Interventional Radiology Procedures Research Articles

Cone-Beam CT With Enhanced Needle Guidance and Augmented Fluoroscopy Overlay: Applications in Interventional Radiology.

Digital flat-panel detector cone-beam CT (CBCT), introduced in the early 2000s, was historically used in interventional radiology primarily for liver-directed therapies. However, contemporary advanced imaging applications, including enhanced needle guidance and augmented fluoroscopy overlay, have evolved substantially over the prior decade and now work synergistically with CBCT guidance to overcome limitations encountered with other imaging modalities. CBCT with advanced imaging applications has become increasingly used to facilitate a broad range of minimally invasive procedures, particularly relating to pain and musculoskeletal interventions. Potential advantages of CBCT with advanced imaging applications include greater accuracy for complex needle paths, improved targeting in the presence of metal artifact, enhanced visualization during injection of contrast medium or cement, increased ease when space in the gantry is limited, and reduced radiation doses versus conventional CT guidance. Nonetheless, CBCT guidance remains underutilized, partly relating to lack of familiarity with the technique. This article describes the practical implementation of CBCT with enhanced needle guidance and augmented fluoroscopy overlay and depicts the technique's application for an array of interventional radiology procedures, including epidural steroid injections, celiac plexus block and neurolysis, pudendal block, spine ablation, percutaneous osseous ablation fixation and osteoplasty, biliary recanalization, and transcaval type II endoleak repair.

The role of serotonin inhibition within the treatment of carcinoid syndrome.

Carcinoid syndrome is the most frequent hormonal complication associated with neuroendocrine neoplasms. It was first reported in 1954, and the classical symptoms are diarrhoea, flushing and abdominal pain. It is caused by the secretion of several vasoactive substances, the most prominent being serotonin, which play a pathophysiological role in the clinical symptoms which characterise carcinoid syndrome. Therefore, the focus of carcinoid syndrome treatment is to reduce serotonin production and hence improve the patient's quality of life. There are a variety of management options for carcinoid syndrome including medical, surgical and loco-regional interventional radiological procedures. The most widely used are somatostatin analogues with three clinically approved drugs: lanreotide and octreotide (first-generation) and pasireotide (second-generation). Both everolimus and interferon used in combination with octreotide have shown significant reduction in urinary 5-hydroxyindoleacetic acid compared to octreotide alone. Telotristat ethyl has been increasingly utilised for patients with symptoms despite taking somatostatin analogues. It has also been shown to have a significant improvement in bowel movement frequency which was associated with a significant improvement in quality of life. Peptide receptor radionuclide therapy has proven symptomatic improvement in patients with uncontrolled symptoms. Chemotherapy is primarily reserved for patients with high proliferation tumours, with limited research on the efficacy in reducing symptoms. Surgical resection remains the optimal treatment due to being the only one that can achieve a cure. Liver-directed therapies are considered in patients where curative resection is not possible. There are therefore numerous different therapies. This paper describes the pathophysiology and therapy of carcinoid syndrome.

Association of Organizational Pathways With the Delay of Emergency Surgery

Delayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date. To examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France. This prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded. Emergency surgery. The main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1. A total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P < .001). The adjusted odds ratio for delay was 1.80 (95% CI, 1.17-2.78) when comparing NOR with DET. In this cohort study, the frequency of delayed emergency surgery in France was 32.5%. Reduced delays were found in organizational pathways that included dedicated theaters and teams. These preliminary results may pave the way for comprehensive large-scale studies, from which results may potentially inform new guidelines for quicker and safer access to emergency surgery.

Actualization of methodology of diagnostic reference levels establishment for interventional radiological procedures

Interventional procedures are accompanied with high levels of patient exposure and even with the possibility of radiation skin damage. That’s why any actions leading to reduction of patients’ exposure levels are of utmost importance. Implementation of diagnostic reference levels is considered to be one of the most successful actions to reduce patient exposure levels. However the basic concept of diagnostic reference levels cannot be used for interventional radiology due to fact that procedures are not standardized. The article studies the main difficulties in applying the standard concept of diagnostic reference levels for interventional radiology procedures and proposes a new concept, taking into account the specifics of these procedures; the domestic and international documents are analyzed. The list of interventional procedures for diagnostic reference levels establishment is suggested based on the statistical data on performed procedures in the Russian Federation. The results of this study were used for the new Russian guidelines “Optimization of radiation protection of patients undergoing medical radiation diagnostic examinations through the use of diagnostic reference levels”.

