ABSTRACT
Artificial intelligence (AI) is rapidly evolving and has transformative potential for interventional radiology (IR) clinical practice. However, formal training in AI may be limited for many clinicians and therefore presents a challenge for initial implementation and trust in AI. An understanding of the foundational concepts in AI may help familiarize the interventional radiologist with the field of AI, thus facilitating understanding and participation in the development and deployment of AI. A pragmatic classification system of AI based on the complexity of the model may guide clinicians in the assessment of AI. Finally, the current state of AI in IR and the patterns of implementation are explored (pre-procedural, intra-procedural, and post-procedural).
ABSTRACT
The introduction of artificial intelligence (AI) in interventional radiology (IR) will bring about new challenges and opportunities for patients and clinicians. AI may comprise software as a medical device or AI-integrated hardware and will require a rigorous evaluation that should be guided based on the level of risk of the implementation. A hierarchy of risk of harm and possible harms are described herein. A checklist to guide deployment of an AI in a clinical IR environment is provided. As AI continues to evolve, regulation and evaluation of the AI medical devices will need to continue to evolve to keep pace and ensure patient safety.
ABSTRACT
BACKGROUND: To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH). METHODS: A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4. RESULTS: Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term. CONCLUSION: PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.
Subject(s)
Embolization, Therapeutic , Lower Urinary Tract Symptoms , Prostatic Hyperplasia , Transurethral Resection of Prostate , Male , Humans , Prostate/surgery , Prostate/blood supply , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Treatment Outcome , Transurethral Resection of Prostate/adverse effects , Embolization, Therapeutic/methods , Arteries , Minimally Invasive Surgical Procedures/adverse effects , Lower Urinary Tract Symptoms/etiology , Observational Studies as TopicABSTRACT
This article discusses the percutaneous delivery and deployment of lumen-apposing metallic stents for the creation of percutaneous cholecysto-enteric anastomoses for internal drainage of the gallbladder.
Subject(s)
Drainage , Gallbladder , Humans , Anastomosis, Surgical , Gallbladder/diagnostic imaging , Stents , Endosonography , Ultrasonography, InterventionalABSTRACT
PURPOSE: To evaluate the safety and effectiveness of percutaneous cholecystoenteric anastomosis (PCEA) creation in patients with indwelling cholecystostomy tubes who are high-risk surgical candidates. MATERIALS AND METHODS: Fourteen (male, 10; female, 4) patients with a mean age of 79 years (range, 53-92 years) with previously inserted cholecystostomy tubes underwent PCEA with the adjacent duodenum using a lumen-apposing metal stent (LAMS) between January 2015 and October 2022. Intraprocedural adverse events and postprocedural safety and effectiveness outcomes were evaluated. Nine procedures were performed under sedation and 5 under general anesthesia. RESULTS: Technical success was achieved in 100% of the patients. In 12 patients (86%), the existing cholecystostomy tube was removed after the insertion of the LAMS. Three patients (21%) had a pre-existing cholecystoduodenal fistula, in which the stent was placed, and 11 (79%) underwent creation of a de novo anastomosis. The mean procedure time was 1.5 hours (range, 1-2 hours). The mean length of stay after the procedure was 2.4 days (range, 1-10 days). There were no intraprocedural adverse events. One patient with severe pre-existing cardiac comorbidities died during his postprocedural stay despite a technically successful procedure. One patient had delayed closure of the long-standing cholecystocutaneous tract. CONCLUSIONS: Early clinical experience with PCEA using an LAMS suggests that it is a safe and effective option for the creation of internal gallbladder drainage in patients who are not candidates for surgical cholecystectomy.
