Image-Guided Energy Ablation for Palliation of Painful Bony Metastases-A Systematic Review.

PURPOSE: To analyze the effectiveness of image-guided energy ablation techniques with and without concurrent therapies in providing palliative pain relief in patients with bone metastases. MATERIALS AND METHODS: Ovid Embase, Ovid Medline, and Pubmed were searched from inception to April 14, 2023, using search terms related to bone lesions and MeSH terms regarding ablation therapy. English peer-reviewed primary articles were included that reported pain scores following image-guided energy-based ablation of bone metastases. Exclusion criteria included nonpalliative treatment, pain scores associated with specific treatment modalities not reported, and nonmetastatic bone lesions. Mean percentage reduction in pain score was calculated. RESULTS: Of the 1,396 studies screened, 54 were included. All but 1 study demonstrated decreased pain scores at final follow-up. Mean reductions in pain scores at final follow-up were 49% for radiofrequency (RF) ablation, 58% for RF ablation and adjunct, 54% for cryoablation (CA), 72% for cryoablation and adjunct (CA-A), 48% for microwave ablation (MWA), 81% for microwave ablation and adjunct (MWA-A), and 64% for high-intensity focused ultrasound (US). Postprocedural adverse event rates were 4.9% for RF ablation, 34.8% for RF ablation and adjunct, 9.6% for CA, 12.0% for CA-A, 48.9% for MWA, 33.5% for MWA-A, and 17.0% for high-intensity focused US. CONCLUSIONS: Image-guided energy ablation demonstrated consistently strong reduction in pain across all modalities, with variable postprocedural adverse event rates. Owing to heterogeneity of included studies, quantitative analysis was not appropriate. Future primary research should focus on creating consistent prospective studies with established statistical power, explicit documentation, and comparison with other techniques.

The applications of augmented reality in image-guided tumor ablations: A scoping review.

BACKGROUND: Interventional radiology employs minimally invasive image-guided procedures for diagnosing and treating various conditions. Among these procedures, alcohol and thermal ablation techniques have shown high efficacy. However, these procedures present challenges such as increased procedure time, radiation dose, and risk of tissue injury. This scoping review aims to explore how augmented reality (AR) can mitigate these challenges and improve the accuracy, precision, and efficiency of image-guided tumor ablation while improving patient outcomes. METHODS: A scoping review of the literature was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline to identify published literature investigating AR in image-guided tumor ablations. We conducted our electronic searches using PubMed, Scopus, Web of Sciences and CINAHL from inception to April 27th, 2023. The following Boolean terms were used for the search: ("augmented reality" OR "AR" OR "navigation system" OR "head mounted device" OR "HMD") AND ("tumor ablation" OR "radiofrequency tumor ablation" OR "microwave tumor ablation" OR "cryoablation"). We considered articles eligible for our scoping review if they met the following conditions: (1) published in English only, (2) focused on image-guided tumour ablations, (3) incorporated AR techniques in their methodology, (4) employed an aspect of AR in image-guided tumour ablations, and (5) exclusively involved human subjects. Publications were excluded if there was no mention of applying AR, or if the study investigated interventions other than image-guided tumour ablations. RESULTS: Our search results yielded 1,676 articles in our initial search of the databases. Of those, 409 studies were removed as duplicates. 1,243 studies were excluded during the title and abstract screening. 24 studies were assessed for eligibility in the full-text stage. 19 studies were excluded, resulting in a final selection of only five studies that satisfied our inclusion criteria. The studies aimed to assess AR's efficacy in tumor ablations. Two studies compared an optical-based AR system with CT guidance. Two studies used a head-mounted AR device, while one used a dual-camera setup. Various tumor types were examined, including bone, abdominal soft tissue, breast, hepatic, renal, colorectal, and lung lesions. All studies showed positive results, including reduced radiation exposure, shorter procedures, and improved navigation, and targeting assistance. CONCLUSION: AR systems enhance image-guided tumor ablations by improving the accuracy of ablation probe placements and increasing efficiency. They offer real-time guidance, enhanced visualization, and improved navigation, resulting in optimal needle placement. AR reduces radiation exposure and shortens procedure times compared to traditional CT-guided techniques. However, limitations like small sample sizes and technical challenges require further research. Despite this, AR shows potential benefits and larger, diverse studies are needed for validation.