Prophylactic bilateral internal iliac balloon occlusion to control hemorrhage in placenta accreta spectrum: a boon for obstetricians.

Placenta accreta spectrum (PAS) is abnormal placental adhesion beyond superficial myometrium, which may lead to severe life-threatening hemorrhage requiring massive blood transfusions in the peripartum period. Prophylactic balloon catheterization of bilateral internal iliac arteries with or without additional embolization with Cesarean hysterectomy in patients with PAS prevent excessive intraoperative hemorrhage and may also obviate the need for hysterectomy. To study the efficacy of intervention radiological procedures in controlling intraoperative hemorrhage in patients with PAS. This ethically approved prospective study was conducted between November 2017 and October 2019 and written informed consent was obtained from all patients. Consecutive patients diagnosed with PAS during the antepartum period were evaluated. A total of 18 patients with PAS underwent prophylactic balloon catheterization of the bilateral internal iliac arteries followed by delivery of the infant. Interventional and intraoperative data of these patients were collected and compared with retrospectively collected data of patients (control group) who underwent hysterectomy without prophylactic balloon occlusion over the past four years (January 2016-November 2019). Significantly lower intraoperative blood loss (2.8 L vs. 4.7 L; P = 0.048) and pure red blood cell (PRBC) requirement (P = 0.026) between patients who had hysterectomy with and without interventional radiological management was observed. Significantly higher blood loss (P = 0.006) and fluid requirement (P = 0.007) was observed with a higher degree of placental invasion. Only 1 (6%) major procedure-related complication was observed. Interventional radiological procedures are effective in significantly reducing intraoperative blood loss and blood product requirement in patients with PAS.

Abstract 5465: Immune cell dynamics of patients and mice with hepatocellular carcinoma treated with anti-PD-L1 plus anti-CTLA-4 combination therapy

Abstract Background: Hepatocellular carcinoma (HCC) is one of the major causes for cancer-related death. Single agent immunotherapy or combined immunotherapy have become the standard of care in advanced HCC. Recently, the combination of durvalumab (dur) plus a single dose of 300 mg tremelimumab (trem) (STRIDE regimen) have received FDA approval based on results from the HIMALAYA trial. However, immune responses have not been studied in detail. We tested the combination of 4 × 75 mg trem plus dur and locoregional therapies in HCC at and conducted correlative studies. Methods: We enrolled 28 patients with biopsy proven advanced HCC in an open-labeled phase 2 trial using dur and trem combined with ablative therapies (NCT02821754). Patients received four doses of 75mg trem every 4 weeks and 1500mg dur every 4 weeks until progression. Patients underwent an interventional radiologic procedure (RFA/TACE) on day 36. Peripheral blood mononuclear cells (PBMC) and serum from patients enrolled were collected at baseline and after 1 cycle (day 28). PBMC was analyzed by multicolor spectral cytometry using a 17 antibody pan immune cell panel and a 25 antibody T cell panel. Serum samples from patients were collected at baseline and on day 28. Serum samples were analyzed with a 34-plex cytokine/chemokine array. Mice with orthotopically injected HCC (RIL-175 and Hep55.1C) were treated with anti-PD-L1 plus anti-CTLA4 and followed for tumor responses. Hepatic lymphocytes, tumor infiltrating lymphocytes (TILs), and splenocytes were analyzed by spectral cytometry from mice treated with immune checkpoint inhibitors. Results: 28 patients with advanced HCC were enrolled in this study. The best clinical response for treatment was the following, partial response (PR, n=5), stable disease (SD, n=12), progressive disease (PD, n=8), and not evaluable (n=3). Median PFS and OS were 4.5 and 20.8 months respectively. Patient PBMC analysis demonstrated an increase of regulatory T cells 1.65 times from baseline after 28 days in all patients. The frequency of Tbet+CD4+ T cells showed a non-significant increase in patients demonstrating a PR. Serum cytokine analysis revealed the levels of IL-18, IL-10, CCL-2, and VEGF-a increased in responders after treatment. in contrast, an increase of IL-6 and TNF-alpha after treatment was found only in patients with PD. In animal experiments, the size of liver tumors treated with anti-PDL1 and anti-CTLA4 were significantly smaller than that with isotype controls. The lymphocytes in the adjacent livers and tumor-infiltrating lymphocytes (TILs) were analyzed. PD1+CD8+ T cells and Tbet+CD4+ T cells in the liver and TILs increased with combination treatment. Conclusion: Anti-PD-L1 and anti-CTLA4 combination therapy have an anti-tumor effect on HCC. We observed an expansion of PD1+ CD8+ T cells and Tbet+ CD4+ T cells. Citation Format: Yuta Myojin, Benjamin Ruf, Mohamed-Reda Benmebarek, Kylynda Bauer, Rajiv Trehan, Kelley Coffman, Chi Ma, Cecilia B. Monge, Changqing Xie, Tim Greten. Immune cell dynamics of patients and mice with hepatocellular carcinoma treated with anti-PD-L1 plus anti-CTLA-4 combination therapy. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5465.

