Interventional Radiology Procedures Research Articles

Procedural sedation and analgesia in pediatric diagnostic and interventional radiology: An expert DELPHI consensus document developed by the ITALIAN scientific society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI).

Children undergoing diagnostic and interventional radiology procedures often require sedation to achieve immobility and analgesia if the procedure is painful. In the past decades, leading scientific organizations have developed evidence-based guidelines for procedural sedation and analgesia in children outside of the operating room. Their recommendations are being applied to procedural sedation in radiology. However, some questions remain open regarding specific aspects contextualized to the radiology setting, such as elective prone sedation, the urgency of the procedure, when venous access or airway protection is required, and others. To address the unresolved issues of procedural sedation and analgesia in pediatric diagnostic and interventional radiology. An expert panel of pediatricians, pediatric anesthesiologists, intensivists, and neuroradiologists selected topics representative of current controversies and formulated research questions. Statements were developed by reviewing the literature for new evidence, comparing expertise and experience, and expressing opinions. Panelists' agreement with the statements was collected anonymously using the DELPHI method. Twelve evidence-based or expert opinion incorporate are presented, considering risks, benefits, and applicability. This consensus document, developed by a multidisciplinary panel of experts involved in the field, provides statements to improve the quality of decision-making practice in procedural sedation and analgesia in pediatric radiology.

Radiation Exposure and Safety Considerations in Interventional Radiology: Comparison of a Twin Robotic X-ray System to a Conventional Angiography System.

Background/Objectives: To evaluate radiation exposure in standard interventional radiology procedures using a twin robotic X-ray system compared to a state-of-the-art conventional angiography system. Methods: Standard interventional radiology procedures (port implantation, SIRT, and pelvic angiography) were simulated using an anthropomorphic Alderson RANDO phantom (Alderson Research Laboratories Inc. Stamford, CT, USA) on an above-the-table twin robotic X-ray scanner (Multitom Rax, Siemens Healthineers, Forchheim, Germany) and a conventional below-the-table angiography system (Artis Zeego, Siemens Healthineers, Forchheim, Germany). The phantom's radiation exposure (representing the potential patient on the procedure table) was measured with thermoluminescent dosimeters. Height-dependent dose curves were generated for examiners and radiation technologists in representative positions using a RaySafe X2 system (RaySafe, Billdal, Sweden). Results: For all scenarios, the device-specific dose distribution differs depending on the imaging chain, with specific advantages and disadvantages. Radiation exposure for the patient is significantly increased when using the Multitom Rax for pelvic angiography compared to the Artis Zeego, which is evident in the dose progression through the phantom's body as well as in the organ-related radiation exposure. In line with these findings, there is an increased radiation exposure for the performing proceduralist, especially at eye level, which can be significantly minimized by using protective equipment (p < 0.001). Conclusions: In this study, the state-of-the-art conventional below-the-table angiography system is associated with lower radiation dose exposures for both the patient and the interventional radiology physician compared to an above-the-table twin robotic X-ray system for pelvic angiographies. However, in other clinical scenarios (port implantation or SIRT), both devices are suitable options with acceptable radiation exposure.

Evaluation of lower detection limit and performance analyses related to the incident angle of X-rays and absolute dose using a triple-type dosimeter

