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Background: Despite advances in therapy options, pulmonary embolism (PE) continues to carry a high risk of mortality and morbidity. Currently, therapeutic options are limited with only 2 US Food and Drug Administration-cleared catheter-based embolectomy devices approved for the treatment of intermediate-risk PE. The novel Helo PE thrombectomy catheter (Endovascular Engineering, Inc) has a flexible and collapsible funnel with an internal agitator for a dual mechanism of treatment for acute PE. We sought to investigate the safety and feasibility of the novel Helo PE thrombectomy catheter in intermediate-risk PE. Methods: A prospective, single-arm feasibility study evaluating the Helo PE catheter was performed in patients presenting with intermediate-risk PE. Patients underwent preprocedural and postprocedural computed tomography angiography. Primary efficacy was the difference in preprocedural to postprocedural right ventricle/left ventricle (RV/LV) ratio. Primary and secondary safety outcomes were all-cause mortality, major life-threatening bleeding, device-related serious adverse events, pulmonary or cardiac injury, and clinical decompensation at 48 hours postprocedure and at 30 days. Results: A total of 25 patients from 8 centers were consented and included in the analysis. Preprocedural computed tomography angiography revealed an RV/LV ratio of 1.53 ± 0.27. All patients underwent a successful thrombectomy procedure. Postprocedure, the RV/LV ratio was reduced to 1.15 ± 0.18, translating into a 23.2 ± 12.81% decrease from baseline. No patients underwent adjunctive thrombolysis. Two patients had adjunctive catheter-directed embolectomy with an alternative device. Two patients had postprocedural anemia requiring transfusion but did not meet criteria for major life-threatening bleeding by VARC-2 criteria. There were no major adverse events including no deaths, major bleeding, pulmonary injury, or vascular complications at 48 hours or 30 days post procedure. Conclusions: In this multicenter first-in-human study, use of the Helo PE thrombectomy catheter was feasible and safe for the treatment of acute PE.
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Moral distress is a term used to describe the cognitive-emotional dissonance that is experienced when one is compelled to act contrary to one's moral requirements. This occurs as a result of systemic constraints that prevent an individual from taking actions that they perceive as morally right, resulting in a perceived violation of one's core values and duties. There has been a growing interest in the prevalence of moral distress in healthcare, particularly as a root cause of burnout. A recent national survey on moral distress in radiology found that 98% of respondents experienced at least some degree of moral distress with 18% of respondents having left a position due to moral distress. One of the scenarios associated with the highest degree of moral distress related to the conflict that arises when one feels unable to fulfill teaching responsibilities due to high clinical demands. Now more than ever, clinician-educators are asked to do more with less time, fewer resources, and in an increasingly demanding work environment that is often discordant with providing quality education to their learners. In this manuscript, we aim to discuss the factors contributing to moral distress in radiologist clinician-educators as a framework to better understand the implications of these drivers, and to offer our perspective on potential mitigating measures.
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Agotamiento Profesional , Principios Morales , Radiólogos , Humanos , Radiólogos/psicología , Agotamiento Profesional/psicología , Docentes Médicos/psicología , Radiología/educación , Estrés Psicológico/psicología , Distrés PsicológicoRESUMEN
PURPOSE: The aim of this study is to uncover potential areas for cost savings in uterine artery embolization (UAE) using time-driven activity-based costing, the most accurate costing methodology for direct health care system costs. METHODS: One hundred twenty-three patients who underwent outpatient UAE for fibroids or adenomyosis between January 2020 and December 2022 were retrospectively reviewed. Utilization times were captured from electronic health record time stamps and staff interviews using validated techniques. Capacity cost rates were estimated using institutional data and manufacturer proxy prices. Costs were calculated using time-driven activity-based costing for personnel, equipment, and consumables. Differences in time utilization and costs between procedures by an interventional radiology attending physician only versus an interventional radiology attending physician and trainee were additionally performed. RESULTS: The mean total cost of UAE was $4,267 ± $1,770, the greatest contributor being consumables (51%; $2,162 ± $811), followed by personnel (33%; $1,388 ± $340) and equipment (7%; $309 ± $96). Embolic agents accounted for the greatest proportion of consumable costs, accounting for 51% ($1,273 ± $789), followed by vascular devices (15%; $630 ± $143). The cost of embolic agents was highly variable, driven mainly by the number of vials (range 1-19) of tris-acryl gelatin particles used. Interventional radiology attending physician only cases had significantly lower personnel costs ($1,091 versus $1,425, P = .007) and equipment costs ($268 versus $317, P = .007) compared with interventional radiology attending physician and trainee cases, although there was no significant difference in mean overall costs ($3,640 versus $4,386; P = .061). CONCLUSIONS: Consumables accounted for the majority of total cost of UAE, driven by the cost of embolic agents and vascular devices.
