Radiological Management Research Articles

Paraspinal Myosistis After Stereotactic Radiation Surgery

Myositis of the paraspinal muscles can be a clinically significant side effect of spinal radiation surgery. This report describes the typical clinical scenario, relevant radiologic findings, treatment, and management with the best available evidence.

Abstract No. 553 The growth of clinical interventional radiology: increasing interventional radiology evaluation and management charges over time

To determine whether interventional radiology (IR) evaluation and management (E&M) charges have increased and to compare with charges from vascular surgery (VS) E&M claims were compared for IR and vascular surgery (VS) using the Medicare Physician Supplier Procedure Summary Master Files 2010 to 2018. IR and VS were identified by specialty codes. E&M was defined by relevant CPT codes. The number of E&M claims per year per 100,000 Medicare beneficiaries and E&M as a percentage of all Medicare charges were compared for each specialty using linear regression modeling. Subgroup analysis by practice setting (inpatient vs. outpatient) and patient type (new vs. established patient) was performed for IR. Between 2010 and 2018, IR E&M encounters increased from 177 to 412 claims per 100,000 beneficiaries (+133%, P < 0.001, R2 = 0.94). VS E&M encounters increased from 4954 claims per 100,000 beneficiaries to 5373 claims per 100,000 beneficiaries (+8%, P = 0.005, R2 = 0.71). E&M accounted for 1.9% of IR Medicare revenue in 2010 and increased to 2.7% in 2018 (40% relative increase). E&M declined from 7.6% of VS Medicare revenue in 2010 to 5.1% in 2018 (33% relative decrease). For IR, E&M growth was higher for outpatients (+178%) vs. inpatients (+25%) and established patients (+138%) vs. new patients (+122%). Driven primarily by outpatient and established patient encounters, IR E&M claims more than doubled between 2010 and 2018, implying that more IRs are embracing a longitudinal care model that involves pre- and post-procedure outpatient evaluations. Although IR E&M revenue was lower than VS, the rate of increase in E&M revenue was much greater for IR than VS.

Abstract No. 442 The role of telemedicine in the maintenance of interventional radiology outpatient evaluation and management volume during the COVID-19 global pandemic

To assess the impact of COVID-19 on the overall volume of IR outpatient-based evaluation and management encounters (E&M) and to demonstrate the role of telehealth in offsetting the loss of volume caused by COVID-19

Apoplexy in sporadic pituitary adenomas: a single referral center experience and AIP mutation analysis.

To analyze the clinical, laboratory, and radiological findings and management of patients with clinical pituitary apoplexy and to screen for aryl hydrocarbon receptor-interacting protein (AIP) mutations. The clinical findings were collected from the medical records of consecutive sporadic pituitary adenoma patients with clinical apoplexy. Possible precipitating factors, laboratory data, magnetic resonance imaging (MRI) findings and treatment were also analyzed. Peripheral blood samples were obtained for DNA extraction from leukocytes, and the entire AIP coding region was sequenced. Thirty-five patients with pituitary adenoma were included, and 23 (67%) had non-functioning pituitary adenomas. Headache was observed in 31 (89%) patients. No clear precipitating factor was identified. Hypopituitarism was observed in 14 (40%) patients. MRI from 20 patients was analyzed, and 10 (50%) maintained a hyperintense signal in MRI performed more than three weeks after pituitary apoplexy (PA). Surgery was performed in ten (28%) patients, and 25 (72%) were treated conservatively with good outcomes. No AIP mutation was found in this cohort. Patients with stable neuroophthalmological impairments can be treated conservatively if no significant visual loss is present. Our radiological findings suggest that hematoma absorption lasts more than that observed in other parts of the brain. Additionally, our study suggests no benefits of AIP mutation screening in sporadic patients with apoplexy.

