The optimization process is an important part of image-based diagnostics and treatments, requiring collaboration among medical physicists, radiologists, physicians, radiographers, nurses, engineers, and vendors. However, such teamwork can be challenging in some departments. In spring 2024, questionnaires were sent to Swedish medical physicists working with radiology, interventional radiology, or surgery facilities using radiological equipment. The surveys included modality-specific questions about optimization processes. The aim was to explore differences in optimization processes between modalities and departments, identify common challenges, and understand factors facilitating effective optimization. Results showed variations in optimization processes across different modalities, where successful optimization processes were harder to achieve for stationary fluoroscopy systems and mobile fluoroscopy systems than for the other modalities. Common challenges included limited time and lack of knowledge about image quality issues, while close collaboration, continuous meetings with focus on optimization, and good communication were mentioned as important factors for obtaining successful optimization processes.

Percutaneous Endobiliary Radiofrequency Ablation (PERFA) for Unresectable Cholangiocarcinoma.

BACKGROUND Upper-gastrointestinal (GI) bleeds refractory to endoscopic hemostasis can be treated with endovascular coil embolization. Transcatheter arterial embolization with endovascular coils is an effective and minimally invasive option with high success rates, and coil migration is a rare complication. This report describes the case of a 90-year-old woman with an upper-GI bleed managed with emergency transcatheter arterial embolization, presenting with an endovascular coil migration. CASE REPORT A 90-year-old woman presented to the emergency department (ED) with abdominal pain, dizziness, and diarrhea (day 0). Imaging revealed a duodenal bulb ulcer with a contained perforation, for which she underwent endovascular coil embolization on day 2. Thirteen days later, during an outpatient esophagogastroduodenoscopy (EGD), the endovascular coil was identified at the junction of the duodenal bulb and second portion of the duodenum. The endovascular coil was not removed due to risk of bleeding. At 6 weeks, she re-presented with mild symptoms and was managed conservatively. At 4 months, she remained asymptomatic and the endovascular coil had not passed. At 21-month follow-up, the endovascular coil remained unpassed, with intermittent symptoms, a finding that highlights the long-term management and challenges of this complication. CONCLUSIONS Due to the rarity of endovascular coil migration, there is no standard method for managing this complication. It is important to assess each patient individually, manage patient symptoms, and consult with interventional radiology and surgery as needed. This case shows that reporting such cases is essential to expand the limited literature, inform best practices, and guide clinicians faced with this rare complication.

Abstract Proximal fallopian tube obstruction (pFTO) is a common and potentially reversible cause of female subfertility. Image-guided techniques have established interventional radiology as a central discipline in the diagnosis and treatment of this condition. This review summarizes the pathophysiology, imaging evaluation, and management of pFTO, with a primary focus on fluoroscopy-guided transcervical fallopian tube recanalization (FTR). Normal tubal anatomy, mechanisms of proximal obstruction, and the diagnostic and therapeutic roles of hysterosalpingography are reviewed. Technical aspects of FTR, including patient selection, procedural technique, periprocedural care, and follow-up, are described. Published outcomes demonstrate technical success rates exceeding 90% with favorable pregnancy outcomes in appropriately selected patients and low complication rates. Given its safety profile, cost-effectiveness, and ability to immediately restore tubal patency, fluoroscopic FTR represents an effective first-line, minimally invasive treatment for women with isolated pFTO and an important application of image-guided therapy in infertility care.

Arteriovenous fistulas provide reliable vascular access to process high volumes of blood during hemodialysis. Fistula dysfunction can interrupt dialysis treatment and warrants prompt assessment of patency. In this study, we evaluate the diagnostic accuracy of infrared thermography as an accessible point-of-care screening tool to assess mature arteriovenous fistula patency in new flow-related complications that hinder hemodialysis. Thirty adults undergoing hemodialysis were recruited who had been referred to interventional radiology due to new flow-related complications of their mature arteriovenous fistulas, hindering hemodialysis. Assessments of fistulas were first carried out by thermography, then compared with CT angiography for validation. Thermography demonstrated all instances of stenoses and occlusions in arteriovenous fistulas and their superficial drainage veins, with 100% sensitivity, 94% specificity, 100% negative predictive value, 92% positive predictive value, and 97% accuracy rate. In one case, while thermography suggested superficial stenosis, this could not be demonstrated on CT angiography. Thermography was also able to show superficial venous aneurysmal dilatations. In six cases, fistula dysfunction was secondary to central venous stenoses, and thermography demonstrated consequent superficial venous distensions and collateralizations in the arm. Thermography shows potential to offer an accessible, portable, inexpensive, non-invasive, and radiation-free point-of-care screening tool for the assessment of arteriovenous fistula patency with high accuracy.

