Interventional Radiology Service Research Articles

Abstract No. 487 Expanding the diagnostic toolbox: introduction of core needle liver biopsies in Tanzania

Hepatocellular carcinoma (HCC) is the fourth most common cancer in Africa and tends to present earlier with worse outcomes in Africa than in Europe and North America. Although risk factor management plays a key role in reducing the burden of HCC, early and accurate detection are equally as important. Additionally, for cultural reasons, patients wish to have pathologic confirmation of diagnosis even when there is no treatment available. In Tanzania, no core needle biopsies (CNBs) were routinely performed at the nation’s largest public hospital until the introduction of an interventional radiology (IR) service in 2018. All patients who underwent liver CNB by the IR service at Muhimbili National Hospital (MNH) from October 2018 to September 2020 were included in the study. All procedures were performed by Tanzanian IR trainees as primary operators. Patient and procedural data, including demographic information, complications, and pathology results were collected and analyzed. Data was stored in REDCap, a HIPAA-compliant data management platform. A total of 51 core needle biopsies of the liver were performed on 49 patients. While 22 were done under direct supervision by US visiting faculty (43.1%), 29 were done independently by Tanzanian IR fellows (56.9%). All 51 were technically successful. No minor complications occurred. One major complication (Society of Interventional Radiology Class C) occurred (patient developed abdominal pain and rigors 30 minutes post-procedure). Of the 38 samples returned, 37 were diagnostic (97.4%); 33 confirmed malignancy, the most common types of which were hepatocellular carcinoma (14/33, 42.4%) and metastatic disease (14/33, 42.4%). Previously at MNH, fine-needle aspiration was used to assess hepatic lesions. While cheaper, it is not as reliable as CNB, with a lower sensitivity, specificity, and diagnostic accuracy. The introduction of a superior method of diagnosing hepatic lesions has provided surgeons and oncologists with a tool for earlier diagnosis. Furthermore, with the introduction of new IR procedures like transarterial catheter embolization and radiofrequency ablation to the region, patients can expect better treatment and prolonged survival.

Current Interventional Radiology-Related Benchmarked Clinical Quality Measures Are Less Likely to be “Capped” Than Diagnostic Radiology Clinical Quality Measures

In the merit-based incentive payment system (MIPS), quality measures are considered topped out if national median performance rates are ≥95%. Quality measures worth 10 points can be capped at 7 points if topped out for ≥2 years. This report compares the availability of diagnostic radiology (DR)-related and interventional radiology (IR)-related measures worth 10 points. A total of 196 MIPS clinical quality measures were reviewed on the Center for Medicare and Medicaid Services MIPS website. There are significantly more IR-related measures worth 10 points than DR measures (2/9 DR measures vs 9/12 IR measures; P = .03), demonstrating that clinical IR services can help mixed IR/DR groups maximize their Center for Medicare and Medicaid Services payment adjustment.

Variations in utilization and clinical outcomes for endoscopic sphenopalatine artery ligation and endovascular arterial embolization in a single multi-hospital network

PurposeEndoscopic sphenopalatine artery ligation (ESPAL) and endovascular arterial embolization (EAE) are increasingly common treatment options for patients with refractory epistaxis. The objective of this study was to compare the utilization pattern and clinical outcomes between these interventions within our single multi-hospital network. Materials and methodsA retrospective study of all patients undergoing ESPAL and/or EAE within any of the hospitals in a single healthcare network between 2008 and 2017 was conducted. We compared differences in procedure utilization with various hospital characteristics. Secondarily, we evaluated clinical outcomes and costs associated with each procedure. ResultsForty-three ESPAL and 33 EAE procedures were performed across 7 hospitals, with the majority of procedures being performed at teaching institutions (65% and 91%, p = .013). The majority of both interventions were performed in larger hospitals and EAE patients were more likely to undergo inter-hospital transfer compared to ESPAL patients (48.5% and 16.3%, p = .02). Success rates for ESPAL and EAE were comparable (95% and 93%); however, the median direct cost of treatment for EAE was significantly higher than the cost for ESPAL ($12984.89 and $5002.02, p < .0001). ConclusionsThe majority of both ESPAL and EAE interventions were performed at teaching and larger hospitals. Transfers occurring prior to EAE may have been due to the limited availability of interventional radiology services, and likely contributed to the increased cost of treatment. ESPAL is a known cost-effective management strategy and should be considered early in treatment algorithms of refractory epistaxis.

