[Sustainability and climate protection : Implications on patient-centered care in radiology]. / Nachhaltigkeit und Klimaschutz : Auswirkungen auf die patientenzentrierte Versorgung in der Radiologie.

BACKGROUND: Sustainability and patient-centered radiology (PCR) include a multivariant, complex network of synergic and opportunistic elements. PCR is a subfactor of the social element, climate protection is part of the ecological element, and sustainable economics are part of the financial element. OBJECTIVES: We aimed to identify PCR-symbiotic and PCR-opposed elements of sustainability using literature research. This article will provide an overview of the core sustainability elements and innovative concepts for supporting PCR. MATERIALS AND METHODS: A digital literature search was carried out to identify scientific publications about sustainability and PCR via Medline. Results are provided as a narrative summary. RESULTS: In particular, the social component and parts of the ecological element of sustainability support PCR. Climate protection and a natural environment show a positive correlation with health and patient satisfaction. Patient contact improves the quality of the diagnostic report and promotes satisfaction of patients and radiologists. However, increasing economization is often conditionally compatible with the social core element of sustainability and especially with PCR. Digital tools can ease communication and improve reports in times of increasing workload. CONCLUSION: Socially and environmentally sustainable radiology supports the well-being of both employees and patients. Innovative concepts are necessary to balance the ecological elements of sustainability with employees' and patients' interests.

Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey.

With the increasing need for minimally invasive procedures based on lower complication rates, higher patient acceptance, and technical developments, there is a growing focus on the sound interventional training of young radiologists. This survey aimed to analyze the current situation in interventional radiology (IR) training in Germany to detect shortcomings and identify areas for improvement.From November 1-30, 2020, an online questionnaire was distributed to representative radiological associations and societies with the request to forward it to radiology residents and radiologists < 40 years. The 44 questions covered six distinct areas from personal working conditions to the characterization of the IR department, training conditions, role of women in IR, and attendance at congresses/external training.A total of 330 participants completed the questionnaire. 77 % of participants expressed a high interest in IR, and 47 % could even imagine subspecializing in interventional radiology. Most institutions provided the necessary learning conditions and infrastructure. The rate of overall satisfaction with IR training conditions was 45 % (vs. a dissatisfaction rate of 39 %). However, females showed a lower satisfaction rate with their training environment than male participants (28 % vs. 51 %; P = 0.06). Positive correlations with work satisfaction were found for the presence and duration of the IR rotation, the number of partly independently/mentored performed interventions, and structured feedback. Moreover, the need for a structured training curriculum was expressed by 67 % of participants.Radiological residents and young radiologists expressed a high interest in interventional radiology, and they rate the infrastructure of German hospitals regarding IR as sufficient. However, they expressed the need for consistent IR rotations and better-structured resident and postgraduate education (curricula & interviews).Interest in interventional radiology among radiological residents and young radiologists in Germany is high, but satisfaction with interventional radiology training leaves room for improvement. The most frequently mentioned aspects that can improve IR training were · organized rotations of at least 6 months. · structured curriculums with face-to-face feedback. · structured guidance by senior interventionists during procedures. CITATION FORMAT: · Sieren M, Katoh M, Mahnken AH et al. Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey. Fortschr Röntgenstr 2022; 194: 1346 - 1357.

Patient Centered Radiology - An Introduction in Form of a Narrative Review. / Patientenzentrierte Radiologie ­ Eine Hinführung durch ein narratives Review.

BACKGROUND: Patient centered radiology represents a crucial aspect for modern sustainable radiology. The definition of patient-centered consists of a focus on patients' individual values and wishes with a respectful integration in medical decisions. In this narrative review we try to give a practical introduction into this complex topic with the extension to a person-centered radiology, which additionally encompasses values and wishes of radiological and other medical colleagues. METHODS: Medline search between 2010 and 2021 using "patient-centered radiology" with additional subjective selection of articles for this narrative review. RESULTS: Regarding patients' experiences the main literature focus were patients' fears of examinations (movement restrictions, uncertainty). Most patients would prefer a direct communication with the radiologist after the examination. Regarding interdisciplinary communication the radiological expertise and quality is highly appreciated; however, there was a general wish for more structured- or itemized reporting. Concerning working conditions radiologists were satisfied despite high psychosocial working pressure. CONCLUSION: Most of the literature on this topic consists of surveys evaluating the current state. Studies on interventions such as improved information before examinations or patient-readable reports are still scarce. There is a dilemma between an increasing radiological workload and the simultaneous wish for more patient-centered approaches such as direct radiologist-patient communications in the daily routine. Still on our way to a more value-based radiology we have to focus on patient communications and a patient-centered medicine. KEY POINTS: · Patient centered radiology has a focus on the integration of patients' individual values and wishes in their decisions.. · Radiologists are clinicians, who an additional diagnostic and therapeutic surplus for patients and referring physicians.. · The recent literature on this topic consists basically on the evaluation of the current status.. · Most patients prefer a direct communication with the radiologist.. · To gain a "value based" radiology we to focus on an optimized communication with patients and referring physicians.. CITATION FORMAT: · Schreyer AG, Schneider K, Dendl LM et al. Patient Centered Radiology - An Introduction in Form of a Narrative Review. Fortschr Röntgenstr 2022; 194: 873 - 881.

