Society of Interventional Radiology Foundation Funding to National Institutes of Health Funding: Report from the Society of Interventional Radiology Foundation/National Institutes of Health Task Force.

The Society of Interventional Radiology Foundation (SIRF) aims to support interventional radiology (IR) investigators by awarding numerous grants to promote the advancement of scientific knowledge in IR. Over the last 19 years, SIRF has awarded 227 research grants, amounting to more than $4.7 million. To increase the engagement of interventional radiologists and IR scientists with the National Institutes of Health (NIH), SIRF created a SIRF/NIH taskforce in 2020. Over the past couple of years, the task force has been working to assess the return on investment of SIRF grants in terms of NIH funding because this metric is an effective measure of assessing the early success of foundation funding. The objectives of this report are to assess SIRF funding from 2002 to 2020 and investigate the conversion of this funding into NIH grants by the same investigators. During the study period, more than $37.6 million in NIH funds were awarded to SIRF awardees, which shows a return of 8 NIH dollars for every 1 SIRF dollar invested.

Utilization of Endovascular and Surgical Treatments for Symptomatic Uterine Leiomyomas: A Population Health Perspective.

PURPOSE: To conduct a population-level analysis of surgical and endovascular interventions for symptomatic uterine leiomyomata by using administrative data from outpatient medical encounters. MATERIALS AND METHODS: By using administrative data from all outpatient hospital encounters in California (2005-2011) and Florida (2005-2014), all patients in the outpatient setting with symptomatic uterine leiomyomata were identified. Patients were categorized as undergoing hysterectomy, myomectomy, uterine artery embolization (UAE), or no intervention. Hospital stay durations and costs were recorded for each encounter. RESULTS: A total of 227,489 patients with uterine leiomyomata were included, among whom 39.9% (n = 90,800) underwent an intervention, including hysterectomy (73%), myomectomy (19%), or UAE (8%). The proportion of patients undergoing hysterectomy increased over time (2005, hysterectomy, 53.2%; myomectomy, 26.9%; UAE, 18.0%; vs 2013, hysterectomy, 80.1%; myomectomy, 14.4%; UAE, 4.0%). Hysterectomy was eventually performed in 3.5% of patients who underwent UAE and 4.1% who underwent myomectomy. Mean length of stay following hysterectomy was significantly longer (0.5 d) vs myomectomy (0.2 d) and UAE (0.3 d; P < .001 for both). The mean encounter cost for UAE ($3,772) was significantly less than those for hysterectomy ($5,409; P < .001) and myomectomy ($6,318; P < .001). Of the 7,189 patients who underwent UAE during the study period, 3.5% underwent subsequent hysterectomy. CONCLUSIONS: The proportion of women treated with hysterectomy in the outpatient setting has increased since 2005. As a lower-cost alternative with a low rate of conversion to hysterectomy, UAE may be an underutilized treatment option for patients with uterine leiomyomata.

Assessment of Image-Guided Intratumoral Delivery of Immunotherapeutics in Patients With Cancer.

Importance: Direct intratumoral delivery of immunotherapies is a compelling approach to overcoming barriers to systemic immunotherapy efficacy. While the use of intratumoral delivery of immunotherapy drugs is increasing rapidly in both the investigational and standard of care domains, the feasibility and safety of these interventions, particularly for deeper lesions that require image-guidance, remain unknown. Objective: To address current knowledge gaps in image-guided techniques for intratumoral immunotherapy delivery and the safety of these interventions. Design, Setting, and Participants: This case series study was performed at a single tertiary cancer center over a 2-year period from January 2016 to January 2018. Patients were followed until January 2019. All patients who underwent image-guided intratumoral delivery of immunotherapy agents in the standard of care, off-label, or investigational setting during the study period were included. Data were analyzed from February 1 to June 1, 2019. Exposures: Image-guided biopsies and intratumoral injections of immunotherapies across several clinical trials as well as standard of care talimogene laherparepvec therapy. Main Outcomes and Measures: Technical success, defined as the delivery of the prescribed injectate volume in its entirety, for image-guided biopsy and injections and procedure-related adverse events. Results: A total of 85 patients (median [interquartile range] age, 61 [47-71] years; 42 [52%] men) underwent 498 encounters during the study period. These encounters comprised 327 image-guided intratumoral investigational agent injections in 67 patients in clinical trials, including 33 patients with melanoma (50%), 14 patients with sarcoma (21%), 3 patients with ovarian cancer (4.5%), 2 patients with breast cancer (3%), and 2 patients with colon cancer (3%). An additional 18 patients with melanoma underwent 113 image-guided talimogene laherparepvec injections. There were no adverse events reported related to the technical component of the procedure, specifically needle insertion or biopsy. Serious adverse events (Common Terminology Criteria for Adverse Events score ≥3), including dyspnea and severe flu-like symptoms developing within 24 hours of the injection and requiring hospitalization, occurred after 3 of 327 investigational agent injections (2%) and 4 of 113 talimogene laherparepvec injections (4%). Conclusions and Relevance: The findings of this case series study suggest that intratumoral injections of immunotherapies were feasible across a range of histological conditions and target organs. Immediate postdelivery anticipated adverse events occurred in a small number of instances. Performing physicians should have the necessary safeguards in place to respond as needed. Optimal methods for intratumoral drug delivery remain unresolved, and efforts to standardize drug delivery techniques are required.

