A technique for determining pump injector settings for an on-table CT or 3D DSA in interventional radiology.

INTRODUCTION: On-Table computed tomography (CT) or 3D digital subtraction angiography (DSA) in interventional radiology (IR) has become a valuable diagnostic tool. METHODS: A review of the literature found a poor evidential base supporting the technical parameters for iodinated contrast delivery during these acquisition sequences. RESULTS AND CONCLUSION: This technical note presents an easy method of estimating the parameters needed to reliably obtain diagnostic on-table CT or 3D DSA images, whilst attempting minimising contrast dose. IMPLICATIONS FOR PRACTICE: A systematic approach to estimating contrast delivery regimes during on-table CT and 3D DSA can help ensure diagnostic quality images are obtained. Further clinical studies are now required to rigorously evaluate this protocol.

Initial single centre experiences of a radiographer advanced practitioner led nephrostomy exchange programme.

INTRODUCTION: To evaluate the technical success, radiation dose, complications and costs from the introduction of a radiographer-led nephrostomy exchange service. METHODS: Post-graduate qualified interventional radiographers with several years' experience in performing other interventional procedures began performing nephrostomy exchanges. Training was provided by an interventional radiologist. Each radiographer performed ten procedures under direct supervision followed by independent practice with remote supervision. Each radiographer was then responsible for the radiological report, discharge, re-referral for further exchange and, where indicated, sending urine samples for culture and sensitivity. Data extraction included the time interval between exchanges, radiation dose/screening time and complications. RESULTS: Thirty-eight long-term nephrostomy patients had their histories interrogated back to the time of the initial insertion. The mean (range) age at nephrostomy insertion was 67 (35-93) years and 65% were male. Indications for nephrostomy were prostatic or gynaecological malignancy, ureteric injury, bulky lymphoma and post-transplant ureteric stricture. A total of 170 nephrostomy exchanges were performed with no statistically significant differences in the radiation dose, fluoroscopy time nor complication rates between consultants and radiographers. There was, however, a statistically significant reduction in the time interval between nephrostomy exchanges for the radiographer group (P = 0.022). CONCLUSION: Interventional radiographers can provide a safe, technically successful nephrostomy exchange program with radiation doses equivalent to radiologists. This is a cost-effective solution to the capacity issues faced in many departments, whilst providing career progression, job satisfaction and possibly improved care. IMPLICATIONS FOR PRACTICE: Radiographer-led interventional services should be considered by other institutions as a means of providing effective nephrostomy exchanges.