on the infusion under aseptic conditions of iodated contrast into the peritoneal catheter, followed by the introduction of a guidewire into the catheter for guidewire manipulation. The available literature about catheterography is quite scarce and mainly based on case reports, case series, and small retrospective studies. In this minireview, we describe the guidewire manipulation techniques explored so far and their pros and cons. In addition, four interesting cases of catheterography performed in our center are also reported. In conclusion, in this minireview, the pros and cons of catheterography have been outpointed. Radiologic manipulation of peritoneal catheters may represent an effective and safe solution for malfunctioning peritoneal catheters and may also be exploited as "bridge therapy" to laparotomy in patients temporarily unsuitable for surgery. The advantages of this procedure are that it does not require long-term hospitalization and allows immediate resume of peritoneal dialysis.

Statistical-based modeling strategy for entrance skin dose estimation in patient undergoing body interventional radiology.

Interventional radiology (IR) provides significant advancements in diagnostic and therapeutic procedures, yet concerns persist regarding radiological risks such as erythema, burns, and epilation. Direct dose measurements observed difficulties regarding the perturbation of the detector probe in X-ray images during fluoroscopy-guided procedures, high-cost expenses, and non-compliant patients. This study aims to develop a statistical-based model for estimating entrance skin dose (ESD) in body IR procedures using patient radiation-dose recording data. Models are categorized into vascular and non-vascular procedures. This study demonstrates that the simplified models are sufficient in estimating patient ESDs for both IR groups, with a 95% confidence interval. This user-friendly method enables radiologists to calculate doses without complex parameters such as the backscatter factor and mass-energy absorption coefficient, as required in conventional calculation methods. It not only does this support to radiologists in effectively refining treatment protocols, but also enables patients to monitor their received doses immediately after treatment ends.

Computed Tomography-guided Puncture: Preprocedural Preparation, Technical Tips, and Radioprotection.

Computed tomography-guided puncture is a useful technique for various interventional radiology procedures. Puncture from various locations and angles becomes possible using this technique. Moreover, bone and air do not interfere with the computed tomography image. Therefore, computed tomography-guided puncture is feasible even in difficult cases of ultrasonography-guided procedures. However, a computed tomography-guided procedure can cause radiation exposure to patient and operator. Therefore, utmost attention should be given to minimizing radiation exposure. This study aimed to provide a brief review of pre-procedural preparation and the technical tips for the computed tomography-guided puncture and introduce recent topics related to the radioprotection of computed tomography-guided puncture.

Tonal Imprints From Procedure to Prognosis.

Three mixed media, acrylic, ink, and airbrush paintings explore an image-guided interventional radiological procedure and hopeful prognosis.

Interventional radiology procedures for metastatic spine tumors

ObjectiveInterventional radiology procedures can offer locoregional tumor control and palliative options for patients with metastatic disease to spine to relieve pain, to delay neurologic deficits, and to improve quality of life and daily function. FindingsMultiple thermal energies for percutaneous ablation of metastases to the spine exist and are chosen according to tumor characteristics, volume, and location. Vertebral augmentation is most often combined with ablation for structural stability. Intravascular embolization of metastases provides tumor palliative or presurgical devascularization. ConclusionAblation, vertebral augmentation, and intravascular embolization are efficacious minimally invasive options for the management of spinal tumors.

A systematic review of surgical and interventional radiology procedures for pediatric idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is defined as elevated intracranial pressure and consequent symptoms (mainly headache and visual deterioration) occurring in the absence of secondary causes. Surgical and interventional radiology procedures should be considered for refractory IIH and mainly include cerebrospinal fluid (CSF) diversion techniques, optic nerve sheath fenestration (ONSF), and venous sinus stenting (VSS). Our study aims to review the current literature on the application of these techniques in clinical practice. A systematic literature review on the surgical and interventional radiology treatment of IIH was conducted, focusing on ONSF, VSS, and CSF diversion techniques. According to PRISMA guidelines, all reports published in PubMed in the last 30 years (1993-2023) were considered, and among 722 papers, 48 were included in the present study, resulting in a total study population of 454 children or adolescents (11 months-17 years old). Among 454 patients, 193 underwent an invasive approach, divided into CSF diversion (115/193), ONSF (65/193), VSS (11/193), cranial subtemporal decompression (8/193), and internal cranial expansion (9/193). Sixteen of the 193 patients (8%) required reintervention due to relapsing symptoms or surgical complications, particularly those who underwent CSF diversion. Furthermore, 9/115 required shunt revision due to shunt obstruction or malfunction. We extracted data on the outcome of each procedure: of the 193 patients, 71 experienced a positive outcome with symptom resolution or improvement, while 27 demonstrated a negative outcome. Severe and refractory cases of IIH are eligible for invasive treatments. CSF diversion is the most frequently used technique, despite its high failure risk and need for reintervention. ONSF has shown good results in terms of outcome and safety, particularly in children with visual symptoms. VSS is the most recent approach, indicated in children with stenosis of the venous sinus. In our study population, VSS demonstrated good results in terms of symptom resolution and need for reintervention, but its use remains limited to a few centers. https://www.crd.york.ac.uk/, PROSPERO (CRD42024504244).

Tumor ablation in children.

Tumor ablation represents an increasingly important topic in pediatric interventional radiology. Many ablative techniques are well known and established in the adult population, and the adoption of these techniques in the pediatric field is increasing. Image-guided tumor ablation represents a wide category of interventional radiology procedures that can be applied to both benign and malignant pediatric solid tumors. Tumor ablation, either alone or in combination with locoregional therapy, can have curative, debulking, or palliative effects on a wide variety of histological tumor types.

Knowledge and practices of interventional radiology staff regarding radiation protection

Interventional radiology (IR) has become a widespread medical imaging technique, offering minimally invasive treatment options. However, IR procedures can expose patients and staff to substantial radiation risks, necessitating enhanced radiation protection practices. This study aimed to survey the knowledge and practices of interventional radiology staff regarding radiation protection. A cross-sectional study with a descriptive aim, based on a questionnaire was done. The study subjects were all healthcare personnel of all specialties having practiced in interventional radiology between 2019 and 2022 at the University Hospital Center of Rabat. The statistical processing was carried out using Microsoft Excel 2013® and the IBM SPSS Statistical program version 20 (IBM Inc. NY, USA). The results indicated that 59.4% of participants had not received any specific training in radiation protection, and 45% were unaware of the radiation-induced risks associated with interventional radiology procedures. Regarding safety practices, 75% of participants maintained a distance of at least 1 meter from the x-ray source, while only 6% used the lowest possible exposure settings. Concerning the use of radiation protection devices, 87.5% of participants wore a lead apron, 75% used a thyroid shield, 6.3% wore lead glasses, and 37.5% utilized suspended mobile screens, whereas 12.5% did not use any radiation protection devices. Additionally, 84% of participants wore their personal dosimeter, though not consistently. The knowledge and practices of most interventional radiology personnel are inadequate for effective radiation protection. Regular, ongoing training in radiation safety is essential to improve adherence to protection standards and enhance overall safety in clinical practice.