O81: MAMMA: MASTITIS AND MAMMARY ABSCESS MANAGEMENT AUDIT

Abstract Presenting Author Email: alona.courtney@imperial.ac.uk Research question Is there significant variation in the management of mastitis and breast abscesses between different hospitals in the UK and Ireland? Background and Aim Lactational mastitis affects a third of breastfeeding women, 11% of whom develop breast abscesses. Non-lactational mastitis affects 5-9% of women. Management of mastitis includes alleviation of milk stasis and antibiotics. Ultrasound-guided needle aspiration is the recommended method of treatment for breast abscesses. Despite guideline recommendations, there is evidence suggesting significant variation in practice, particularly concerning antibiotic prescribing, rates of incision and drainage and length of inpatient treatment. Considering that the majority of breast surgeons are no longer participating in the on-call roster and the acute presentation of primary breast infections, we hypothesise that such variation in practice indeed exists across the UK and Ireland, where patients are treated by non-breast specialist general surgeons. The aim of the MAMMA study is to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland and to provide recommendations for best practice. Design Patients: Inclusion criteria: all female patients over the age of 16 with symptoms of mastitis or breast abscess. Exclusion criteria: 1) male patients, 2) underlying breast cancer, 3) breast surgery within 90 days of presentation, 4) breast implant in situ on the ipsilateral side. Intervention / Comparator (or main explanatory variable in an observational study): The following guidelines will be used as audit standards: 1) WHO Mastitis Guidelines 2000, 2) GAIN Guidelines on the Treatment, Management &amp; Prevention of Mastitis 2008, 3) ABM Clinical Protocol #4: Mastitis 2014, 4) NICE Clinical Knowledge Summaries: Mastitis and Breast Abscess MAMMA: Mastitis And Mammary abscess Management Audit Outcomes: Phase 1 will increase our understanding of the patient treatment pathways and ease of access to specialist breast services for patients with mastitis and breast abscesses. Phase 2 will collect prospective, real-time data on the management of mastitis and breast abscesses nationwide. Specifically, MAMMA will enable us to gather precise evidence on antibiotic prescribing, rate of operative versus radiological management, waiting time to ultrasound scan, rate of inpatient versus outpatient treatment, length of hospital stay and the rate of follow-up by breast surgeons. This highquality data will be instrumental in updating guidelines and help to standardise the management of mastitis and breast abscess across the UK and Ireland. Study design The study will be carried out in 3 phases with the support of a national trainee collaborative: 1) national practice survey, 2) prospective audit, 3) prospective re-audit. All acute hospitals that manage patients with mastitis and breast abscess will be invited to participate. All participating centres will be required to register this audit as per local protocol. All study data will be collected and managed using REDCap electronic data capture tool. Team and Infrastructure MAMMA National trainee collaborative will be established with the assistance of the Mammary Fold Academic and Research Committee and other regional research collaboratives. It will be the driving force behind this project. The trainee collaborative will be overseen by the MAMMA Steering Committee, convened from key stake-holders from a variety of medical and surgical specialties, allied health care professionals and patient representatives, who are directly involved in the management of patients with breast infections. MAMMA Study Management Group (SMG) will be responsible for audit management, data analysis, dissemination of results and drafting of publication. Regional trainee leads will represent each HEE region in the UK and Ireland and will be responsible for recruitment and coordination of local collaboratives; they will be directly accountable to the SMG. Local trainee collaboratives will consist of a local lead, maximum of two collaborators and one data validator. Further information is available on www.mammastudy.com.

Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery.

Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.

Knowing the unknowns: Uncertainties during radiological emergencies

Emergency management implies making decisions under uncertainty. Though this is a truism, uncertainties faced by different actors during radiological emergencies have not been investigated as intensively as other emergencies and lack a systematic analysis during realistic conditions. Hence, the goal of this study is to identify and analyse the uncertainties that may appear during radiological emergencies. Furthermore, this research explores among which actors and at which stages of decision-making process these uncertainties appear.For this purpose, non-participatory observation has been used during 11 nuclear or radiological emergency exercises in the period of 2017–2018 at 29 observation points in 6 countries and 1 international exercise. The observers recorded actual behavior of different actors (participants of the observed exercises) under live conditions.Results provide valuable insights into the complex decision-making process related to actions taken for the protection of individuals and society at large during realistic exercises of a radiological emergency. Most uncertainties synthesized from our observations are related to the practical implementation of emergency actions, e.g. the potential for unexpected failure of communication tools or channels, or the inadequacy of emergency plans to cope with the real situation. A high number of uncertainties were also associated to knowledge gaps, e.g. related to the consistency of radiological assessments or the insufficient familiarity of emergency actors with the rules and procedures. The findings of this study can inspire emergency planners and other stakeholders to strengthen radiological emergency management, advance emergency response practices, and improve communication and collaboration between different actors in emergency situations.