Cost comparison of osteopathic manipulative treatment for patients with chronic low back pain.

Chronic low back pain (cLBP) is the second leading cause of disability in the United States, with significant physical and financial implications. Development of a multifaceted treatment plan that is cost effective and optimizes patients' ability to function on a daily basis is critical. To date, there have been no published prospective studies comparing the cost of osteopathic manipulative treatment to that of standard care for patients with cLBP. To contrast the cost for standard of care treatment (SCT) for cLBP with standard of care plus osteopathic manipulative treatment (SCT+OMT). This prospective, observational study was conducted over the course of 4months with two groups of patients with a diagnosis of cLBP. Once consent was obtained, patients were assigned to the SCT or the SCT+OMT group based on the specialty practice of theirphysician. At enrollment and after 4 months of treatment, all patients in both groups completed two questionnaires: the 11 point pain intensity numerical scale (PI-NRS) and the Roland Morris Disability Questionnaire (RMDQ). Cost data was collected from the electronic medical record of each patient enrolled in the study. Chi-square (χ2Yates) tests for independence using Yates' correction for continuity were performed to compare the results for each group. There was a total of 146 patients: 71 (48.6%) in the SCT+OMT group and 75 (51.4%) in the SCT group. The results showed no significant differences between themean total costs for the SCT+OMT ($831.48±$553.59) and SCT ($997.90±$1,053.22) groups. However, the utilization of interventional therapies (2; 2.8%) and radiology (4;5.6%) services were significantly less for the SCT+OMT group than the utilization of interventional (31; 41.3%) and radiology (17; 22.7%) therapies were for the SCT group (p<0.001). Additionally, the patients in the SCT+OMT group were prescribed fewer opioid medications (15; 21.1) than the SCT (37; 49.3%) patients (p.001). Patients in the SCT group were approximately 14.7 times more likely to have received interventional therapies than patients in the SCT+OMT group. Likewise, the patients in the SCT group were approximately four times more likely to have received radiological services. Paired t tests comparing the mean pre- and 4 month self reported pain severity scores on the RMDQ for 68 SCT+OMT patients (9.91±5.88 vs. 6.40±5.24) and 66 SCT patients (11.44±6.10 vs. 8.52±6.14) found highly significant decreases in pain for both group (<0.001). The mean total costs for the SCT and SCT+OMT patients were statistically comparable across 4 months of treatment. SCT+OMT was comparable to SCT alone in reducing pain and improving function in patients with chronic low back pain; however, there was less utilization of opioid analgesics, physical therapy, interventional therapies, radiologic, and diagnostic services for patients in the SCT+OMT group.

Pediatric interventional radiology workforce in North America: a descriptive analysis of demographics, educational backgrounds and scholarly activities.

