Team Of Radiologists Research Articles

Role of interventional radiology in management of post-liver transplant anastomotic complications

BackgroundLiver transplantation is considered to be the treatment of choice in cases of end-stage liver disease; however, as a major procedure, the operation is fraught with complications. The etiology, symptoms, and diagnostic methods for arterial, portal, and biliary issues are thoroughly discussed. Interventional procedures such as balloon angioplasty and stent placement in the arterial and portal systems, as well as biliary interventional procedures, are described.ResultsIn our study, we reviewed 25 cases of post-living donor transplanted liver, with anastomotic complications including biliary stenosis 40%, hepatic vein stenosis 20%, portal vein stenosis 16%, biliary leakage 16%, and hepatic artery stenosis or pseudo-aneurysm 16%. We had 10 cases of biliary stenosis, 7 of which were successfully treated with the insertion of an internal/external drain, and one case failed. Two patients died. We had four cases of hepatic venous obstruction with successfully implanted stents and a perfect outcome, efficacy, and patency rate of 100%. We also had two cases of hepatic artery stenosis that were perfectly managed by stent placement, with a patency rate of 100%. We came across two cases of hepatic artery pseudo-aneurysm. One case failed due to large sac size, while the other was successful. Finally, in our study, we had a 100% success rate in 5 cases of portal vein stenosis in the early postoperative period.ConclusionsPercutaneous IR was effective treatment for hepatic vein occlusion, portal vein stenosis, hepatic artery stenosis, and anastomotic biliary stricture after living donor liver transplantation. The interventional radiology team is now an integral part of the multi-disciplinary care of transplant patients. As new interventional instruments are developed and experience is gained, the outcomes of interventional treatments will continue to improve.

KUB-UNet: Segmentation of Organs of Urinary System from a KUB X-ray Image

PurposeThe alarming increase in diseases of urinary system is a cause of concern for the populace and health experts. The traditional techniques used for the diagnosis of these diseases are inconvenient for patients, require high cost, and additional waiting time for generating the reports. The objective of this research is to utilize the proven potential of Artificial Intelligence for organ segmentation. Correct identification and segmentation of the region of interest in a medical image are important to enhance the accuracy of disease diagnosis. Also, it improves the reliability of the system by ensuring the extraction of features only from the region of interest. MethodA lot of research works are proposed in the literature for the segmentation of organs using MRI, CT scans, and ultrasound images. But, the segmentation of kidneys, ureters, and bladder from KUB X-ray images is found under explored. Also, there is a lack of validated datasets comprising KUB X-ray images. These challenges motivated the authors to tie up with the team of radiologists and gather the anonymous and validated dataset that can be used to automate the diagnosis of diseases of the urinary system. Further, they proposed a KUB-UNet model for semantic segmentation of the urinary system. ResultsThe proposed KUB-UNet model reported the highest accuracy of 99.18% for segmentation of organs of urinary system. ConclusionThe comparative analysis of its performance with state-of-the-art models and validation of results by radiology experts prove its reliability, robustness, and supremacy. This segmentation phase may prove useful in extracting the features only from the region of interest and improve the accuracy diagnosis.

A Sri Lankan child with hypersplenism secondary to pre-hepatic portal hypertension, successfully managed with partial splenic artery embolization: a case report and review of the literature