Radiological management of postoperative lymphorrhea.

Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI. Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated. The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.

Radiological management and follow-up of post-COVID-19 patients

Most of the patients who overcome the SARS-COV-2 infection do not present complications and do not require a specific follow-up, but a significant proportion (especially those with moderate/severe clinical forms of the disease) require clinicalradiological follow-up. Although there are hardly any references or clinical guidelines regarding the long-term follow-up of post-COVID-19 patients, radiological exams are being performed and monographic surveillance consultations are being set up in most of the hospitals to meet their needs. The purpose of this work is to share our experience in the management of the post-COVID-19 patient in two institutions thathave had a high incidence of COVID-19 and to propose general follow-uprecommendations from a clinical and radiological perspective.

Percutaneous Management of Recurrent Head and Neck Cancer: Current Role and Evolving Principles in the Multidisciplinary Setting.

In this review, we will outline the role of percutaneous interventional radiological management of recurrent head and neck (H&N) cancer in the context of a multidisciplinary setting which consists of surgery, radiation therapy, as well as established and evolving systemic therapies that may impact current practice. Management of recurrent H&N cancer is complex, with attention to the preservation of function and minimal treatment-related morbidity. The favored treatment modalities in local recurrence previously treated with radiotherapy are surgical resection, and if unresectable, for chemotherapy as definitive treatment, or as a prelude to resection if there is good tumor response. Unfortunately, some of these patients are too frail for major surgery or to withstand the toxicity of chemotherapy. There is a gap for effective local therapy without the morbidity of surgery, toxicity of re-irradiation, and systemic side effects of chemotherapy. Percutaneous interventions have the potential to bridge that gap as well as provide palliative symptomatic treatment for patients that have exhausted all treatment options. In the multidisciplinary setting involving the treatment of complex recurrent H&N cancer, percutaneous management now plays a viable and effective role with a foothold in this team-based approach.

Super selective percutaneous transhepatic coil embolization of intrahepatic pseudoaneurysm after pediatric liver transplantation: a case report

BackgroundIntrahepatic arterial pseudoaneurysms are a rare, life-threatening complication after pediatric liver transplantation. Treatment of choice represents interventional radiological management with endovascular embolization of the segmental artery proximal and distal to the aneurysm. However, this technique results in loss of arterial perfusion distal to the aneurysm with subsegment arterial ischemia.Case presentationWe report a case of a 1-year-old girl with a pseudoaneurysm in the split-liver graft. Direct percutaneous, transhepatic access to the pseudoaneurysm was performed followed by super selective coil application into the aneurysm.ConclusionSuper selective percutaneous, transhepatic coil application is feasible even in pediatric patients after liver transplantation and results in preservation of the entire course of the liver artery.

Splenic vein stenting for recurrent chylous ascites in sinistral portal hypertension: a case report

BackgroundSinistral portal hypertension results from obstruction or stenosis of the splenic vein and is characterized by normal portal vein pressures and liver function tests. Gastrointestinal bleeding is the most common presentation and indication for treatment. Although sinistral portal hypertension-related chylous ascites is rare, several cases have described successful treatment with portal venous, rather than splenic venous, recanalization. Splenectomy is effective in the treatment of sinistral portal hypertension-related bleeding, although recent studies have evaluated splenic vein stenting and splenic arterial embolization as minimally-invasive treatment alternatives. Splenic vein stenting may be a viable option for other presentations of sinistral portal hypertension.Case presentationA 59-year-old gentleman with a history of necrotizing gallstone pancreatitis was referred to interventional radiology for management of recurrent chylous ascites. Analysis of ascites demonstrated a triglyceride level of 1294 mg/dL. Computed tomography revealed splenic and superior mesenteric venous stricture. The patient elected to undergo minimally invasive transhepatic portal venography, which confirmed the presence of splenic vein and superior mesenteric vein stenosis. Venography of the splenic vein showed reversal of portal venous flow, multiple collaterals, and a pressure gradient of 14 mmHg. Two 10 mm × 40 mm Cordis stents were placed, which decreased the pressure gradient to 7 mmHg and resolved the portosystemic collaterals. At 6 months follow-up, the patient had no recurrent episodes of ascites.ConclusionThe current case highlights the successful treatment of sinistral portal hypertension-related intractable chylous ascites treated with transhepatic splenic vein stenting. Splenic venous stent patency rates of 92.9% at 12 months have been reported. Rebleeding rates of 7.1% for splenic vein stenting, 16% for splenectomy, and 47.8% for splenic arterial embolization have been reported in the treatment of sinistral portal hypertension-related gastrointestinal bleeding. The literature regarding splenic vein stenting for sinistral portal hypertension-related ascites is less robust. Technical and clinical success in the current case suggests that splenic vein recanalization may be a safe and viable option in other sinistral portal hypertension-related symptomatology.Level of Evidence: Level 4, Case Report.