Life expectancy of patients with hepatocellular carcinoma according to the upfront treatment: A nationwide analysis.

The purpose of this study was to update the life expectancy of patients with hepatocellular carcinoma (HCC) in an exhaustive nationwide population according to the upfront treatment performed. From the French Program for the Medicalization of Information System database, all patients older than 18 years diagnosed with a de novo HCC from January 2011 to December 2018 were retrospectively selected. Five-year survival rates (95% confidence intervals [CI]) were computed according to the first surgical or interventional radiology procedures performed. A total of 63,996 patients (80% men) with a median age of 68 years (Q1, Q3: 61, 77) were selected, including 24,007 patients who underwent at least one procedure (5-year survival of 45.5%; (95% CI: 44.8-46.2), and 39,989 with none (5-year survival, 9.6%; (95% CI: 9.3-10.0). Only 20.5% (13,101/63,996) of patients could undergo an upfront curative procedure. Liver transplantation achieved the best outcome, whether performed upfront (n=791; 5-year survival, 79.0% [95% CI: 76.1-82.1]) or during subsequent steps (n=2217; 5-year survival 80.9% [95% CI: 79.2-82.7]). Tumor ablation (n=5306), open resection (n=5171), and minimally-invasive resection (n=1833) achieved 5-year survival rates of 53.8% (95% CI: 52.3-55.4), 54.1% (95% CI: 52.6-55.6), and 66.2% (95% CI: 63.7-68.7), respectively, with more patients with cirrhosis and subsequent procedures in the tumor ablation group. Patients with upfront transarterial (chemo)embolization (n=10,247) and selective internal radiation therapy (n=659) had 5-year survival rates of 31.3% (95% CI: 30.3-32.4) and 18.5% (95% CI: 15.2-22.5). While HCC remains mostly diagnosed at an advanced stage associated with a poor prognosis, all the curative options provide 5-year survival rates above 50%.

The clinical applications of interventional radiological techniques in obstetrics and gynaecology

Key content Uterine artery embolisation can be used as a minimally invasive technique for the management of benign gynaecological conditions refractory to other medical treatments. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists (RCR) recommend the use of interventional radiology (IR) techniques for the prophylaxis and management of postpartum haemorrhage. Interventional radiologists can percutaneously drain post‐operative collections or tubo‐ovarian abscesses. Interventional radiology plays a role in the management of early pregnancy complications such as ectopic pregnancy and gestational trophoblastic disease. Interventional radiology can aid the care of patients with gynaecological malignancies. Learning objectives To understand the various IR techniques applicable to obstetrics and gynaecology To understand the risk and benefit profiles of these techniques To understand when the techniques could be appropriate and how they compare to surgical alternatives Ethical issues There are limited data regarding the use of some IR procedures owing to the ethical issues of using experimental techniques to treat pregnant women or women who wish to conceive. The availability of IR procedures is hospital specific so treatment is not available to all who may benefit.

