Interventional Radiology Research Research Articles

Fostering research in pediatric interventional radiology: needs assessment and suggestions for support.

Due to the rarity of pediatric diseases, collaborative research is the key to maximizing the impact of research studies. A research needs assessment survey was created to support initiatives to foster pediatric interventional radiology research. To assess the status of pediatric interventional radiology research, identify perceived barriers, obtain community input on areas of research/education/support, and create metrics for evaluating changes/responses to programmatic initiatives. A survey link was sent to approximately 275 members of the Society for Pediatric Interventional Radiology (SPIR) between May and October 2020. Data was collected using a web-based interface. Data collected included practice setting, clinical role, research experience, research barriers, and suggestions for future initiatives. Fifty-nine surveys were analyzed with a staff physician survey response rate of 28% (56/198). A wide range of practice sizes from 15 countries were represented. Respondents were predominantly staff physicians (95%; 56/59) with an average of 11years (range: 1-25years) of clinical experience working at academic or freestanding children's hospitals. A total of 100% (59/59) had research experience, and 70% (41/58) had published research with a mean of 30 peer-reviewed publications (range: 1-200). For job security, 56% (33/59) of respondents were expected or required to publish, but only 19% (11/58) had research support staff, and 42% (25/59) had protected research time, but of those, 36% (9/25) got the time "sometimes or never." Lack of support staff, established collaborative processes, and education were identified as top barriers to performing research. The needs assessment survey demonstrated active research output despite several identified barriers. There is a widespread interest within the pediatric interventional radiology community for collaborative research.

Awareness of interventional radiology and image guided musculoskeletal interventions among orthopaedic surgeons, rheumatologists, and physiatrists: A multi-site analysis

PurposeEvaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education. Materials and methodsA 17-question survey was distributed to orthopaedic surgeons, physiatrists, and rheumatologists in the 14-hospital health system. It inquired about demographics, practice environment, awareness of interventional radiology (IR) and MSK radiology (MSKR) training, referral patterns, and knowledge of image-guided MSK interventions. ResultsIn total, 59 of 303 physicians completed the survey (41% orthopaedists, 35% physiatrists, and 24% rheumatologists). Most (93%) were attendings and 41% were female. A minority of survey respondents (17%) recognized the designation of IR as a distinct specialty of medicine per the American Board of Medical Specialties, in contrast to MSKR, which is not designated as a distinct specialty. When queried about IR procedures not under investigation, 24% selected genicular artery embolization and 31% selected embolization for adhesive capsulitis. Barriers to referral were as follows: 21% of specialists performed the procedure, 17% listed electronic medical record challenges, 14% reported scheduling difficulty, 13% reported no barriers, 11% reported difficulty consulting, 11% referred to another specialty, 10% did not have enough knowledge of image guided procedures, and 3% reported the procedure is not performed by IR or MSKR. ConclusionsSurvey data reveal a knowledge gap among surveyed physicians regarding IR as a specialty as well as areas of IR research in MSK disorders. Findings suggest areas where referring physicians can be educated and identify barriers to referral.

Abstract No. 234 Systematic Review and Update on Economic Research in Interventional Radiology

Abstract No. 234 Systematic Review and Update on Economic Research in Interventional Radiology

Barriers to research in interventional radiology within the UK

To identify these barriers to research within interventional radiology (IR) and suggest potential solutions to support IR academia within the UK and beyond. An electronic survey was compiled using Google Forms and distributed to the British Society of Interventional Radiology (BSIR) members by email and through social media (Twitter). The survey was open between 15 October 2021 and 15 December 2021. Questions included prior research experience and qualifications, research interests and barriers to research development. The data were analysed in Microsoft Excel 365. One hundred and six responses were received with the majority from junior (42.5%) and senior radiology trainees (25.5%). Eight-three percent had not undertaken formal research qualifications with 56.4% stating they would like to undertake a PhD or MD; 81.1% stated they planned to be involved in research. The most common perceived barriers were lack of time (64.2%), lack of research experience (61.3%), and lack of senior supervision (58.5%). Developing and supporting the academic IR infrastructure is vital to ensure the future of IR. Radiology trainees have shown interest in being involved with IR research and undertaking formal research training. Additional support from local hospitals, national societies, and the Royal College of Radiologists are required.

