Adoption of the Transradial Approach for Neurointerventions: A National Survey of Current Practitioners.

OBJECTIVES: The transradial approach (TRA) is technically feasible for both diagnostic and therapeutic neurointerventions. It improves patient comfort and is not associated with increased procedural complications when compared to the transfemoral approach (TFA). To date, no studies have looked at barriers to adoption of TRA in the neurointerventionalist community. This study aims to obtain neurointerventionalist perspectives on their adoption of TRA. MATERIALS AND METHODS: Online survey distributed to neurointerventionalists. RESULTS: A total of 55 neurointerventionalists, 52 of whom utilized TRA, responded to our survey. Overall, participants were not concerned about TRA's technical feasibility for diagnostic or therapeutic neurointerventions or about procedural complications. Most of our cohort adopted TRA due to its increased patient comfort and to reduce access site complications. In-institution interventionalists were strongly perceived to be the most effective method of teaching TRA when compared to other methods. Catheters and equipment issues were reported by about 30% of our cohort as a barrier to TRA adoption. CONCLUSIONS: The neurointerventionalist community largely perceives TRA to be technically feasible and was not concerned about its procedural complications. In-person institutionalists are strongly perceived to be the most effective method of teaching the approach. A significant barrier to adoption seems to be related to catheters and equipment issues.

Transition to virtual appointments for interventional neuroradiology due to the COVID-19 pandemic: a survey of satisfaction.

BACKGROUND: The COVID-19 pandemic has changed the way medicine is practiced, including the implementation of virtual care in many specialties. In the field of interventional neuroradiology (INR), virtual clinics are an uncommon practice with minimal literature to support its use. Our objective was to report prospective, single-centre data regarding patient and physician experience with virtual INR clinics for routine follow-up appointments. METHODS: We surveyed all patients that participated in a virtual INR clinic follow-up appointment at our hospital over a 3 month period. Information gathered included length of appointment delays (ie, wait times), length of appointment times, overall satisfaction, and perceived safety metrics. A survey was also sent out to all physicians who participated in virtual clinics with similar questions. RESULTS: 118/122 patients and 6/6 physicians completed the survey. Wait times before previous in-person appointments were perceived to be much longer than virtual appointments, whereas in-person appointment times were longer. 112/118 (94.9%) patients and 4/6 (67%) physicians reported general satisfaction with their virtual clinic experience. There were 8/118 patients who felt their conditions could not be safely assessed virtually, compared with 1/6 (17%) physicians. Lastly, 72.2% of patients reported that they would prefer virtual or telephone visits in the future for non-urgent follow-up, and 5/6 (83%) of physicians reported the same. CONCLUSION: Virtual INR clinics are more efficient and are preferred among patients and physicians for non-urgent follow-up appointments. Our study demonstrates the feasibility of a virtual platform for INR care, which could be sustainable for future practice.

Simulation in Angiography - Experiences from 5 Years Teaching, Training, and Research. / Simulation in der Angiografie ­ Erfahrungen aus 5 Jahren Lehre, Ausbildung und Forschung.

PURPOSE: The example of university radiology/neuroradiology illustrates how high-tech angiography simulators can be used meaningfully in teaching, clinical training and research. MATERIALS AND METHODS/TECHNICAL BASICS: A VIST LAB simulator (Mentice, Gothenburg, Sweden), which has been continuously developed both in terms of software and hardware, has been in use since 2013. Recently, the simulator has been integrated into the angiography suite Azurion (Philips, Amsterdam, Netherlands). RESULTS/AREAS OF APPLICATION: In student education there is the possibility for intensive examination of cerebrovascular diseases and their therapy in small group lessons. The training of beginners in diagnostic and interventional angiography begins mandatorily on the simulator. Research questions are the proof of validity and the training effect, but also the influence on patient safety and the possible cost reduction of an intervention. CONCLUSION: As a result of continuous further development in recent years, simulators are now very well suited for both student teaching and beginner medical training. In the future, even experienced interventionalists could benefit from further technical advances, which should also be driven by academic research. Possible effects would be the reduction of examination times, complications and costs. KEY POINTS: · Angiography simulators are useful in teaching students, medical training and research.. · Linking a simulator to an angiography suite increases the degree of reality even further.. · Real patient cases can be practiced and thus patient safety can be increased.. · Future developments should also increase the benefit for experienced interventionalists.. · Integration of simulators into certification programs (e. g. DEGIR) is to be targeted in the future.. CITATION FORMAT: · Kreiser K, Gehling K, Zimmer C. Simulation in Angiography - Experiences from 5 Years Teaching, Training, and Research. Fortschr Röntgenstr 2019; 191: 547 - 552.

Radiology research in mainland China in the past 10 years: a survey of original articles published in Radiology and European Radiology.

