CT-guided microcoil versus hook-wire localization of pulmonary nodule prior to video-assisted thoracoscopic surgery without fluoroscopic guidance.

BACKGROUND: Both microcoils and hook-wires are commonly utilized for preoperative pulmonary nodule localization due to their convenience, but it remains unclear which one should be prioritized for recommendation. AIMS: To compare the safety and efficacy of microcoils and hook-wires for pulmonary nodule localization. METHODS: From January 2021 to December 2021, 310 consecutive patients (113 males and 197 females) with 341 pulmonary nodules who underwent CT-guided microcoil or hook-wire localization prior to video-assisted thoracoscopic surgery (VATS) at our center were retrospectively included in this study. There were 161 patients in the microcoil group and 149 patients in the hook-wire group. The successful localization rate, complication rate, radiation exposure, and medical costs were compared between the two groups. RESULTS: A total of 341 pulmonary nodules were localized, with a success rate of 99% (180/184) in the microcoil group and 93% (146/157) in the hook-wire group, respectively. All patients successfully underwent VATS. Multivariate analysis revealed that hook-wire localization, shorter needle depth into the lung tissue and the longer waiting time from localization to VATS were the risk factors for the localization failure. The incidences of pneumothorax in the microcoil group and hook-wire group were 34.8% (56/161) and 34.9% (52/149), respectively (P = 0.983). The incidences of pneumorrhagia were 13% (24/184) and 46.5% (73/157), respectively (P = 0.000). Multivariate analysis revealed that hook-wire localization and greater depth of needle penetration into lung tissue were risk factors for pneumorrhagia. CONCLUSION: Microcoil localization of pulmonary nodules is superior to hook-wire localization in terms of efficacy and safety. This finding provides insight into priority and broader promotion of microcoil localization.

Radiation dose analysis in interventional neuroradiology of unruptured aneurysm cases.

This study aimed to evaluate the radiation doses (peak skin dose (PSD) and bilateral lens dose) for each interventional neuroradiology procedure. A direct measurement system consisting of small radiophotoluminescence glass dosimeter chips and a dosimetry cap made of thin stretchable polyester was used for radiation dosimetry. The mean PSDs for each procedure were 1565 ± 590 mGy (simple technique coil embolization (STCE) cases), 1851 ± 825 mGy (balloon-assisted coil embolization (BACE) cases), 2583 ± 967 mGy (stent-assisted coil embolization (SACE) cases), 1690 ± 597 mGy (simple flow-diverter stenting (FDS) cases), and 2214 ± 726 mGy (FDS + coiling cases). The mean PSD was higher in SACE cases than in STCE, BACE, and simple FDS cases. Moreover, the PSD exceeded 2000 mGy and 3000 mGy in 46 (67.6%) and 19 (27.9%) SACE cases, respectively. The left lens doses for each procedure were 126 ± 111 mGy (STCE cases), 163 ± 152 mGy (BACE cases), 184 ± 148 mGy (SACE cases), 144 ± 60 mGy (simple FDS cases), and 242 ± 178 mGy (FDS + coiling cases). The left lens dose in SACE cases was higher than that in STCE cases and exceeded 500 mGy in 3 (4.4%) patients. In FDS + coiling cases, the mean PSD and left lens dose were 2214 ± 726 mGy and 242 ± 178 mGy, respectively. The left lens dose was higher than that in the STCE and BACE cases, with two (15.4%) patients receiving doses >500 mGy in FDS + coiling cases. The detailed data obtained in this study are expected to contribute to the promotion of radiation dose optimization.

Experience and perspective with intravascular imaging and invasive coronary physiology: Insights from allied health professionals.

BACKGROUND: Although intravascular imaging (IVI) and invasive coronary physiology (ICP) are utilized in percutaneous coronary intervention (PCI) with robust positive clinical evidence, their adoption in cardiac catheterization laboratories (CCLs) is still limited. AIMS: The aim of our survey was to assess the perspectives on the experiences of allied health professionals in CCLs' utility of IVI and ICP. METHODS: An anonymous online survey was conducted through multiple channels, including the Cardiovascular Research Technologies (CRT) 2023 Nurses and Technologists Symposium, social media, Cath Lab Digest link, and field requests, leading to diverse representation of allied health professionals. RESULTS: A total of 101 CCL members participated in the survey. First, 59% of responders noted an increased use of IVI in their institutions over recent years. For those experiencing an increase, 49% credited training, 45% emerging evidence, and 34% attributed new CCL members. Barriers to IVI usage were perceived increased procedure time (58%), staff resistance (56%), procedural cost (48%), and difficulty interpreting findings (44%). Regarding ICP, 61% reported using it in approximately 25% to 75% of cases, while 10% utilized it in 75% to 100% of CCL procedures. Interpreting ICP results was mixed, with 56% confident in interpreting all ICP results and 6% unable to interpret any ICP results. CONCLUSION: Our findings highlight opportunities for increasing routine utilization of IVI and ICP in the CCL through allied health professionals. By providing education and training, we can elevate familiarity with the equipment and subsequently build a CCL culture that advocates for both IVI and ICP.