Bibliometric analysis of interventional radiology studies in PubMed-indexed literature from 1991 to 2020

PurposeTo evaluate interventional radiology (IR) research over time based on the study type of published articles and the visibility of articles to non-radiology clinicians. MethodsWe performed a search of all PubMed-indexed literature from January 1, 1991, through November 11, 2020, for clinical IR articles classified by their study type, categorized as: 1) meta-analyses/systematic reviews/practice guidelines; 2) randomized controlled trials; 3) non-randomized controlled trials; and 4) longitudinal/observational studies. Clinical IR articles were defined as those that met keyword criteria constructed from Society of Interventional Radiology procedure guides. Data were also collected on medical specialty journal categories that published IR-related articles. ResultsWhen we examined the first vs. the last decade of our study period, the number of IR articles published increased across all study types: randomized controlled trials (374 to 2620; 601% change), longitudinal/observational studies (2324 to 12,447; 436%), meta-analyses/systematic reviews/practice guidelines (1179 to 6135; 420%), non-randomized controlled trials (471 to 2161; 359%). The journal categories with the highest mean percentage increase of IR articles across all study types were obstetrics and gynecology (659%), peripheral vascular disease (342%), and emergency medicine (221%). We found a decrease of IR articles published in surgery (−6.0%), pediatrics (−14%), and pulmonary (−21%) journals. ConclusionThe number of IR articles grew quickly and at a similar rate compared with all PubMed-indexed articles and increased as a proportion of articles published in non-imaging specialty journals. This indicates greater visibility of IR studies for all clinicians and is encouraging towards the advancement of IR techniques.

Gender-Based Survey Analysis of Research and Mentoring in Interventional Radiology

PurposeThis study sought to define gender-related differences in attitudes, perceptions, and aspirations among trainees interested in interventional radiology (IR) and to analyze their experiences in research and mentorship. Materials and MethodsA cross-sectional survey study was conducted among the members of the Society of Interventional Radiology Resident, Fellow, and Student section and Medical Student section in the summer of 2020. The anonymous, internally validated 27-item survey assessed demographics, research attitudes and experiences, mentorship, and career aspirations. Descriptive statistics were calculated using Fisher exact analyses and Student t-tests. The institutional review board approved the protocols for this study. ResultsOf 105 respondents who indicated their gender, 30% were women and 70% were men. Although both genders reported similar levels of research experience, female trainees were less likely to feel valued and encouraged by their institution to engage in research (2.79 out of 4 vs 3.16 out of 4, P = .02) and were less likely to indicate that their program required them to participate in research (2.47 vs 3.06, P = .01). Female residents and fellows reported more difficulty in finding a mentor (2.88 vs 3.28, P = .04) and received less mentorship relating to IR education (29% vs 64%, P = .002). ConclusionsThis work provides a perspective on the perceived obstacles faced by female trainees in pursuing research and finding effective mentorship in the field of IR. These data may guide future interventions to boost interest and engagement in IR research and residency programs in a way that promotes gender diversity and equity in the field.

Mentorship in Interventional Radiology: Addressing Obstacles to Pursuing Research and Innovation Among IR Trainees

To ascertain the perceived obstacles that medical students and Interventional Radiology (IR) residents face performing IR research during training and incorporating research into their future careers. The study was reviewed and exempt from Institutional Review Board review. Participants' attitudes and perceived barriers toward performing IR research, and experience with mentorship in IR were assessed using a 27-item survey sent to all members of the Society of Interventional Radiology Resident, Fellow and Student (SIR-RFS, n=445), and Medical Student Council (SIR-MSC, n=267) sections between July and September 2020. Descriptive statistics were computed for all assessed categorical variables. Fisher's exact tests were performed to measure the significance of association between categorical variables. Of the 712 students and residents surveyed, 151 (∼21%) responded. Of respondents, 100% reported that conducting research is important to advancing the field of IR. The highest ranked factors and obstacles to performing IR research were increased clinical demands (67.9%), lack of time (46.2%), lack of institutional support (41.5%), and lack of research experience (35.8%). Interestingly, those with a mentor were more likely to report an interest in pursuing a career in IR compared to those without a mentor (98.6% vs 41.0%, p < 0.0001). Furthermore, those with a mentor were more likely to report an interest in pursuing IR research compared to those without a mentor (32.5% vs 14.4%, p < 0.0001). There are many obstacles to performing IR research. Strong mentorship is an avenue to address these deterrents. The deployment of mentorship programs in IR is needed to ensure trainees can overcome the barriers outlined in this study and successfully pursue research careers in IR.