BackgroundHypersplenism, one of the major complications of portal hypertension, is traditionally treated by splenectomy. However, partial splenic artery embolization is an evolving minimally invasive intervention to treat these patients effectively.Case presentationA 13-year-old girl was referred for further evaluation of isolated splenomegaly with pancytopenia. She did not have bleeding manifestations or features of anemia. She never had hematemesis or melena. On examination, she was pale. Abdominal examination revealed massive splenomegaly of 10 cm below the costal margin without hepatomegaly. Rest of the examination was unremarkable. Her investigations revealed a white cell count of 1700/mm3 (neutrophils 9.8% and lymphocytes 88.7%), hemoglobin 9.5 g/dL and platelet count 42,000/mm3. Blood picture showed pancytopenia without abnormal cells. Her reticulocyte count was 1.9%. Complete liver profile was normal. Abdominal ultrasonography revealed massive splenomegaly with the oblique length of 17 cm and normal echogenic liver with normal size. Cavernous transformation of portal vein with portal hypertension was evident. Mesenteric angiogram showed portal vein thrombosis and markedly tortuous splenic artery. Anti-nuclear antibodies and double-stranded DNA were negative. Ham test and urine for hemosiderin were negative. Clauss fibrinogen assay was normal. Hemoglobin high performance liquid chromatography for hemoglobin subtypes was normal. Anti-phospholipid antibodies were negative. JAK2 V617F mutation was not identified. Diagnosis of pre hepatic portal hypertension was made. Her upper gastrointestinal endoscopy was normal. Partial splenic artery coil embolization was done by interventional radiology team. Vaccines against capsulated organisms were given. Post-procedure contrast abdominal computed tomography revealed infarction of approximately 70% of the spleen and blood counts were improved. Index case is in the follow up for 3 years. She is on penicillin prophylaxis with regular blood count and annual upper gastrointestinal endoscopy monitoring.ConclusionsMinimally invasive interventions such as partial splenic artery embolization should be considered in managing the patients with hypersplenism secondary to portal hypertension.

Cardiac Multislice Computed Tomography in the Detection of Phenotypic Polymorphism of Hypertrophic Cardiomyopathy

Background. Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease with a prevalence of 1 case per 500 people and is the most common cause of sudden cardiac death in young patients. As clinical manifestations and electrocardiographic data are nonspecific and diverse, noninvasive imaging techniques play a key role in the detection of HCM and the understanding of its pathophysiology.
 The aim. To evaluate the possibilities of ECG-synchronized cardiac multislice computed tomography (MSCT) as a highly informative diagnostic tool for assessing the morpho-functional state of the heart in patients with HCM.
 Materials and methods. This was a retrospective analysis conducted at the National Amosov Institute of Cardiovascular Surgery from January 2020 to December 2021. We examined 221 cardiac MSCT scans of patients who underwent the examination to assess the spread of myocardial hypertrophy. Particular attention was paid to the presence of crypts at different levels of the left ventricle (LV), anatomical features of the mitral valve and subvalvular apparatus. The presence of systolic pulling of the anterior mitral valve to the interventricular septum, myocardial mass, LV end-diastolic, LV end-systolic volumes and the corresponding indices of body surface area, ejection fraction were determined and calculated during the functional analysis. Additionally, the anatomy and patency of the coronary arte­ ries were assessed. The studies were performed on a 640-slice Canon Aquilion One CT scanner with retrospective ECG gating and subsequent image processing. The studies were transferred to a workstation for review and evaluation by a team of radiologists.
 Results. The mean patient age was 46 ± 23 years, 48% were male. Mean maximal LV wall thickness was 19 mm (range 16–34). In 159 patients (71.9%), there was an asymmetric form of HCM with a predominant thickening of the anterior and anteroseptal segments of the left ventricle at the basal and midventricular levels. Fifty-four (24.4%) patients had symmetric form of HCM. The midventricular form of HCM was detected in 4 patients (1.8%). Apical form of HCM was detected in 3 patients (1.3%). One patient was diagnosed with a tumor-like variant of HCM (0.5%). In 198 patients (89.6%), systolic anterior motion of the mitral valve to the interventricular septum was found. In 95 cases (42.9%), morphological abnormality, abnormality of the number or attachment of the papillary muscles were detected. Forty-eight myocardial crypts were detected in 44 patients (21.7%). In 194 patients (87.7%), patent coronary arteries without signs of stenosis were found, 68 patients (30.7%) had 74 myocardial bridges (33.4%).
 Conclusions. HCM is a genetic heart disease with enormous phenotypic diversity. Due to its high spatial resolution, cardiac MSCT is an accurate diagnostic tool, which allows to assess the morphofunctional state of the LV, mitral valve, subvalvular apparatus, as well as to analyze the anatomy and narrowing of coronary arteries in patients with HCM.

