New Developments in Image-Guided Percutaneous Irreversible Electroporation of Solid Tumors.

PURPOSE OF REVIEW: This review will describe the various applications, benefits, risks, and approaches of conventional irreversible electroporation (IRE), as well as highlight the new technological developments of this procedure along with their clinical applications. RECENT FINDINGS: Minimally invasive image-guided percutaneous IRE ablation has emerged as a newer, non-thermal ablation technique for tumors in the solid organs, particularly within the liver, pancreas, kidney, and prostate. IRE allows for ablation near heat-sensitive structures, including major blood vessels and nerves, and is not susceptible to the heat sink effect. However, it is limited by certain requirements, such as the need for precise parallel placement of at least two probes with a maximum inter-probe distance of 2.5 cm to reduce the risk of arching phenomenon, the requirement for general anesthesia with muscle relaxant, and the need for cardiac synchronization. However, new technological advancements in the ablation system and image guidance tools have been introduced to improve the efficiency and efficacy of IRE. IRE is a safe and effective treatment option for solid tumor ablation within the liver, pancreas, kidney, and prostate. Compared with other ablation techniques, IRE has several advantages, such as the absence of heat sink effect and minimal injury to blood vessels and bile ducts while activating the immune system. Novel techniques such as H-FIRE, needle placement systems, and robotics have enhanced the accuracy and performance in placement of IRE probes. IRE can be especially beneficial when combined with chemotherapy, immunomodulation, and immunotherapy.

The Confounding Ultrasound Diagnosis of Ectopic Pregnancy: Lessons From Peer Learning.

ABSTRACT: As the treatment of ectopic pregnancy (EP) has shifted increasingly to medical therapies, the ultrasound (US) diagnosis of EP must necessarily favor specificity over sensitivity. Our review of peer learning cases of EP and early intrauterine pregnancies found several types of pitfalls and problems, which will be described in this essay. These issues include the following: differentiation of tubal EP from a corpus luteum by echogenicity relative to ovarian parenchyma, push technique, and claw sign; how to distinguish interstitial EP from eccentrically located intrauterine pregnancies (angular); use of trophoblastic flow in abnormal intrauterine locations to help identify cesarean scar or cervical implantations; recognition that hemoperitoneum without visualized EP may be due to EP or hemorrhagic cyst; and that distinguishing an abortion in progress from a pregnancy of unknown location may not always be possible and requires clinical follow-up. This essay will also illustrate the consensus terminology that our radiology department has developed in conjunction with our obstetrics and gynecology colleagues to communicate clear diagnoses and reduce the risk of misdiagnosis and adverse outcomes.

Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways.

OBJECTIVE: As of June 30, 2020, interventional radiology (IR) fellowships will cease to exist and will be replaced by the integrated IR, independent IR, and early specialization in IR (ESIR) pathways. The objective of this study is to determine the alignment in the number of available positions between the ESIR and independent IR pathways. METHODS: An analysis was performed of 150 residency programs offering at least 1 of the 3 IR training pathways. Information regarding the most up-to-date list for integrated IR, independent IR, ESIR, and IR fellowship programs were obtained from the Society of Interventional Radiology (SIR), the Electronic Residency Application Service (ERAS), and the Accreditation Council for Graduate Medical Education (ACGME) websites. A 4-question survey was distributed to residency program directors and residency program coordinators to confirm the number of positions offered in each of the training pathways at their institution. RESULTS: Ninety-nine of 113 ESIR programs (87.6% response rate) reported a total of 176 approved ESIR positions. One hundred and eleven fellowship programs in the United States currently offer a total of 331 positions. Seventy-seven integrated IR programs and 48 independent IR programs offer 150 and 133 positions, respectively, for a total of 283 advanced IR training positions. DISCUSSION: A substantial discrepancy currently exists with IR training pathways, as the number of available ESIR positions far outnumbers the available independent IR pathway positions. There is a continuing need for communication with residency programs and frequent reevaluation of the various IR training pathways to maintain the most accurate database.