Limited Resources at a Community Based Level 1 Trauma Center: Does This Affect Pelvic Angioembolization Times During Daylight Hours versus after Hours, Weekends, and Holidays?

Hemodynamically unstable patients with pelvic fractures require swift intervention due to the high mortality of their injuries. A delay in embolization of these patients significantly affects survival. We therefore, hypothesized that there would be a significant difference between time to embolization at our larger rural Level 1 Trauma Center. This study investigated the relationship between interventional radiology (IR) order time to IR procedure start time over 2 time periods at our large, rural Level 1 Trauma Center with those having sustained a traumatic pelvic fracture requiring IR, and having been identified as being in shock. The current study found no statistically significant difference from time from order to IR start between the 2 cohorts (Mann-Whitney U test, P = .902). The results suggest we are delivering a consistent standard of care at our institution for pelvic trauma, based on IR order time to start of the procedure.

The Role of the Transjugular Intrahepatic Porto-Systemic Shunt in an Emergency Setting.

Transjugular intrahepatic porto-systemic shunt (TIPSS) is an interventional radiology procedure whose aim is to create artificial communication between the portal and the hepatic blood flow in order to reduce the pressure gradient in portal hypertension. The indications to perform a TIPSS procedure can be framed in an elective or emergency setting: refractory ascites to diuretic therapy and secondary prophylaxis of variceal hemorrhage are the most frequent reasons for executing a TIPSS in an election context, while acute uncontrolled variceal bleeding is the principal indication that a TIPSS needs to be performed in an emergency setting. In recent years, the role of the TIPSS has been redefined for several conditions, such as ectopic varices, portal vein thrombosis, Budd-Chiari syndrome, hepatic veno-occlusive disease, and many others. This review aims to perform a deep analysis of when and why a TIPSS procedure should be carried out in an emergency, pointing out the related most common technical difficulties and complications.

A wearable active-type X-ray dosimeter having novel functions to derive both incident direction and absolute exposure dose

Currently, interventional radiology (IVR) procedures using X-ray fluoroscopic equipment are widely used to perform medical diagnosis and treatment, and during these procedures medical staff are often exposed to scattered X-rays. This study aims to propose a concept of a novel dosimetric system that can analyze both the X-ray incident angle and radiation exposure dose simultaneously. Our dosimeter consists of three active-type detectors. Absolute dose rates can be determined by the center detector, and the side detectors can derive incident direction. Incident windows of the side detectors have symmetrically-sloped titanium filters to enlarge the angular dependence. These filters create a difference in the responses measured by the left and right detectors when X-rays are incident to a centered position; from this, the incident angle of the X-rays can be calculated. To verify the concept, basic experiments using a clinical fluoroscopic system were performed. It was found that our dosimeter can derive the incident angle of X-rays between ± 50° and determine the absolute dose with proper angular dependence correction. Furthermore, a fluoroscopic procedure was mimicked using a human body phantom and a mannequin on which our dosimeter with a wearable optical camera was placed. Although commercial dosimeters can determine exposure doses with a systematic uncertainty of ± 13.4%, our dosimetric system can analyze absolute exposure doses with a systematic uncertainty of ± 4.2%.

Pyogenic sacroiliitis caused by Salmonella schwarzengrund in a young healthy woman: a case report and literature review

BackgroundSalmonella species are a leading cause of diarrheal diseases worldwide. Recent epidemiological studies have shown that Salmonella schwarzengrund (S. schwarzengrund) is highly prevalent in various regions. Herein, we report that S. schwarzengrund caused sacroiliac joint (SIJ) infection with septic shock in a young woman, although she was immunocompetent.Case presentationA 20-year-old woman presented with left hip pain, accompanied by vasopressor-requiring hypotension. Her imaging examinations showed fluid collection in her SIJ and a small abscess in the left iliac muscle. Later, the blood and aspiration fluid culture and genetic analysis revealed the presence of S. schwarzengrund. We diagnosed sacroiliac joint (SIJ) infection with septic shock caused by S. schwarzengrund. Her condition improved after performing several interventional radiology (IVR) procedures for SIJ abscesses and providing appropriate antibiotic treatment. Finally, she was discharged without any sequelae. Screening tests and genetic analysis about her immunodeficiency did not indicate a congenital disorder.ConclusionThese clinical courses indicate that S. schwarzengrund could cause the fatal SIJ infection irrespective of the host immunocompetence. Considering the recent increase in the diagnostic rate of S. schwarzengrund, this case emphasized the need to be more cautious about Salmonella species infection.