Utilidad de la oclusión aórtica con balón REBOA para el control de las hemorragias puerperales en pacientes con anomalías de la implantación placentaria

Background and aims: Abnormalities of placental implantation, which make up the spectrum of placenta accreta, are associated with high maternal morbidity and mortality due to massive bleeding during delivery. Placing aortic occlusion balloons helps control the bleeding, facilitating surgical intervention. A new device, resuscitative endovascular balloon occlusion of the aorta (REBOA), minimizes the risks and complications associated with the placement of traditional aortic balloons and is also efficacious in controlling bleeding. The aim of this study is to evaluate the usefulness, efficacy, and safety of REBOA in puerperal bleeding due to abnormalities of placental implantation. Material and methodsBetween November 2019 and November 2021, our interventional radiology team placed six REBOA devices in six women scheduled for cesarean section due to placenta accrete. Results Mean blood loss during cesarean section after REBOA (3507.5mL) was similar to the amounts reported for other aortic balloons. The mean number of units of packed red blood cells required for transfusion was 3.5. Using REBOA provided the surgical team with adequate conditions to perform the surgery. There were no complications derived from REBOA, and the mean ICU stay was < 2 days. Conclusion The technical characteristics of the REBOA device make it a safe and useful alternative for controlling massive bleeding in patients with placenta accreta.

Barriers to Informed Consent in Interventional Radiology: A Pilot Study

BackgroundInformed consent is a central part of the relationships between patients and interventional radiology teams, but consent practices are variable and limited. PurposeThis study explored consent practices among clinicians and staff in an academic IR department to identify barriers to informed consent. MethodsSystematic interviews were conducted with 17 clinicians and staff about their roles in obtaining informed consent, perceptions of what informed consent and capacity determinations entail, and barriers to patients’ understanding of IR procedures. FindingsResults revealed four key barriers to adequate informed consent: limited procedural experience/knowledge by the consenting clinician, unclear division of responsibilities, inconsistent approaches to assessing capacity and surrogate decision making, and wide variation in patients’ baseline understandings. DiscussionThis variation seemed to stem from a lack of shared understanding about consent processes and responsibilities, highlighting an important area for quality improvement in IR that would benefit from a larger multipractice investigation of consent practices.

Radiology volunteers to support a breast cancer screening program in Peru: Description of the project, preliminary results, and impressions

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.