When using a wearable active-type dosimeter for real-time dosimetry during X-ray fluoroscopic procedures, medical staff should be aware of the potential for an inaccurate exposure dose due to the large angular dependence. To address this issue, our research group has proposed a triple-type active dosimeter. With this device, the incident angle of scattered X-rays can be determined based on the signal difference between two dosimeters placed side-by-side, in which the wedge filters on the entrance windows are arranged symmetrically. In addition, the absolute dose can be determined from the central dosimeter with angular dependence correction. Although the concept of using wedge filters was proven in a previous study, the wedge filter materials have not been sufficiently studied. In this study, therefore, we sought to determine which of several materials was best suited as a wedge filter material for medical applications: aluminum (Al), titanium (Ti), or copper (Cu). We analyzed the performance of dosimeters with the different wedge filter materials in terms of estimation accuracy and lower detection limit. Using a clinical fluoroscopic system with a tube voltage of 80 kV, the scattered X-rays generated from an elliptical cylinder water phantom were measured while varying the incident direction of the X-rays from −50° to +50° in 10-degree intervals. The experimental results showed that the incident angles were properly determined when using the Ti filter, but the estimation accuracy was slightly lower when using the Al and Cu filters. The accuracy of absolute dose was evaluated from the standard deviation of the absolute dose data between −50° and +50°. As a result, the accuracies when using the Al, Ti, and Cu filters were 3.6%, 3.9%, and 5.9%, respectively. The lower detection limit when using the Cu filter showed a significantly higher value (0.50 μSv/s), but that with the Ti filter was reasonable (0.07 μSv/s). Based on these experimental evaluations, we concluded that the Ti filter would be suitable for use in a triple-type dosimeter. Finally, we investigated the expected dose rates of scattered X-rays in various interventional radiology (IVR) procedures described in the literature and determined that our dosimeter could be used for actual dose measurement.

Comparison of experimental measurements and fast Monte Carlo simulations for typical set-ups in fluoroscopically-guided interventional procedures

PyMCGPU-IR is an application based on the Monte Carlo code MCGPU-IR that automatically retrieves procedure information from X-ray systems and medical worker positions from a tracking camera system. PyMCGPU-IR calculates personal dose equivalent values, doses in organs and effective dose values for both patient and medical staff in interventional radiology procedures and displays them visually. The code’s main advantage lies in its time efficiency, enabling simulations in under two minutes with statistical uncertainties below 5% (k = 2).This study involved testing in a hospital room using an interventional X-ray system. A RANDO phantom simulated the patient, with passive dosimeters affixed to the back for measuring skin dose values. A PMMA slab phantom represented the operator, with passive and active dosimeters affixed to its front surface to measure Hp(10). The irradiation conditions were simulated with PyMCGPU-IR using voxelized geometries to represent both phantoms. Results demonstrate good agreement between PyMCGPU-IR simulations and measured patient skin dose values, with differences of up to 5% for mean skin dose and up to 14% for the peak skin dose. Concerning Hp(10) values on the operator phantom, PyMCGPU-IR calculated values fall within the uncertainty ranges of dosimeter measurements for most points. The highest Hp(10) discrepancy is 42%, which is acceptable when compared with the typical variability observed between active and passive personal dosimeters measurements in interventional radiology. The results demonstrate PyMCGPU-IR’s satisfactory performance for patient and personal dosimetry, compared to existing solutions like commercial skin dose calculation software and personal physical dosimeters.

A cross-sectional observational study on quality assurance and radiation safety in interventional radiology

Background Interventional Radiology (IR) is anticipated to play an increasingly pivotal role in modern healthcare, providing vital minimally invasive procedures for diagnosis and treatment. As the frequency and complexity of IR procedures continue to evolve, maintaining impeccable standards in quality assurance (QA) and radiation safety becomes paramount. This study is designed to assess prevailing QA practices comprehensively, gauge adherence to forthcoming radiation safety guidelines, and proactively identify areas primed for advancement within diverse interventional radiology units. Methods Employing a prospective cross-sectional observational design on 48 health professionals, an array of healthcare facilities, each equipped with a state-of-the-art IR unit, will be purposefully selected. The study cohort will encompass diverse participants, including interventional radiologists, radiologic technologists, nurses, and medical physicists. The study will be conducted in the Acharya Vinoba Bhave Rural Hospital’s facilities equipped with interventional radiology units. Analysis will be done by using R studio version 4.3.1 by using t-test and chi-square. Expected results The anticipated quantitative data analysis will undoubtedly yield nuanced insights into the participants’ multifaceted roles, experiences, and prospective perceptions concerning QA and radiation safety practices. In equal measure, the quantitative analysis is poised to uncover recurring thematic strands about the efficacy of current QA frameworks, radiation safety protocols, and the multifarious challenges envisaged in maintaining elevated standards. Study implication As this study unfolds, it will illuminate the evolving landscape of QA and radiation safety intrinsic to interventional radiology. This study is poised to guide future practice improvement, refine training paradigms, and shape forthcoming policies within this dynamic field by casting a discerning eye on potential gaps and imminent challenges. The conclusive insights are anticipated to underscore the enduring commitment required to ensure the safety of patients and healthcare professionals, concurrently fostering the pioneering trajectory of interventional radiology procedures.