Pediatric interventional radiology has grown as an advanced subspecialty with increased demand, number and complexity of cases, and number of pediatric institutions offering a pediatric interventional radiology service. Despite the overall increase in the number of pediatric interventionalists over the past two decades, there is a heterogeneity in their academic backgrounds and a lack of uniform training pathways. To analyze the demographics, academic backgrounds and scholarly activities of pediatric interventionalists across the United States (U.S.) and Canada. A list of all members of the Society for Pediatric Interventional Radiology was obtained and pediatric interventionalists at academic and private practice institutions in the U.S. and Canada were included. Publicly available online sources were used to gather demographic and educational information about each pediatric interventionalist, which included the online curriculum vitae, the HealthGrades.com and Doximity.com websites, and Elsevier's Scopus database. Demographic and educational data including age, gender, educational background, additional degrees, academic rank, previous leadership positions, and metrics of scholarly activities were recorded. Fellowships in diagnostic pediatric radiology, adult interventional radiology and/or pediatric interventional radiology were recorded. Mann-Whitney U tests and Kruskal-Wallis tests were used to compare differences between groups. One hundred and twenty-five pediatric interventionalists were included, of whom 24 (19.2%) were female. The mean age was 48.6years (standard deviation [SD]: 10.6, median: 45years, range: 36-82years). There was no statistical difference between median age for male versus female pediatric interventionalists (44.5years vs. 45years, P=0.89). A majority of pediatric interventionalists were American medical school graduates (96, 76.8%), while 29 (23.2%) were international medical graduates. Eighty-three percent (104) of the pediatric interventionalists completed diagnostic radiology residency training in the U.S., most commonly at the University of Cincinnati in Ohio (6.4%) and Washington University in St. Louis, MO (5.6%). Among fellowship training, pediatric interventionalists completed a pediatric radiology fellowship (61.6%), adult interventional radiology fellowship (40%) and/or a dedicated pediatric interventional radiology fellowship (57.6%). The mean±SD (median) publications, citations and Hirsch index (h-index) for pediatric interventionalists were 32±45 (12), 68±1,317 (120) and 9±10 (5), respectively. There was a statistically higher number of publications, citations and h-index with increasing academic rank at the assistant, associate and professor levels (P<0.001 for all groups). International medical graduate pediatric interventionalists had a higher, but not statistically significant, median publication count (26 vs. 11, P=0.0.25), citation count (236 vs. 93, P=0.36) and h-index (9.0 vs. 5, P=0.24) compared to pediatric interventional radiologists from American medical schools. Pediatric interventionalists in North America are predominantly male, with about a quarter having graduated from international medical schools. Pediatric radiology fellowship, followed by pediatric interventional radiology fellowship, was the most frequently pursued training pathway.

Uterine Artery Embolization for Secondary Postpartum Hemorrhage

Postpartum hemorrhage (PPH) affects approximately 14 million women yearly, accounts for 25% of delivery-related deaths in the world and is the main cause of emergency peripartum hysterectomy. Traditionally, PPH is defined as at least 500 mL of blood loss after vaginal delivery or 1000 mL of blood loss after cesarean-section. However, several authors have suggested a simpler definition to include women who experience hemodynamic instability after birth regardless of amount of blood loss. Secondary PPH is defined as bleeding that occurs after 24 hours to 12 weeks from delivery, and can fail medical management. It is imperative that the clinical team recognize the signs and symptoms of secondary PPH and, if necessary, consult the interventional radiology service for a minimally invasive option of uterine artery embolization, which has shown up to 95% success rate.

The State of Interventional Radiology in Myanmar: A National Report

Purpose: Radiology global outreach programs have increased in recent years but progressed more slowly than other specialties. Establishing radiology services is increasingly recognized as a priority in resource-limited settings. Myanmar has a tremendous disease burden that is treatable with interventional radiology (IR) techniques, and aims to grow and effectively integrate this service into its public healthcare sector. Through collaborations between Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and Myanmar Radiological Society (MRS), the field of IR has grown exponentially over recent years. This study aims to provide a Myanmar national IR report on the current trends and future challenges. Methods and materials: Descriptive variables across five domains (facility and equipment, workforce, supplies, infrastructure, and casemix) from the four public sector hospitals with IR capability were obtained between 2016-2019. The four hospitals were Yangon General Hospital (YGH), Yangon Specialty Hospital (YSH), Mandalay General Hospital (MGH), and Defense Services General Hospital (DSGH). Data were analyzed to demonstrate progress in IR and the differing casemix. Results: There are currently four IR-capable hospitals and nine interventional radiologists across Myanmar’s public healthcare sector. IR case volumes tripled from 514 cases in 2016 to more than 1,500 cases in 2019. The three most common procedures performed were trans-arterial chemoembolization (TACE, 63%), bronchial arterial embolization (BAE, 7.7%), and drainages (7.7%). Significant challenges to the growth and adoption of IR services span the domains of infrastructure, equipment and supplies, workforce, and IR awareness, among other clinical specialties. Conclusion: Myanmar’s healthcare priorities, coupled with international radiological outreach programs, have led to rapid growth of IR. The exponential growth in case volumes is promising for Myanmar and other developing countries. But to widen the scope of practice and integrate the service within local clinical workflows, a holistic effort that addresses multiple domains is needed in the future.