V05-11 LAPAROSCOPIC MANAGEMENT OF XANTHOGRANULOMATOUS PYELONEPHRITIS – COMPARISON OF TWO DIFFERENT YET SIMILAR CASES

You have accessJournal of UrologyCME1 May 2022V05-11 LAPAROSCOPIC MANAGEMENT OF XANTHOGRANULOMATOUS PYELONEPHRITIS – COMPARISON OF TWO DIFFERENT YET SIMILAR CASES Catarina Laranjo Tinoco, Andreia Cardoso, Ricardo Matos Rodrigues, Sara Anacleto, Ana Sofia Araújo, Mário Cerqueira Alves, and Emanuel Carvalho-Dias Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Andreia CardosoAndreia Cardoso More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mário Cerqueira AlvesMário Cerqueira Alves More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Xanthogranulomatous pyelonephritis (XGPN) is a destructive form of chronic pyelonephritis with frequent involvement of adjacent organs (with abscesses and fistulas). We present a video comparison of the laparoscopic nephrectomy of two XGPN cases. METHODS: In this video we present two cases of laparoscopic nephrectomy of XGPN cases – a simpler case (patient 1) and a more complex one with the intraoperative diagnosis and repair of a pyeloduodenal fistula (patient 2). Both patients were middle-aged females with a history of urolithiasis, who presented to the emergency department (ER) with similar symptoms: flank pain and weight loss in the previous month. The computed tomography scans showed typical signs of XGPN of right kidney: an enlarged kidney with important dilation and densification of the collecting system, caused by urinary stones. The patients were admitted to the urology ward and started on intravenous (IV) antibiotics. Patient 1 was submitted to ultrasound-guided percutaneous nephrostomy and psoas drain placement and was discharged after 9 days, with both catheters and oral antibiotics. She was readmitted after 3 months for the elective right nephrectomy. Patient 2’s also had a percutaneous nephrostomy placed by the Urology team and a hepatic drain in an abscess placed by the Radiology team. The patient stayed in the hospital for 2 weeks and was discharged after drains removal. Her right nephrectomy was scheduled for 1.5 months after. The definitive treatment of this condition is surgical with nephrectomy, drainage of concomitant abscesses and removal of the involved tissues. Our video presents and compares these patients’ laparoscopic surgeries. RESULTS: The surgical time was 2 hours in patient 1 and 4 hours in patient 2, with no intraoperative complications. Patient 1 recovered quickly and was discharged after 3 days. Patient 2 was required to stay on bowel rest with a nasogastric tube placed for 3 days. She started solid food ingestion on day 5 with great tolerance and was discharged on post-operative day 8. No post-operative complications were observed. The pathology report was similar for both patients: terminal kidney with XGPN. CONCLUSIONS: Laparoscopic management of xanthogranulomatous pyelonephritis is challenging due to the loss of anatomical planes and inflamed tissues, so a systematic approach is advisable. The management of pyeloduodenal fistulas can also be made by laparoscopy, as demonstrated in our video, the first reported case of laparoscopic treatment of this kind of fistula. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e519 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catarina Laranjo Tinoco More articles by this author Andreia Cardoso More articles by this author Ricardo Matos Rodrigues More articles by this author Sara Anacleto More articles by this author Ana Sofia Araújo More articles by this author Mário Cerqueira Alves More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF DownloadLoading ...

Beware of the jolly toddler who has not read the right textbooks.

It was one of those busy days in the children's emergency department (ED) in December 2021. Omicron was the dominant virus. Along came an 18-month-old girl, whose mother gave a history that she was unsettled for 5 days with upper respiratory symptoms, constipation, and abdominal pain. She was being treated for constipation. She would not allow the junior doctor to examine her, but made friends with the consultant after extensive bribery involving bubbles, stickers, colouring and choice of movie. Clinical observations and examination were normal when done whilst watching the aforesaid movie. Her abdomen was soft and non-tender. A period of observation was decided on, given the history. At the same time, there was a 15-year-old boy in ED with fever and abdominal pain. Appendicitis was suspected; the surgical team got ready to take him to theatre. The ED team expressed concerns as he looked relatively well but with a raised serum C Reactive Protein (CRP) of 202 mg/L. Abdominal ultrasound was reported as showing ileitis. Negotiations between both teams were started, facilitated by the ED consultant. The toddler, in the Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2, decided that more food supplies were in order after consuming personal supplies of Hula Hoops, and approached the consultant. She departed into the waiting room after procuring biscuits and orange juice. Attention returned to the 15-year-old; it was decided that he should be admitted and observed. Once this was settled, further history taken from the mother revealed that over the past 3 days her daughter woke up at night screaming with pain, so much so that neighbours would call and ask if all was well. A peculiar history of neighbours checking in the great city of London was notable. It was decided to perform an abdominal ultrasound, based on the history. Extensive negotiations with the radiology team commenced and 2 h later it was agreed the ultrasound would be done at a sister hospital. The toddler had in the meantime spent 3 h in ED eating and drinking and enjoying the facilities. Hula Hoops were removed from the toddler's fingers by the consultant, on account of the fact that she was requesting an ultrasound for intussusception and did not want to look foolish (the consultant not the toddler). The toddler amicably ate the removed Hula Hoops and set off after waving a cheerful goodbye. ED became busy and numerous children were seen. Two hours later the radiologist called – abdominal ultrasound showed a doughnut-shaped mass, an ileocolic intussusception. At the receiving hospital, a fresh bag of Hula Hoops was removed from the toddler who showed great anger at this turn of events, especially as this was followed by cannulation. Bloods showed a non-specific CRP of 11 mg/L. The toddler was transferred to a tertiary centre where an air enema resulted in resolution of the intussusception. As it turned out she was also COVID positive on nasopharyngeal swabs. She was discharged home and is subsequently living happily ever after. As for the 15-year-old, he too was COVID positive, diagnosed as having Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS).1 He continued to spike fevers, was started on IV methylprednisolone and had a good outcome. PIMS-TS is notably a great masquerader,1 mimicking appendicitis on this occasion. The toddler was unique: 5 days of varied symptoms, normal examination and an excellent appetite. The clue was in the history. In the COVID-19 pandemic, when our concentration is on the obviously sick children, along comes one who teaches us an unforgettable lesson. What we see in ED is a snapshot, the movie is evolving at home, hence history is the key. Paediatrics is a speciality like no other, extraordinary learning interspersed with magic.