Background: Prior work identified greater workforce attrition among subspecialist radiologists than among generalist radiologists. Further variation among subspecialties could yield gaps in patient access to subspecialty radiologic care. Objective: To evaluate associations of individual radiologist subspecialties with workforce attrition. Methods: This retrospective study used a subset of subspecialist radiologists (analyzed by individual radiologist-year observations) from an earlier study of a national sample of Medicare-enrolled radiologists from 2014 to 2022. The prior analysis determined radiologist characteristics, practice characteristics, and designations of radiologist attrition (i.e., a clinically active radiologist's workforce exit based on lack of subsequent claims in a Medicare fee-for-service-dataset or a commercial, Medicare Advantage, and Medicaid dataset). The present analysis assigned radiologists to one of seven subspecialities (abdominal imaging, breast imaging, cardiothoracic imaging, musculoskeletal imaging, neuroradiology, nuclear medicine, vascular and interventional radiology [VIR]) using Medicare fee-for-service claims data, weighted by work relative value units, and a classification based on the Neiman Imaging Types of Service. Independent associations with attrition were identified by multivariable logistic regression analysis. Nonlinear regression models were used to estimate attrition as a function of years of practice and thereby estimate mean career lengths. Results: The analysis included 159,490 radiologist-years for 29,770 subspecialist radiologists. The attrition rate over the study period was 2.2% and varied across subspecialties from 1.0% (VIR) to 4.3% (cardiothoracic imaging). Year-by-year attrition rates increased from 1.4% in 2014 to 2.7% in 2022 and also increased over time for each subspecialty (percentage-point increase ranging from 0.4% [musculoskeletal imaging] to 2.1% [cardiothoracic imaging]). Adjusted odds of attrition, compared with abdominal imaging, were significantly higher for breast imaging (OR=1.31) and cardiothoracic imaging (OR=1.81), significantly lower for VIR (OR=0.78), and not significantly different for other subspecialties. Mean estimated career length was 1.1 years and 1.5 years greater for men than for women among academic and nonacademic radiologists, respectively; these gender differences were smaller within individual subspecialties (academic: 0.4-0.6 years; nonacademic: 0.2-0.5 years). Conclusion: Attrition increased over time for each subspecialty but varied among subspecialties. Clinical Impact: Recruitment and retention initiatives are needed broadly across the workforce to avoid departure cycles that potentially exacerbate individual subspecialty shortages.

Current implementation and perception of palliative interventional radiology procedures for patients with refractory cancer pain among interventional radiologists in Japan: a nationwide survey.

To prospectively assess the incidence, types, and risk factors for complications following interventional radiology–guided peripherally inserted central catheter (PICC) placement in adult cancer patients at a lower-middle-income-country tertiary center. In this single-center prospective cohort, all cancer patients ≥14 years who received a 4 Fr single-lumen PICC under ultrasound guidance with fluoroscopic tip confirmation were followed until line removal. Weekly structured follow-up (in-person or telephonic) was conducted. Complications were recorded using predefined criteria. Associations with demographic, clinical, and procedural factors were analyzed using chi-square/Fisher's exact or t/Mann–Whitney U tests. Fifty-six PICCs were placed in 48 patients (50% female; 28 solid and 28 hematologic cancers), contributing 4,386 catheter-days (median dwell time: 54 days). Twenty-five lines (44.6%) developed complications (32 events; 7.3/1,000 catheter-days). The most frequent were occlusion (17.9%; 2.3/1,000 days), catheter-related bloodstream infection, defined clinically rather than culture-confirmed (12.5%; 1.6/1,000 days), dislodgement (10.7%), and break/leak (10.7%). No symptomatic deep vein thrombosis (DVT) occurred. Complications led to premature removal in 21 lines (37.5%), with an 87.5% device-loss rate among affected catheters. Mean dwell time was significantly longer in lines with complications (103.6 vs. 57.9 days; p = 0.021). Higher body mass index showed a trend (p = 0.053), but other factors, including age, cancer type, puncture attempts, and tip position, were not associated with complication rates. PICC complications remain common despite imaging guidance and are driven chiefly by prolonged dwell time and patient factors, not insertion technique. Mechanical problems (including occlusion, dislodgement, and breakage) and catheter-related infections were the most common complications, and no symptomatic DVT was observed, although subclinical events could not be excluded.