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Leiomioma , Embolización de la Arteria Uterina , Humanos , Femenino , Embolización de la Arteria Uterina/economía , Estudios Retrospectivos , Leiomioma/terapia , Leiomioma/economía , Leiomioma/diagnóstico por imagen , Adulto , Radiología Intervencionista/economía , Persona de Mediana Edad , Neoplasias Uterinas/terapia , Neoplasias Uterinas/economía , Neoplasias Uterinas/diagnóstico por imagen , Costos de la Atención en Salud/estadística & datos numéricos , Ahorro de Costo , Radiografía Intervencional/economíaRESUMEN
PURPOSE: To compare the impact of a commercial tracking database on inferior vena cava filter retrievals with that of physician tracking and no tracking. MATERIALS AND METHODS: From January 2013 to December 2021, 532 filters were placed at a single institution and followed in 3 phases: (a) Phase 1, pretracking (January 1, 2013, to February 28, 2015); (b) Phase 2, commercial database tracking (March 1, 2015, to June 30, 2019); and (c) Phase 3, commercial database tracking with separate tracking by an interventional radiologist (July 1, 2019, to December 31, 2021). Patients excluded from the commercial database due to human error served as a control group. Outcomes of commercial database entry, 2-year filter retrieval rates, dwell times, and factors contributing to retrieval candidacy were collected. RESULTS: Two-year retrieval rates in Phases 1, 2 and 3 were 20%, 31%, and 46%, respectively (Phase 1 vs 2, P = .04; Phase 2 vs 3, P = .009). Median dwell times across Phases 1, 2, and 3 were 168 days (4-1,313 days), 140 days (3-1,988 days), and 188 days (13-734 days) (P = .33), respectively. There was no difference in retrieval rates (P = .86) and dwell times (P = .50) between patients enrolled in the database group and those enrolled in the control group. Across all phases, 48% of patients enrolled in the database were not successfully contacted, and only 6% were categorized as "likely to consult" filter retrieval. During Phase 3, 100% of patients achieved a retrieval disposition. CONCLUSIONS: A commercial tracking database had low success rates of contacting patients and did not increase filter retrieval rates relative to those in the control group; however, physician tracking increased retrieval rates.
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Médicos , Filtros de Vena Cava , Humanos , Estudios Retrospectivos , Remoción de Dispositivos , Factores de Tiempo , Vena Cava InferiorRESUMEN
PURPOSE: To systematically review cost research in interventional radiology (IR) published since the Society of Interventional Radiology Research Consensus Panel on Cost in December 2016. MATERIALS AND METHODS: A retrospective assessment of cost research in adult and pediatric IR since December 2016 to July 2022 was conducted. All cost methodologies, service lines, and IR modalities were screened. Analyses were reported in a standardized fashion to include service lines, comparators, cost variables, analytical processes, and databases used. RESULTS: There were 62 studies published, with most from the United States (58%). Incremental cost-effectiveness ratio, quality-adjusted life-years, and time-driven activity-based costing (TDABC) analyses were performed in 50%, 48%, and 10%, respectively. The most frequently reported service line was interventional oncology (21%). No studies on venous thromboembolism, biliary, or IR endocrine therapies were found. Cost reporting was heterogeneous owing to varying cost variables, databases, time horizons, and willingness-to-pay (WTP) thresholds. IR therapies were more cost-effective than their non-IR counterparts for treating hepatocellular carcinoma ($55,925 vs $211,286), renal tumors ($12,435 vs $19,399), benign prostatic hyperplasia ($6,464 vs $9,221), uterine fibroids ($3,772 vs $6,318), subarachnoid hemorrhage ($1,923 vs $4,343), and stroke ($551,159 vs $577,181). TDABC identified disposable costs contributing most to total IR costs: thoracic duct embolization (68%), ablation (42%), chemoembolization (30%), radioembolization (80%), and venous malformations (75%). CONCLUSIONS: Although much of the contemporary cost-based research in IR aligned with the recommendations by the Research Consensus Panel, gaps remained in service lines, standardization of methodology, and addressing high disposable costs. Future steps include tailoring WTP thresholds to nation and health systems, cost-effective pricing for disposables, and standardizing cost sourcing methodology.