CT guided versus non-image guided bone marrow aspiration and biopsy: Comparison of indications, specimen quality and cost.

PURPOSE: To compare the indications, specimen quality, and cost of CT versus non-image guided bone marrow aspirate and biopsy (BMAB). METHODS: All CT and non-image guided BMAB performed from January 2013-July 2022 were studied. Body-mass-index (BMI), skin-to-bone distance, aspirate, and core specimen quality, and core sample length were documented. Indications for CT guided BMAB were recorded. Categorical variables were compared using chi-squared test and continuous variables using Mann-Whitney test. Analysis of per-biopsy factors used linear mixed-effect models to adjust for clustering. Cost of CT and non-image guided BMAB was taken from patient billing data. RESULTS: There were 301 CT and 6535 non-image guided BMABs studied. All CT guided BMAB were studied. A subset of 317 non-image guided BMAB was selected randomly from the top ten CT BMAB referrers. BMI (kg/m2) and skin-to-bone distance (cm) was higher in the CT versus the non-image guided group; 34.4 v 26.8, p < 0.0001; 4.8 v 2.5, p < 0.0001, respectively. Aspirate and core sample quality were not different between groups, p = 0.21 and p = 0.12, respectively. CT guided core marrow samples were longer, p < 0.0001. The most common CT BMAB referral indications were large body habitus (47.7 %), failed attempt (18.8 %) and not stated (17.4 %). Cost of a CT guided BMAB with conscious sedation was $3945 USD versus $310 USD for non-image guided. CONCLUSION: CT guided BMAB are commonly performed in patients with large body habitus and failed attempt. However, the cost is 12.7 fold higher with no increase in specimen quality. These findings can help referrers be cost conscious.

CT-Guided Fiducial Marker Implantation with Ultra-fine 25-Gauge Needle Prior to Proton Therapy for Liver Malignancies.

PURPOSE: Proton therapy is highly effective for liver malignancies, and to increase its accuracy, placement of fiducial markers in the liver is preferred. We retrospectively evaluated the safety and feasibility of CT-guided fiducial marker implantation using ultra-fine 25-gauge needles before proton therapy for liver malignancies. MATERIALS AND METHODS: Between May 2016 and April 2021, 334 cases were investigated. All of procedures were performed without anesthesia. Technical success was defined as the completion of implantation at the intended site. Tumor-marker distance and possibility of synchronization between tumors and markers were evaluated and compared with Mann-Whitney U test. Complications were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: Technical success rate was 97.3%. Tumor-marker distance was 19.1 mm (median, range 0-96) in the group in which the implanted marker was synchronized with tumor (n = 315), while it was 34.5 mm (median, range 6-94) in the group in which the implanted marker was not synchronized (n = 13) (p value = 0.011 < 0.05). The complication rate was 2.4%, 2 were classified as grade 4 and 5 as grade 1, and 1 as grade 2. There were no grade 3 or higher complications that seemed to be related to the procedure. CONCLUSION: CT-guided marker implantation using a 25-gauge needle achieved a satisfactory success rate with few complications and was useful for the image-guided and respiratory-synchronized proton therapy. LEVEL OF EVIDENCE 3: Local non-random sample.

Deciphering the Radiation Dose Summary Page in Interventional Fluoroscopy.