A multidisciplinary approach to axillary lymph node staging with ultrasound in the setting of a highly suggestive or suspicious breast mass

The radiologists' role in axillary imaging in the setting of a suspicious breast mass is evolving in light of the Z0011 trial leading to expected practice variation. The purpose of our project was to generate a standardized algorithm guiding the utilization of axillary ultrasound in the setting of a highly suggestive or highly suspicious breast mass (BI-RADS 4C or 5) without a known cancer diagnosis. The algorithm was created with Z0011 practices in mind while reflecting the clinical preferences of our radiology and surgical teams. The four breast surgeons at our academic institution were individually queried regarding their preferred axillary imaging and biopsy approach. The best practices for axillary imaging were then developed in a breast imaging intradepartmental meeting. There was agreement among the surgical group that the presence of suspicious axillary lymph node (s) on ultrasound could be used for treatment planning and patient discussion but would not be used for surgical planning in most cases. They also agreed that an ultrasound-guided core needle biopsy of a suspicious axillary lymph node should be deferred until after surgical consultation. Discussion among our breast radiologists resulted in the consensus that axillary ultrasound in the setting of a BIRADS 4 or 5 mass should be deferred at its initial presentation unless there is palpable lymphadenopathy, suspicious lymph node on mammography, or a tumor is at least stage T3, presumably excluding them from Z0011 criteria. The decision was also made to defer biopsies of suspicious axillary lymph nodes without prior surgical consultation/discussion.

Gastrointestinal Stromal Tumor of the Proximal Small Intestine Revealed by Hemorrhagic Shock: About 02 Cases and Review of the Literature

Gastrointestinal stromal tumors are mesenchymal tumors that represent 0.1% to 0.3% of all malignant tumors. Their clinical presentation is nonspecific but presentation by massive hemorrhage with hemodynamic instability is rare. We report the cases of 02 young patients who presented a fulminant digestive hemorrhage with hemodynamic instability and whose endoscopic exploration did not reveal any obvious etiology. That’s why we involved interventional radiology and surgical team in order to localize and confirm the diagnosis of a hemorrhagic jejunal GIST and then to ensure the hemostasis by small bowel resection taking away the jejunal tumor.