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Radiología Intervencionista , Adulto , Humanos , Niño , Análisis Costo-Beneficio , Consenso , Estudios RetrospectivosRESUMEN
PURPOSE: To assess patient and provider satisfaction with interventional radiology (IR) outpatient telehealth and in-person clinic. MATERIALS AND METHODS: This institutional review board-approved study analyzed patient satisfaction with clinic via survey after an IR outpatient telehealth or in-person visit. A physician telehealth experience survey was completed by 8 IR physicians. RESULTS: During the initial survey period, 44 (83%) of 53 patients completed a survey via telephone compared with 37 (23%) of 158 patients who were offered an electronic survey during the second survey period. Of 81 respondents, 18 (22%) were in-person and 63 (78%) were via telehealth. Of the respondents, nearly all patients (97%) in the telehealth group reported satisfaction with their telehealth clinic visit, with similar rates of high patient satisfaction between in-person and telehealth visits (P = .51). Most patients (98%) in the telehealth group strongly agreed that their physician's recommendations were clear in the telehealth visit and that their visit was private, similar to in-person visits (P = .13). A telehealth visit saved time for all patients (100%), with 78% reporting >1 hour of time-saving. All IR physicians (n = 8) reported greater efficiency with telehealth clinic than with in-person clinic and that follow-up patterns would change if telehealth was available. However, all providers (100%) found telephone visits less satisfying than in-person visits, with video visits being either equally satisfying (71%) or less satisfying (29%). CONCLUSIONS: Patient satisfaction with the in-person and telehealth outpatient IR clinic was high, with patients and providers reporting time-saving and greater efficiency with telehealth, suggesting that telehealth should remain an important component of outpatient IR clinic care.
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Radiología Intervencionista , Telemedicina , Humanos , Satisfacción del Paciente , Atención Ambulatoria , Pacientes AmbulatoriosRESUMEN
A male in his 70s presented to the emergency department with sudden-onset abdominal pain and syncope. While in the emergency department, he developed worsening hypotension and anaemia. A CT angiogram was suggestive of abdominal apoplexy (spontaneous intraperitoneal haemorrhage), which was treated successfully with embolisation of the bleeding vessels. Spontaneous bleeding was thought to be related to his initiation of apixaban 1 week previously. The patient made an excellent recovery and was transitioned back to oral anticoagulation.
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Dolor Abdominal , Hemoperitoneo , Masculino , Humanos , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/etiología , Hemoperitoneo/terapia , Dolor Abdominal/etiología , Abdomen , Angiografía , AnticoagulantesAsunto(s)
Apendicitis , Humanos , Apendicitis/complicaciones , Apendicitis/diagnóstico por imagen , Apendicitis/cirugía , Endoscopios , Abdomen , HígadoAsunto(s)
Embolización Terapéutica , Hiperplasia Prostática , Resección Transuretral de la Próstata , Arterias , Análisis Costo-Beneficio , Humanos , Masculino , Próstata/diagnóstico por imagen , Próstata/cirugía , Resección Transuretral de la Próstata/métodos , Resultado del Tratamiento , Estados UnidosRESUMEN
Venous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.
