Fast-Track Registration: A Way to Increase Efficiency in the IR Division.

PURPOSE: To evaluate changes in patient registration process at an academic 2-suite IR Division to determine if moving registration from the waiting room to the vascular holding area decreased amount of time patients spent in the Radiology Department and improved start times. MATERIALS AND METHODS: A data collection sheet was created by evaluating patient-related processes; event timestamps were recorded on the sheet. The control group consisted of 33 patients who registered using the traditional process. The fast-track group consisted of 29 patients who bypassed the traditional registration procedure and were registered by nurses in the vascular holding area. RESULTS: Total time between control and fast-track groups significantly decreased from an average time of 215 minutes to 178 minutes (P = .020). The average start time improved significantly from an average of 63 minutes after scheduled procedure start time for the control group to 33 minutes after the scheduled procedure start time for the fast-track group (P = .009). Start time (P = .022), time spent in recovery area (P = .006), and total time, after correcting for differences in laboratory test turnaround time, (P = .010) decreased in variability after implementation of fast-track registration. CONCLUSIONS: Implementing fast-track registration for outpatient subcutaneous port placement in the IR Division improved start times and decreased total time patients spent in the hospital, while also reducing variability in the process.

Transarterial chemoembolization in a patient with severe reactions to iodinated contrast: Successful treatment using gadolinium contrast with C-arm computed tomography.

Severe reactions to modern iodinated contrasts are uncommon. Breakthrough reactions in the setting of pretreatment with corticosteroids are even rarer. Patients with a history of these refractory reactions can create challenging situations in the diagnostic and therapeutic process. Here, we present a case of an 83-year-old male with hepatocellular carcinoma and a history of multiple severe reactions to iodinated contrast. The patient required a transarterial chemoembolization but the conventional technique was unavailable due to the allergy. Gadolinium-based contrast was substituted and used in conjunction with C-arm CT and a percutaneous ethanol injection to treat the tumor. After nearly 3 years, there is no evidence of residual or recurrent hepatocellular carcinoma.

Iliac bone biopsy complicated by hematoma: Hemostasis achieved with glue injection.

Serious hemorrhage after a bone biopsy is a rare complication of the procedure. Due to the infrequency of this complication, there is limited literature available regarding the treatment. Here, we present a case of a 70-year-old male who developed a symptomatic gluteal hematoma after an iliac bone lesion biopsy. Hemostasis was achieved by injecting an N-butyl cyanoacrylate glue solution into the bone cannulation site under CT-guidance.

Colon cancer metastasis to the sternum: palliative treatment with radiofrequency ablation and cement injection.

Colon cancer metastasis to bone is extremely rare and has devastating consequences on patients' quality of life. Furthermore, radiofrequency ablation in conjunction with cementoplasty to nonweight bearing, flat bones has not been widely reported as palliative treatment for pain as a result of bone metastasis. Here, we present a case of a 47-year-old man who developed a sternal metastasis from an invasive adenocarcinoma of the colon originally diagnosed several years prior. The pain from the metastasis was originally treated with external beam radiation therapy, but after 6 weeks of continuous pain, it was retreated using radiofrequency ablation in conjunction with cementoplasty.