RESUMEN
PURPOSE: To provide guidance on quality improvement thresholds for outcomes and complications of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease. MATERIALS AND METHODS: A multidisciplinary writing group conducted a comprehensive literature search to identify studies on the topic of interest. Data were extracted from relevant studies and thresholds were derived from a calculation of 2 standard deviations from the weighted mean of each outcome. A modified Delphi technique was used to achieve consensus agreement on the thresholds. RESULTS: Data from 29 studies, including systematic reviews and meta-analyses, retrospective cohort studies, and single-arm trials were extracted for calculation of the thresholds. The expert writing group agreed on thresholds for local control, overall survival and adverse events associated with image-guided thermal ablation. CONCLUSION: SIR recommends utilizing the indicator thresholds to review and assess the efficacy of ongoing quality improvement programs. When performance falls above or below specific thresholds, consideration of a review of policies and procedures to assess for potential causes, and to implement changes in practices, may be warranted.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Ablación por Catéter , Neoplasias Pulmonares , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Humanos , Pulmón , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia , Mejoramiento de la Calidad , Radiología Intervencionista , Estudios RetrospectivosRESUMEN
PURPOSE: To state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. MATERIALS AND METHODS: A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS: A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. CONCLUSION: SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Ablación por Catéter , Neoplasias Pulmonares , Canadá , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Humanos , Pulmón , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia , Radiología Intervencionista , Estudios RetrospectivosRESUMEN
PURPOSE: To perform a systematic review and meta-analysis assessing patency outcomes following drug-coated balloon angioplasty (DCBA) in hemodialysis circuits. MATERIALS AND METHODS: MEDLINE and EMBASE systematic searches were performed from inception to November 2018 to identify comparative studies assessing DCBA vs plain old balloon angioplasty (POBA) in hemodialysis circuits. Abstract selection, data extraction, and quality assessment were performed by 2 independent reviewers. Primary outcome was loss of target lesion patency at 3, 6, 12, and 24 months for autogenous arteriovenous fistula (AVF), prosthetic arteriovenous graft (AVG), and hemodialysis-related central venous stenosis. RESULTS: Twelve studies comprising 908 patients were included. There was a significant improvement in patency among AVF after DCBA vs POBA at 3, 6, 12, and 24 months (odds ratio 0.58 [95% confidence interval, 0.36-0.94]; odds ratio 0.40 [95% confidence interval 0.23-0.70]; odds ratio 0.39 [95% confidence interval, 0.25-0.61]; and odds ratio 0.20 [95% confidence interval, 0.07-0.62]). This benefit persisted on subgroup analysis of randomized controlled trials (RCTs) only. Meta-analysis of results specific to AVG could not be performed, as only 1 RCT was identified that favored DCBA. Hemodialysis-associated central vein stenosis did not demonstrate a significant difference in patency rates between DCBA and POBA on meta-analysis. Twelve-month mortality and same-day complication rates did not differ between arms. CONCLUSIONS: Significant improvement in patency was identified with DCBA in AVF at 3, 6, 12, and 24 months. A single comparative study identified benefit of DCBA use in the AVG group. No significant benefit was identified with DCBA for central stenosis.
Asunto(s)
Angioplastia de Balón/instrumentación , Derivación Arteriovenosa Quirúrgica/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Fármacos Cardiovasculares/administración & dosificación , Materiales Biocompatibles Revestidos , Oclusión de Injerto Vascular/terapia , Diálisis Renal , Dispositivos de Acceso Vascular , Anciano , Anciano de 80 o más Años , Angioplastia de Balón/efectos adversos , Derivación Arteriovenosa Quirúrgica/mortalidad , Implantación de Prótesis Vascular/mortalidad , Fármacos Cardiovasculares/efectos adversos , Femenino , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/mortalidad , Oclusión de Injerto Vascular/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
PURPOSE: To develop a new adverse event (AE) classification for the interventional radiology (IR) procedures and evaluate its clinical, research, and educational value compared with the existing Society of Interventional Radiology (SIR) classification via an SIR member survey. MATERIALS AND METHODS: A new AE classification was developed by members of the Standards of Practice Committee of the SIR. Subsequently, a survey was created by a group of 18 members from the SIR Standards of Practice Committee and Service Lines. Twelve clinical AE case scenarios were generated that encompassed a broad spectrum of IR procedures and potential AEs. Survey questions were designed to evaluate the following domains: educational and research values, accountability for intraprocedural challenges, consistency of AE reporting, unambiguity, and potential for incorporation into existing quality-assurance framework. For each AE scenario, the survey participants were instructed to answer questions about the proposed and existing SIR classifications. SIR members were invited via online survey links, and 68 members participated among 140 surveyed. Answers on new and existing classifications were evaluated and compared statistically. Overall comparison between the two surveys was performed by generalized linear modeling. RESULTS: The proposed AE classification received superior evaluations in terms of consistency of reporting (P < .05) and potential for incorporation into existing quality-assurance framework (P < .05). Respondents gave a higher overall rating to the educational and research value of the new compared with the existing classification (P < .05). CONCLUSIONS: This study proposed an AE classification system that outperformed the existing SIR classification in the studied domains.