Fluoroscopy is an advanced medical imaging modality that utilizes x-rays to acquire real-time images throughout a medical examination. It is commonly used in various procedures such as in interventional radiology, cardiac catheterization, and gastrointestinal and genitourinary studies. While fluoroscopy is a valuable diagnostic and therapeutic tool, it exposes patients and medical staff to ionizing radiation, which carries health risks. A radiation dose summary page is a report generated by the fluoroscope that displays important information about the procedure. It provides an overview of the radiation doses administered during a fluoroscopic procedure, as well as certain technical parameters used during the irradiation events. The contents of a radiation dose summary page may vary depending on the make and model of the fluoroscope but some common elements include the cumulative reference air kerma, which serves as a surrogate of radiation dose delivered to the patient, and the dose-area product, which takes account of the x-ray beam area and is a measure of the total amount of energy imparted on the patient. Other imaging acquisition parameters may be also included in the dose summary page, including tube voltage, tube current, pulse width, pulse rate, spectral filters, primary and secondary angles, and source-to-image distance. The radiation dose summary page for fluoroscopy is a useful tool for physicians, technologists, and medical physicists, allowing them to comprehend the technical details of a fluoroscopically guided procedure. ©RSNA, 2024.

Stickiness of 7 types of iodinated contrast media used during interventional radiology and interventional cardiology procedures.

INTRODUCTION: During Interventional Cardiology (IC) and Interventional Radiology (IR) procedures operators' gloves, guide wires and catheters may stick together due to the inherent stickiness of Iodine Containing Contrast Media (ICCM). This may result in displacement of materials, compromising technical success. In this study we compare the stickiness of seven frequently used types of ICCM. MATERIAL AND METHODS: Xenetix 300, Hexabrix 320 (Guerbet, Villepinte, France), Ultravist 300 (Bayer, Leverkusen, Germany), Visipaque 270, Omnipaque 300, Visipaque 320 (GE, Wauwatosa, WI) and Iomeron300 (Bracco, Milano, Italy) are compared using a probe-tack test. Pieces of surgical gloves are put together with 0.1 ml of of ICCM in between, and subsequently pulled apart under computer control. Stickiness is measured as the work needed to separate the probes. RESULTS: From least to most sticky results were: Hexabrix 320 (mean Work (mJ); range: 0.70; 0.16-1.23), Visipaque 270 (1.18; 0.47-1.89), Visipaque 320 (1.70; 0.59-2.81), Iomeron 300 (3.01; 1.82-4.20), Xenetix 300 (5.83; 3.96-7.69), Ultravist 300 (5.83; 2.83-8.84), Omnipaque 300 (8.14; 6.95-9.33). The four least sticky ICCM differ statistically significantly (p = 0.000-0.004) from the remaining. In this research Omnipaque 300, Ultravist 300 and Xenetix 300 are the stickiest and may hence pose the greatest practical problems during procedures; in contrast, Hexabrix 320, Visipaque 270 and Visipaque 320 are the least sticky in this research and may therefore aid in constraining complications caused by stickiness. CONCLUSION: A significant and reproducible difference in stickiness exists between commercially available ICCM, Hexabrix 320, Visipaque 270, Visipaque 320 and Iomeron 300, being least sticky.

Percutaneous Sclerotherapy of Venous Malformations.

Venous malformation (VM) stands as the most prevalent form of vascular malformation, characterized by its diverse morphology. These lesions can manifest in any part of the body, affecting different tissue planes and giving rise to symptoms such as pain, swelling, or physical dysfunction. In the realm of treatment, direct puncture VM sclerotherapy holds its place as the primary approach. This technique involves the administration of a sclerosing agent into the VM channels during contrast phlebography while simultaneously managing the outflow veins through different methods. The process of VM sclerotherapy induces endothelial damage, thrombosis, and fibrosis, resulting in symptom relief through lesion shrinkage. It is crucial to exercise caution techniques and sclerosing agents during VM sclerotherapy to minimize procedural complications, enhance clinical outcomes, and ultimately improve the patient's overall quality of life.

Interventional Treatment of Pediatric Venous Thromboembolic Disease.

This review explores the clinical presentation of lower extremity DVT and pulmonary embolism (PE), treatment strategies, and outcomes for venous thromboembolism (VTE) in the pediatric population. Traditional therapy for pediatric VTE was anticoagulation alone with thrombolysis and surgery reserved only in life or limb-threatening cases. Catheter-directed thrombolysis (CDT), pharmacomechanical thrombectomy (PMT) and mechanical thrombectomy (MT) have emerged as effective and safe treatment options for VTE management. Although most data are from adult studies, early pediatric studies suggest that these interventional procedures can be effective in children. The significant clinical impact of post-thrombotic syndrome (PTS) is also discussed, as PTS can lead to lifelong physical symptoms and psychosocial damage.

Portal Venous Disease.