PURPOSE: To evaluate the features and trends of Radiology research in Mainland China through bibliometric analysis of the original articles published in Radiology and European Radiology (ER) between 2006 and 2015. MATERIALS AND METHODS: We reviewed the original articles published in Radiology and ER between 2006 and 2015. The following information was abstracted: imaging subspecialty, imaging technique(s) used, research type, sample size, study design, statistical analysis, study results, funding declarations, international collaborations, number of authors, department and province of the first author. All variables were examined longitudinally over time. RESULTS: Radiology research in Mainland China saw a substantial increase in original research articles published, especially in the last 5 years (P < 0.001). Within Mainland China's Radiology research, neuroradiology, vascular/interventional Radiology, and abdominal Radiology were the most productive fields; MR imaging was the most used modality, and a distinct geographic provenience was observed for articles published in Radiology and ER. CONCLUSION: Radiology research in Mainland China has seen substantial growth in the past 5 years with neuroradiology, vascular/interventional Radiology, and abdominal Radiology as the most productive fields. MR imaging is the most used modality. Article provenience shows a distinct geographical pattern. KEY POINTS: • Radiology research in Mainland China saw a substantial increase. • Neuroradiology, vascular/interventional Radiology, and abdominal Radiology are the most productive fields. • MRI is the most used modality in Mainland China's Radiology research. • Guangdong, Shanghai, and Beijing are the most productive provinces.

[Interventional neuroradiology: current options]. / Az intervenciós neuroradiológia korszeru lehetoségei.

Modern interventional neuroradiology has a leading role in the treatment of ischemic and hemorrhagic stroke, and it provides more and more important treatment options for degenerative diseases of the vertebral column and the management of correlated pain. During the last decades interventional neuroradiology has played a primary role in the treatment of intracranial berry aneurysms due to the continuous technical improvements. Ongoing studies proved superiority of mechanical stent-thrombectomy in acute proximal occlusion of cerebral arteries. Less invasive neurointerventional methods, such as vertebroplasty, are widely used in osteoporotic and neoplastic pathologic fractures of the vertebral bodies. These treatments should be performed in a specialized center by well trained physicians.

An update on brain imaging in transient ischemic attack.

Neuroimaging is critical in the evaluation of patients with transient ischemic attack (TIA) and MRI is the recommended modality to image an ischemic lesion. The presence of a diffusion (DWI) lesion in a patient with transient neurological symptoms confirms the vascular origin of the deficit and is predictive of a high risk of stroke. Refinement of MR studies including high resolution DWI and perfusion imaging using either MRI or CT further improve the detection of ischemic lesions. Rapid etiological work-up includes non-invasive imaging of cervical and intracranial arteries to search for symptomatic stenosis/occlusion associated with an increased risk of stroke.

Technical limitations of dual-energy CT in neuroradiology: 30-month institutional experience and review of literature.

BACKGROUND: Dual-energy CT (DECT) has been shown to be a useful modality in neuroradiology. OBJECTIVE: To assess failure modes and limitations of DECT in different neuroimaging applications. PATIENTS AND METHODS: Dual-source DECT scans were performed in 72 patients over 30 months to differentiate contrast agent staining or extravasation from intracranial hemorrhage (ICH) (n=40); to differentiate calcium from ICH (n=2); for metal-artifact reduction (n=5); and for angiographic assessment (n=25). A three-material decomposition algorithm was used to obtain virtual non-contrast (VNC) and iodine (or calcium) overlay images. Images were analyzed in consensus by two board-certified radiologists to determine the success of the algorithm and to assess confounding factors. Furthermore, a dilution experiment using cylinders containing defined heparinized swine blood, normal saline, and selected iodine concentrations was conducted to assess other possible confounding factors. RESULTS: Dual-energy analysis was successful in 65 (90.2%) patients. However, the algorithm failed when images were affected by beam hardening (n=3, 4.2%), the presence of a fourth material (parenchymal calcification) (n=3, 4.2%), or motion (n=1, 1.4%). In the dilution experiment, a saturation effect was seen at high iodine concentrations (≥37 mg/ml). VNC and iodine overlay images were not reliable above this concentration, and beam-hardening artifacts were noted. CONCLUSIONS: DECT material decomposition is usually successful in neuroradiology. However, it can only distinguish up to three preselected materials. A fourth material such as parenchymal calcium may confound the analysis. Artifacts such as beam hardening, metallic streak, or saturation effect can also impair material decomposition.

[Hybrid operation theatre from the perspective of neurosurgery]. / Hybridoperationssaal aus Sicht der Neurochirurgie.

BACKGROUND: The integration of hybrid operation theatre into neurosurgical and neuroradiological routines is revolutionizing in particular the management of neurovascular emergencies, such as subarachnoid aneurysmal hemorrhage (SAH) or ruptured arteriovenous malformations. RESULTS: The direct interaction between neurosurgeons and neuroradiologists in a joint environment changes and accelerates all diagnostic and therapeutic steps because all relevant procedures, including treatment control can be performed in a single room. Interventions of the skull base or the spine are also a domain of such hybrid theatre. CONCLUSION: As this new concept requires organisational changes throughout the entire patient management, a change of mindset is also needed at the institutional level in order to attain maximum benefits from such a setting.