Comparison of periprocedural and procedure room times between moderate sedation and monitored anesthesia care in interventional radiology.

In recent years, there has been increased utilization of monitored anesthesia care (MAC) in interventional radiology (IR) departments. The purpose of this study was to compare pre-procedure bed, procedure room, and post-procedure bed times for IR procedures performed with either nurse-administered moderate sedation (MOSED) or MAC. An institutional review board-approved single institution retrospective review of IR procedures between January 2010 and September 2022 was performed. Procedures performed with general anesthesia or local anesthetic only, missing time stamps, or where <50 cases were performed for both MAC and MOSED were excluded from the study. Pre-procedure bed, procedure room, post-procedure bed, and total IR encounter times were compared between MAC and MOSED using the t-test. The effect size was estimated using Cohen's d statistic. 97,480 cases spanning 69 procedure codes were examined. Mean time in pre-procedure bed was 27 min longer for MAC procedures (69 vs. 42 min, P < 0.001, d = 0.95). Mean procedure room time was 11 min shorter for MAC (60 vs. 71 min, P < 0.001, d = 0.48), and mean time in post-procedure bed was 10 min longer for MAC (102 vs. 92 min, P < 0.001, d = 0.22). Total IR encounter times were on average 27 min longer for MAC cases (231 vs. 204 min, P < 0.001, d = 0.41). MAC improves the utilization of IR procedure rooms, but at the cost of increased patient time in the pre- and post-procedure areas.

Unusual vascular cause of syncope in an adult patient: type 2 proatlantal intersegmental artery.

A proatlantal intersegmental artery anomaly may present with symptoms such as dizziness and syncope. Because it has the risk of damage in surgical and interventional radiological procedures, to know the presence of this unusual vascular anomaly is very important.

Evaluación mediante TC de las complicaciones de la úlcera gastroduodenal

Gastric and duodenal ulcers (GDUs) are decreasing both in frequency and rate of mortality. However, GDUs with complications continue to have higher mortality rates and are seldom suspected in patients presenting with acute abdomen. Although upper endoscopy plays a central role in the diagnosis and treatment of GDUs, CT is crucial when serious complications appear, namely uncontrolled acute haemorrhage, perforation, organ penetration, or gastric obstruction. Radiologists have a special role to play in these situations, providing the diagnosis and extent of complications, thus contributing to decision making which can range from conservative management to endoscopic, surgical or interventional radiology procedures. The aim of our study is to describe the CT indications and protocols for patients with a suspected GDU with complications and present the main imaging findings for the different types of complications, while providing differential diagnoses.

Impact of Work Environment on Job Satisfaction among Interventional Radiologists in Japan: A Cross-sectional Study.