Portal interventions in pediatric patients present unique difficulties when compared to adult procedures. In addition, children who need a portal intervention require a different workup and clinical management. Based on these elements, the clinical decisions for the study and treatment of these pathologies are different. This review is intended to present a summary of the interventional radiologist's role in treating pediatric portal venous diseases. Focus is placed on the technical elements, patient management and procedural indications while discussing different interventions involving the portal vein, providing some recommendations supported by recent research and the authors' experience.

Fibroadipose Vascular Anomaly: Diagnosis and Treatment.

Fibro-Adipose Vascular Anomaly (FAVA) is a recently identified type of vascular malformation predominantly affecting adolescent females. Comprising abnormal adipose and vascular components, FAVA is frequently misdiagnosed as other vascular anomalies. It primarily manifests with pain, functional impairment, and musculoskeletal symptoms, particularly in the lower extremities. Accurate diagnosis requires a combination of clinical, radiologic, and histopathologic evaluation, with MRI and ultrasound being the primary imaging tools. Management of FAVA is multidisciplinary and tailored to individual patients. Interventional radiology procedures, such as percutaneous cryoablation, sclerotherapy, and embolization, are effective in long term control of symptoms. Cryoablation is particularly successful in alleviating pain and improving function. Surgical resection is reserved for specific cases with extensive lesions involving joints or when there is severe muscle or joint dysfunction. Additionally, sirolimus, an mTOR inhibitor, has shown promise in symptom relief, although further research is needed to confirm its long-term efficacy. Early diagnosis and treatment are essential for improving the quality of life in FAVA patients. Advances in imaging and treatment strategies have enhanced the ability to manage this complex and rare condition effectively.

Percutaneous Image-Guided Treatment of Pediatric Deep-Vein Occlusions.

Pediatric venous occlusions are a growing cause of morbidity and mortality, especially in hospitalized patients. Catheter-directed recanalization is a safe and effective treatment option in appropriately selected patients. Benefits of catheter directed therapies (CDTs) include the prevention of pulmonary embolism and end organ failure acutely as well as superior vena cava syndrome and post-thrombotic syndrome chronically. Timely diagnosis, recognition of underlying factors for thrombosis, and familiarity with the spectrum of tools and techniques for CDT are essential to optimizing outcomes in the acute setting. Recanalization of chronic venous occlusions can similarly provide symptomatic relief and achieve long term vessel patency. This review will detail the scope, techniques, and outcomes for CDT in the treatment of acquired systemic deep vein occlusions.

Factors affecting radiation dose, radiation exposure time and procedural time in arterial embolization for active hemorrhage.

PURPOSE: To evaluate patient and procedure-related factors contributing to the radiation dose, cumulative fluoroscopy time (CFT), and procedural time (PT) of Arterial Embolization (AE) for suspected active bleeding. METHODS: Data on patients who underwent AE for suspected bleeding was retrospectively gathered between January 2019 and April 2022. Data collected included the dependent variables consisting of dose-area product (DAP), CFT, PT, and independent variables consisting of demographic, bleeding-specific, and procedure-specific parameters. All statistical computations were performed in SPSS statistics. The alpha value was set at 0.05. RESULTS: Data from a total of 148 AE were collected with an average patient's age of 61.06 ± 21.57 years. Higher DAP was independently associated with male sex (p < 0.002), age ranges between 46 and 65 years (p = 0.019) and > 66 years (p = 0.027), BMI above 30 (p = 0.016), attending with less than 10 years of experience (p = 0.01), and bleeding in the abdomen and pelvis (p = 0.027). Longer CFT was independently associated with attending with less than 10 years of experience (p < 0.001), having 2 (p = 0.004) or > 3 (p = 0.005) foci of bleed, and age between 46 and 65 years (p = 0.007) and ≥ 66 years (p = 0.017). Longer PT was independently associated with attending with less than 10 years of experience (p < 0.001) and having 2 (p = 0.014) or > 3 (p = 0.005) foci of bleed. CONCLUSION: The interventionist experience influenced radiation dose, CFT and PT. Dose was also affected by patients' sex, age, BMI, as well as bleeding location. CFT was also affected by patients' age, and both CFT and PT were also affected by the number of bleeding foci. These findings highlight the multifaceted factors that affect radiation dose and procedural time, emphasizing the importance of interventionist expertise, patient's age, sex, BMI, location and number of bleeds.

Uterine Artery Embolization in the Office-Based Lab.

Uterine artery embolization has an over 25-year track record of safety and efficacy. It has been evident for quite some time that this procedure can performed in an office-based lab. In this article, some of the prerequisites to performing uterine artery embolization in an office-based lab are reviewed.