Perspective on the New IR Residency Selection Process: 4-year Experience at a Large, Collaborative Training Program.

Interventional Radiology (IR) was officially approved by the American Board of Medical Specialties in 2012 and the Accreditation Council of Graduate Medical Education as a unique, integrated residency in 2014. Its establishment and distinction from diagnostic radiology was compelled by the increasing emphasis on clinical care delivery by IRs. The shift in the IR training paradigm, as exemplified in the Integrated IR residency programs, appeals to a distinct cohort of applicants, prompting the need to re-evaluate the recruitment and selection process. This article discusses selection criteria for identifying ideal candidates for the new IR training model (focusing on Integrated IR residency training), highlights the importance of collaboration between the IR and DR selection committees, and illustrates the changes made at a single institution over the course of 4 selection cycles prior to the COVID-19 pandemic as well as significant changes in the current climate of the global pandemic.

Congenital portosystemic shunt occlusion with an Amplatzer PFO occlusion device: a case report.

BACKGROUND: Congenital portosystemic shunts are embryological malformations in which portal venous flow is diverted to the systemic circulation. High morbidity and mortality are seen in patients with concurrent hepatic encephalopathy, hepatopulmonary syndrome, and pulmonary hypertension. Endovascular therapy, in the correct patient population, offers a less invasive method of treatment with rapid relief of symptoms. CASE PRESENTATION: In this report, we discuss the treatment of a two-year-old male with abnormal chorea-like movements, altered mental status, anisocoria and hyperammonemia diagnosed with an intrahepatic congenital portosystemic shunt between the inferior vena cava and right portal vein. Given the patient's amenable anatomy and shunt type, embolization was performed with an 18 mm Amplatzer patent foramen ovale occlusion device. CONCLUSIONS: Portosystemic shunts are a rare congenital abnormality without universal treatment guidelines. An Amplatzer PFO occlusion device can provide a novel method of shunt closure given appropriate shunt type, size and anatomy.

Bedside intravascular ultrasound-guided fibrin sheath balloon maceration and inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation.

Inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation has been described as a technique to prevent potentially lethal pulmonary embolism in this critically ill population. With long-standing extracorporeal membranous oxygenation cannulae, venous fibrin sheaths may develop, which may predispose to filter maldeployment or inadequate embolus filtration. This report describes the use of a balloon catheter to disrupt a fibrin sheath at patient bedside using intravascular ultrasound guidance to facilitate inferior vena cava filter placement.

MRI Assessment of Hepatocellular Carcinoma after Local-Regional Therapy: A Comprehensive Review.

Nearly 80% of cirrhotic patients diagnosed with hepatocellular carcinoma (HCC) are not eligible for surgical resection and instead undergo local-regional treatment. After therapy for HCC, patients undergo imaging surveillance to assess treatment efficacy and identify potential sites of progressive tumor elsewhere within the liver. Accurate interpretation of posttreatment imaging is essential for guiding further management decisions, and radiologists must understand expected treatment-specific imaging findings for each of the local-regional therapies. Of interest, expected imaging findings seen after radiation-based therapies (transarterial radioembolization and stereotactic body radiation therapy) are different than those seen after thermal ablation and transarterial chemoembolization. Given differences in expected posttreatment imaging findings, the current radiologic treatment response assessment algorithms used for HCC (modified Response Evaluation Criteria in Solid Tumors classification, European Association for the Study of Liver Diseases criteria, and Liver Imaging and Reporting Data System Treatment Response Algorithm) must be applied cautiously for radiation-based therapies in which persistent arterial phase hyperenhancement in the early posttreatment period is common and expected. This article will review the concept of tumor response assessment for HCC, the forms of local-regional therapy for HCC, and the expected posttreatment findings for each form of therapy. Keywords: Abdomen/GI, Liver, MR-Imaging, Treatment Effects, Tumor Response © RSNA, 2020.

Characteristic Cerebrovascular Findings Associated with ACTA2 Gene Mutations.

A specific mutation (Arg179) of the ACTA2 gene has previously been described to cause a syndrome of multisystemic smooth muscle dysfunction with an extremely characteristic cerebrovascular appearance.1 Accurate neuroimaging diagnosis of this entity is important as this syndrome predisposes to complications such as early-onset ischemic stroke and ascending thoracic aortic aneurysm.2,3 The following case demonstrates a previously undescribed ACTA2 mutation (Met46) with an identical cerebrovascular imaging appearance to that of Arg179 mutations, but a less severe overall phenotype.

Essentials of Spine Trauma Imaging: Radiographs, CT, and MRI.