National audit of seven-day working care in radiology.

ObjectivesTo evaluate the extent to which our current provision of diagnostic and interventional radiology services matches existing clinical demand and future government proposals as set out in the Royal College of Radiologists published guidance on providing seven-day acute care.MethodsIn June 2018, all UK radiology department audit leads were sent a questionnaire designed to assess compliance for each standard of the Royal College of Radiologists published guidance on providing seven-day acute care.Results135 hospitals (68%) responded. Of those that responded, 96% of departments have a diagnostic radiologist rota for clinicians to discuss acute cases and review imaging and 48% of departments do not have a fully staffed consultant rota 24 h a day, seven days a week for interventional radiology. There is significant variance in MRI radiographer availability within departments, ranging from 18.8% during Saturday/Sunday evening/overnight up to a maximum of 63.9% during Saturday daytime. 11% of departments participate in a regional out of hours cross-organisation reporting rota. 40% of departments have no 24/7 RIS technical support and 34% have no PACS technical support out of hours.ConclusionThere is a wide variation in practice across radiology departments in the UK. Although there are some standards that the majority of hospitals are achieving, there is a significant short-fall in fundamental aspects of providing acute seven-day care. The multifactorial nature in which these problems have arisen means there is no easy solution to combat these issues. There is a requirement for significant investment and political commitment to improve staffing and infrastructure in order to address the current situation.Advances in knowledgeA UK wide evaluation of the current provision of seven-day working in radiology showing 54% of hospitals do not have a UK working-time regulations compliant Interventional radiology rota, severe lack of availability of acute MRI out of hours and significant deficiencies in providing technical support out of hours. A sustainable and efficient seven-day service is currently not being provided.

Rare case of arterioportal fistula in a Nigerian; Presentation and successful management with transcatheter arterial embolization

Arterioportal fistula (APF) is a rare and potentially fatal cause of portal hypertension. In this case report, we present an unwonted case of a Nigerian with this disorder. As well, this article documents details of successful therapy for such a large APF with transcatheter arterial embolization which was carried out locally. This study is thus a first-of-its-kind for our African subregion. We hope that this article will help to highlight the role and significance interventional radiology services and expertise in an emerging health-care system as the one seen in West Africa – particularly as it relates to its benefits in the field of hepatology.

Trends of interventional radiology procedures during the COVID-19 pandemic: the first 27\xa0weeks in the eye of the storm