This study aims to measure job satisfaction among interventional radiology physicians in Japan and analyze the factors affecting job satisfaction. A web-based survey was conducted among the members of the Japanese Society of Interventional Radiology between October and December 2021. Participants were questioned regarding their job satisfaction, workplace, work status, and demographic information. Principal component analysis was applied to 15 reasons related to job satisfaction, and the factors affecting job satisfaction were analyzed. Valid responses were obtained from 901 (31.9%) of the 2,824 interventional radiology physicians invited to participate. Job satisfaction was reported as "very satisfied" in 79 (8.8%), "moderately satisfied" in 426 (47.3%), "neither satisfied nor dissatisfied" in 230 (25.5%), "moderately dissatisfied" in 133 (14.8%), and "very dissatisfied" in 33 (3.7%) respondents. Thus, there were 505 (56.0%) satisfied physicians. Three principal components were extracted from the reasons for job satisfaction. Job satisfaction tended to be higher among those who reported performing a higher number of interventional radiology procedures and was positively associated with a higher rate of work time dedicated to interventional radiology and the first principal component (the environment of clinical practice, research, and interventional radiology education). The third principal component (salary and work environment) and the absence of an "IkuBoss" [a boss who takes initiative in creating a work environment supportive of the work-life balance of colleagues] were associated with lower job satisfaction. More than half the participants reported high job satisfaction. Job satisfaction of interventional radiology physicians in Japan was positively associated with a favorable clinical, research, and educational environment and negatively associated with the absence of an "IkuBoss," noninterventional radiology work, overtime work, and salary.

Assessment of Efficacy and Complications of Endovascular Interventions for Critical Limb Ischemia in Germany: A Nationwide Study.

Endovascular interventional radiological procedures have become the mainstay for the treatment of critical limb ischemia (CLI) due to arterial stenosis or occlusion. Open surgical or endovascular procedures, such as percutaneous transluminal angioplasty (PTA) or stenting can be used as a treatment strategy. The aim is to evaluate the success and major complication rates of interventional radiology treatments for CLI in Germany in 2021, and to compare these results with internationally published data. Data for PTA and stenting in CLI for 2021 was obtained from the quality management system of the German Society of Interventional Radiology (DeGIR). 16 393 PTA procedures, 701 stenting procedures, and 8110combined procedures were documented for 2021. Data was analyzed for technical and clinical success rates, as well as major complication rates documented mainly as major bleeding, distal embolization, and aneurysm formation. PTA had technical and clinical success rates of 96.3 % and 92.33 %, respectively. Stenting had technical and clinical success rates of 98.7 % and 96.15 %, respectively. PTA and stenting combined had success rates of 98.71 % and 96.91 %, respectively. The major complications were mainly: major bleeding (PTA: 0.40 %; stenting: 1.28 %; PTA and stenting: 0.54 %), distal embolization (PTA: 0.48 %; stenting: 1 %; PTA and stenting: 0.96 %), and aneurysm formation (PTA: 0.19 %; stenting: 0.43 %; PTA and stenting: 0.19 %). All procedures showed high technical and clinical success rates, while the complication rates were low. Interventional radiologists in Germany perform effective and safe treatment for CLI, achieving outcomes that tend to surpass internationally published data. · German interventional radiologists provide safe and effective critical limb ischemia treatment.. · Major complications occurred at maximum in 1.28 % of cases.. · Outcomes tend to surpass international data, indicating strong performance..

Radiation shielding assessment for interventional radiology personnel: Geant4 dosimetry of lead-free compositions

The inherent biological hazards associated with ionizing radiation necessitate the implementation of effective shielding measures, particularly in medical applications. Interventional radiology, in particular, poses a unique challenge as it often exposes medical personnel to prolonged periods of high x-ray doses. Historically, lead and lead-based compounds have been the primary materials employed for shielding against photons. However, the drawbacks of lead, including its substantial weight causing personnel’s inflexibility and its toxicity, have raised concerns regarding its long-term impact on both human health and the environment. Barium tantalate has emerged as a promising alternative, due to its unique attenuation properties against low-energy x-rays, specifically targeting the weak absorption area of lead. In the present study, we employ the Geant4 Monte Carlo simulation tool to investigate various formulations of barium tantalate doped with rare earth elements. The aim is to identify the optimal composition for shielding x-rays in the context of interventional radiology. To achieve this, we employ a reference x-ray spectrum typical of interventional radiology procedures, with energies extending up to 90 keV, within a carefully designed simulation setup. Our primary performance indicator is the reduction in air kerma transmission. Furthermore, we assess the absorbed doses to critical organs at risk within a standard human body phantom protected by the shield. Our results demonstrate that specific concentrations of the examined rare earth impurities can enhance the shielding performance of barium tantalate. To mitigate x-ray exposure in interventional radiology, our analysis reveals that the most effective shielding performance is achieved when using barium tantalate compositions containing 15% Erbium or 10% Samarium by weight. These findings suggest the possibility of developing lead-free shielding solutions or apron for interventional radiology personnel, offering a remarkable reduction in weight (exceeding 30%) while maintaining shielding performance at levels comparable to traditional lead-based materials.