Traumatic injuries of the spine portend long-term morbidity and mortality. Timely diagnosis and appropriate management of mechanical instability of the spine is of utmost importance in preventing further neurologic deterioration. We present a comprehensive review of the indications for spinal imaging in the trauma setting, describe each imaging modality including plain radiographs, multidetector computed tomography and magnetic resonance imaging, basic anatomy and common fracture patterns, and discuss the traditional spinal injury classification systems and the new Subaxial Cervical Spine Injury Classification and Thoracolumbar Injury Classification and Severity score.

Endovascular Iliocaval Stent Reconstruction for Inferior Vena Cava Filter-Associated Iliocaval Thrombosis: Approach, Technical Success, Safety, and Two-Year Outcomes in 120 Patients.

PURPOSE: To report technical success, outcomes, and patency of iliocaval stent reconstruction for inferior vena cava (IVC) filter-bearing iliocaval thrombosis. MATERIALS AND METHODS: A total of 120 patients with 123 IVC filters and symptomatic iliocaval thrombosis underwent stent reconstruction. Mean patient age was 55 years (range, 19-88 y). Filters included 70 (57%) retrievable and 53 (43%) permanent filters. Symptoms included lower extremity swelling or pain (n = 93), ulcers (n = 8), phlegmasia (n = 7), back pain (n = 5), shortness of breath (n = 4), worsening renal function (n = 2), and stenosis identified during translumbar catheter placement (n = 1). Clinical success was defined as decrease in clinical, etiology, anatomy, and pathophysiology (CEAP) score of at least 1; resolution of presenting symptoms; or normalization of renal function in patients with juxtarenal or suprarenal thrombosis on presentation. Technical aspects of reconstruction, technical success, complications, 6-month clinical response, and 6-, 12-, and 24-month primary, primary-assisted, and secondary stent patency rates were recorded. RESULTS: Stent reconstruction was technically successful in all 120 patients, 63 of whom (53%) underwent thrombolysis. Thirty filters (24%) were retrieved, and 93 (76%) were excluded with stent placement across the indwelling filter. Six minor and 2 major complications occurred. Clinical success was achieved in 115 patients (96%) at 6 months. Six-, 12-, and 24-month primary iliocaval stent patency rates were 96.4%, 94.8%, and 87.2%, respectively. Twenty-four month primary-assisted and secondary patency rates were 90.3% and 94.2%, respectively. CONCLUSIONS: Iliocaval stent reconstruction is an effective treatment for filter-associated thrombosis with 100% technical success and 96% clinical success at 6 months. Technical and clinical outcomes in patients who underwent filter retrieval versus filter exclusion were similar.

Transsplenic endovascular recanalization and stenting of a completely occluded portal vein with jejunal variceal embolization in a pediatric liver transplant recipient.

Portal vein thrombosis occurs in 1.4% of pediatric liver transplant candidates and 3.7% of liver transplant recipients. While portal vein recanalization without and with portal vein stenting has been described in adult transplant candidates and recipients, it has never been described in the pediatric transplant population. This report presents a pediatric liver transplant recipient with portal hypertension secondary to portal vein thrombosis successfully managed with transsplenic access and subsequent portal vein recanalization and stenting.

Measuring social contacts in the emergency department.

BACKGROUND: Infectious individuals in an emergency department (ED) bring substantial risks of cross infection. Data about the complex social and spatial structure of interpersonal contacts in the ED will aid construction of biologically plausible transmission risk models that can guide cross infection control. METHODS AND FINDINGS: We sought to determine the number and duration of contacts among patients and staff in a large, busy ED. This prospective study was conducted between 1 July 2009 and 30 June 2010. Two 12-hour shifts per week were randomly selected for study. The study was conducted in the ED of an urban hospital. There were 81 shifts in the planned random sample of 104 (78%) with usable contact data, during which there were 9183 patient encounters. Of these, 6062 (66%) were approached to participate, of which 4732 (78%) agreed. Over the course of the year, 88 staff members participated (84%). A radiofrequency identification (RFID) system was installed and the ED divided into 89 distinct zones structured so copresence of two individuals in any zone implied a very high probability of contact <1 meter apart in space. During study observation periods, patients and staff were given RFID tags to wear. Contact events were recorded. These were further broken down with respect to the nature of the contacts, i.e., patient with patient, patient with staff, and staff with staff. 293,171 contact events were recorded, with a median of 22 contact events and 9 contacts with distinct individuals per participant per shift. Staff-staff interactions were more numerous and longer than patient-patient or patient-staff interactions. CONCLUSIONS: We used RFID to quantify contacts between patients and staff in a busy ED. These results are useful for studies of the spread of infections. By understanding contact patterns most important in potential transmission, more effective prevention strategies may be implemented.