Emergency department imaging utilization post-transcatheter aortic valve replacement: single institution 7-year experience.

PURPOSE: This study aims to highlight presentations, acute findings and imaging phenotypes of patients presenting to the emergency department (ED) within 30 days of a transcatheter aortic valve replacement (TAVR). METHODS: A retrospective review of patients diagnosed with aortic valve disease who underwent a TAVR between Jan 2015 and Nov 2021 at a large academic medical center was completed. From an initial 1271 patients, 146 were included based on their presentation to the ED within 30 days post-TAVR procedure. Patient data, including ED presentation details and imaging results, were recorded and de-identified. RESULTS: Of the 146 post-TAVR patients, there were 168 ED visits within 30 days. The median time to ED after TAVR was 12 days. Respiratory symptoms were the most common complaint (27%). Neurological (23%) and cardiovascular symptoms (18%) followed. Cross-sectional imaging was conducted 250 times across visits, with an average of 1.7 scans per patient. CTs were most frequently used, followed by ultrasounds, especially echocardiograms and duplex extremity vasculature ultrasounds. 30.1% of patients had acute findings from imaging. Specific findings included heart failure (5.5%), access site complications (5.5%), pneumonia (5.5%), intracranial pathologies (3.4% for strokes and 0.7% for hematoma), and pleural effusion (3.4%). Echocardiograms and CTA chest were most associated with significant acute findings. CONCLUSION: Our study highlights the vital role of early and accurate imaging in post-TAVR patients within 30 days post-procedure. As transcatheter approaches rise in popularity, emergency radiologists become instrumental in diagnosing common post-procedural presentations. Continued research is essential to devise post-discharge strategies to curtail readmissions and related costs. Proper imaging ensures prompt, effective care, enhancing overall patient outcomes.

Role of Radiologists in Contract Research Organizations (CROs).

Clinical trials play a vital role in advancing technology and novel therapies in the healthcare world. However, the increasing scale of trials and the complexity of the regulatory approval process is often a barrier for those interested in conducting research. Contract research organizations (CROs) aim to address this problem by offering their infrastructure and expertise to bring a therapy from conception to approval without the need for in-house staff. Clinical trial imaging often plays an essential role in this process, creating a need for radiologists and a unique opportunity to provide irreplaceable value in their ability to interpret and analyze the imaging outcomes of therapies in question. This paper explores the concept of CROs, the crucial role played by radiologists in their operation, and the nature of the CRO - radiologist relationship.