Radiation reduction for interventional radiology imaging: a video frame interpolation solution

PurposeThe aim of this study was to diminish radiation exposure in interventional radiology (IR) imaging while maintaining image quality. This was achieved by decreasing the acquisition frame rate and employing a deep neural network to interpolate the reduced frames.MethodsThis retrospective study involved the analysis of 1634 IR sequences from 167 pediatric patients (March 2014 to January 2022). The dataset underwent a random split into training and validation subsets (at a 9:1 ratio) for model training and evaluation. Our approach proficiently synthesized absent frames in simulated low-frame-rate sequences by excluding intermediate frames from the validation subset. Accuracy assessments encompassed both objective experiments and subjective evaluations conducted by nine radiologists.ResultsThe deep learning model adeptly interpolated the eliminated frames within IR sequences, demonstrating encouraging peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM) results. The average PSNR values for angiographic, subtraction, and fluoroscopic modes were 44.94 dB, 34.84 dB, and 33.82 dB, respectively, while the corresponding SSIM values were 0.9840, 0.9194, and 0.7752. Subjective experiments conducted with experienced interventional radiologists revealed minimal discernible differences between interpolated and authentic sequences.ConclusionOur method, which interpolates low-frame-rate IR sequences, has shown the capability to produce high-quality IR images. Additionally, the model exhibits potential for reducing the frame rate during IR image acquisition, consequently mitigating radiation exposure.Critical relevance statementThis study presents a critical advancement in clinical radiology by demonstrating the effectiveness of a deep neural network in reducing radiation exposure during pediatric interventional radiology while maintaining image quality, offering a potential solution to enhance patient safety.Key points• Reducing radiation: cutting IR image to reduce radiation.• Accurate frame interpolation: our model effectively interpolates missing frames.• High visual quality in terms of PSNR and SSIM, making IR procedures safer without sacrificing quality.Graphical

A Good Prognosis of Patients with Acute Pancreatitis Combined with Pulmonary Embolism: Early Identification and Intervention.