Safety and Effectiveness of Moderate Sedation With Ketamine and Midazolam Combination in Vascular and Interventional Radiology Procedures

Ketamine is known to induce dissociative anesthesia while maintaining airways and hemodynamics. The aim of this study is to assess the safety and effectiveness of moderate sedation using a mixture of ketamine and midazolam in vascular and interventional radiology procedures. Patients received aggregate doses of the mixture of 50 mg ketamine and 2.5 mg midazolam, diluted in 10 mL of normal saline. The starting dose was 10 mg of ketamine followed by 10–20 mg increments after 10–15 minutes. Side effects were observed in 5 patients. No cardiovascular or respiratory complications were encountered. The mean lowest Ramsay score during the procedure was 1.9 ± 0.5 (range, 1–3) and the mean highest Ramsay score during the procedure was 2.7 ± 0.7 (range, 2–5). Aldrete score was recorded in 72 patients with a mean of 9.7 (range, 7–10). Ketamine and midazolam combination appears to be effective in providing adequate moderate sedation and analgesia.

Diagnosis of gynecologic malignancy after the treatment of presumed benign fibroid disease with interventional radiology procedures: a retrospective cohort study

To ascertain the finding of future diagnosis of malignancy in women who undergo nonsurgical treatment for uterine fibroid disease with interventional radiology (IR) procedures. Mixed-methods retrospective cohort study. Two tertiary care academic hospitals in Boston, Massachusetts. A total of 491 women who underwent radiologic intervention for fibroids between 2006 and 2016. Uterine artery embolization or high-intensity focused ultrasound ablation. Subsequent surgical interventions and diagnosis of gynecologic malignancy after the IR procedure. During the study period, 491 women underwent treatment of fibroids with IR procedures; follow-up information was available for 346 cases. The mean age was 45.3 ± 4.8 years, and 69.7% were between the ages of 40 and 49 years. Regarding ethnicity, 58.9% of patients were white, and 26.1% were black. The most common symptoms were abnormal uterine bleeding (87%), pelvic pressure (62.3%), and pelvic pain (60.9%). A total of 106 patients underwent subsequent surgical treatment of fibroids. Of the 346 patients who had follow-up, 4 (1.2%) were diagnosed with leiomyosarcoma after their interventional treatment for fibroids. An additional 2 cases of endometrial adenocarcinoma and 1 case of a premalignant lesion of the endometrium were noted. The proportion of patients who went on to be diagnosed with leiomyosarcoma after conservative IR treatments appears to be higher than previously reported. A thorough preprocedural workup and patient counseling regarding the possibility of underlying uterine malignancy should be undertaken.

Impact of the COVID-19 Pandemic on Interventional Radiology inGermany.

To investigate the effect of the ongoing COVID-19 pandemic on interventional radiology (IR) in Germany in 2020 and 2021. This retrospective study is based on the nationwide interventional radiology procedures documented in the quality register of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR-QS-Register). The nationwide volume of interventions in the pandemic years 2020 and 2021 was compared with the pre-pandemic period (Poisson-test, Mann-Whitney test). The aggregated data were additionally evaluated by intervention type with differentiated consideration of the temporal epidemiological infection occurrence. During the two pandemic years 2020 and 2021, thenumber of interventional procedures increased by appr. 4 % compared to the same period of the previous year (n = 190 454 and 189 447 vs. n = 183 123, respectively, p < 0.001). Only the first pandemic wave in spring 2020 (weeks 12-16) showed a significant temporary drop in the number of interventional procedures by 26 % (n = 4799, p < 0.05). This primarily involved interventions that were not immediately medically urgent, such as pain treatments or elective arterial revascularization. In contrast, interventions in the field of interventional oncology, such as port catheter implantations and local tumor ablations, remained unaffected. The decline of the first wave of infection was accompanied by a rapid recovery and a significant, partly compensatory, 14 % increase in procedure numbers in the second half of 2020 compared to the same period of the previous year (n = 77 151 vs. 67 852, p < 0.001). Subsequent pandemic waves had no effect on intervention numbers. The COVID-19 pandemic in Germany led to a significant short-term decrease in interventional radiology procedures in the initial phase. A compensatory increase in the number of procedures was observed in the subsequent period. This reflects the adaptability and robustness of IR and the high demand for minimally invasive radiological procedures in medical care. · The study shows the nationwide pandemic-related effects on interventional radiology in Germany.. · In quantitative terms, the ongoing pandemic caused a significant, temporary decline in intervention cases only in the initial phase.. · Subsequent waves of infections had no effect on the scope of services provided by interventional radiology.. · Short-term deficits, especially in elective interventions, could be partially compensated.. · Schmidbauer M, Busjahn A, Paprottka P et al. Impact of the COVID-19 Pandemic on Interventional Radiology in Germany. Fortschr Röntgenstr 2023; 195: 597 - 604.