What do family physicians know about interventional radiology? A survey of family physicians at a Large Canadian Annual Scientific Assembly.

PURPOSE: To quantify the level of background knowledge among family physicians with regard to interventional radiology (IR) procedures, duties, and clinical responsibilities and to develop recommendations on how to further educate family physicians in IR. MATERIALS AND METHODS: Paper surveys were administered to family physicians who attended the Ontario College of Family Physicians' Annual Scientific Assembly. Each survey consisted of 14 questions pertaining to IR procedures, clinical duties, collaboration, and education. RESULTS: A total of 213 of 229 (93%) attempted paper surveys were completed. Family physicians rated their knowledge of IR as poor (31%), adequate (53%), good (14%), or excellent (2%). A total of 98%, 71%, 47%, and 38% correctly identified that interventional radiologists performed image-guided biopsies, uterine artery embolization, radiofrequency ablation of tumors, and vascular angioplasties, respectively. Only 7% correctly identified that interventional radiologists are currently not recognized as distinct subspecialists by the Royal College of Physicians and Surgeons of Canada. Approximately 71% would refer patients directly to an interventional radiologist. A total of 96% believed that future education about IR would be "very" or "somewhat" helpful. Approximately 43% selected presentations given by interventional radiologists at family medicine conferences as their preferred method of future education. CONCLUSIONS: The data quantify and demonstrate the knowledge gap that exists among family physicians in Canada regarding IR procedures, duties, and responsibilities. Family physicians strongly support future education and collaboration with interventional radiologists. Eight results-based recommendations are made to further educate family physicians about IR and promote increased collaboration.

Review of Simulation Training in Interventional Radiology.

Simulation training has evolved and is now able to offer numerous training opportunities to supplement the practice of and overcome some of the shortcomings of the traditional Master-Apprentice model currently used in medical training. Simulation training provides new opportunities to practice skills used in clinical procedures, crisis management scenarios, and everyday clinical practice in a risk-free environment. Procedural and nonprocedural skills used in interventional radiology can be taught with the use of simulation devices and technologies. This review will inform the reader of which clinical skills can be trained with simulation, the types of commercially available simulators and their educational validity, and the assessment tools used to evaluate simulation training.

Volume Reduction in Enlarged Kidneys in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Prior to Renal Transplant with Transcatheter Arterial Embolization (TAE): A Systematic Review and Meta-Analysis.

PURPOSE: Symptomatically enlarged kidneys observed in autosomal dominant polycystic kidney disease (ADPKD) patients can lead to compression symptoms and contraindications to renal transplantation. Surgical nephrectomy can be utilized to increase space in the abdomen prior to renal transplantation; however, not all individuals are appropriate candidates for this procedure. Transcatheter arterial embolization (TAE) of the renal arteries can provide a noninvasive way to reduce renal volume in ADPKD. MATERIALS AND METHODS: We performed a systematic literature review on the usage of TAE to reduce renal volume prior to kidney transplantation and to relief compression symptoms in ADPKD. PubMed, Web of Science, and Cochrane Library were searched for articles focused on the usage of TAE to reduce renal volume in symptomatic enlarged kidneys. Renal volume data were compiled, and meta-analysis was performed with three or more studies. RESULTS: Six papers satisfied the inclusion and exclusion criteria. Significant renal volume reduction was observed by 12 months in all studies. Success of TAE was measured with three clinical outcomes: removal of contraindication for renal transplant, relief of compression symptoms, and pulmonary function test. Proportionality meta-analysis of three studies measuring relief of compression symptoms showed no significant differences in heterogeneity (p = 0.4543). CONCLUSION: Current studies conclude that TAE is an effective and minimally invasive option for reduction in renal volume in order to optimize patient outcome for renal transplantation and for relief of compression symptoms. Further prospective studies involving increased sample size and multiple centers should be pursued to establish evidence-based guidelines.