Changing Medicare Utilization of Minimally Invasive Procedures for the Treatment of Chronic Venous Insufficiency.

PURPOSE: To examine changes in the utilization of procedures related to treatment of chronic venous insufficiency (CVI) in the Medicare population. MATERIALS AND METHODS: Service-specific claims data for phlebectomy, sclerotherapy, and radiofrequency (RF) and laser ablation were identified by using Medicare Physician Supplier Procedure Summary master files from 2005 through 2014. Longitudinal national utilization rates were calculated by using annual Medicare enrollment data from 2005 through 2013. Procedure volumes by specialty group and site of service were analyzed. RESULTS: Total annual claims for these procedures in the Medicare fee-for-service beneficiaries increased from 95,206 to 332,244 (Compound Annual Growth Rate [CAGR], 15%) between 2005 and 2014. Per 1,000 beneficiaries, overall utilization increased annually from 2.8 in 2005 to 9.4 in 2013. Most procedures were performed in the private office setting (92% in 2014). In 2014, radiologists had a 10% relative market share, compared with vascular surgeons, other surgeons, and cardiologists, who had 26%, 25%, and 14% market shares, respectively. Cardiologists had the fastest relative growth, with a CAGR of 51% compared with 23% for radiology, 12% for vascular surgery, and 13% for other surgery. Total venous RF ablation services grew with a CAGR of 31%, with radiology and cardiology growing most rapidly (40% and 79%, respectively). Total venous laser ablation services grew with a CAGR of 22%, with radiology growing 15% and cardiology growing most rapidly at 44%. CONCLUSIONS: Utilization of CVI procedures in the Medicare population increased markedly from 2005 through 2014. The overwhelming majority are performed in the private office setting by nonradiologists.

A Primer on Hemodialysis From an Interventional Radiology Perspective.

Interventional radiologists play a central role in the care of patients with end-stage renal disease receiving renal replacement therapy. Ensuring that a patient׳s dialysis access remains suitable for high-quality dialysis is of paramount importance. However, although much has been spoken and written about endovascular techniques and outcomes based on angiographic criteria, little is generally known regarding the function and therefore the requirements of hemodialysis. In this article, we provide a heuristic overview of the mechanics of hemodialysis, with an emphasis on the "breaking points" in the extracorporeal circuit that trigger a patient׳s referral to Interventional Radiology. We also describe how dialysis quality is increasingly becoming linked with dialysis reimbursements. It is thus becoming progressively incumbent on the interventional radiologist to not only ensure that a patient receives high-quality outpatient dialysis but also that the patient׳s dialysis center meets its performance metrics.

Thrombosis in cancer patients: etiology, incidence, and management.

Venous thromboembolism (VTE) is the second most common cause of mortality in cancer patients. The mechanisms of cancer-associated thrombosis (CAT), much like cancer itself, are multi-factorial and incompletely understood. Cancer type, stage, tumor-derived factors and genetics all affect CAT risk. Furthermore, cancer therapies as well as the indwelling vascular devices through which these therapies are delivered can increase the risk for CAT. In this review, we summarize mechanisms of hypercoagulability in cancer patients, patterns of thrombosis associated with cancer, current guidelines for the diagnosis and management of CAT, and important considerations regarding the placement of implantable vascular devices in the care of cancer patients with VTE.

Quantitative endovascular fluorescence-based molecular imaging through blood of arterial wall inflammation.

PURPOSE: To evaluate an author-developed normalization algorithm for quantitative imaging of optical molecular probes through blood and to assess, in the rat aorta after focal aortic injury, the feasibility of measuring protease activity by using this method. MATERIALS AND METHODS: This study was performed according to a protocol approved by the institutional animal care committee. A Monte Carlo simulation was used to determine the pair of near-infrared (NIR) dyes that was best suited for the normalization algorithm. The authors tested the correction method in vitro and in vivo by injecting free dye mixtures intramurally in the aortas of four rats. The potential clinical utility was then evaluated by applying the method to the endovascular measurement of protease activity in a rat model of focal aortic injury. RESULTS: When the Monte Carlo simulation was used in the normalization algorithm, it was predicted that the intensities of signals from two NIR dyes would vary +/-3% across 1 mm of blood compared with the intensity of the raw fluorochrome signal, which would vary +/-60%. This result was validated in vitro. Endovascular imaging of free dye collections revealed that clinically relevant, uncontrollable differences in the amount of blood intervening between the imaging catheter and the dye collection precipitated dramatic variations in raw NIR fluorescence. However, use of the correction method resolved these variations such that the measured signal intensity correlated well with the different dye concentrations in the different animals. Moreover, endovascular imaging of the focal aortic injury model enabled successful measurement of enzyme activity in the walls of the rat aortas. CONCLUSION: The authors implemented a correction method for quantitative real-time endovascular imaging of fluorescence that enables one to resolve the attenuating effects of blood on NIR signal.