Increasing On-Time Starts of Neurology Procedures in Interventional Radiology

The first scheduled surgical or diagnostic procedure of the day sets the tone for the entire daily operating room (OR) schedule. Delayed first procedures of the day result in subsequent delays, affecting productivity, staffing, and most importantly, patient care.Factors that impact the start of the first scheduled case, include late patient arrival, lack of staffing, and incomplete pertinent laboratory results. Subsequently, this may lead to cancelations and will directly affect the patient’s satisfaction with the process. Cases running in procedural rooms past their scheduled end times result in extra pay for staff, while canceled cases lead to lost revenue; these expenses are consequences of inefficiency. It is hard to determine the financial ramifications of late starts to an organization because overhead facility costs and staff salaries are multifactorial and specific to the setting. This quality improvement (QI) project evaluated the effectiveness of a change in shift start time for nurses as a solution to improving on-time starts by measuring first case on-time starts and the patient and radiology team satisfaction scores.

Intramedullary Spinal Cord Lesions: A Single-Center Experience.

ObjectiveSpinal cord tumors constitute a small part of spinal surgery owing to their rarity. This retrospective study describes their current management. MethodsForty-eight patients were treated for an intramedullary tumor between 2014 and 2020 at a single institution. Patients’ files were retrospectively studied. We detailed clinical status according to neurological deficit and ambulatory ability using the modified McCormick Scale, radiological features like number of levels, associated syringomyelia, surgical technique with or without intraoperative electrophysiological monitoring, pathological findings, and postoperative outcome. ResultsThe median age of this population was 43 years, including 5 patients under 18 years. The median delay before first neurosurgical contact was 3 months after the first clinical complaint. Treatment was gross total resection in 43.8%, subtotal resection in 50.0%, and biopsy in 6.2%. A laminectomy was performed for all the patients except 2 operated using the laminoplasty technique. Pathological findings were ependymoma in 43.8%, hemangioblastoma in 20.8%, and pilocytic astrocytoma in 10.4%. Six patients were reoperated for a tumor recurrence less than 2 years after the first surgical resection. One patient was reoperated for a postoperative cervical kyphosis. ConclusionIntramedullary tumors are still a challenging disease and they are treated by various surgical techniques. They must be managed in a specialized center including a trained surgical, radiological, electrophysiological, and pathological team. Arthrodesis must be discussed before performing extensive laminectomy to avoid postoperative kyphosis.

Practical Preventive Strategies for Extravasation of Contrast Media During CT: What the Radiology Team Should Do

This study aimed to assess the effectiveness of practical preventive strategies (i.e., venous vulnerability assessment and prevention scan protocol rules) taken by our radiology team (radiology nurses, radiology technicians, radiologists) on reducing extravasation of contrast media (ECM) during CT. A total of 73,931 patients who underwent contrast-enhanced CT scans between January 2013 and December 2019 were retrospectively included. Venous vulnerability assessment by the radiology team began in 2015, and prevention scan protocol rules for the prevention of ECM were added in 2017. We defined each period as follows: 2013-2014, no prevention (Period A); 2015-2016, early prevention (Period B, venous vulnerability assessment only); and 2017-2019: late prevention (Period C, venous vulnerability assessment with prevention scan protocol rules). The incident reports, radiology reports, and medical records of patients in whom ECM occurred were reviewed. We compared the frequency of ECM during each period. ECM occurred in 0.39% (292/73,931) of the patients. The frequencies of ECM for Periods A, B, and C were 0.62% (121/19,505), 0.43% (89/20,847), and 0.24% (82/33,579), respectively. There were significant differences in the frequencies of ECM among the three periods (Chi-squared test, p < 0.01). Implementation of venous vulnerability assessment and prevention scan protocol rules by a radiology team can be a practical and simple solution to reduce the risk of ECM during CT.

The Loss of the Guidewire of a Central Venous Catheter: A Case Report

Central venous catheterization is a common procedure in emergency and intensive care unit, but it has a high risk of certain complications especially infectious and thromboembolic, which remains frequent. We report a case of a rare complication of catheter insertion which was the migration of guidewire through the circulating system from the femoral vein to the jugular vein. The management of guidewire migration can be either interventional or surgical depending on the experience of the surgical and interventional radiology team.