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Colangitis Esclerosante/cirugía , Embolización Terapéutica , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/terapia , Arteria Esplénica , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Arteria Esplénica/diagnóstico por imagen , Arteria Esplénica/fisiopatología , Síndrome , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To prospectively validate electromagnetic hand motion tracking in interventional radiology to detect differences in operator experience using simulation. METHODS: Sheath task: Six attending interventional radiologists (experts) and 6 radiology trainees (trainees) placed a wire through a sheath and performed a "pin-pull" maneuver, while an electromagnetic motion detection system recorded the hand motion. Radial task: Eight experts and 12 trainees performed palpatory radial artery access task on a radial access simulator. The trainees repeated the task with the nondominant hand. The experts were classified by their most frequent radial artery access technique as having either palpatory, ultrasound, or overall limited experience. The time, path length, and number of movements were calculated. Mann-Whitney U tests were used to compare the groups, and P < .05 was considered significant. RESULTS: Sheath task: The experts took less time, had shorter path lengths, and used fewer movements than the trainees (11.7 seconds ± 3.3 vs 19.7 seconds ± 6.5, P < .01; 1.1 m ± 0.3 vs 1.4 m ± 0.4, P < .01; and 19.5 movements ± 8.5 vs 31.0 movements ± 8.0, P < .01, respectively). Radial task: The experts took less time, had shorter path lengths, and used fewer movements than the trainees (24.2 seconds ± 10.6 vs 33.1 seconds ± 16.9, P < .01; 2.0 m ± 0.5 vs 3.0 m ± 1.9, P < .001; and 36.5 movements ± 15.0 vs 54.5 movements ± 28.0, P < .001, respectively). The trainees had a shorter path length for their dominant hand than their nondominant hand (3.0 m ± 1.9 vs 3.5 m ± 1.9, P < .05). The expert palpatory group had a shorter path length than the ultrasound and limited experience groups (1.8 m ± 0.4 vs 2.0 m ± 0.4 and 2.3 m ± 1.2, respectively, P < .05). CONCLUSIONS: Electromagnetic hand motion tracking can differentiate between the expert and trainee operators for simulated interventional tasks.
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Cateterismo Periférico , Competencia Clínica , Fenómenos Electromagnéticos , Mano , Destreza Motora , Arteria Radial , Radiografía Intervencional , Radiólogos , Fenómenos Biomecánicos , Estudios de Factibilidad , Humanos , Proyectos Piloto , Estudios Prospectivos , Punciones , Factores de TiempoRESUMEN
PURPOSE: To evaluate whether the recalculation of lung shunt fraction (LSF) is necessary prior to next-stage or same lobe repeat radioembolization. MATERIALS AND METHODS: Retrospective chart review was performed for patients who underwent radioembolization between February 2008 and December 2018. Eighty of 312 patients had repeat mapping angiograms and LSF calculations. A total of 160 LSF calculations were made using planar imaging (155, [97%]) and single-photon emission computed tomography (5 [3%]) technetium-99m macroaggregated albumin hepatic arterial injection imaging. The mean patient age was 61.8 years ± 12.7; 69 (86%) patients had metastatic disease and 11 (14%) had hepatocellular carcinoma. RESULTS: Patients had a median LSF of 5% (interquartile range [IQR] 3%-9%) with a median absolute difference of 1.25 (IQR 0.65-3.4) and a median of 76 days (IQR 42.5-120 days) between repeat LSF calculations. There was a median change in LSF of 0.2% between mapping studies (P = .11). There was no statistical significance between the repeat LSFs regardless of the arterial distribution (P = .79) or between tumor types (P = .75). No patients exceeded lung dose limits using actual or predicted prescribed dose amounts. The actual median lung dose was 2.6 Gy (IQR 1.8-4.4 Gy, maximum = 20.5) for the first radioembolization and 2.0 Gy (IQR 1.3-3.7 Gy, maximum = 10.1) for the second radioembolization. CONCLUSIONS: No significant difference in LSF was identified between different time points and arterial distributions within the same patient undergoing repeat radioembolization. In patients who receive well under 30-Gy lung dose for the initial treatment and a 50-Gy cumulative lung dose, repeat radioembolization treatments in the same patient may not require a repeat LSF calculation.