A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia.

PURPOSE: To summarize current evidence on outcomes and complications of prostatic artery embolization as a treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. METHODS AND MATERIALS: A database search of MEDLINE, Embase, Web of Science, and Cochrane Library was performed for published literature up to August 2015 concerning PAE in the treatment of BPH. Inclusion and exclusion criteria were applied by two independent reviewers, and disagreements were resolved by consensus. Peer-reviewed studies concerning PAE with BPH with a sample size >10 and at least one measured parameter were included. RESULTS: The search yielded 193 articles, of which ten studies representing 788 patients, with a mean age of 66.97 years, were included. Patients had LUTS ranging from moderate to severe. At 6 months following procedure, PV, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05), while for PSA there was no significant change. At 12 and 24 months, PV, PSA, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05). IIEF was unchanged at 6 and 12 months but was significantly reduced at 24 months. CONCLUSION: This suggests that PAE is effective in treating LUTS in the short and intermediate term.

The Management of Cephalic Arch Stenosis in Arteriovenous Fistulas for Hemodialysis: A Systematic Review.

AIM: To conduct a systematic review of management of current cephalic arch stenosis (CAS) and associated outcomes in the context of dysfunctional hemodialysis access. MATERIALS AND METHODS: PubMed, Web of Science, and Cochrane Library were searched to retrieve literature on the management of CAS. Studies had to focus on management of access stenosis solely in the cephalic arch. Case reports and literature reviews were excluded. Studies were categorized by intervention, and primary and secondary patency data were compiled. Studies were aggregated, and meta-analyses were performed where possible. RESULTS: Nine papers satisfied the aforementioned criteria: five were retrospective studies and four were prospective studies. CAS management strategies have included percutaneous transluminal balloon angioplasty (PTA), peripheral cutting balloons, surgical cephalic vein transpositions, bare stents, and stent grafts. Reporting strategies varied between studies. Meta-analyses showed that results were variable even within studies using the same modality, particularly for PTA. CONCLUSION: No singular, definitive management strategy exists for CAS. Current studies are limited by being primarily single-center retrospective trials featuring heterogenous patient populations, interventions, and endpoints. Priorities for future studies should include larger randomized trials, more uniform management strategies and endpoints, and a longer duration of follow-up.

Endovascular intervention in renovascular disease: a pictorial review.

UNLABELLED: Interventional radiologic procedures offer a significant and expanding role in the management of various renovascular diseases including renal artery stenosis, renal artery aneurysm and pseudoaneurysm, renal vascular malformations, renal tumours, trauma, and resistant hypertension. In this article, we discuss these entities in the context of currently accepted definitions, incidence, modes of diagnosis, and management as they pertain to the practice of interventional radiology. Particular emphasis is placed on current interventional procedures for managing and treating these diseases as well as emerging procedures and technologies. TEACHING POINTS: • Highlights the literature on renovascular diseases • Reviewing the role of various interventional procedures in the management of renovascular disease • Review of imaging techniques in the identification and characterisation of renovascular disease.

Thermal versus impedance-based ablation of renal cell carcinoma: a meta-analysis.

BACKGROUND: Percutaneous radiofrequency ablation (RFA) of renal carcinoma has become an established treatment modality. However, thermal (TB) versus impedance-based (IB)-RF generators have not been previously compared. METHODS: A literature search on the application of RFA for renal masses using TB or IB-RF generators was performed. The safety, efficacy, and long-term outcomes of TB versus IB-based RFA were assessed using the outcome measures of technical success, local recurrence rate, complications, and preservation of renal function. RESULTS: Across the 27 included studies, pooled results suggested comparable results for technical success (TB-RFA 98.53 % vs. IB-RFA 98.78 %, P = 0.9813). Clinical efficacy results were also similar across both generators (91.0 % TB-RFA vs. 91.5 % IB-RFA; P = 0.73). At follow-up, no differences in renal function (relative risk [RR] 0.5, 95 % confidence interval [CI] 0.45-5.48), and local recurrence (RR 0.717, 95 % CI 0.49-1.50) were observed. The pooled proportion of overall complication rates was 13.1 % for TB-RFA and 11.5 % for IB-RFA. CONCLUSION: No differences in the observed parameters were found either during surgery or at follow-up.

