Occupational radiation and pregnancy: reality or disinformation? A review of the literature and summary of current clinical guidelines.

Exposure to ionizing radiation is a decisive factor in women's choice of entering the field of interventional radiology. This issue explains the low percentage of women in interventional radiology and the high number of women who take leave from work when they are pregnant even though they have no problems with their pregnancy. The current guidelines and legal framework regarding pregnancy and ionizing radiation from different national institutions are not in line with the scientific evidence. They establish recommendations based on disinformation and a need to protect the fetus that has not been scientifically validated. Lack of knowledge and lack of evidence-based information could contribute to gender-based inequality at work. This article reviews the evidence from the articles and clinical guidelines in PubMed, paying special attention to publications from the last five years (2015-2020). Additionally, it reports the results of an online survey of healthcare professionals exposed to radiation in their work.

Radiación ocupacional y embarazo: realidad o desinformación. Revisión en la literatura y actualización según guías clínicas vigentes / Occupational radiation and pregnancy: reality or disinformation? A review of the literature and summary of current clinical guidelines

La exposición a radiaciones ionizantes es un factor condicionante a la hora de elegir radiología vascular intervencionista, lo que justifica el bajo porcentaje de radiólogas dedicadas a ello y el elevado número de bajas en trabajadoras embarazadas de servicios de radiodiagnóstico sin patología gestacional. Las recomendaciones y actual legislación sobre embarazo y manejo de radiaciones ionizantes de las diferentes instituciones nacionales no se ajustan a evidencias científicas, estableciendo medidas de protección basadas en desinformación y una protección injustificada al feto cuya validez no se ha demostrado científicamente. El desconocimiento y falta de información basada en evidencias podría ser una causa de esta disparidad laboral relacionada con el género de los trabajadores.Se realiza una revisión en la base de datos PubMed de los artículos y guías de práctica clínica más relevantes, con especial atención a los publicados en los últimos 5 años (2015-2020), y se describen los resultados de una encuesta online realizada a trabajadores sanitarios expuestos.(AU)

Exposure to ionizing radiation is a decisive factor in women's choice of entering the field of interventional radiology. This issue explains the low percentage of women in interventional radiology and the high number of women who take leave from work when they are pregnant even though they have no problems with their pregnancy. The current guidelines and legal framework regarding pregnancy and ionizing radiation from different national institutions are not in line with the scientific evidence. They establish recommendations based on disinformation and a need to protect the fetus that has not been scientifically validated. Lack of knowledge and lack of evidence-based information could contribute to gender-based inequality at work.This article reviews the evidence from the articles and clinical guidelines in PubMed, paying special attention to publications from the last five years (2015-2020). Additionally, it reports the results of an online survey of healthcare professionals exposed to radiation in their work.(AU)

Efficacy of Paclitaxel Balloon for Hemodialysis Stenosis Fistulae After One Year Compared to High-Pressure Balloons: A Controlled, Multicenter, Randomized Trial.

PURPOSE: A controlled, prospective, multicenter, randomized trial to compare primary patency after angioplasty with a drug-coated balloon versus plain angioplasty balloon in stenosis of dysfunctional fistulae and grafts for hemodialysis. MATERIALS AND METHODS: A total of 136 patients (148 angioplasties) at four centers were randomized to receive a drug-coated balloon or plain angioplasty balloon after satisfactory angioplasty with a high-pressure balloon. The inclusion criteria were clinical signs of vascular dysfunction confirmed by Doppler Ultrasound and/or angiography. The primary endpoint was target lesion patency defined as time elapsed between the completion of effective and the appearance of restenosis at 6 and 12 months after angioplasty. Secondary endpoints included the relationship between the location of the stenosis, previous angioplasty, demographic variables and survival. RESULTS: Primary patency after angioplasty was higher in the group treated with the drug-coated balloon than the plain angioplasty balloon (153.01 to 141.69 days at 6 months; 265.78 to 237.83 days at 12 months). Drug-coated balloon angioplasty resulted in superior patency after 6 and 12 months, but this result was not statically significant (P = 0.068 at 6 months; P = 0.369 at 12 months). There was no relation between target lesion patency and the other variables studied. Overall mortality in the plain angioplasty balloon group was higher (9% vs. 5.7%) but not statistically significant. CONCLUSIONS: Drug-coated balloon angioplasty resulted in superior survival of dysfunctional peripheral vascular access at 6 and 12 months, but this result was not statistically significant. Both arms show equivalent complications and similar mortality. LEVEL OF EVIDENCE: Level Ia, therapeutic study, RCT. EBM ratings will be based on a scale of 1-5.

