Radiation and the Pregnant IR: Myth versus Fact.

The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. Radiation exposure during pregnancy is a source of concern for many women interventional radiologists. There are misconceptions about the actual risks and what is safe. This article will address the myths surrounding occupational radiation exposure and clarify the facts.

Achieving Speaker Gender Equity at the SIR Annual Scientific Meeting: The Effect of Female Session Coordinators.

PURPOSE: To examine the impact of targeted efforts to increase the number of female speakers at the Society of Interventional Radiology (SIR) Annual Scientific Meeting (ASM) by reporting gender trends for invited faculty in 2017/2018 vs 2016. MATERIALS AND METHODS: Faculty rosters for the 2016, 2017, and 2018 SIR ASMs were stratified by gender to quantify female representation at plenary sessions, categorical courses, symposia, self-assessment modules, and "meet-the-expert" sessions. Keynote events, scientific abstract presentations, and award ceremonies were excluded. In 2017, the SIR Annual Meeting Committee issued requirements for coordinators to invite selected women as speakers. Session coordinators are responsible for issuing speaker invitations, and invited speakers have the option to decline. RESULTS: Years 2017 and 2018 showed increases in female speaker representation, with women delivering 13% (89 of 687) and 14% (85 of 605) of all assigned presentations, compared with 9% in 2016 (46 of 514; P = .03 and P = .01, respectively). Gender diversity correlated with the gender of the session coordinator(s). When averaged over a 3-year period, female speakers constituted 7% of the speaker roster (112 of 1,504 presentations) for sessions led by an all-male coordinator team, compared with 36% (108 of 302) for sessions led by at least 1 female coordinator (P < .0001). Results of the linear regression model confirmed the effect of coordinator team gender composition (P < .0001). CONCLUSIONS: Having a woman as a session coordinator increased female speaker participation, which suggests that the inclusion of more women as coordinators is one mechanism for achieving gender balance at scientific meetings.

Permanent versus Retrievable Inferior Vena Cava Filters: Rethinking the "One-Filter-for-All" Approach to Mechanical Thromboembolic Prophylaxis.

Inferior vena cava (IVC) filtration for thromboembolic protection is not without risks, and there are important differences among commercially available IVC filters. While retrievable filters are approved for permanent implantation, they may be associated with higher device-related complications in the long term when compared with permanent filters. Prospective patient selection in determining which patients might be better served by permanent or retrievable filter devices is central to resource optimization, in addition to improved clinical follow-up and a concerted effort to retrieve filters when no longer needed. This article highlights the differences between permanent and retrievable devices, describes the interplay between these differences and the clinical indications for IVC filtration, advises against a "one-filter-for-all" approach to mechanical thromboembolic prophylaxis, and discusses strategies for optimizing personalized device selection.

Occupational Radiation Exposure during Pregnancy: A Survey of Attitudes and Practices among Interventional Radiologists.

PURPOSE: To assess attitudes of interventional radiologists toward occupational ionizing radiation exposure in pregnancy and to survey practice patterns and outcomes. MATERIALS AND METHODS: A 34-question anonymous online survey on attitudes and work practices toward interventional radiologists who worked during pregnancy was sent to active SIR members, including 582 women. RESULTS: There were 534 (10%) respondents, including 142 women and 363 men. Among respondents, men were statistically older than women (P < .001) and had practiced interventional radiology (IR) longer (P < .001). Of female interventional radiologists, 55% had worked during pregnancy and reported no specific mutagenic events in their offspring. Spontaneous abortions (11%) and use of reproductive technology (17%) matched that of women with similar age and socioeconomic background. Although more women changed their work practice because of concerns of occupational exposure than men (23% vs 13%), this change was largely limited to the duration of a pregnancy. Among pregnant interventional radiologists, 4 (6%) completely abstained from performing fluoroscopically guided interventions (FGIs), whereas 31 (46%) continued to spend > 80% of their work week doing FGIs with additional protection. Perceptions of impact of pregnancy on daytime work redistribution varied significantly with gender (P < .001); however, perceptions regarding impact of pregnancy on on-call hours, distribution of complex cases, and need to hire for temporary coverage were similar between the genders. CONCLUSIONS: Most pregnant interventional radiologists continue to practice IR while pregnant. Pregnancy and fetal outcomes parallel that of the general population when matched for demographics. However, perceptions of impact of pregnancy on work lives of colleagues vary notably.

Renewing focus on resident education: increased responsibility and ownership in interventional radiology rotations improves the educational experience.