Meta-analysis of cryoablation versus microwave ablation for small renal masses: is there a difference in outcome?

PURPOSE: We aimed to compare local and metastatic recurrence of small renal masses primarily treated by cryoablation or microwave ablation. MATERIALS AND METHODS: The MEDLINE, CINAHL, and PUBMED databases were searched to review the treatment of small renal masses with cryoablation or microwave ablation. Fifty-one studies met the inclusion criteria. RESULTS: Fifty-one studies representing 3950 kidney lesions were analyzed. No differences were detected in the mean patient age (P = 0.150) or duration of follow-up (P = 0.070). The mean tumor size was significantly larger in the microwave ablation group compared with the cryoablation group (P = 0.030). There was no difference between microwave ablation and cryoablation groups in terms of primary effectiveness (93.75% vs. 91.27%, respectively; P = 0.400), cancer-specific survival (98.27% vs. 96.8%, respectively; P = 0.470), local tumor progression (4.07% vs. 2.53%, respectively; P = 0.460), or progression to metastatic disease (0.8% vs. 0%, respectively; P = 0.120). Patient age was predictive of overall complications in the multivariate analysis (P = 0.020). Local tumor progression with cryoablation was predicted by the mean follow-up duration using univariate (P = 0.009) and multivariate regression (P = 0.003). Clear cell and angiomyolipoma were more frequent in the microwave ablation group (P < 0.0001 and P = 0.03328, respectively), and papillary, chromophobe, and oncocytoma were more frequent in the cryoablation group (P < 0.0001, P < 0.0001, and P = 0.0004, respectively). Open access was used more often in the microwave ablation group than in the cryoablation group (12.20% vs. 1.04%, respectively; P < 0.0001), and percutaneous access was used more frequently in the cryoablation group than in the microwave ablation group (88.64% vs. 37.20%, respectively; P = 0.0021). CONCLUSION: There is no difference in local or metastatic recurrence between cryoablation- and microwave ablation-treated small renal masses.

Reducing blood-borne exposure in interventional radiology: what the IR should know.

Interventional radiologists are at risk of exposure to blood-borne pathogens in their day-to-day practice. Percutaneous exposure from unsafe sharps handling, mucocutaneous exposure from body fluid splashes, and glove perforation from excessive wear can expose the radiologist to potentially infectious material. The increasing prevalence of blood-borne pathogens, including hepatitis B and C, and human immunodeficiency virus, puts nurses, residents, fellows, and interventional radiologists at risk for occupational exposure. This review outlines suggestions to establish a culture of safety in the interventional suite.

Assessing the reliability and quality of online uterine fibroid embolization resources.