To evaluate the feasibility, reproducibility, and clinical outcomes of an image-guided, urethra-sparing transperineal radiofrequency ablation (TPTA) strategy for benign prostatic hyperplasia (BPH) in an outpatient interventional radiology setting. This was a prospective, bicenter, non-randomized study of consecutive men with moderate-to-severe lower urinary tract symptoms (LUTS) refractory or intolerant to medication treated with ultrasound-guided, urethra-sparing TPTA. Outcomes included the International Prostate Symptom Score (IPSS), quality of life, maximum urinary flow rate (Qmax), post-void residual volume (PVR), prostate volume, prostate-specific antigen (PSA), and ejaculatory function [assessed using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF)]; complications were graded using the Clavien-Dindo classification. The primary endpoint was a 12-month change in ejaculatory function; secondary endpoints included composite clinical response (≥ 30% IPSS reduction without retreatment) and urinary and structural changes. At 12 months, clinically meaningful improvements were observed across patient-reported symptoms and concordant objective functional and anatomical parameters in a carefully selected outpatient cohort. The median IPSS decreased from 19.5 at baseline to 5.0 at 6 months and 4.0 at 12 months (P < 0.001), accompanied by sustained increases in the Qmax and reductions in PVR, prostate volume, and PSA (all P < 0.001). Among sexually active men, MSHQ-EjD-SF function scores remained stable during the follow-up period, and antegrade ejaculation was preserved in 90% of patients. The composite clinical response rate (≥ 30% IPSS reduction without retreatment) was 97.1% at both 6 and 12 months, with no device-related Clavien-Dindo ≥ III complications observed. These findings suggest that image-guided, urethra-sparing TPTA is a reproducible outpatient interventional radiology procedure capable of achieving clinically meaningful symptom relief while preserving ejaculatory function, supporting further comparative and multicenter evaluation. Urethra-sparing TPTA has proven to be a safe, feasible, and effective treatment for LUTS and may represent a minimally invasive and effective alternative for BPH.

A three-year summary of the Diagnostic and Interventional Radiology Journal

To systematically review and critically appraise AI methods for RECIST-based radiologic treatment response assessment in solid tumors, comparing image-derived and report-derived approaches and summarizing their performance, agreement with reference standards, and validation quality. This systematic review followed PRISMA guidelines. We searched Embase, MEDLINE, Web of Science, Scopus, and the Cochrane Library on 6 December 2025. We included English-language original studies (2015-2025) in solid tumors where AI directly assigned RECIST response categories and was validated against a reference standard; studies without RECIST-based response endpoints or non-solid tumor populations were excluded. We distinguished image-based techniques that assign RECIST categories from direct analysis of imaging data from report-based techniques that infer RECIST categories from radiology reports using natural language processing. Evidence remains sparse; we identified four eligible studies (two image-based and two report-based). DeepSeek-V3-0324 and GatorTron, both report-based approaches, achieved high accuracy (96.5% and 89%, respectively) in treatment response evaluation, with DeepSeek demonstrating higher expert agreement (κ 0.85-0.90). The nnU-Net and 3D U-Net pipelines, both image-based, showed high segmentation performance (DSC 0.85, VS 0.89) and treatment response classification accuracy of 0.77 for R1, with moderate agreement with the manual reference (κ = 0.60); nnU-Net also achieved moderate to almost perfect agreement (Cohen's κ 0.67-0.81) in RECIST 1.1 measurements. AI-based RECIST-oriented response assessment is feasible and potentially beneficial for standardization, efficiency, and scalability, but current evidence is limited and heterogeneous, requiring larger multi-center studies with rigorous external validation before clinical adoption. Key limitations include data source variability, reference standard inconsistencies, and lack of robust external validation.

Safety of Ketamine Sedation for Interventional Radiology Procedures: Experience in 900 Consecutive Patients.

The Effect of Obesity on Outcomes of Percutaneous Peritoneal Dialysis Catheter Insertion by Interventional Radiologists.

Bioresorbable scaffolds in interventional radiology: Current concepts and future direction.