PURPOSE: To enhance the educational experience among residents rotating through interventional radiology (IR) by encouraging ownership and responsibility. MATERIALS AND METHODS: In May 2006, the authors implemented changes in resident education in IR that included increased clinical responsibilities, structured didactics, and greater hands-on experience, including call. Residents were assigned as first assistants, ownership of cases was encouraged, and assignment to a week on the consult service was instituted to help residents better understand all aspects of IR practice. Additional faculty recruitment and program expansion ensured the same high level of training for the fellowship program. Evaluations were reviewed every year (July 1, 2007-June 30, 2009) for hands-on training, daily teaching, didactic conferences, and overall effectiveness of the clinical service. A graduated scale of 1-5 was used. RESULTS: In 2009, 3 years after the curricular changes were made, the quality of hands-on training, daily case reviews and consults, didactics, and overall education had markedly improved with 89%, 71%, 65%, and 82% of the residents rating these respective aspects of the training as "above expectations" (4 on a scale of 5) or "superior" (5 on a scale of 5) compared with 77%, 23%, 20%, and 60% in 2005-2006. Three years after the changes, the impact of these changes on recruitment patterns also showed improvement, with 28.6% of the class of 2010 pursuing a fellowship in IR. CONCLUSIONS: Increasing resident ownership, responsibility, and hands-on experience improves resident education in IR, which, in turn, promotes interest in the field.

Making the case for early medical student education in interventional radiology: a survey of 2nd-year students in a single U.S. institution.

PURPOSE: To examine perceptions of interventional radiology (IR) among a group of second-year medical students and support the case for early exposure to the field in order to increase visibility and, ultimately, recruitment to this specialty. MATERIALS AND METHODS: Sixty-five members of the class of 2011 from a single U.S. institution were anonymously surveyed about their opinions on IR before and after a 1-hour case-based introductory lecture. RESULTS: Sixty-four students completed the survey in its entirety. Perception about what IR entails varied, with 52% of the students aware of IR involvement in major and potentially life-saving procedures; however, 34% believed that an interventional radiologist primarily performed "minor" procedures or "read films." Previous interaction with interventional radiologists was uncommon. Following the single, case-based introductory IR lecture, 74% of the class was eager to learn more about the specialty, with 22% interested in enrolling in a dedicated hands-on elective in IR. The perception and impression of what IR entails changed significantly for the better for 75% of the students. Before the lecture, 19% were considering IR as a career (first or second choice); this increased to 33% after the introductory lecture. CONCLUSIONS: Although medical students are aware of IR, their exposure and understanding is limited. They are keen to learn more when exposed to it. Reaching out to the medical students early in their career may help in recruiting talent and securing the specialty's growth.

Effects of preoperative gait analysis on costs and amount of surgery.

BACKGROUND: The purpose of this study was to determine the effects of clinical gait analysis (GA) on the costs of care in ambulatory children with cerebral palsy (CP) and the amount of surgery these children undergo. METHODS: A retrospective review identified all ambulatory patients with CP who had undergone lower extremity orthopaedic surgery at our hospital from 1991 to 2005 with at least a 6-month follow-up. The patients were grouped into those who had undergone GA before their index surgery (GA group, N=313) and those who had not (NGA group, N=149). The groups were compared in terms of the number of procedures during index surgery and subsequent surgeries and the direct costs associated with these surgeries. Costs were calculated in US dollars by using a standardized protocol including fees for the surgeon, anesthesia, operating room, hospital stay, physical therapy, and GA. RESULTS: Patients in the GA group were significantly older and less functionally involved, had their first surgery in later years, and had a shorter follow-up than patients in the NGA group (P<0.001). Adjusting for these differences, patients in the GA group had more procedures (GA: 5.8, NGA: 4.2; P<0.001) and higher cost (GA: $43,006, NGA: $35,215; P<0.001) during index surgery, but less subsequent surgery. A higher proportion of patients went on to additional surgery in the NGA group (NGA: 32%, GA: 11%; P<0.001), with more additional surgeries per person-year (NGA: 0.3/person-year, GA: 0.1/person-year; P<0.001) resulting in higher additional costs (NGA: $3009/person-year, GA: $916/person-year; P<0.001). The total number of procedures (GA: 2.6/person-year, NGA: 2.3/person-year; P=0.22) and cost (GA: $20,448/person-year, NGA: $19,535/person-year; P=0.58) did not differ significantly between the 2 groups. CONCLUSIONS: Clinical GA is associated with a lower incidence of additional surgery, resulting in lesser disruption to patients' lives. This finding has not been shown before and may assist patients, physicians, policy makers, and insurance companies in assessing the role of GA in the care of ambulatory children with CP. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Complications with flexible nailing of femur fractures more than double with child obesity and weight >50 kg.

BACKGROUND: Previous studies report that children above the 95th percentile in weight for their age had an increased risk for complications following titanium elastic nailing for femur fractures. The purpose of this study is to examine whether obesity, defined as body mass index (BMI) > 95th percentile, and/or simple weight correlates with an increased rate of complications. METHODS: The incidence of complications was compared between obese and non-obese patients and also between patients who weighed >/=50 kg and those <50 kg. RESULTS: The overall complication rate was 23% (16/71). The complication rate was 17% (10/58) for "non-obese" patients and 46% (6/13) for "obese" patients. This difference was statistically significant (P = 0.03). The complication rate was 46% (6/13) in children who weighed >/=50 kg and 17% (10/58) in children who weighed <50 kg. This difference was also statistically significant (P = 0.03). CONCLUSIONS: This study demonstrates that obesity (BMI > 95th percentile) and weight over 50 kg predispose patients to increased risk of surgical complications when undergoing flexible elastic nailing for femur fractures. Both obese children and children weighing >/=50 kg were two times more likely to have a complication when undergoing this procedure.