PURPOSE: This study was designed to examine the best internet resources about uterine fibroid embolization (UFE) pertinent to medical trainees, radiologists, gynecologists, family physicians, and patients. METHODS: The terms "uterine fibroid embolization," "uterine fibroid embolization," and "uterine artery embolization" were entered into Google, Yahoo, and Bing search engines; the top 20 hits were assessed. The hits were categorized as organizational or nonorganizational. Additionally, 23 radiological and obstetrical organizations were assessed. The DISCERN instrument and Journal of the American Medical Association (JAMA) benchmarks (authorship, attribution, currency, disclosure) were used to assess the information critically. The scope, strength, weaknesses, and unique features were highlighted for the top five organizational and nonorganizational websites. RESULTS: A total of 203 websites were reviewed; 23 were removed in accordance with the exclusion criteria and 146 were duplicate websites, for a total of 34 unique sites. It was found that 35 % (12/34 websites) were organizational (family medicine, radiology, obstetrics/gynecology) and 65 % (22/34 websites) were nonorganizational (teaching or patient resources). The overall mean DISCERN score was 49.6 (10.7). Two-tailed, unpaired t test demonstrated no statistically significant difference between organizational and nonorganizational websites (p = 0.101). JAMA benchmarks revealed 44 % (15/34 websites) with authorship, 71 % (24/34 websites) with attribution, 68 % (23/34 websites) with disclosure, and 47 % (16/34 websites) with currency. CONCLUSIONS: The overall quality of websites for UFE is moderate, with important but not serious shortcomings. The best websites provided relevant information about the procedure, benefits/risks, and were interactive. DISCERN scores were compromised by sites failing to provide resources for shared decision-making, additional support, and discussing consequence of no treatment. JAMA benchmarks revealed lack of authorship and currency.

Complications and reinterventions in uterine artery embolization for symptomatic uterine fibroids: a literature review and meta analysis.

PURPOSE: To perform a literature review of the spectrum of complications associated with UAE relative to surgery and compare the risk of reintervention as well as minor, major, and overall complications. MATERIALS AND METHODS: Literature review was conducted in PubMed, MEDLINE, Cochrane, and CINAHL databases, and meta-analysis was performed. RESULTS: In randomized clinical trials, common complications were discharge and fever (4.00 %), bilateral uterine artery embolization (UAE) failure (4.00 %), and postembolization syndrome (2.86 %). Two trials showed a significantly decreased risk in major complications with UAE, with odds ratios (ORs) of 0.07143 (0.009426-0.5413) and 0.5196 (0.279-0.9678). None of the trials showed a significant difference in OR for minor complications of UAE. None of the trials showed a significant difference in risk for overall complications of UAE. Three trials showed a significantly increased risk for reintervention with UAE with ORs of 10.45 (2.654-41.14), 2.679 (1.289-5.564), and 9.096 (1.269-65.18). In 76 nonrandomized studies, common complications were amenorrhea (4.26 %), pain (3.59 %), and discharge and fever (3.37 %). In 41 case studies, common complications were discharge and fever (n = 22 cases), repeat UAE (n = 6 cases), and fibroid expulsion (n = 5 cases). CONCLUSION: Overall, UAE has a significantly lower rate of major complications relative to surgery, but it comes at the cost of increased risk of reintervention in the future. Educating patients about the rate and types of complications of UAE versus surgery, as well as the potential for reintervention, should help the patient and clinician come to a reasoned decision.

Awareness and level of knowledge of interventional radiology among medical students at a Canadian institution.

PURPOSE: To assess the awareness and level of exposure of interventional radiology (IR) among medical students at a Canadian medical school. To understand how IR can be better described and introduced to medical students. MATERIALS AND METHODS: Electronic anonymous surveys were sent to 542 medical students in their first, second, and third years at a Canadian 3-year medical school. A total of 103 students (19%) responded. Each survey contained 17 questions assessing knowledge, interest, and perception of IR. RESULTS: Fifty-three percent (55/103) of respondents reported "poor" knowledge of IR and only 18% (19/103) said they would consider a career in IR. Respondents cited lack of knowledge (48%, 37/77) or lack of interest (43%, 33/77) as the main reasons why they would not consider IR as a career. Although 92% (95/103) of respondents could name at least one IR procedure, many (54%, 56/103) were unclear as to the duties of an interventional radiologist within the hospital. Seventy-four percent (76/103) of students stated that a mandatory 2-week rotation in radiology during clerkship would be beneficial, whereas 71% (73/103) stated that they would be interested in a 2-week IR selective during their mandatory core surgery rotation. CONCLUSIONS: The knowledge and exposure to IR in medical school is limited. Students were eager to learn more about IR and expressed a desire for more exposure. Early exposure of medical students to IR should be introduced to attract future interventional radiologists as well as increase awareness among future referring physicians.