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: Uterine artery embolization (UAE) is an effective treatment for the management of symptomatic uterine fibroids. We aim to evaluate the efficacy of superior hypogastric nerve block (SHNB) in reducing narcotic analgesia use for postprocedural pain after UAE. METHODS: A retrospective review of 88 consecutive patients with symptomatic fibroids who underwent UAE between August 2015 and August 2018 was performed. A total of 44 patients had intraprocedural SHNB and 44 patients had no SHNB. They were placed on a morphine patient-controlled anesthesia (PCA) pump after the procedure and were admitted for overnight observation. The total amount of PCA narcotic analgesia received was recorded for each patient. Additional factors including fibroid size, fibroid location, and patient age were evaluated to determine the predictors of narcotic use reduction after SHNB. RESULTS: The mean amount of postprocedural morphine use was 51.7 mg in patients who did not receive an SHNB versus 35.9 mg in patients who did receive an SHNB (P = .008), resulting in a 47.2% reduction in narcotic analgesia use in the SHNB cohort. A significant reduction in morphine use with SHNB was associated with fibroid size greater than 5 cm (P = .009), intramural fibroid location (P = .04), and patients 45 years or younger (P = .006). CONCLUSION: The use of SHNB could significantly reduce the amount of narcotic analgesia required for pain control after UAE with larger intramural fibroids and younger patients as predictors of increased efficacy.
Asunto(s)
Leiomioma/terapia , Morfina/uso terapéutico , Bloqueo Nervioso/métodos , Manejo del Dolor/métodos , Dolor Postoperatorio/prevención & control , Embolización de la Arteria Uterina , Neoplasias Uterinas/terapia , Adulto , Analgesia Controlada por el Paciente , Femenino , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Estudios RetrospectivosRESUMEN
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel device approved by the Food and Drug administration (FDA) in 2017 as an alternative to resuscitative emergent thoracotomy (RET). Due to advancements in placement of REBOA, including newly validated placement using anatomic landmarks, REBOA is now widely used by interventional radiologists and emergency physicians in acute subdiaphragmatic hemorrhage. Increased use of REBOA necessitates that radiologists are familiar with verification of proper REBOA placement to minimize complications. This review describes the REBOA device, indications, placement, and complications, summarizing the current available literature.
Asunto(s)
Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Oclusión con Balón/métodos , Procedimientos Endovasculares/métodos , Choque Hemorrágico/diagnóstico por imagen , Choque Hemorrágico/terapia , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/terapia , HumanosAsunto(s)
Cateterismo/normas , Embolización Terapéutica/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Radiografía Intervencional/normas , Cateterismo/efectos adversos , Consenso , Embolización Terapéutica/efectos adversos , Humanos , Radiografía Intervencional/efectos adversos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Absceso/terapia , Drenaje/normas , Radiología Intervencionista/normas , Ultrasonografía Intervencional/normas , Absceso/diagnóstico por imagen , Toma de Decisiones Clínicas , Drenaje/efectos adversos , Humanos , Selección de Paciente , Factores de Riesgo , Succión/normas , Resultado del TratamientoAsunto(s)
Procedimientos Quirúrgicos del Sistema Biliar/normas , Colecistostomía/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Radiología Intervencionista/normas , Procedimientos Quirúrgicos del Sistema Biliar/efectos adversos , Colecistostomía/efectos adversos , Consenso , Humanos , Seguridad del Paciente/normas , Factores de Riesgo , Resultado del TratamientoAsunto(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)
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)
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 TratamientoRESUMEN
OBJECTIVE: We performed balloon-occluded retrograde transvenous obliteration in three consecutive patients with small gastric varices without indwelling balloon catheter occlusion. Foam of 3% sodium tetradecyl sulfate mixed with iodized oil and room air was injected retrograde through the gastrorenal shunt, followed by a thick absorbable gelatin sponge (Gelfoam, Pfizer) plug under only 10-minute balloon occlusion. CONCLUSION: Because complete obliteration of gastric varices was achieved in all patients without any complications, our technique is considered to be safe and effective for small gastric varices.