Pulmonary embolism (PE) is a relatively rare vascular complication of acute pancreatitis (AP), and its mortality rate is high. To our knowledge, relevant literature reports still need to be summarized. In this study, we analyzed the clinical characteristics, treatment, and prognosis of five patients with AP complicated by PE and summarized and reviewed the relevant literature. Clinical data of patients with AP complicated by PE treated in Taizhou Hospital of Zhejiang Province between January 2017 and September 2022 were retrospectively collected. Combined with the relevant literature, the clinical characteristics, treatment, and prognoses of patients with AP combined with PE were analyzed and summarized. Five patients were eventually enrolled in this study. Among the five patients with AP complicated by PE, all (100%) had symptoms of malaise, primarily chest tightness, shortness of breath, and dyspnea. All patients (100%) had varied degrees of elevated D-dimer levels and a significant decrease in the pressure of partial oxygen (PO2) and pressure of arterial oxygen to fractional inspired oxygen concentration ratio (PaO2/FiO2). Computed tomographic angiography (CTA) or pulmonary ventilation/perfusion imaging revealed a pulmonary artery filling defect in these patients. One patient (20%) had left calf muscular venous thrombosis before the occurrence of PE. Four patients (80%) were treated with lowmolecular- weight heparin (LMWH), and one patient (20%) was treated with rivaroxaban during hospitalization; all continued oral anticoagulant therapy after discharge. All patients (100%) were cured and discharged. No patients showed recurrence of AP or PE. PE is a rare but life-threatening complication of AP. However, once diagnosed, early treatment with anticoagulation or radiological interventional procedures is effective, and the prognosis is good. Core Tips: Pulmonary embolism (PE) is a rare but life-threatening complication of acute pancreatitis (AP). Its early diagnosis and timely anticoagulation or radiological intervention can reduce mortality. However, only nine cases have been reported in the English literature thus far, and they are all case reports. Our study is the first systematic analysis of patients with AP combined with PE with a review of the relevant literature. Our patients and those reported in the literature were discharged with good prognoses under treatment such as anticoagulation and vascular intervention. These cases remind clinicians that, in patients with AP, especially those with risk factors for venous thrombosis, it is necessary to monitor the D-dimer level dynamically. Clinicians should pay attention to AP patients' symptoms and related examinations to reduce the chance of a missed diagnosis or misdiagnosis of PE.

Spontaneous Contralateral Adrenal Hemorrhage during Periduodenal Abscess Drain Placement

A spontaneous adrenal hemorrhage is a rare complication occurring in the setting of interventional radiology procedures. Here, we present the case of a 73-year-old male who underwent CT-guided drainage of a periduodenal collection. During the procedure, he developed sudden onset left back pain and hypertension, which revealed a left adrenal gland hemorrhage on CT imaging. Potential mechanisms for this complication include a physiological stress response, procedure-associated hypercoagulability, and direct trauma to the adrenal gland. Moreover, an adrenal hemorrhage should be monitored closely as it can lead to severe clinical consequences requiring treatment with IV analgesics and antihypertensives.

Development and evaluation of modified lead gloves to reduce hand radiation dose during interventional radiological procedures

We developed lead gloves that minimize radiation dose to the operator's hands during interventional radiological procedures and that do not impede the operator's surgical capabilities. Existing lead gloves can protect the operator's hands by shielding radiation, but use of such gloves may impair preception sensitivity, resulting in a reduction in the operator's surgical ability. Accordingly, in this study, we developed modified lead gloves that can reduce radiation dose while maintaining operator sensitivity during procedures by modifying the operator's main surgical finger area in existing lead gloves. To evaluate the performance of developed modified lead gloves, radiation was applied in surgical conditions without gloves and with surgical gloves, lead gloves, and modified lead gloves. The radiation dose was evaluated for each condition. When the modified lead gloves were worn, the degree of shielding was similar to when conventional lead gloves were worn. Based on these results, if the operator wears modified lead gloves during interventional radiological procedures, they will protect the hands from radiation while maintaining physical sensitivity in the hands.

Abstract TP63: Eliminate Delays: Utility of a Cross-Trained Nurse Responder Team in Acute Stroke