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Angiografía , Carcinoma Hepatocelular/terapia , Embolización Terapéutica , Neoplasias Hepáticas/terapia , Pulmón/diagnóstico por imagen , Neumonitis por Radiación/prevención & control , Radiofármacos/administración & dosificación , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/patología , Embolización Terapéutica/efectos adversos , Femenino , Humanos , Circulación Hepática , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Circulación Pulmonar , Dosis de Radiación , Neumonitis por Radiación/diagnóstico por imagen , Neumonitis por Radiación/etiología , Radiofármacos/efectos adversos , Retratamiento , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Resultado del TratamientoRESUMEN
Telehealth has not previously been widely implemented as a result of regulatory and reimbursement concerns; however, in the current national emergency of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services has relaxed many of its rules, allowing increased adoption of telehealth services, improving the safety and access of outpatient health care. A complete understanding of the regulatory requirements, technologic options, and billing processes of telehealth is required to initiate a successful clinic. A model is presented here based on a single institution's experience with implementing telehealth in the outpatient interventional radiology clinic.
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Betacoronavirus , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Radiología Intervencionista/métodos , Telemedicina/métodos , COVID-19 , Centers for Medicare and Medicaid Services, U.S. , Humanos , SARS-CoV-2 , Estados UnidosRESUMEN
OBJECTIVE: Cerebrospinal fluid (CSF) leak is a well-known complication of skull or sinus surgery. Radionuclide cisternography has high sensitivity for detection of CSF leak, commonly performed in conjunction with radioactivity assay of nasal pledgets. Our objective was to highlight the usefulness of single photon emission tomography/computed tomography (SPET/CT) in radionuclide cisternography by presenting a case of a 41 years old man with right sided rhinorrhea following craniotomies and sinus surgery, who was subjected to radioactivity assay of nasal pledgets and radionuclide cisternography for suspected CSF leak. Although no CSF leak was detected by radioactivity assay of pledgets placed in the nasal cavity, asymmetric radiotracer activity was noted on cisternographic images in the left temporal region, which was found to correspond to an enlarged CSF space in the left middle cranial fossa, not CSF leak, on SPET/CT images. CONCLUSION: SPET/CT was useful in the differentiation of asymmetric CSF radiotracer activity caused by a normal variant or post surgical changes of anatomic structures from abnormal radiotracer activity secondary to CSF leakage on radionuclide cisternography.
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Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/patología , Líquido Cefalorraquídeo/citología , Líquido Cefalorraquídeo/diagnóstico por imagen , Mielografía/métodos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Radiofármacos/farmacocinéticaRESUMEN
OBJECTIVE: The purposes of this study were to determine the accuracy of radiology reports in the diagnosis of pediatric pilomatricoma and to describe the characteristic imaging findings in a large cohort. MATERIALS AND METHODS: Query of a pathology database between January 2009 and February 2014 yielded 623 specimens from 596 patients. Seventy-four patients (41 girls, 33 boys; mean age, 8.9 years) underwent imaging of the 80 excised lesions. Ninety imaging studies were available (58 ultrasound, 11 CT, 21 MRI). Radiology reports were reviewed. The lesions were evaluated for location, size, and imaging characteristics. RESULTS: Pilomatricoma was included as an indication for two (2.2%) imaging studies. No differential diagnosis was given in 34 (37.8%) imaging reports. In the radiology reports, pilomatricoma was suggested as a possibility for 12 (13.3%) lesions. Foreign body reaction (13.3%), dermoid cyst (10.0%), and sebaceous cyst (8.9%) were other leading suggested diagnoses. In six (6.7%) reports, lesions were described as aggressive tumors. In nine (10.0%) reports additional studies were recommended. In all examinations, the lesions involved both skin and subcutaneous tissues without infiltration of the deep tissues. Hypoechoic rim (82.8%), internal reticulations (65.5%), and flow at Doppler examination (63.2%) were the most common sonographic features. MRI characteristics were enhancement (100.0%), heterogeneous T2-weighted hyperintensity with intermixed hypointensity (76.2%), T1-weighted isointensity in relation to skeletal muscle (66.7%), and absence of restricted diffusion (100.0%). CONCLUSION: Although pilomatricoma is a common tumor of the skin and subcutaneous tissues, imaging is infrequently used in the diagnosis, and therefore, many radiologists are not aware of the lesion. The imaging features of pilomatricoma are consistent in all imaging modalities.