Diagnostic reference levels and complexity indices in interventional radiology: a national programme.

OBJECTIVES: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. METHODS: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. RESULTS: The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. CONCLUSIONS: The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. KEY POINTS: • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.

Valor de la ecografía doppler en la disfunción de los accesos vasculares periféricos para hemodiálisis / Value of doppler ultrasonography in the study of hemodialysis peripheral vascular access dysfunction

Objetivo . El objetivo principal del estudio es evaluar la sensibilidad y especificidad de la ecografía dúplex-Doppler para estudiar la disfunción de los accesos vasculares periféricos para hemodiálisis, y analizar el índice de resistencia y el flujo en la arteria aferente. Material y métodos. Se estudiaron prospectivamente 178 pacientes con 178 accesos vasculares periféricos disfuncionantes durante al menos 3 sesiones de hemodiálisis seguidas. Se realizaron ecografía dúplex-Doppler, angiografía y seguimiento clínico y analítico durante 3 meses (si la angiografía fue negativa). Se calcularon los valores de sensibilidad, especificidad, valores predictivos y cocientes de probabilidad. Se estudiaron morfológicamente la arteria aferente, la anastomosis arteriovenosa y la vena eferente, y se midieron el índice de resistencia y el flujo de la arteria aferente, el diámetro de la anastomosis, y el flujo y velocidad picosistólica en la vena eferente. Resultados. La muestra final la constituyeron 159 pacientes. Los valores de sensibilidad, especificidad, valor predictivo positivo y negativo y cociente de probabilidad positivo y negativo, fueron 0,98 (IC 95% 0,88-1), 0,74 (IC 95% 0,66-0,81), 0,96, 0,82, 3,7 y 0,03 respectivamente. El índice de resistencia fue < 0,5 en el 78,5% de los accesos vasculares periféricos normofuncionantes y > 0,5 en el 86,1% de los disfuncionantes. Se encontraron aneurismas en 19 de los accesos vasculares periféricos nativos y seudoaneurismas en 7 de los protésicos. El flujo invertido apareció en 57 accesos vasculares periféricos. Conclusión. La ecografía doppler dúplex es un método eficaz de detección y caracterización de estenosis y trombosis del accesos vasculares periféricos y aporta información morfológica y hemodinámica (AU)

Objective. The main objectives of this study were to evaluate the sensitivity and specificity of duplex Doppler ultrasonography in the study of hemodialysis peripheral vascular access dysfunction and to analyze the resistance index and flow in the afferent artery. Material and methods. We prospectively studied 178 patients with 178 peripheral vascular accesses that were dysfunctional in at least three consecutive hemodialysis sessions. Patients underwent duplex Doppler ultrasonography and clinical and laboratory follow-up for three months (provided angiography findings were negative). We calculated the sensitivity, specificity, predictive values, and coefficients of probability. We studied the morphology of the afferent artery, the arteriovenous anastomosis, and the efferent vein, and we measured the resistance index and the flow of the afferent artery, the diameter of the anastomosis, and the flow and peak systolic velocity in the efferent vein. Results. The final sample consisted of 159 patients. The sensitivity, specificity, positive and negative predictive values, and positive and negative coefficients of probability were 0,98 (95% CI: 0,88-1.00), 0,74 (95% CI: 0,66-0,81), 0,96, 0,82, 3.7, and 0,03, respectively. The resistance index was less than 0,5 in 78.5% of the peripheral vascular accesses with normal function and greater than 0,5 in 86.1% of the dysfunctional peripheral vascular accesses. We found aneurysms in 19 of the native peripheral vascular accesses and pseudoaneurysms in 7 of the prosthetic grafts. Inverted flow was seen in 57 peripheral vascular accesses. Conclusion. Duplex Doppler ultrasonography is an efficacious method for detecting and characterizing stenosis and thrombosis in peripheral vascular accesses, and it provides information about the morphology and hemodynamics (AU)