ObjectivesWhile the Novel Coronavirus (COVID-19) pandemic looks to persist, institutions promote delaying procedures. Understanding trends and demands of interventional radiology (IR) procedures in the infected and COVID-free populations are needed in long-term planning. We detail IR procedure trends in the first 27 weeks of the pandemic and compare with the pre-pandemic era.MethodsIn this IRB approved retrospective electronic case review, all IR patients in our institution from 1 January to 9 July 2020, the same period in 2019 pre-pandemic and the Severe Acute Respiratory Syndrome (SARS-CoV) outbreak were included. IR procedures were classified using Interventional Radiology—Procedure Acuity Scale (IR-PAS) and category of IR procedures. Along with descriptive frequencies, the Mann–Whitney U test and Chi-square test of independence were performed.ResultsDuring the pandemic, 3655 IR procedures were performed compared to 3851 procedures pre-pandemic. No statistically significant difference in weekly IR caseloads across IR-PAS tiers between both periods (p = .088) and category of procedure (p = .054) were noted. General intervention procedures remained the largest proportion and musculoskeletal procedures the minority, in both periods. More general intervention radiology and oncology procedures were performed during the COVID-19 pandemic compared to the SARS-CoV outbreak. Thirty-four (0.93%) IR procedures were performed on 30 COVID-19 patients. There was no IR procedure-related COVID-19 cross-transmission.ConclusionsDemand for IR procedures among COVID-free patients remains high, and IR procedures involving COVID-19 represents a fraction of the IR caseload. A sustainable model in providing timely IR services to COVID-free patients needs to be considered.

Teaching Physician Supervision: Medicare's Ongoing Imperative for Academic Radiologists.

OBJECTIVE. Medicare permits radiologists to bill for trainee work but only in narrowly defined circumstances and with considerable consequences for noncompliance. The purpose of this article is to introduce relevant policy rationale and definitions, review payment requirements, outline documentation and operational considerations for diagnostic and interventional radiology services, and offer practical suggestions for academic radiologists striving to optimize regulatory compliance. CONCLUSION. As academic radiology departments advance their missions of service, teaching, and scholarship, most rely on residents and fellows to support expanding clinical demands. Given the risks of technical noncompliance, institutional commitment and ongoing education regarding teaching supervision compliance are warranted.

The Impact of COVID-19 on Interventional Radiology Services in the UK

IntroductionThe coronavirus disease 2019 (COVID-19) has created unprecedented challenges on the healthcare system. The aim of this multi-centre study was to measure the impact of COVID-19 on IR services in the UK.Material and MethodsRetrospective cross-sectional study of IR practice in six UK centres during the COVID-19 pandemic was carried out. All therapeutic IR procedures were identified using the respective hospital radiology information systems and COVID-19 status found on the hospital patient record systems. The total number of therapeutic IR procedures was recorded over two time periods, 25/03/2019–21/04/2019 (control group) and 30/03/2020–26/04/2020 (COVID-19 group). The data points collected were: procedure type, aerosol-generating nature, acute or elective case, modality used, in- or out-of-hours case and whether the procedure was done at the bedside (portable).ResultsA 31% decrease in overall number of IR procedures was observed during COVID-19 compared to the control group (1363 cases vs 942 cases); however, the acute work decreased by only 0.5%. An increase in out-of-hours work by 10% was observed. COVID-19 was suspected or laboratory proved in 9.9% of cases (n = 93), and 15% of total cases (n = 141) were classed as aerosol-generating procedures. A 66% rise in cholecystostomy was noted during COVID-19. Image-guided ablation, IVC filters, aortic stent grafting and visceral vascular stenting had the greatest % decreases in practice during COVID-19, with 91.7%, 83.3%, 80.8% and 80.2% decreases, respectively.ConclusionDuring the global pandemic, IR has continued to provide emergency and elective treatment highlighting the adaptability of IR in supporting other specialties.