Potential Bias in Image-Guided Procedure Research: A Retrospective Analysis of Disclosed Conflicts of Interest and Open Payment Records

PurposeTo assess the prevalence of positive conflicts of interest (COI) disclosures in United States–based interventional radiology (IR) research as well as the level of agreement between disclosed financial relationships and Open Payment Data for top-cited image-guided procedure research. Materials and MethodsAll publications in volume 30 (2019) of the Journal of Vascular and Interventional Radiology (JVIR) were reviewed to estimate the prevalence of COI disclosures in IR research. Publications were categorized as primary research, systematic review, or other. The prevalence was subsequently compared across JVIR publication subtypes and categories and on the basis of whether they were device-focused publications using χ2 tests. Additionally, the Web of Science database was searched for the top 10 most cited studies of 10 common image-guided procedures with available U.S. physician payment data. The payments were categorized as historical (>1 year prior to publication) or active (<1 year prior to publication) and compared with the disclosed financial COIs using 1-way analysis of variance. ResultsPositive COI disclosures were present in 114 (29%) of the 397 publications in JVIR volume 30. Positive COI disclosures were most prevalent in standards of practice (50%, P = .01) and more prevalent in device-focused publications (54% vs 23%, P < .01). Among the 396 authors of 100 United States–based top-cited image-guided procedure publications, 383 (97%) failed to disclose at least 1 active financial relationship, with an average of $57,937 in undisclosed payments per publication. ConclusionsCOI are prevalent in IR, similar to other areas of healthcare research, and COI in top-cited image-guided procedure research are often underreported.

Abstract No. 98 Relationships between conflicts of interest and publication type: the importance of managing bias in interventional radiology research

To characterize the relationships between disclosed conflicts of interest (COIs) and publication type in the Journal of Vascular and Interventional Radiology (JVIR) to identify opportunities to support the integrity of interventional radiology (IR) research.

Abstract No. 478 Procedure dictations to t-test: leveraging natural language parsing in interventional radiology for extracting clinically significant medical data from unstructured dictations

Interventional radiology generates a large volume of procedure documentation that contain a wealth of medical data but in highly variable free-form text, which can hinder our ability to analyze and utilize the data. We designed a pipeline based on natural language parsing (NLP) and advanced pattern matching for 700 unstructured chest port insertion dictations as a proof of concept to demonstrate how raw text could be turned into quantitative data for analysis. We pulled 700 chest port insertion dictations from our medical system. Only patient MRN, date/time of procedure, sex, age, and the raw dictations were included in our initial dataset. We preprocessed and validated the data with both R and Python code. Glitches and anomalies from the data procurement process were filtered, the note was formatted, and abbreviations were clarified. We worked on implementing pattern matching and natural language parsing to extract useful quantitative information from the raw text. Apache CTakes, an open-source and free NLP program specifically designed for clinical text, and the National Library of Medicine’s Unified Medical Language System were used to standardize categorical and semantical relationships between words. R was used to perform statistical analysis. Extracted variables: From the 700 cases, we extracted out variables including indication for port insertion, left or right internal jugular approach, quantity of Versed or Fentanyl given, and the total sedation time. Of the 700 cases, the program identified 644 right IJ insertions vs. 40 left IJ insertions. A preliminary t-test identified a statistical significance (P = 0.01) in sedation time between right versus left IJ insertions. Our proof-of-concept pipeline demonstrates the utility of NLP in interventional radiology research and potential quality improvement. Although building the pipeline require a significant technical degree of knowledge and effort, it has potential to be a more effective method to quickly analyze a large dataset of unstructured documents. We are currently investigating the incorporation of more advanced NLP techniques and applying our pipeline on a broader scope of practice.

Evidence-based interventional radiology: past, present and future

Evidence-based interventional radiology is the result of the evolution and integration of evidence-based medicine and interventional radiology. It adopts the concepts and methods of evidence-based medicine to guide the best clinical practice in interventional radiology. We aim to systematically elaborate on the status quo of Clinical Research, Systematic Review/Meta-Analysis and Clinical Practice Guidelines in interventional radiology, analyze the existing problems, and put forward thoughts and suggestions on promoting the development of evidence-based interventional radiology in the future.

Placement of double-J stent in patients with malignant ureteral obstruction: antegrade or retrograde approach?

To determine whether antegrade or retrograde methods should be preferred for double-J stent placement in patients with malignant ureteral obstruction (MUO). The medical records of patients treated for MUO in the Urology and Interventional Radiology Clinic, Konya Training and Research Hospital, were reviewed retrospectively. Patients with benign aetiology were excluded from the study. Reports of the procedures, ultrasonography findings, computed tomography (CT), angiography, and pyelography images and the follow-up records of patients with MUO were assessed. A total of 111 patients and 114 ureteral stenting treatments were included in the study; 63 (55.3%) were operated on using the antegrade ureteral stenting (AUS) method, whereas 51 (44.7%) were operated on using the retrograde ureteral stenting (RUS), method, and the characteristics of these groups were evaluated. The presence of hydroureteronephrosis and ureteral tortuosity were determined. Overall success rates were found to be 95.2% using the AUS method and 47.1% using the RUS method. The technical success of the antegrade method was significantly higher in patients with or without tortuosity (respectively: p=0.005, Z shape p=0.001, pigtail shape p=0.035″). The technical success of the antegrade method was significantly higher in patients with hydroureteronephrosis (p=0.001). The AUS technique should be the first choice for double-J stent placement in patients with MUO.

