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)

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.

[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.

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

No disponible

El riesgo de sufrir un accidente de tráfico en España debido al alcohol / Risk of suffering a traffic accident ascribable to alcohol abuse

Objetivo: Estimar el incremento relativo del riesgo de sufrir un accidente de tráfico en España atribuible al alcohol a partir del registro de accidentes de circulación con víctimas de la Dirección General de Tráfico. Métodos: La serie de casos constituida por los conductores de al menos 18 años de edad implicados en accidentes de circulación con víctimas en España (excluyendo los accidentes de peatones) durante los años 1990 a 1999 ha sido analizada mediante el método de exposición inducida propuesto inicialmente por Cuthbert y modificado con posterioridad, que a partir de la comparación de la proporción de conductores implicados en accidentes simples y en accidentes múltiples permite obtener estimaciones de los riesgos relativos de sufrir un accidente de tráfico para las diferentes categorías de conductor, controlando la exposición y ajustado los resultados por las circunstancias ambientales.Resultados: no es posible de forma válida calcular el riesgo que representa el alcohol para la accidentalidad vial según la información que consta en el registro de accidentes de la Dirección General de Tráfico. Conclusiones: para poder estimar el riesgo del alcohol es necesario que se reforme la legislación y se establezca la aplicación obligatoria de la prueba de detección de alcohol a todo conductor involucrado en un accidente de tráfico y asimismo es preciso que se cree una variable exclusiva del alcohol en el cuestionario de accidentes de circulación con víctimas, en la que figure el resultado de la prueba analítica

Objective: To estímate the relative increase in the risk of suffering a traffic accident ascribable to alcohol abuse from the registry of traffic accidents with victims carried out by the Dirección General de Tráfico (Spanish traffic authority DGT). Methods: the series of cases made up by at least 18 years old drivers involved in traffic accidents with victims in Spain form 1990 to 1999 was analyzed. Accidents with pedestrians were excluded. The induced exposure method originally suggested by Cuthbert and subsequently modified was used to carry out the analysis. From the comparison of the drivers ratio involved in single-vehicle and multiple-vehicle accidents, said method allows to achieve relative risk estimates of suffering a traffic accident for the different driver categories, controlling the exposure and adjusting the results by the environmental circumstances. Results: According to the information recorded by the Dirección General de Tráfico, it is not possible to assess the risk that alcohol represents in road accidents. Conclusions: In order to estimate the risk of alcohol abuse, it is necessary to change legislation and to establish the compulsory application of alcohol test to every driver involved in a traffic accident. Likewise, it is necessary to create an exclusive variable of alcohol in the questionnaire of traffic accidents with victims in which the result of the analytic test appears

El método de exposición inducida de Cuthbert para la estimación del riesgo de sufrir un accidente de tráfico / Cuthbet´s induced exposure method to estimate the risk of having a traffic accident

Objetivo: Comparar la variación que se produce en las estimaciones de riesgo de sufrir un accidente de tráfico obtenidas mediante la introducción de modificaciones en el método de exposición inducida de cuthbert y, en función de los resultados, proponer mejoras sobre la aplicación original. Métodos: La serie de casos constituida por los conductores de al menos 18 años de edad implicados en accidentes de circulación con víctimas en España (excluyendo los accidentes con peatones) y recogidos por la Dirección General de Tráfico durante los años 1990 a 1999 ha sido analizada mediante la aplicación de los dos métodos, el original y el modificado, a partir de la proporción de conductores de una determinada clase involucrados en accidentes simples y en múltiples, controlando la exposición y ajustando los resultados por las circunstancias ambientales. Resultados: La magnitud de los incrementos de riesgo estimados guarda una relación exponencial respecto a los riesgos relativos escalares basados directamente en valores logarítmicos que ofrece el método original de Cuthbert. Conclusiones: Las correlaciones realizadas en el desarrollo teórico del modelo de Cuthbert han logrado: 1) Aumentar la validez del método para estimar los riesgos relativos de las características del conductor y del vehículo 2) Extender el método al estudio de las condiciones ambientales; y 3) Posibilitar la aplicación del método a las variables de sólo dos categorías, ya sean del conductor, del vehículo o del ambiente

Traffic accident through the introduction of changes in Cuthbert´s induced exposure method and, according to the results, to suggest improvements about the original application. Objetive: To compare the variation that takes place when estimating the risk of having ax Methods: The case series is comprised by drivers with at least 18 years involved in traffic accidents with victims (excluding those accidents in which pedestrians were involved). Cases were collected by the Direction General de Trafico (Spanish traffic authority) from 1990 to 1999. The analysis of said data was carried out according to the original method and to the modified one, taking as a starting point the ratio of drivers from a particular kind involved in single-an multiple-vehicle accidents. The exposure was controlled and the results were adjusted taking into account the environmental circumstances. Results: Far-reaching estimated increases in risk show an exponential relationship regarding relative risks directly based on the logarithmic values offered by cuthbert´s original method. Conclusions: Corrections carried out in the theoretical development of Cuthbert´s model managed 1) to increase the method validity for estimating the relative risk of the driver and car characteristics, 2) to extend the method to the study of environmental conditions, and 3) to facilitate the method application to the variables of only two categories: driver, car, or environment