Assuntos
Ductos Pancreáticos , Fístula Pancreática , Stents , Humanos , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/etiologia , Fístula Pancreática/cirurgia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Constrição Patológica , Resultado do Tratamento , Masculino , Pessoa de Meia-Idade , Feminino , Colangiopancreatografia Retrógrada Endoscópica/instrumentaçãoRESUMO
Hysteroscopy is a common gynecologic surgical procedure. Certain diagnoses, notably intrauterine adhesions and cervical stenosis, make hysteroscopy more complicated because of an increased likelihood of complications. Three patients, 1 with cervical stenosis and 2 with Asherman syndrome, underwent ultrasound (US)-guided adhesiolysis. Access to the uterine cavity was obtained by either direct balloon-aided dilation or the US-guided Seldinger technique, followed by balloon-aided dilation to enter the endometrial cavity and disrupt intrauterine/intracervical adhesions. In this case series, we describe a novel approach of using US-guided balloon dilation to safely and effectively treat intrauterine adhesions and to decrease the risk of perforation.
Assuntos
Ginatresia/complicações , Histeroscopia/métodos , Ultrassonografia de Intervenção/métodos , Doenças Uterinas/complicações , Doenças Uterinas/cirurgia , Adulto , Feminino , Humanos , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/cirurgia , Resultado do Tratamento , Doenças Uterinas/diagnóstico por imagem , Útero/diagnóstico por imagem , Útero/cirurgiaRESUMO
PURPOSE: To design a sustainable process to improve optional inferior vena cava (IVC) filter retrieval rates based on the Define, Measure, Analyze, Improve, Control (DMAIC) methodology of the Six Sigma process improvement paradigm. MATERIALS AND METHODS: DMAIC, an acronym for Define, Measure, Analyze, Improve, and Control, was employed to design and implement a quality improvement project to increase IVC filter retrieval rates at a tertiary academic hospital. Retrievable IVC filters were placed in 139 patients over a 2-year period. The baseline IVC filter retrieval rate (n = 51) was reviewed through a retrospective analysis, and two strategies were devised to improve the filter retrieval rate: (a) mailing of letters to clinicians and patients for patients who had filters placed within 8 months of implementation of the project (n = 43) and (b) a prospective automated scheduling of a clinic visit at 4 weeks after filter placement for all new patients (n = 45). The effectiveness of these strategies was assessed by measuring the filter retrieval rates and estimated increase in revenue to interventional radiology. RESULTS: IVC filter retrieval rates increased from a baseline of 8% to 40% with the mailing of letters and to 52% with the automated scheduling of a clinic visit 4 weeks after IVC filter placement. The estimated revenue per 100 IVC filters placed increased from $2,249 to $10,518 with the mailing of letters and to $17,022 with the automated scheduling of a clinic visit. CONCLUSIONS: Using the DMAIC methodology, a simple and sustainable quality improvement intervention was devised that markedly improved IVC filter retrieval rates in eligible patients.
Assuntos
Remoção de Dispositivo/normas , Embolia Pulmonar/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Filtros de Veia Cava/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Clínicos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos em Cuidados de Saúde/normas , Adulto JovemAssuntos
Quilo , Embolização Terapêutica/métodos , Doenças Linfáticas/terapia , Escleroterapia/métodos , Ducto Torácico , Idoso , Embucrilato/administração & dosagem , Óleo Etiodado/administração & dosagem , Esponja de Gelatina Absorvível/administração & dosagem , Humanos , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/urina , Masculino , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem , Ducto Torácico/diagnóstico por imagem , Resultado do Tratamento , UrinaAssuntos
Ligadura/métodos , Doenças Linfáticas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ducto Torácico/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Feminino , Humanos , Doenças Linfáticas/diagnóstico por imagem , Pessoa de Meia-Idade , Pescoço/cirurgia , Radiografia , Resultado do TratamentoAssuntos
Transplante de Pulmão , Complicações Pós-Operatórias/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/instrumentação , Ativador de Plasminogênio Tecidual/uso terapêutico , Doença Aguda , Catéteres , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Radiografia Intervencionista , Resultado do TratamentoAssuntos
Parede Abdominal/cirurgia , Cesárea , Descompressão Cirúrgica/métodos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Ultrassonografia de Intervenção/métodos , Varizes/cirurgia , Parede Abdominal/diagnóstico por imagem , Adulto , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Segundo Trimestre da Gravidez , Cuidados Pré-Operatórios , Resultado do Tratamento , Varizes/diagnóstico por imagemRESUMO
Abdominal aortic aneurysm (AAA) is a significant vascular disease found in 4% to 8% of the screening population. If ruptured, its mortality rate is between 75% and 90%, and it accounts for up to 5% of sudden deaths in the United States. Therefore, screening of AAA while asymptomatic has been a crucial portion of preventive health care worldwide. Ultrasound of the abdominal aorta is the primary imaging modality for screening of AAA recommended for asymptomatic adults regardless of their family history or smoking history. Alternatively, duplex ultrasound and CT abdomen and pelvis without contrast may be appropriate for screening. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation
Assuntos
Humanos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Doenças Assintomáticas , Programas de Triagem Diagnóstica , UltrassonografiaRESUMO
Pulmonary arteriovenous malformations (PAVMs) occur in 30% to 50% of patients with hereditary hemorrhagic telangiectasia. Clinical presentations vary from asymptomatic disease to complications resulting from the right to left shunting of blood through the PAVM such as paradoxical stroke, brain abscesses, hypoxemia, and cardiac failure. Radiology plays an important role both in the diagnosis and treatment of PAVM. Based on different clinical scenarios, the appropriate imaging study has been reviewed and is presented in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Assuntos
Humanos , Telangiectasia Hemorrágica Hereditária/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , EcocardiografiaRESUMO
Percutaneous biliary interventions have a well-established role in the management of hepatobiliary diseases. Good outcomes include recognizing and avoiding complications. This section will cover the "standard" technique of percutaneous biliary drainage, pearls to decrease the risk of problems, and approaches to treat those complications in patients undergoing percutaneous transhepatic cholangiography and percutaneous transhepatic biliary drainage.
Assuntos
Doenças Biliares/diagnóstico por imagem , Doenças Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Erros Médicos/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Radiografia Intervencionista , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Meios de Contraste , Drenagem/métodos , Humanos , Doença IatrogênicaRESUMO
Placement of gastrostomy tubes can be done with different techniques. The radiologic-guided tube placement relies on image guidance for safe placement of the tube. A thorough knowledge of the immediate and delayed hazards is essential. This article outlines the potential complications and how to recognize, avoid, and treat them. Several clinical examples are included. Key Words: gastrostomy, complication, feeding tubes, image guidance.
Assuntos
Gastrostomia , Erros Médicos/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Radiografia Intervencionista , Humanos , Doença IatrogênicaRESUMO
Image-guided percutaneous nephrostomy is a relatively safe and successful procedure for access to the renal collecting system for multiple purposes including relief of urinary obstruction, urinary diversion, access for endourologic procedures, and diagnostic testing. Although placing a percutaneous nephrostomy catheter is most times straightforward, providing immediate benefit for the patient and satisfaction for the practitioner, there can be situations that make the procedure more difficult or risky. A thorough review of the patient's imaging and medical record will help to set a path for success. However, there may be innuendos and unforeseen circumstances that occur. Having knowledge of most of these "stumbling blocks" and how to deal with them will keep you on the path. This paper serves to fill some of that mental file with the aim to increase clinical success.