FATAL ABDOMINAL WALL HEMATOMA AFTER ENOXAPARIN IN A PATIENT WITH MULTIPLE RISK FACTORS

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Rectus sheath hematoma is an accumulation of blood within the rectus sheath, is not usually fatal and can be similar to intra abdominal pathologies. Multiple risk factors are associated with this type of bleeding of the inferior epigastric artery. CASE PRESENTATION: Case of 82 years old female that went to the ER due to chest pain, 6/10 in severity, pounding, non-radiating associated with elevated blood pressure of 270/150mmHg. The patient was admitted with a diagnosis of acute coronary syndrome for which dual-antiplatelet therapy of clopidogrel and aspirin at loading doses and full anticoagulation with subcutaneous enoxaparin 1 mg/kg were given. After a few hours after admission, the patient developed sudden right side abdominal pain but due to the severity of pain she was unable to provide a precise description of the pain. Physical examination was remarkable for right sided abdominal tenderness and a palpable induration of approximately 15cm by 15cm. Carnett's sign and Fothergill's signs were also positive. An abdominopelvic CT scan with PO contrast described a large right sided anterolateral abdominal and pelvic wall hematoma measuring 21.5cm anterior-posterior, 15cm in transverse and 26cm in the craniocaudal direction. The patient developed hemorrhagic shock despite multiple blood product transfusions, aggressive intravenous fluid resuscitation and IV vasopressor therapy. The hypovolemic shock persisted for which emergent exploratory OR was indicated in which evacuation of the hematoma and ligation of inferior epigastric artery were performed. However, the patient subsequently developed multiple organ failure due to persistent hypotension that ultimately caused her death. DISCUSSION: This case resulted in a rare rectus sheath hematoma fatality most likely propagated by the patient's underlying risk factors such as arterial hypertension, asthma, being female gender, advanced age, and receiving a full dose of anticoagulation along with dual antiplatelet therapy. Due to the lack of interventional radiology services in our facility, this patient had an emergent surgical intervention without the expected results as the patient had a prolonged period of hypotension causing multiorgan damage. CONCLUSIONS: Hemodynamically unstable rectus sheath hematoma in a setting where interventional radiology is unavailable, exploratory surgical intervention for ligation or embolization of bleeding vessels and evacuation of hematoma must be performed as soon as possible to avoid fatalities associated with delayed treatment. Reference #1: Nourbakhsh E, Anvari R, Nugent K. (2011) Abdominal wall hematomas associated with low-molecular-weight-heparins: an important complication in older adults, J Am Geriatr Soc, vol. 59 (pg. 1543-5) https://doi.org/10.1111/j.1532-5415.2011.03529.x Reference #2: Peng, Wang B., Luo B. (2014): Spontaneous Abdominal Wall Hematoma Caused By Abdominal exercise as a complication of warfarin therapy. Chinese Medical Journal, Volume 127 - Issue 9 - p 1796 https://https://doi.org/10.3760/cma.j.issn.0366-6999.20132338 Reference #3: Goldstein J., Sebire D. (2013): Abdominal wall haematoma in the obese: a dangerous phenomenon. Journal of Surgical Case Reports, Volume 2013, Issue 7 https://doi.org/10.1093/jscr/rjt060 DISCLOSURES: No relevant relationships by Greisha Gonzalez Santiago, source=Web Response No relevant relationships by Paola Lopez, source=Web Response No relevant relationships by Hiram Maldonado Rivera, source=Web Response No relevant relationships by Carlos Ramos Encarnacion, source=Web Response No relevant relationships by Joel Rodriguez Ramos, source=Web Response

The Economic Footprint of Interventional Radiology in the United States: Implications for Systems Development.

Despite the growing presence of interventional radiology (IR) in inpatient care, its global impact on the health care system remains uncharacterized. The aim of this study was to quantitate the use of IR services rendered to hospitalized patients in the United States and the impact on cost. The National Inpatient Sample 2016 was queried. Using the International Classification of Diseases, 10th revision, Clinical Modification/Procedure Classification System, adult inpatients who underwent routine IR procedures were identified. Unadjusted and adjusted analyses were performed. Weighted patient data are presented to provide national estimates. Of the 29.7 million inpatient admissions in 2016, 2.3 million (7.8%) had at least one IR procedure. Patients who needed IR were older (62.8 versus 57.1 years, P < .001), were sicker on the basis of the All Patient Refined Diagnosis Related Groups (27% major or extreme versus 14% for non-IR, P < .001), and had higher inpatient mortality (8.2% versus 1.7%, P < .001). While representing 7.8% of all admissions, this cohort accounted for 18.4% ($68.4 billion) of adult inpatient health care costs and about 3 times higher mean hospitalization cost compared with other inpatients ($29,402 versus $11,062, P < .001), which remained significant even after controlling for age and All Patient Refined Diagnosis Related Group. Approximately 1 in 10 US inpatients are treated by IR during their hospitalizations. These patients are sicker, with about 4 times higher mortality and 2.5 times greater length of stay, accounting for almost one-fifth of all health care costs. These findings suggest that IR should have a voice in discussions of means to save costs and improve patient outcomes in the United States.