Seudoaneurisma de la cola pancreática: tratamiento percutáneo mediante inyección de trombina / Pancreatic tail pseudoaneurysm: percutaneous treatment by thrombin injection

Los seudoaneurismas de arterias viscerales secundarios a pancreatitis aguda y/o crónica suponen una complicación relativamente frecuente y potencialmente grave. Las técnicas endovasculares constituyen el tratamiento más aceptado en la actualidad, dada la mayor morbimortalidad de la cirugía. La trombosis del seudoaneurisma mediante la inyección percutánea de trombina con control ecográfico está emergiendo como una opción útil en aquellos casos en los que no es posible la embolización por vía endovascular. Presentamos el caso de un paciente con un seudoaneurisma de la arteria pancreática transversa secundario a pancreatitis crónica, tratado con éxito mediante administración percutánea de trombina (AU)

Visceral artery pseudoaneurysms secondary to acute and/or chronic pancreatitis are a relatively common and potentially serious complication. Endovascular techniques are the most currently accepted techniques, given the higher morbidity-mortality of surgery. The thrombosis of the pseudoaneurysm using an ultrasound-guided percutaneous thrombin injection is emerging as a useful option in those cases in which endovascular embolisation is not possible. We present the case of a patient with a pseudoaneurysm of the transverse pancreatic artery secondary to chronic pancreatitis, and successfully treated by administering percutaneous thrombin (AU)

[Pancreatic tail pseudoaneurysm: percutaneous treatment by thrombin injection]. / Seudoaneurisma de la cola pancreática: tratamiento percutáneo mediante inyección de trombina.

Visceral artery pseudoaneurysms secondary to acute and/or chronic pancreatitis are a relatively common and potentially serious complication. Endovascular techniques are the most currently accepted techniques, given the higher morbidity-mortality of surgery. The thrombosis of the pseudoaneurysm using an ultrasound-guided percutaneous thrombin injection is emerging as a useful option in those cases in which endovascular embolisation is not possible. We present the case of a patient with a pseudoaneurysm of the transverse pancreatic artery secondary to chronic pancreatitis, and successfully treated by administering percutaneous thrombin.

Value of doppler ultrasonography in the study of hemodialysis peripheral vascular access dysfunction.

OBJECTIVE: The main objectives of this study were to evaluate the sensitivity and specificity of duplex Doppler ultrasonography in the study of hemodialysis peripheral vascular access dysfunction and to analyze the resistance index and flow in the afferent artery. MATERIAL AND METHODS: We prospectively studied 178 patients with 178 peripheral vascular accesses that were dysfunctional in at least three consecutive hemodialysis sessions. Patients underwent duplex Doppler ultrasonography and clinical and laboratory follow-up for three months (provided angiography findings were negative). We calculated the sensitivity, specificity, predictive values, and coefficients of probability. We studied the morphology of the afferent artery, the arteriovenous anastomosis, and the efferent vein, and we measured the resistance index and the flow of the afferent artery, the diameter of the anastomosis, and the flow and peak systolic velocity in the efferent vein. RESULTS: The final sample consisted of 159 patients. The sensitivity, specificity, positive and negative predictive values, and positive and negative coefficients of probability were 0,98 (95% CI: 0,88-1.00), 0,74 (95% CI: 0,66-0,81), 0,96, 0,82, 3.7, and 0,03, respectively. The resistance index was less than 0,5 in 78.5% of the peripheral vascular accesses with normal function and greater than 0,5 in 86.1% of the dysfunctional peripheral vascular accesses. We found aneurysms in 19 of the native peripheral vascular accesses and pseudoaneurysms in 7 of the prosthetic grafts. Inverted flow was seen in 57 peripheral vascular accesses. CONCLUSION: Duplex Doppler ultrasonography is an efficacious method for detecting and characterizing stenosis and thrombosis in peripheral vascular accesses, and it provides information about the morphology and hemodynamics.

Solución del caso 24. Isquemia aguda de miembros inferiores secundaria a intoxicación crónica por ingesta de ergotamínicos / No disponible

No disponible

Bezoar de localización colónica / Colonic bezoar

No disponible