Predictors of disease severity and outcome of hospitalized renal transplant recipients with COVID-19 infection: a systematic review of a globally representative sample.

Introduction. COVID-19 presents a special challenge to the kidney transplant population.Methods. A systematic review of articles that examined COVID-19 in kidney transplant recipients was performed. Patients' demographics, clinical, laboratory and radiological presentations, immunosuppression modification, and COVID-19 specific management were abstracted and analyzed. COVID-19 severity was classified into mild, moderate, and severe. Disease outcome was classified by whether the patient was discharged, still hospitalized, or died.Results. 44 articles reporting individual data and 13 articles reporting aggregated data on 149 and 561 kidney transplant recipients respectively with COVID-19 from Asia, Europe and America fulfilled all inclusion and exclusion criteria. Among studies reporting case specific data, 76% of cases had severe disease. Compared to patients with mild/moderate disease, patients with severe disease had higher CRP, LDH, Ferritin, D-dimer and were more likely to have bilateral lung involvement at presentation and longer time since transplantation (P < 0.05 for all). Recipients' age, gender and comorbidities did not impact disease severity. Patients with severe disease had a more aggressive CNI reduction and more antiviral medications utilization. Outcome was reported on 145 cases, of those 34 (23%) died all with severe disease. Longer duration from transplant to disease diagnosis, hypoxia and higher LDH were associated with mortality (P < 0.05). Different immunosuppression reduction strategies, high dose parenteral corticosteroids use and various antiviral combinations did not demonstrate survival advantage. Similar finding was observed for studies reporting aggregated data.Conclusion. COVID-19 in kidney transplant patients is associated with high rate of disease severity and fatality. Higher LDH and longer time since transplantation predicted both disease severity and mortality. None of the COVID-19 specific treatment correlated with, or improved disease outcome in kidney transplant recipients.

Novel interventional radiological management for lymphatic leakages after gynecologic surgery: lymphangiography and embolization.

Post-operative lymphatic leakage is a common complication of a radical gynecologic surgery involving aggressive lymph node dissection. Its manifestation varies from asymptomatic lymphoceles to life-threatening chylous ascites. In the past, nuclear medicine lymphoscintigraphy was the sole imaging modality for the confirmation of the leakage, of which application is limited due to its poor spatial resolution. While a conservative treatment with percutaneous drainage was the mainstream treatment method, surgical exploration was the last resort for the recalcitrant leakages. Recently, there have been a series of innovations in the field of interventional radiology, including intranodal Lipiodol® lymphangiography, dynamic magnetic resonance (MR) lymphangiography, lymphatic embolization, and mesenteric lymph node lymphangiography. Intranodal Lipiodol® lymphangiography provides very reliable and secure access to the lymphatic system, while requiring only fundamental skills and equipment available to all interventional radiologists. Besides, Lipiodol® is being received a spotlight for its potential therapeutic effects on refractory lymphatic leakage. Dynamic MR lymphangiography plays a vital role in the diagnosis and management of non-traumatic lymphatic diseases, as well as in the post-operative lymphatic leakage with its superior contrast, spatial and temporal resolution. Lymphatic embolization is a technique of using N-BCA glue, a liquid embolic agent, for lymphatic leakages. It can be further described as lymphopseudoaneurysm (LPA) embolization or lymph node embolization, according to which structure is being embolized. Lymphatic embolization opened a new realm of possibilities in the field of interventional lymphology, resulting in the development of treatment approaches for chylous ascites and lymphoceles. Mesenteric lymph node lymphangiography offers the opacification of the upstream mesenteric chylous lymphatic system and can detect lymphatic leakage from the intestinal trunk or the more proximal parts of the mesenteric lymphatic system. With the advent of these latest interventional radiological techniques, more comprehensive approaches to the management of recalcitrant post-operative lymphatic leakages have been enabled.