Despite recommendations and guidelines on patient contact shielding in X-ray imaging, substantial uncertainties remain in clinical practice, particularly concerning computed tomography (CT) examinations and vulnerable groups such as pediatric and pregnant patients. This study identifies gaps in existing recommendations and offers a comprehensive statement of the actual risks and benefits associated with patient shielding. A systematic literature search was conducted using Google Scholar and PubMed, alongside current national and international guidelines. Our special report focused on patient shielding in projection radiography, interventional radiology, and CT, with special emphasis on vulnerable patient groups sensitive to radiation exposure. Current research lacks robust, evidence-based data comparing the benefits and risks of patient shielding, especially in CT. In projection radiography and interventional radiology, patient shielding offers minimal benefits and may inadvertently increase radiation exposure due to interference with automatic exposure control or necessitate repeated examinations. This issue is particularly addressed in pediatric and pregnant patients. In CT, the benefits and risks are more complex, with substantial research gaps hindering informed decision-making. Traditional and generalized recommendations for patient contact shielding do not adequately account for technological advancements and individual patient needs. The use of patient shielding should be reconsidered on a case-by-case basis, guided by evidence-based research. There is an urgent need for clinical studies to assess the benefits, and in particular the risks in real-world settings, facilitating the development of precise patient-specific guidelines. Question While patient shielding can increase radiation dose due to interference with automatic exposure controls, uncertainties persist regarding patient shielding in X-ray imaging practices. Findings There is marginal evidence of the clinical risks of patient shielding, and urgent needs exist for patient-specific evidence-based shielding guidelines. Clinical relevance By critically evaluating the ambiguous guidelines on patient shielding and highlighting the lack of evidence-based risks of patient shielding, this study argues for individualized, evidence-based practices to improve patient safety in clinical radiology.

Cybersecurity for Interventional Radiologists: A Clinical Imperative for Protecting Patient Data and Imaging Systems.

We investigated the utility and outcomes of interventional radiology procedures in postpancreaticoduodenectomy patients at a high-volume tertiary center with 24/7 access to an interventional radiology service. Retrospective review of all patients who underwent pancreaticoduodenectomy between January 2019 and December 2023 and analysis performed on patients who underwent interventional radiology procedures within the first 90 days postoperatively, assessing the indication, outcome, and timing of procedures. Out-of-hours intervention was defined as any procedure undertaken outside of the institution's regular hours of Monday-Friday, 8 am -4:30 pm . A total of 293 pancreaticoduodenectomies were performed during the study period. A total of 212 postoperative interventional radiology procedures were performed on a total of 112 (38%) patients. A total of 152 (71.7%) procedures were completed in-hours, while 60 (28.3%) procedures performed out-of-hours. The immediate technical and overall success rates were 98.1% and 85.4%, respectively. Almost 30% of patients required out-of-hours emergency interventional radiology procedures. Given this finding, the propensity of pancreaticoduodenectomy patients to deteriorate rapidly, and the significant impact of failure to rescue in the morbidity and mortality associated with this operation, we believe that centers performing pancreaticoduodenectomy should have adequate access to interventional radiology services with 24-hour availability.

Geospatial assessment of accessibility and territorial equity in lung cancer screening: A regional study

Caudally directed posterior high-dose-rate brachytherapy for reirradiation of para-aortic lymph node recurrence: A technical innovation enabled by interventional radiology.

To assess whether patient factors, including age, sex, and diabetic involvement, are associated with adverse events during the course of tunneled peritoneal dialysis (PD) catheter placed by interventional radiology (IR). This retrospective cohort study examined patients (n = 104) who required kidney replacement and underwent their initial tunneled PD catheter insertion procedure by the IR team at an academic teaching hospital between July 2021 and May 2024. An adverse event during the course of PD was defined as the first episode of peritonitis, catheter dysfunction, catheter insufficiency, catheter intolerance, or death. Inferential analyses included logistic regression and Cox proportional-hazards models to assess potential risk factors. Of the included patients, 32 (30.8%) experienced at least 1 episode of peritonitis during their PD course, with 6 patients experiencing multiple episodes. Diabetic involvement had the highest hazard ratio of 1.59 (95% confidence interval, 0.92-2.75; P = .094), suggesting a potential association with the occurrence of adverse events. Staphylococcus infections appeared to be more common in late-onset peritonitis (P = .03). Peritonitis remains a major adverse event of PD despite current best practices. Moreover, the differences in the causative organism based on the time of episode warrant further attention, especially in terms of its management and empiric antibiotics. Diabetic involvement also remains a significant risk for the occurrence of an adverse event in the course of the inserted catheter. A deeper understanding of the complexities associated with PD is essential to achieving better clinical outcomes.