Background: Over the past year, it was noted that having two separate teams (Rapid Response (RRT) and Code Stroke) delayed the care of multiple stroke patients. Challenges encountered included: waiting for the Code Stroke Team to arrive, delays in essential stroke care metrics (door to needle, door to groin, &amp; door to start of device), and waiting for Interventional Radiology (IR) personnel to begin IR procedures. Purpose: The purpose of this project was to determine if a cross-trained Nurse Responder Team would decrease the time to essential nursing stroke care interventions and wait times to neuro-interventional acute stroke treatment. Methods: Utilizing the Plan-Do-Check-Act quality improvement method, we cross-trained our Rapid Response Nurses to various types of emergency responses including Code Stroke. Thus, the evolution a Rapid Response Team to a Nurse Responder Team. Training consisted of on-line learning management system courses, preceptorship, and simulation training. Data was collected and analyzed at various times throughout the Code Stroke process. Time markers collected included: time RRT call was changed to Code Stroke, time the Stroke Team arrived, and time between when a Code Stroke patient arrived in IR without an available IR nurse to initial groin puncture. Results: Implementing a multiple code cross-trained Nurse Responder Team reduced the need to call another nursing response team to begin the Code Stroke process. This resulted in a decrease in treatment times, the number of patient hand-offs, wait times for IR endovascular procedures, door to needle time, door to groin time and door to start of device time. The median door to needle time before the nurse responder team was 90 minutes and after the nurse responder team the median was 52.5. The before median door to groin time was 104 minutes and after door to groin time was 91.3. The percentage of time, the door to start of device within 60 minutes for patients transferred from outside hospital or 90 minutes in presented directly, was increased from 16.7 to 53.8% with initiation of the Nurse Responder Team. Conclusions: A cross-trained Nurse Responder Team improved stroke quality indicators.

Clinical benchmarking of a commercial software for skin dose estimation in cardiac, abdominal, and neurology interventional procedures.

Radiation exposure from interventional radiology (IR) could lead to potential risk of skin injury in patients. Several dose monitoring software like radiation dose monitor (RDM) were developed to estimate the patient skin dose (PSD) distribution in IR. This study benchmarked the accuracy of RDM software in estimating PSD as compared to GafChromic film baseline in-vivo measurements on patients during cardiac, abdominal, and neurology IR procedures. The prospective study conducted in four IR departments included 81 IR procedures (25 cardiac, 31 abdominal, and 25 neurology procedures) on three angiographic systems. PSD and field geometry were measured by placing GafChromic film under the patient's back. Statistical analyses were performed to compare the software estimation and film measurement results in terms of PSD and geometric accuracy. Median values of measured/calculated PSD were 1140/1005, 591/655.9, and 538/409.7mGy for neurology, cardiac, and abdominal procedures, respectively. For all angiographic systems, the median (InterQuartile Range, IQR) difference between calculated and measured PSD was -10.2% (-21.8%-5.7%) for neurology, -4.5% (-19.5%-15.5%) for cardiac, and -21.9% (-38.7%--3.6%) for abdominal IR procedures. These differences were not significant for all procedures (p>0.05). Discrepancies increased up to -82% in lower dose regions where the measurement uncertainties are higher. Regarding the geometric accuracy, RDM correctly reproduced the skin dose map and estimated PSD area dimensions closely matched those registered on films with a median (IQR) difference of 0cm (-1-0.8cm). RDM is proved to be a useful solution for the estimation of PSD and skin dose distribution during abdominal, cardiac and neurology IR procedures despite a geometry phantom which is not specific to the latter type of IR procedures.

The burden of cervical cancer survivorship: Understanding morbidity and survivorship needs through hospital admissions

ObjectiveTo describe disease- and treatment-related survivorship burden amongst survivors of cervical cancer and identify risk factors for hospital admissions after initial treatment. MethodsRetrospective chart review including patients treated for cervical cancer from 2014 to 2020 at a single urban academic institution. Clinical, demographic, and hospital admission characteristics were summarized. Associations between patient characteristics and likelihood of admission were examined using univariate and multivariate regression. ResultsOf 366 patients undergoing surveillance following completion of primary treatment, 156 (43 %) were hospitalized for cancer or treatment-related sequela in the median follow-up of 3.6 years (IQR 1.4–6.4), with a median of 2 admissions (IQR 1–4.5) per patient and 570 unique admissions. While 65 (35 %) of admitted patients had multiple reasons for admission, the most common reasons for admission were: gastrointestinal complications (43 %), infection (38 %), genitourinary complications (33 %), and pain control (23 %). A substantial proportion of admitted patients underwent interventions including surgical procedures (57 %), transfusion of blood products (40 %), and interventional radiology procedures (28 %) and utilized supportive care services including case management (53 %), physical therapy (40 %), and occupational therapy (36 %). On multivariate analysis, odds of admission were higher among Black patients (aOR 2.4, p <.01), uninsured patients (aOR 2.7, p <.05), those with lower performance status (aOR 1.4, p <.05), and those with recurrence (aOR 5.5, p <.001). ConclusionSurvivors of cervical cancer represent a high-risk population frequently hospitalized after initial treatment. Black patients, uninsured patients, those with recurrence, and those with lower performance status faced higher odds of admission. Comprehensive, team-based care is necessary to address complex survivorship needs.