American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings.

Background Treatment of blunt splenic trauma (BST) continues to evolve with improved imaging for detection of splenic vascular injuries. Purpose To report on treatments for BST from 11 trauma centers, the frequency and clinical impact of splenic vascular injuries, and factors influencing treatment. Materials and Methods Patients were retrospectively identified as having BST between January 2011 and December 2018, and clinical, imaging, and outcome data were recorded. Patient data were summarized descriptively, both overall and stratified by initial treatment received (nonoperative management [NOM], angiography, or surgery). Regression analyses were used to examine the primary outcomes of interest, which were initial treatment received and length of stay (LOS). Results This study evaluated 1373 patients (mean age, 42 years ± 18; 845 men). Initial treatments included NOM in 849 patients, interventional radiology (IR) in 240 patients, and surgery in 284 patients. Rates from CT reporting were 22% (304 of 1373) for active splenic hemorrhage (ASH) and 20% (276 of 1373) for contained vascular injury (CVI). IR management of high-grade injuries increased 15.6%, from 28.6% (eight of 28) to 44.2% (57 of 129) (2011-2012 vs 2017-2018). Patients who were treated invasively had a higher injury severity score (odds ratio [OR], 1.04; 95% CI: 1.02, 1.05; P < .001), lower temperature (OR, 0.97; 95% CI: 0.97, 1.00; P = .03), and a lower hematocrit (OR, 0.96; 95% CI: 0.93, 0.99; P = .003) and were more likely to show ASH (OR, 8.05; 95% CI: 5.35, 12.26; P < .001) or CVI (OR, 2.70; 95% CI: 1.64, 4.44; P < .001) on CT images, have spleen-only injures (OR, 2.35; 95% CI: 1.45, 3.8; P < .001), and have been administered blood product for fewer than 24 hours (OR, 2.35; 95% CI: 1.58, 3.51; P < .001) compared with those chosen for NOM, after adjusting for key demographic and clinical variables. After adjustment, factors associated with a shorter LOS were female sex (OR, 0.84; 95% CI: 0.73, 0.96; P = .009), spleen-only injury (OR, 0.72; 95% CI: 0.6, 0.86; P < .001), higher admission hematocrit (OR, 0.98; 95% CI: 0.6, 0.86; P < .001), and presence of ASH at CT (OR, 0.74; 95% CI: 0.62, 0.88; P < .001). Conclusion Contained vascular injury and active splenic hemorrhage (ASH) were frequently reported, and rates of interventional radiologic management increased during the study period. ASH was associated with a shorter length of stay, and patients with ASH had eight times the odds of undergoing invasive treatment compared with undergoing nonoperative management. © RSNA, 2021 See also the editorial by Patlas in this issue.

CT Imaging and Management of Blunt Splenic Trauma: Lessons for Today and Tomorrow

CT Imaging and Management of Blunt Splenic Trauma: Lessons for Today and Tomorrow

Impact of clinical information on CT diagnosis by radiologist and subsequent clinical management by physician in acute abdominal pain.