Radio-Frequency Identifier Devices (RFIDs): Our Experience With Wireless Localisation in Non-palpable Breast Masses at a UK Tertiary Breast Imaging Unit.

The aim of this report is to evaluate the impact of the percutaneous ultrasound-guided placement of wireless radio-frequency identifier devices (RFIDs; Hologic LOCalizer, Marlborough, Massachusett) and its impact in our practice of preoperative localisation of biopsy-proven breast cancers, post-vacuum assisted biopsy-site hematoma, and lymph nodes for targeted dissection pre-operatively.A single institutional retrospective analysis of RFID usage for preoperative localisation in screening and symptomatic patients with non-palpable biopsy-proven breast carcinoma was reviewed from the radiology information system at our tertiary breast imaging unit. Its impact on the radiological and surgical team practice was reviewed, including the number of appointments, the interval between scheduling image-guided localisation and intraoperative localisation, procedure failure, average deployment, and surgical time. Feedback from surgeons and pathologists practice was also taken into consideration.Fifty-nine RFID clips were placed for wireless localisation of breast cancers, lymph nodes, and post-vacuum-assisted biopsy hematoma over nine months. Seventy-three per cent (73%; n=43/59) of RFID devices were placed in biopsy-proven carcinomas under direct ultrasound guidance. The learning curve was small, as the delivery system was similar to the commonly used localisation clips.The pilot process involved RFID with radioisotope injections for the breast mass for the initial 28% (n=12 /43) cases, which were gradually transitioned into RFID only. Radioisotope was used for sentinel node purposes if required. For targeted node dissection, 3% (n=2/59) patients received RFID for biopsy-proven metastatic node localisation, with one of two with adjunct radioisotope injection. Post-vacuum-assisted biopsy (VAB) hematoma was localised in 24% (n=14/59) cases, four of which received adjunct radioisotope in the pilot phase.The average procedure time for RFID deployment was five minutes. The average time for surgery was 20 minutes. 1.6% (n=1/59) incidence of RFID slipping from the surface of the site through surgical exposure attributed to the superficial and immediate pre-operative placement of the RFID. This was salvageable with adjunct radioisotope injection within the pilot phase. There were no incidences of repeat localisation or repeat exploration surgeries.Planned pre-operative localisation with RFID allows for better planning and less pressured service delivery and a success rate of 98-99%. This ultimately avoids lost theatre time and patient demotivation. Surgeons have reported excellent intra-operative detectability in their approach. There has been no difficulty in the detection of the RFID within the surgical cavity despite hematoma. RFID localisers are expensive compared to our usual practice of radioisotope injection but this can be recuperated through uncoupled tariffs like gain in slots of one-stop clinics, flexibility for placement, and avoiding lost theatre time, as these can be placed up to 30 days before surgery.

Early results of a French care-related adverse events database in radiology

PurposeThe purpose of this study was to report the initial results of the declaration of care-related adverse events (CRAEs) in radiology in the French National Authority for Health (HAS) database for accreditation of radiological medical teams. Materials and methodsBetween October 2018 and December 2020, 48 radiological teams (32 teams in 2019 and 16 teams in 2020; 471 registered radiologists) signed up to the team accreditation process, a system supported by the HAS. Reports of the CRAEs in radiology started in September 2019 after the team registration phase. ResultsAmong the 89 CRAEs reported, 28 (31%) were targeted as interventional radiology, 27 (30%) as linked to contrast media and 11 (12%) as related to MRI care; the 23 other CRAEs reported included five defaults in the transmission of requests or results, five delays in diagnosis or treatment, four patient-identity monitoring events, four diagnostic radiology complications, four radiation protection events and one patient information problem. The severity was rated as “minor” for 53% of CRAEs and as “serious to critical” or “catastrophic” for 8% and 9% of CRAEs, respectively. They were preventable or probably preventable in 84% of all events. ConclusionThese early results of this nation-wide CRAEs declaration database show the diversity of all CRAEs and their causes in radiological practice in France, and provide a global vision of areas for improvement of the quality of care in radiology. This should convince other radiologists to declare CRAEs and allow, in time, the production of recommendations and patient safety solutions as to limit the risks associated with radiological care.