Radiation dose to multidisciplinary staff members during complex interventional procedures

IntroductionComplex interventional radiology procedures involve extensive fluoroscopy and image acquisition while staff are in-room. Monitoring occupational radiation dose is crucial in optimization. The purpose was to determine radiation doses received by staff involved in complex interventional procedures performed in a dedicated vascular or neuro intervention room. MethodsIndividual real-time radiation dose for all staff involved in vascular and neuro-interventional procedures in adult patients was recorded over a one-year period using wireless electronic dosimeters attached to the apron thyroid shield. A reference dosimeter was attached to the C-arm near the tube housing to measure scattered, unshielded radiation. Radiology staff carried shoulder thermo-luminescent dosimeters with monthly read-out to monitor dose over time. ResultsOccupational radiation dose was measured in 99 interventional procedures. In many cases prostate artery embolization procedures exposed radiologists to high radiation doses with a median of 15.0 μSv and a very large spread, i.e. 0.2–152.5 μSv. In all procedures except uterine fibroid embolization radiographers were exposed to lower doses than those of radiologists, with endovascular aortic repair being the procedure with highest median exposure to assisting radiographers, i.e. 2.2 μSv ranging from 0.1 to 36.1 μSv. Median radiation dose for the reference dosimeter was 670 μGy while median staff dose for all procedures combined was 3.2 μGy. ConclusionRadiation doses for multiple staff were determined and the ratio between staff dose and reference dosimeter indicated proper use of shielding in general. Some high-dose procedures may need further optimization for certain staff members, especially those not primarily employed in radiology. Implications for practiceThe study provides benchmark doses that may be used widely in audits and in the ongoing effort to optimize radiation protection for staff in interventional radiology.

National survey to update the diagnostic reference levels in interventional radiology procedures in Italy: working methodology.

Interventional Radiology (IR) deals with the diagnosis and treatment of various diseases through medically guided imaging. It provides unquestionable benefits to patients, but requires, in many cases, the use of high doses of ionizing radiation with a high impact on radiation risks to patients and to overall dose to the population. The International Commission on Radiological Protection introduced Diagnostic reference levels (DRLs) as an effective tool to facilitate dose verification and optimize protection for patients undergoing radiological procedures. In addition, EURATOM Council Directive 2013/59 and its Italian transposition (Legislative Decree 101/2020) have reiterated that DRLs must be established for many common radiological diagnostic procedures to compare the radiation dose delivered for the same diagnostic examination. Within this framework, Istituto Superiore di Sanità-Italian National Institute of Health (ISS)-, in collaboration with relevant Italian Scientific Societies, has provided documents on DRLs in radiological practices such as diagnostic and IR and diagnostic nuclear medicine. These reference documents enable National Hospitals to comply national regulation. The implementation of DRLs in IR is a difficult task because of the wide distribution of doses to patients even within the same procedure. Some studies have revealed that the amount of radiation in IR procedures is influenced more by the complexity of the procedure than by the weight of the patient, so complexity should be included in the definition of DRLs. For this reason, ISS promoted a survey among a sample of Italian Centers update national DRL in IR procedures with related complexity factors than can be useful for other radiological centers and to standardize the DRLs values. In the present paper the procedural methodology developed by ISS and used for the survey will be illustrated.