The impact of clinical information on radiological diagnoses and subsequent clinical management has not been sufficiently investigated. This study aimed to compare diagnostic performance between radiological reports made with and without clinical information and to evaluate differences in the clinical management decisions based on each of these reports. We retrospectively reviewed 410 patients who presented with acute abdominal pain and underwent unenhanced (n = 248) or enhanced CT (n = 162). Clinical information including age, sex, current and past history, physical findings, and laboratory tests were collected. Six radiologists independently interpreted CTs that were randomly assigned with or without clinical information, made radiological diagnoses, and scored the diagnostic confidence level. Four general and emergency physicians simulated clinical management (i.e., followed up in the outpatient clinic, hospitalized for conservative therapy, or referred to other departments for invasive therapy) based on reports made with or without the clinical information. Reference standards for the radiological diagnoses and clinical management were defined by an independent expert panel. The radiological diagnoses made with clinical information were more accurate than those made without clinical information (93.7% vs. 87.8%, p = 0.008). Median interpretation time for radiological reporting with clinical information was significantly shorter than that without clinical information (median 122.0 vs. 139.0 s, p < 0.001). Clinical simulation better matched the reference standard for clinical management when radiological diagnoses were made with reference to clinical information (97.3% vs. 87.8%, p < 0.001). Access to adequate clinical information enables accurate radiological diagnoses and appropriate subsequent clinical management of patients with acute abdominal pain. • Radiological interpretation improved diagnostic accuracy and confidence level when clinical information was provided. • Providing clinical information did not extend the interpretation time required by radiologists. • Radiological interpretation with clinical information led to correct clinical management by physicians.

Conflicting clinical and radiological management decisions.

Gliosis with hemorrhagic transformation is a late reported complication of stroke. Sometimes there is a big discrepancy between clinical and radiological diagnosis, and clinical decisions must be multi‐aspect decisions and not dependent on a single discrepant investigation result.

The multidisciplinary management of recurrent tracheoesophageal fistula after esophageal atresia: Experience with 135 cases from a tertiary center

Background & aimsRecurrent tracheoesophageal fistula (rTEF) after esophageal atresia requires complex management across different specialties. This study reviews our experience and discusses a multidisciplinary (MDT) approach adopted in the past 4 years. MethodsWe reviewed the medical records of 100 patients with rTEF managed by an MDT approach (post-MDT group) from 2016 to 2019. These cases were compared to a historical group of 35 patients with rTEF from 2012 to 2015 (pre-MDT group). ResultsOf the 135 patients with rTEF, 124 were referred from other hospitals. Preoperative examination found tracheomalacia in 23 patients, vocal fold immobility in 19 patients, and laryngomalacia in five patients. The incidence of postoperative anastomotic leak, anastomotic stricture, and repeat recurrences was 28.1%, 23.0%, and 8.9%, respectively. The overall mortality rate was 4.4%. No statistical difference in postoperative complications was noted between the two groups. The duration of stay in the pediatric intensive care unit (P = 0.038), the duration of intubation (P = 0.049), the postoperative hospital stay (P = 0.011), and the total length of hospital stay (P = 0.001) were significantly lower in the post-MDT group. Mid-term follow-up showed 23 patients had pathological gastroesophageal reflux. Five of them underwent fundoplication and recovered. ConclusionThe MDT approach by fostering coordination of surgical, medical, radiological, and nutritional management is beneficial in the management of rTEF and leads to a satisfactory outcome .

Current State of Affairs with Regard to Continuing Medical Education for Technicians in Radiology in Francophone West Africa

Background: This study aimed to determine the level of continuing medical education (CME) of medical imaging technicians in French-speaking West Africa. Materials and methods: This opinion survey was administered to radiology technicians in French-speaking West Africa from 1st June to 31st October 2020, i.e. over a period of 5 months concerning their level of CME and their need for CME. Results: Out of 100 technicians, 69% were men. The mean age was 40 years, with extremes ranging from age 23 to age 57. The majority of technicians (64%) worked in the public sector and 78% had work experience of less than 11 years. Most technicians were holders of a Bachelor’s degree (73%). The types of CMEs they knew were congresses, seminars, and modular training in 46% of the cases. The most available CMEs were seminars (63%). All technicians agreed on the need for CME and 96% said it had an impact on the delivery of radiology services. Technicians who had received CME at least once represented 61%. For 90% of technicians, the specific CME sought was management in radiology (33.33%) and radiation protection (25.81%). Conclusion: The need for CME is increasingly indisputable to radiology technicians in French-speaking West Africa; however, it remains a luxury for them, due to its scarcity and its high cost.