Overall Impact of the COVID-19 Pandemic on Interventional Radiology Services: A Canadian Perspective.

Purpose:The aim of this national survey was to assess the overall impact of the coronavirus disease 2019 (COVID-19) pandemic on the provision of interventional radiology (IR) services in Canada.Methods:An anonymous electronic survey was distributed via national and regional radiology societies, exploring (1) center information and staffing, (2) acute and on-call IR services, (3) elective IR services, (4) IR clinics, (5) multidisciplinary rounds, (6) IR training, (7) personal protection equipment (PPE), and departmental logistics.Results:Individual responses were received from 142 interventional radiologists across Canada (estimated 70% response rate). Nearly half of the participants (49.3%) reported an overall decrease in demand for acute IR services; on-call services were maintained at centers that routinely provide these services (99%). The majority of respondents (73.2%) were performing inpatient IR procedures at the bedside where possible. Most participants (88%) reported an overall decrease in elective IR services. Interventional radiology clinics and multidisciplinary rounds were predominately transitioned to virtual platforms. The vast majority of participants (93.7%) reported their center had disseminated an IR specific PPE policy; 73% reported a decrease in case volume for trainees by at least 25% and a proportion of trainees will either have a delay in starting their careers as IR attendings (24%) or fellowship training (35%).Conclusion:The COVID-19 pandemic has had a profound impact on IR services in Canada, particularly for elective cases. Many centers have utilized virtual platforms to provide multidisciplinary meetings, IR clinics, and training. Guidelines should be followed to ensure patient and staff safety while resuming IR services.

Operations Transition to Mitigate COVID-19 on an Interventional Radiology Service.

The coronavirus disease pandemic (COVID-19) started in China in December 2019. Countries around the world remain affected several months later. Despite attempts to limit dissemination by social distancing, the United States currently has more total infections than any other nation on earth.[1] At one point in New York City, COVID-specific admission surges reached 350 patients/100,000 population, stressing the limits of staff and resources.[2]

Outbreak of Bloodstream Infections in Hemodialysis Patients Highlight the Importance of a Working Partnership Between Infection Prevention and Interventional Departments

<h3>Background</h3> Research shows that collaboration between Infection Prevention (IP) and procedural personnel is vital to optimum patient outcomes. In the summer of 2019, a 350 bed acute care hospital experienced an outbreak of Central Line Associated Bloodstream Infections (CLABSI) in patients with implanted hemodialysis (HD) catheters. All infections had an onset of 10 days or less from device insertion in Interventional Radiology (IR). Only one CLABSI in three years was related to a dialysis catheter. Before June 2019, no issues within IR had been identified by Infection Prevention. <h3>Methods</h3> In July 2019, a multidisciplinary team with representation from: Surgical Services, IR, IP, Nephrology, and Environmental Services (ES) was convened. The project spanned July to October of 2019 in a five step process: Observe, research, define, implement, and monitor. A goal of decreasing CLABSI in HD patients with implanted devices in IR to the baseline of zero was established. National Healthcare Safety Network (NHSN) standards were used to define CLABSI. Observations to identify improvement opportunities and findings were divided into five categories: Physical barriers, aseptic technique, attire, environmental cleaning, and policies. Literature reviews, professional guidelines, and staff interviews helped to establish procedural guidelines and gain insight to perceived barriers. A solid improvement plan was then developed. Remediation on aseptic technique, environmental cleaning, and attire were provided. Weekly audits of hand hygiene and attire were conducted after improvement processes had been established. <h3>Results</h3> Four CLABSIs were identified in the outbreak. The goal of zero CLABSI, in the target month of November 2019, was achieved with no CLABSI identified in the focus population. <h3>Conclusions</h3> Each observation consistently revealed sub-optimal environmental cleaning and aseptic technique. Staff interviews highlighted gaps in understanding surrounding policies and best practice. Proactive efforts and collaboration between IR and IP are necessary to prevent outbreaks such as this from occurring.