Subject(s)
Gallstones , Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Gallstones/diagnostic imaging , Gallstones/surgery , Pilot Projects , Endosonography/methods , Treatment Outcome , Drainage/adverse effects , Anastomosis, Surgical , Stents , Retrospective StudiesABSTRACT
Hemobilia is a term used to describe bleeding caused by abnormal communication between blood vessels and bile ducts. Some vascular anomalies, such as aneurysms or arterio-biliary fistulas, facilitate the appearance of this type of biliary bleeding. Other causes have been described such as iatrogenic causes secondary to percutaneous procedures, infections, tumors, and trauma. We report two cases of hemobilia. The first one presented with acute biliary bleeding with secondary hypovolemic shock. Bleeding was controlled after percutaneous interventions with a selective embolization technique. The second case was a patient who presented to the emergency department after a fall from his height. During hospitalization, acute cholangitis was documented, associated with hemobilia. A wide papillotomy and biliary duct instrumentation were done with the extraction of a large blood clot. Angiography is the standard for diagnosis and embolization becomes the best tool for the detection and control of vascular abnormalities that can perpetuate bleeding.
ABSTRACT
La principal indicación para el estudio de las glándulas paratiroides son las masas y, específicamente, la sospecha de adenomas, que son la patología más frecuente. Entre las diferentes modalidades diagnósticas disponibles, las de mayor sensibilidad para su detección son el ultrasonido y la gammagrafía con sestamibi, que en conjunto alcanzan la mayor especificidad para el diagnóstico. La evaluación mediante ultrasonido de las glándulas paratiroides tradicionalmente se ha considerado compleja y operador-dependiente; sin embargo, con las nuevas tecnologías de alta resolución es mucho más sencilla y nos obligamos a identificarlas en forma rutinaria, sean normales o patológicas. En este trabajo se hace una revisión sobre la anatomía normal, las técnicas de exploración y los hallazgos normales y anormales en ultrasonido de paratiroides para realizar un abordaje sencillo en la práctica diaria.
The main indication for the study of the parathyroid glands is the suspicion of masses and specifically the suspicion of adenomas, which are the most frequent pathology. Among the different diagnostic modalities available, the most sensitive for detection are ultrasound and Sestamibi scintigraphy, which together achieve the highest specificity for diagnosis. Ultrasound evaluation of the parathyroid glands has traditionally been considered complex and operator dependent, but with the new high resolution technologies it is much simpler and we are obliged to identify them routinely, whether normal or pathological. In the present work, a review is made on the normal anatomy, exploration techniques and normal and abnormal findings in parathyroid ultrasound to perform a simple and practical approach to daily practice.
Subject(s)
Humans , Parathyroid Glands , Radionuclide Imaging , Adenoma , UltrasonographyABSTRACT
El adenoma de paratiroides es generalmente identificado por hallazgos incidentales de hormona paratiroidea (PTH) y calcio elevados asociado a niveles de fósforo disminuido. Las imágenes diagnósticas identifican la posición de la glándula respecto al parénquima tiroideo y visualizan la lesión por tratar. El manejo de esta patología va desde la extirpación completa (paratiroidectomía) hasta la realización de procedimientos mínimamente invasivos como la ablación del adenoma. En esta revisión, se describe el caso de una paciente mayor quien es llevada a urgencias por alteración del estado de conciencia. Los estudios realizados evidencian aumento en los niveles de PTH y calcio junto a imágenes sugestivas de adenoma de glándula paratiroides. Fue manejada con ablación percutánea con alcohol en tres oportunidades con lo que se normalizaron los parámetros de hormonas en sangre y recuperó el nivel de conciencia sin secuelas (Acta Med Colomb 2011; 36: 41-44).
Parathyroid adenoma is generally detected by the incidental finding of high blood levels of parathyroid hormone (PTH) and calcium, in association with decreased phosphorus. Diagnostic imaging is useful in order to establish the location of the parathyroid gland with regard to the thyroid parenchyma, and to visualize the lesion that is to be treated. The management of this disease has changed from complete extirpation of the parathyroid gland to minimally invasive procedures, such as ethanol ablation of the adenoma. In this review, the case is described of an elderly woman who is taken to the emergency department because of an alteration in consciousness. Her workup gave evidence of increased PTH and calcium levels. Imaging studies were suggestive of parathyroid adenoma. The patient was treated with percutaneous ethanol ablation, which was performed three times. The levels of hormones and calcium returned to normality, and the patient recovered her level of consciousness with no apparent sequels (Acta Med Colomb 2011; 36: 41-44).