Modified design of x-ray protective clothing to enhance radiation protection for interventional radiologists.

In interventional radiology procedures, the operator typically stands on the right side of the patient's right thigh to manipulate devices through the femoral sheath. Because the standard x-ray protective clothing is designed as sleeveless and scatter radiations from the patient are mainly incident from the left-anterior direction to the operator, the arm hole of the clothing may be a significant unprotected area, contributing to an increase in the operator's organ doses and effective dose. This study aimed to compare the organ doses and effective dose received by the interventional radiologist when wearing the standard x-ray protective clothing and when wearing the modified clothing with an additional shoulder guard. The experimental setup aimed to simulate actual clinical practice in interventional radiology. The patient phantom was located at the beam center to generate scatter radiation. An adult female anthropomorphic phantom loaded with 126 nanoDots (Landauer Inc., Glenwood, IL) was used to measure organ and effective doses to the operator. The standard wrap-around type x-ray protective clothing offered 0.25-mm lead-equivalent protection, and the frontal overlap area offered 0.50-mm lead-equivalent protection. The shoulder guard was custom-made with a material providing x-ray protection equivalent to lead of 0.50mm thickness. The organ and effective doses were compared between the operator wearing the standard protective clothing and the one wearing the modified clothing with a shoulder guard. After adding the shoulder guard, doses to the lungs, bone marrow, and esophagus decreased by 81.9%, 58.6%, and 58.7%, respectively, and the effective dose to the operator decreased by 47.7%. Widespread use of modified x-ray protective clothing with shoulder guards can significantly decrease the overall occupational radiation risk in interventional radiology.

Artificial Intelligence, Augmented Reality, and Virtual Reality Advances and Applications in Interventional Radiology.

Artificial intelligence (AI) uses computer algorithms to process and interpret data as well as perform tasks, while continuously redefining itself. Machine learning, a subset of AI, is based on reverse training in which evaluation and extraction of data occur from exposure to labeled examples. AI is capable of using neural networks to extract more complex, high-level data, even from unlabeled data sets, and better emulate, or even exceed, the human brain. Advances in AI have and will continue to revolutionize medicine, especially the field of radiology. Compared to the field of interventional radiology, AI innovations in the field of diagnostic radiology are more widely understood and used, although still with significant potential and growth on the horizon. Additionally, AI is closely related and often incorporated into the technology and programming of augmented reality, virtual reality, and radiogenomic innovations which have the potential to enhance the efficiency and accuracy of radiological diagnoses and treatment planning. There are many barriers that limit the applications of artificial intelligence applications into the clinical practice and dynamic procedures of interventional radiology. Despite these barriers to implementation, artificial intelligence in IR continues to advance and the continued development of machine learning and deep learning places interventional radiology in a unique position for exponential growth. This review describes the current and possible future applications of artificial intelligence, radiogenomics, and augmented and virtual reality in interventional radiology while also describing the challenges and limitations that must be addressed before these applications can be fully implemented into common clinical practice.

Development of a Periprocedure Trigger for Outpatient Interventional Radiology Procedures in the Veterans Health Administration.