Angiographic Atlas of the Visceral Vascular Anatomy in Translational Rat Models.

To characterize angiographic and cross-sectional imaging anatomy of the rat visceral vasculature in 2 translational models. Animal studies were conducted in accordance with institutional guidelines and approval of the Institutional Animal Care and Use Committees. Retrospective review of digital subtraction arteriography was performed in 65 Wistar and 50 Sprague-Dawley male rats through a left common carotid artery or right common femoral artery approach. MR imaging of the abdomen was performed on the rats to correlate imaging modalities. Aortography was performed in 3 locations, including cranial to the celiac artery, cranial to the renal arteries, and cranial to the caudal (inferior) mesenteric artery, enabling characterization of the visceral branch arteries in all 65 Wistar rats. Selective arteriography of first-, second-, and third-order branch vessels of the aorta was performed allowing characterization of normal and variant anatomy. Dedicated selective arteriography was performed of the celiac artery in 65 Wistar and 10 Sprague-Dawley rats, of the common hepatic artery in 65 Wistar and 50 Sprague-Dawley rats, and of the cranial mesenteric artery in 43 Wistar rats. MR imaging enabled correlation with the lobar and portal venous anatomy. Analysis of arteriography and MR imaging in these rat models will provide translational researchers with anatomic details needed to develop new endovascular protocols for small animal research in interventional radiology.

Abstract No. 469 Representation of developing countries in interventional radiology research

The developing world accounts for greater than ¾ of the global population, yet prior studies have shown a disproportionately low representation of developing countries in the medical literature. No prior study has assessed the participation of authors from the developing world in interventional radiology (IR) journals. The purpose of this study was to determine the representation of studies from developing countries in two influential IR journals. We reviewed all articles published from January 2014 through December 2016: 1) Journal of Vascular and Interventional Radiology (JVIR) and 2) CardioVascular and Interventional Radiology (CVIR). The country of origin of the first author was identified for each study. Each country was grouped into either “developed” or “developing” based on designations provided by the International Monetary Fund. We compared representation of developing countries by journal and year using Chi-Square tests with Freeman-Halton extension, as appropriate. 1300 articles were reviewed from 2014 to 2016, of which 153 (12%) were from developing countries. The most prevalent developing country was China with 88 articles (58%), followed by Turkey with 24 (16%), India with 13 (8%), and Brazil with 9 (6%). Excluding China, only 5% of articles were from Developing countries. In contrast, the United States accounted for 462 articles (36%), followed by Japan with 113 (9%). There was significantly less representation of developing countries in JVIR (9%) compared with CVIR (15%) (p = 0.003). There was no significant difference in representation of developing countries between the years (p = 0.3). Developing countries are disproportionately under-represented in two influential IR journals. Further study is needed to determine reasons for this low representation and to develop strategies to increase the number of IR publications from parts of the world where the disease burden is greatest.

Evaluating the Costs of IR in Health Care Delivery: Proceedings from a Society of Interventional Radiology Research Consensus Panel

Evaluating the Costs of IR in Health Care Delivery: Proceedings from a Society of Interventional Radiology Research Consensus Panel

Nursing Care of a Patient Undergoing Bariatric Embolization

Recently, there has been research in interventional radiology regarding a new experimental treatment called bariatric embolization. The procedure involves embolizing the left gastric artery (LGA) to suppress the production of the hormone ghrelin in the fundus of the stomach. This procedure is done using a percutaneous minimally invasive technique and has been performed in an outpatient setting. Early clinical data support bariatric embolization as a potentially safe and efficacious procedure that warrants further investigation for its utilization in managing weight loss in the morbidly obese. The purpose of this article is to discuss the nursing implications of a new procedure for the treatment of morbid obesity (i.e., body mass index >40 kg/m2) involving LGA embolization.

Abstract No. 523 - Implementing big data interventional radiology research: lessons learned

Abstract No. 523 - Implementing big data interventional radiology research: lessons learned

Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel

Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel

Abstract No. 360 - The minipig as an animal model for interventional radiology research

Abstract No. 360 - The minipig as an animal model for interventional radiology research

Abstract No. 379 - CT-guided percutaneous lung biopsy: are lesions closer to the diaphragm more likely for failure and complications?

Abstract No. 379 - CT-guided percutaneous lung biopsy: are lesions closer to the diaphragm more likely for failure and complications?