Radiation Exposure and Protection in Computed Tomography Fluoroscopy.

Computed tomography (CT) fluoroscopy-guided procedures, such as those used for percutaneous biopsy, drainage, and radiofrequency ablation, are highly safe and quite often very successful due to the precision offered by the real-time, high-resolution tomographic images. Even so, international guidelines raised concerns regarding operator exposure to high doses of radiation during these procedures. In light of these concerns, operators conducting CT fluoroscopy-guided procedures not only need to be cognizant of the exposure risk but also exhibit sufficient knowledge of radiation protection. This paper reviews the current literature on experimental and clinical studies of radiation exposure doses to operators during CT fluoroscopy-guided procedures. In addition to the literature review, this paper also introduces different approaches that can be implemented to ensure appropriate radiation protection.

Percutaneous Transsplenic Embolization of Gastric Varices in Left-sided Portal Hypertension.

An 81-year-old man with previously diagnosed cancer of the pancreatic body presented with melena and anemia. Upper gastrointestinal endoscopy showed gastric varices with bleeding in the entire stomach. Contrast-enhanced computed tomography identified a splenic vein occlusion resulting from invasion by the pancreatic body cancer and dilated collateral pathways from the splenic hilum to the gastric fundus. The patient was diagnosed with gastric varices associated with left-sided portal hypertension caused by obstruction of the splenic vein and underwent percutaneous transsplenic embolization with n-butyl-2-cyanoacrylate mixed with lipiodol. Splenic subcapsular hematoma occurred and was treated conservatively. The patient died of advanced cancer 5 months after the procedure, without experiencing rebleeding. Percutaneous transsplenic embolization was effective in treating gastric variceal bleeding caused by left-sided portal hypertension.

Practical Radiation Protection for Interventional Radiologist.

As per the International Commission on Radiological Protection 2010 recommendation, it was stated that "interventional radiologists performing difficult procedures with high workloads may be exposed to high doses" and that education and training of medical staffs in radiation exposure is "an urgent priority." There are many reports on the textbook aspects of radiation protection, but reports on the practical aspects of radiation protection have remained to be scarce. Various methods of reducing radiation exposure are described as "useful" or "can be reduced," but the priority of these methods and the "extent" to which they contribute to reducing radiation exposure are not clear. Thus, in this article, we will look into the protection of interventional radiologist from radiation exposure in a practical way, giving priority to clarity rather than academic accuracy.

A Case of Percutaneous Transesophageal Jejunostomy after Subtotal Esophagectomy.

An 80-year-old woman who underwent subtotal esophagectomy with gastric tube reconstruction for esophageal cancer developed carcinoma of the left upper gingiva. The local recurrence of the gingival carcinoma resulted in trismus and prevented oral intake. Then she underwent a percutaneous transesophageal jejunostomy tube placement in the preserved cervical esophagus. Enteral feeding continued for three months with no complications until oral intake was possible. A percutaneous transesophageal jejunostomy is possible using the postoperatively preserved cervical esophagus.

Simultaneous Drainage of the Abscess Cavity and Intestinal Tract for an Intra-abdominal Abscess Secondary to Major Leakage: A Case Report.

This case report describes a 72-year-old man who developed an intra-abdominal abscess and major postoperative anastomotic leakage. He reported a history of pancreaticoduodenectomy, partial hepatectomy, and segmental colectomy for hepatic and colonic invasion of extrahepatic cholangiocarcinoma. Three catheters, (one in the transverse colon and two in the abscess cavity) were placed simultaneously through the drainage tract formed by the intraoperatively placed Pleats drain. The intra-abdominal abscess resolved following this intervention and has not recurred since. Postoperative drainage and starvation were continued for 52 and 84 days, respectively. This case report describes a novel technique of catheter insertion from the abscess cavity into the intestine through the site of rupture to reduce intestinal pressure and partially block the enteric fistula.

Central venous access port placement by translumbar approach using angio-CT unit in patients with superior vena cava syndrome.

PURPOSE: To evaluate the clinical results of central venous access port (CV port) placement by translumbar inferior vena cava cannulation using angio-CT unit for cancer patients with superior vena cava syndrome. MATERIALS AND METHODS: A CV port was placed by translumbar inferior vena cava cannulation using an angio-CT unit, in 14 consecutive patients. All patients had occlusion or advanced stenosis of the superior vena cava due to cancer progression. RESULTS: The technical success rate of the percutaneous translumbar CV port placement was 100%. The only complication related to port placement was bleeding in the right iliopsoas muscle seen on CT in one patient, but it stopped with conservative treatment. The mean initial device service interval was 125 days (range 6-448 days). Complications in the chronic phase occurred in two patients, one with catheter-related infection and the other with catheter breakage, for a rate of 0.44/1000 catheter days. In the patient with the broken catheter, the port chamber placement site was cut and replaced with a new catheter by guidewire exchange. CONCLUSIONS: CV port placement with translumbar inferior vena cava cannulation using an angio-CT unit for cancer patients with superior vena cava syndrome was safe and effective.