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.

Selenium and cancer: some nutritional aspects.

The level of selenium in cancer patients is lower than that in control subjects. However, low selenium levels in body fluids can be due to the malnutrition observed in these patients. There is evidence from epidemiologic studies that high dietary selenium intakes and high selenium status in people are associated with lower cancer mortality. However, contradictory information has been found in some prospective studies. The presence of other nutrients in selenium-rich foods can influence the role of the selenium in cancer etiology. Therefore, there are selenium antagonistic elements that inhibit the anticarcinogenic effects of selenium and other antioxidant micronutrients such as ascorbic acid, retinol, beta-carotene, alpha-tocopherol, and some other elements have a synergistic effect on the prevention of cancer.

Lack of relationship between plasma thrombomodulin and portal hypertension in alcoholic liver disease.

The present study was performed to analyze the relationship between portal hypertension and alterations of the endothelium-derived proteins thrombomodulin, plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1), which were determined in plasma samples of 28 alcoholic cirrhotic patients and 46 controls. Although cirrhotics showed lower levels of PAI-1, but higher thrombomodulin and t-PA levels than controls, no relationship was observed between thrombomodulin, t-PA or PAI-1 and portal pressure. Therefore, the hypothesis that splachnic endothelial damage secondary to portal hypertension leads to altered thrombomodulin, t-PA and PAI-1 levels in alcoholic cirrhosis is not supported by the results of this study.

Estimation of effective dose in some digital angiographic and interventional procedures.

In general, effective dose values for similar interventional vascular radiology (IVR) procedures are different. This is due to problems with the classification of radiological procedures, which make comparisons difficult. Patient size, examination technique and clinical condition as well as the skill of the medical radiologists also affect effective dose. Currently, there is a broad agreement on the classification of similar procedures so that effective dose estimates can be made from measurements of the dose area product (DAP). Thus, reference dose values may be established and comparative studies between different services and hospitals can be made. The objective of this study is to provide dose data for some digital angiographic and interventional procedures. Values of measured DAP for 143 patients for five types of procedures are presented. Procedures investigated were abdominal angiography, arteriography of lower limbs, biliary drainage, embolization of spermatic vein and nephrostomy. All the procedures were performed using digital equipment. Values of DAP and effective dose were 30 Gy cm2 and 6.2 mSv for arteriography of lower limbs and 150 Gy cm2 and 38.2 mSv for biliary drainage. In each one of these procedures, effective dose values per minute of fluoroscopy and per radiography film have been calculated. It is possible to use this information for the rapid estimation of effective dose.

[Stasis priapism secondary to PGE1: transformation into high-flow priapism]. / Priapismo de éstasis secundario a PGE1: transformación en priapismo de alto flujo.

Since vasoactive agents were first introduced for the diagnosis and treatment of Erectile Dysfunction (ED), the most feared side effect has been priapism. The arrival of Prostaglandin E1 (PGE1) limited to a large extent the incidence of this complication due to its fast systemic and intracavernous metabolism. A case of stasis priapism following a low dose PGE1 injection (10 mcg) after 48 hours evolution and its surprising conversion to high flow priapism after the surgical procedures performed to solve this complication is presented here.

Transient hemolytic anemia after transjugular intrahepatic portosystemic stent shunt.

Management of variceal bleeding secondary to portal hypertension constitutes a challenging issue, particularly in child's C cirrhotic patients. Recently, transjugular placement of self-expanding metallic stents in the liver (TIPS), creating a shunt between the portal and hepatic branches has provided a safe and promising therapeutic approach in this clinical situation. We report here the case of a 66-year-old male cirrhotic patient who developed a moderately severe clinical picture of Coombsnegative hemolytic anemia (serum hemoglobin, 93 g/l, serum bilirubin 160.74 umol/L (9.4 mg/dl), indirect 6.3 mg/dl (107.73 umol/L); serum LDH 1220 mu/l, reticulocytes, 5.1%, serum ferritin 1221 micrograms/l, schistocytes in peripheral blood smear) the week after undergoing a TIPS, suggesting the development of microangiopathic hemolytic anaemia secondary to red blood cell disruption by passing through the metallic network of the stent.