Interventional radiology (IR) is the newest medical specialty. However, it lacks robust quality assurance metrics, including adverse event (AE) surveillance tools. Considering the high frequency of outpatient care provided by IR, automated electronic triggers offer a potential catalyst to support accurate retrospective AE detection. We programmed previously validated AE triggers (admission, emergency visit, or death up to 14 days after procedure) for elective, outpatient IR procedures performed in Veterans Health Administration surgical facilities between fiscal years 2017 and 2019. We then developed a text-based algorithm to detect AEs that explicitly occurred in the periprocedure time frame: before, during, and shortly after the IR procedure. Guided by the literature and clinical expertise, we generated clinical note keywords and text strings to flag cases with high potential for periprocedure AEs. Flagged cases underwent targeted chart review to measure criterion validity (i.e., the positive predictive value), to confirm AE occurrence, and to characterize the event. Among 135,285 elective outpatient IR procedures, the periprocedure algorithm flagged 245 cases (0.18%); 138 of these had ≥1 AE, yielding a positive predictive value of 56% (95% confidence interval, 50%-62%). The previously developed triggers for admission, emergency visit, or death in 14 days flagged 119 of the 138 procedures with AEs (73%). Among the 43 AEs detected exclusively by the periprocedure trigger were allergic reactions, adverse drug events, ischemic events, bleeding events requiring blood transfusions, and cardiac arrest requiring cardiopulmonary resuscitation. The periprocedure trigger performed well on IR outpatient procedures and offers a complement to other electronic triggers developed for outpatient AE surveillance.

Abstract No. 36 Radial Access in the Setting of Angiography and Embolization for Trauma: Our Experience

Traditionally, transradial artery access (TRA) has been secondary to transfemoral artery access (TFA) for interventional radiology (IR) procedures, especially in the setting of trauma. As interventionists have demonstrated increasing confidence in TRA in emergent settings such as in cardiac and stroke cases, the use of TRA in the setting of trauma has gained increasing traction. We aim to describe our experience with TRA for IR angiography and embolization in the setting of trauma. We performed a retrospective review of all arterial angiography and possible embolization cases in the setting of trauma performed by IRs at our level 1 trauma center from 2015 to 2022. Cases were extracted from our institutional database using the search terms “trauma,” “gunshot,” “gsw,” and “mvc.” We manually reviewed and excluded the non-trauma cases. 630 trauma patients (mean age, 41 years; 30.4% female) underwent 685 arterial angiography with possible embolization. 91.7% (628/685) of cases underwent TFA; 6.9% (47/685) underwent TRA; 0.1% (1/685) underwent brachial artery access; 0.1% (1/685) underwent subclavian artery access; and 0.4% (3/685) underwent TFA first but transitioned to TRA. There was no significant difference in age (mean, 40.9 TFA; mean, 39.1 TRA; P = 0.42) or sex (P = 0.87) between those who underwent TFA vs TRA. TRA were successfully performed for 23 pelvic, 1 splenic, 2 renal, 10 hepatic, 1 mesenteric, 2 intercostal artery, and 8 combination cases. Reasons for TFA to TRA transition include difficulty accessing the femoral artery or the bleeding target artery. Reasons given for attempting TRA before TFA include groin hematomas and pelvic binder. 87.2% (41/47) had a pre-procedural CT/CTA demonstrating hemorrhage or pseudoaneurysm. 72.3% (34/47) had a post-procedure CT/CTA for follow-up. The average contrast usage for TRA cases was 106.4 cc with mean fluoro time of 17.5 min. The reintervention rate was 14.9% (7/47) due to rebleeding or no active bleeding seen on the initial angiogram. There were no reported radial access site complications. Although IRs traditionally have relied on TFA for trauma angiography and embolization, TRA can be an alternative, safe option for a variety of emergent cases. TRA may be the route of choice in trauma patients with groin hematomas or pelvic binders.

Abstract No. 584 Common Interventional Radiology Procedures Performed by Physician Assistants and Nurse Practitioners: Medicare Trends from 2010 to 2018

Abstract No. 584 Common Interventional Radiology Procedures Performed by Physician Assistants and Nurse Practitioners: Medicare Trends from 2010 to 2018