Percutaneous cementoplasty in the palliative, multimodal treatment of primary bone tumors of the distal aspect of the radius in four dogs.

OBJECTIVE: To (1) evaluate the analgesic effect of percutaneous cementoplasty (PC) in dogs with primary bone tumor (PBT) of the distal aspect of the radius and (2) evaluate the impact on the course of disease by adding PC to a palliative, multimodal treatment protocol in these dogs. STUDY DESIGN: Prospective pilot study. ANIMALS: Dogs (n=4) with PBT of the distal aspect of the radius. METHODS: Tumor lesions were filled percutaneously with polymethylmethacrylate under fluoroscopic guidance. Pamidronate was administered once in a week before PC. Radiotherapy and chemotherapy were initiated 2 and 6 weeks after PC, respectively. Force plate analysis was performed immediately before 2, and 6 weeks after PC. Survival time was defined from PC to euthanasia. RESULTS: Two dogs had a significant increase in peak vertical force 2 weeks after PC (P=.043) and remained free of lameness for 18 and 20 weeks, respectively. One dog had an acute relapse after an initially lame-free period of 10 days. The remaining dog failed to improve (P=.686). Three dogs developed at least 2 complications including transient worsening of the lameness after PC, cement leakage, wound infection and suspected thromboembolism in combination with cough and anemia. Median survival was 4.8 months (range, 1-5.7 months). CONCLUSIONS: PC in combination with pamidronate significantly improved lameness in 2 dogs; however, PC is not risk-free. Deep wound infection, intraarticular cement leakage, and venous thrombosis were the main complications. CLINICAL RELEVANCE: PC might be a useful addition to established palliative, multimodal treatment protocols in dogs with PBT; however, because of the complications encountered PC warrants further study before routine use can be considered.

Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty.

The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe midline back pain due to osteoporotic spine fractures.

Detection of cement leakage after vertebroplasty with a non-flat-panel angio unit compared to multidetector computed tomography--an ex vivo study.

The purpose of this study was to investigate the detection of cement leakages after vertebroplasty using angiographic computed tomography (ACT) in a non-flat-panel angio unit compared to multidetector computed tomography (MDCT). Vertebroplasty was performed in 19 of 33 cadaver vertebrae (23 thoracic and 10 lumbar segments). In the angio suite, ACT (190 degrees ; 1.5 degrees per image) was performed to obtain volumetric data. Another volumetric data set of the specimen was obtained by MDCT using a standard algorithm. Nine multiplanar reconstructions in standardized axial, coronal, and sagittal planes of every vertebra were generated from both data sets. Images were evaluated on the basis of a nominal scale with 18 criteria, comprising osseous properties (e.g., integrity of the end plate) and cement distribution (e.g., presence of intraspinal cement). MDCT images were regarded as gold standard and analyzed by two readers in a consensus mode. Rotational acquisitions were analyzed by six blinded readers. Results were correlated with the gold standard using Cohen's j-coefficient analysis. Furthermore, interobserver variability was calculated. Correlation with the gold standard ranged from no correlation (osseous margins of the neuroforamen, j = 0.008) to intermediate (trace of vertebroplasty canula; j = 0.615) for criteria referring to osseous morphology. However, there was an excellent correlation for those criteria referring to cement distribution, with kappa values ranging from 0.948 (paravertebral cement distribution) to 0.972 (intraspinal cement distribution). With a minimum of j = 0.768 ("good correlation") and a maximum of j = 0.91 ("excellent"), interobserver variability was low. In conclusion, ACT in an angio suite without a flat-panel detector depicts a cement leakage after vertebroplasty as well as MDCT. However, the method does not provide sufficient depiction of osseous morphology.

Interventional management of renal bleeding after partial nephrectomy.

OBJECTIVE: Partial nephrectomy (PN) has emerged as a serious alternative to nephrectomy in oncologic therapy of renal tumours. While complications are rare in general, renal hemorrhage may occur und necessitate angiographic embolization. In this retrospective study, we evaluate the clinical, imaging and procedural findings of seven interventions in five patients with renal hemorrhage after PN. In four out of five patients (80%) the bleeding could be treated successfully by embolotherapy. CONCLUSION: Angiographic embolization in patients with renal hemorrhage after PN is feasible and has a high success rate. The procedure might facilitate avoidance of nephrectomy.

Complications in percutaneous vertebroplasty associated with puncture or cement leakage.

Due to the minimally invasive character and excellent clinical outcome of percutaneous vertebroplasty (PVP), the procedure is being performed in greatly increasing numbers. While PVP has a low complication rate in general, severe complications can occur. We focus on the imaging appearance of complications of PVP associated with puncture or cement leakage--from harmless to life-threatening.