Using Evidence-Based Criteria to Decrease CT Utilization for Liver Imaging

PurposeOverutilization of imaging in radiology increases costs without improvement in patient outcomes. As a part of the regular quality measures, the Centers for Medicare and Medicaid Services deemed our institution to be overutilizing abdomen and abdominopelvic computer tomography (CT) with and without intravenous (IV) contrast. We implemented a quality improvement (QI) effort to reduce use of abdomen CT with and without IV contrast. MethodsWe found high use of abdomen CT with and without IV contrast for liver imaging and implemented an intervention from July 2018 to June 2020. The intervention included updating the liver imaging protocols in alignment with LI-RADS guidelines and hosting educational sessions with the clinical and radiology team to review the updates. Control charts were generated to display changes in the number of CT examinations over time with phase variables indicating two averages, pre- and post-intervention. ResultsGuidelines combined with targeted educational and engaged interventions with providers demonstrated a downshift in the use of abdomen CT with and without IV contrast and upshift in the concurrent abdomen CT with IV contrast only for liver imaging. DiscussionOur quality improvement effort suggests that a combination of national quality metrics guidelines and radiology-led interventions such as education and engagement can reduce overutilization.

Improvement prostate cancer detection rate of suspicious lesions through MRI/TRUS fusion guided biopsy by a multiteam of radiologists

BackgroundThe objective of our study was to analyze the data of our biopsies, determine a detection rate (DR), compare it with the data in the literature and draw possible deductions, so as to offer the patient the possibility of not having other biopsies in the future.MethodsWe have enrolled 189 biopsy-naive patients in the period between September 2018 and December 2020. Each patient underwent multiparametric (mp)-MRI which was reviewed by our team of radiologists. In our center, each examination is examined by 4 radiologists separately with an overall final result. Through the t student test, any statistically significant differences between the DRs and the concordance rate between the positive cores and the suspected area on MRI were analyzed for each urologist who performed the procedure.ResultsThe absolute (DR) was 69.3% (131/189 patients). The relative DR for each PIRADS score was 41% for PIRADS 3, 70.2% for PIRADS 4, 89.3% for PIRADS 5. We found a high percentage of agreement between the positive biopsy samples and the suspicious area identified on MRI: 90.8% (119/131 patients). There were no statistically significant differences between the DRs of the urologists who performed the procedure (p = 0.89), nor for the percentage of agreement between the positivity of the core and the suspected area on MRI (p = 0.92).ConclusionsMRI in the future could become the gold standard for performing MRI fusion-guided biopsies to have a better diagnostic result and avoid rebiopsies. A team MRI reading allows greater accuracy in identifying the suspected lesion, which is demonstrated by a high rate of agreement with the positivity of the cores (90.8%). There is a cost problem due to the need to carry out the mpMRI but it could have less impact in the future. In addition, the MRI provides useful information on the extent of the disease (e.g., cT3a/b) which allows you to better plan the surgical strategy or other therapies.

Radiology Technologists Performing Peritoneal Drainage, Local Experience

Abstract Purpose We conducted this study to review our experience of peritoneal drainages (paracentesis) performed by interventional radiology technologists. Materials and Methods This is a retrospective study of peritoneal drainages performed by interventional radiology technologists. Results We reviewed all peritoneal drainages performed in interventional radiology between November 2018 and November 2021. The review process included success rate, volume drained, catheter duration, and complications. Conclusion Interventional radiology technologists can safely perform ultrasound-guided peritoneal drainages. Extending Interventional radiology technologists' role to perform ultrasound-guided peritoneal drainages allows interventional radiologists to do more complex procedures, enhances the workflow, and increases the efficiency of the interventional radiology team.