Asunto(s)
Garantía de la Calidad de Atención de Salud/normas , Radiografía Intervencional/efectos adversos , Radiografía Intervencional/normas , Radiología Intervencionista/normas , Humanos , Sociedades MédicasRESUMEN
A meta-analysis was performed to assess randomized controlled trials comparing local endovascular therapy (with and without intravenous thrombolysis) versus standard care (intravenous thrombolysis alone when appropriate) for acute ischemic stroke. Local endovascular therapy showed a significant improvement in functional independence versus standard care (odds ratio, 1.779; 95% confidence interval, 1.262-2.507; P < .001). This benefit strengthened further on subgroup analyses of trials in which a majority of cases used stent retrievers, trials with intravenous thrombolysis use in both arms when appropriate, and trials that required preprocedural imaging of all patients. There were no significant differences between arms in terms of mortality, hemicraniectomy, intracranial hemorrhage, and cerebral edema rates (P > .05). In conclusion, in the treatment of acute ischemic stroke, local endovascular therapy leads to improved functional independence compared with standard care.
Asunto(s)
Isquemia Encefálica/terapia , Procedimientos Endovasculares , Fibrinolíticos/administración & dosificación , Accidente Cerebrovascular/terapia , Terapia Trombolítica , Administración Intravenosa , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Isquemia Encefálica/fisiopatología , Circulación Cerebrovascular , Evaluación de la Discapacidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Fibrinolíticos/efectos adversos , Humanos , Oportunidad Relativa , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Resultado del TratamientoAsunto(s)
Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición por Inhalación/prevención & control , Máscaras/provisión & distribución , Exposición Profesional/prevención & control , Salud Laboral , Dispositivos de Protección Respiratoria/provisión & distribución , Infecciones del Sistema Respiratorio/terapia , Aerosoles , Humanos , Exposición por Inhalación/efectos adversos , Exposición Profesional/efectos adversos , Tamaño de la Partícula , Infecciones del Sistema Respiratorio/transmisión , Infecciones del Sistema Respiratorio/virología , Medición de Riesgo , Factores de RiesgoAsunto(s)
Biopsia con Aguja/normas , Biopsia Guiada por Imagen/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Radiología Intervencionista/normas , Factores de Edad , Biopsia con Aguja/efectos adversos , Consenso , Humanos , Biopsia Guiada por Imagen/efectos adversos , Seguridad del Paciente/normas , Valor Predictivo de las Pruebas , Factores de RiesgoAsunto(s)
Arterias , Ensayos Clínicos como Asunto/normas , Embolización Terapéutica/normas , Síntomas del Sistema Urinario Inferior/terapia , Próstata/irrigación sanguínea , Hiperplasia Prostática/terapia , Radiografía Intervencional/normas , Proyectos de Investigación/normas , Terminología como Asunto , Arterias/diagnóstico por imagen , Consenso , Embolización Terapéutica/efectos adversos , Humanos , Síntomas del Sistema Urinario Inferior/diagnóstico por imagen , Síntomas del Sistema Urinario Inferior/fisiopatología , Masculino , Pautas de la Práctica en Medicina/normas , Hiperplasia Prostática/diagnóstico por imagen , Hiperplasia Prostática/fisiopatología , Radiografía Intervencional/efectos adversos , Resultado del TratamientoAsunto(s)
Carcinoma de Células Renales/cirugía , Criocirugía/normas , Neoplasias Renales/cirugía , Microondas/uso terapéutico , Ablación por Radiofrecuencia/normas , Radiografía Intervencional/normas , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/secundario , Toma de Decisiones Clínicas , Consenso , Criocirugía/efectos adversos , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Microondas/efectos adversos , Selección de Paciente , Ablación por Radiofrecuencia/efectos adversos , Radiografía Intervencional/efectos adversos , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Carga TumoralAsunto(s)
Isquemia Encefálica/terapia , Educación de Postgrado en Medicina , Radiografía Intervencional/normas , Radiólogos/educación , Radiólogos/normas , Radiología Intervencionista/educación , Radiología Intervencionista/normas , Accidente Cerebrovascular/terapia , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/fisiopatología , Certificación/normas , Competencia Clínica/normas , Consenso , Curriculum , Técnica Delphi , Educación de Postgrado en Medicina/normas , Humanos , Sociedades Médicas , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: It is important for physicians to be aware of the radiation doses as well as the risks associated with diagnostic imaging procedures that they are ordering. METHODS: A survey was administered to patients, medical students, and referring physicians from a number of specialties to determine background knowledge regarding radiation exposure and risk associated with commonly ordered medical imaging tests. RESULTS: A total of 127 patients, 32 referring physicians, and 30 medical students completed the survey. The majority of patients (92%) were not informed of the radiation risks associated with tests that they were scheduled to receive and had false perceptions about the use of radiation and its associated risks. Physicians and medical students had misconceptions about the use of ionizing radiation in a number of radiologic examinations; for example, 25% and 43% of physicians and medical students, respectively, were unaware that interventional procedures used ionizing radiation, and 28% of physicians were unaware that mammography used ionizing radiation. Computed tomographies and barium studies were thought to be associated with the least ionizing radiation among physicians. CONCLUSION: There is a need for educating the public, medical students, and referring physicians about radiation exposure and associated risk so that (1) patients receiving multiple medical imaging tests are aware of the radiation that they are receiving and (2) physicians and future physicians will make informed decisions when ordering such tests to limit the amount of radiation that patients receive and to promote informed consent among patients.