Longitudinal study of interventional radiology activity in a large metropolitan Italian tertiary care hospital: how the COVID-19 pandemic emergency has changed our activity.

ObjectivesTo retrospectively analyze interventional radiology (IR) activity changes in the COVID-19 era and to describe how to safely and effectively reorganize IR activity.MethodsAll IR procedures performed between January 30 and April 8, 2020 (COVID-era group) and the same 2019 period (non-COVID-era group) were retrospectively included and compared. A sub-analysis for the lockdown period (LDP: 11 March–8 April) was also conducted. Demographic, hospitalization, clinical, and procedural data were obtained for both groups and statistically compared with univariable analysis.ResultsA total of 1496 procedures (non-COVID era, 825; COVID era, 671) performed in 1226 patients (64.9 ± 15.1 years, 618 women) were included. The number of procedures decreased by 18.6% between 2019 and 2020 (825 vs 671, p < .001), with a reduction by 48.2% in LDP (188 vs 363, p < .0001). In the LDP COVID era, bedside procedures were preferred (p = .013), with an increase in procedures from the intensive care unit compared with the emergency department and outpatients (p = .048), and an increased activity for oncological patients (p = .003). No incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of healthcare workers in the IR service was registered.ConclusionsCoronavirus disease outbreak changed the interventional radiology activity with an overall reduction in the number of procedures. However, this study confirms that interventional radiology continuum of care can be safely performed also during the pandemic, following defined measures and protocols, taking care of all patients.Key Points • Coronavirus disease pandemic determined a reduction of interventional radiology activity as compared to the same period of the previous year. • Interventional radiology procedures for life-threatening conditions and non-deferrable oncologic treatments were prioritized as opposed to elective procedures. • Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service.

Disease Site-Specific Guidelines for Curative Radiation Treatment During 'Limited Surgery' and 'Hospital Avoidance': A Radiation Oncology Perspective From the Epicenter of COVID-19 Pandemic.

The COVID-19 pandemic has resulted in an unprecedented situation where the standard of care (SOC) management for cancers has been altered significantly. Patients with potentially curable cancers are at risk of not receiving timely SOC multidisciplinary treatments, such as surgery, chemotherapy, radiation therapy, or combination treatments. Hospital resources are in such high demand for COVID-19 patients that procedures, such as surgery, dentistry, interventional radiology, and other ancillary services, are not available for cancer patients. Our tertiary care center is considered the center of the epicenter in the USA. As a result, all non-emergent surgeries have been suspended in order to provide hospital beds and other resources for COVID-19 patients.Additionally, ambulatory efforts to avoid treatment-related morbidity are critical for keeping patients out of emergency departments and hospitals. In this review article, we discuss evidence-based radiation therapy approaches for curable cancer patients during the COVID-19 pandemic. We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ‘bridge’ to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy.

The Interventional Radiology Service During the COVID-19 Pandemic: Steps to Managing the Risk of Infection

It is imperative to ensure the safety of healthcare workers in the angiographic room during the outbreak of the Covid-19 (coronavirus disease 2019). The selection criteria for Interventional radiology (IR) procedures, the preparation of the staff and angiographic suite, ventilation systems, intra- and post-procedural workflow optimization methods are detailed. The specific measures needed to protect occupational safety and health may result in higher costs, longer procedural times and greater technical problems. However, these precautions may help to minimize the spread of the Covid-19 among IR practitioners.