RESUMO
PURPOSE: To provide guidance on quality improvement thresholds for outcomes and complications of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease. MATERIALS AND METHODS: A multidisciplinary writing group conducted a comprehensive literature search to identify studies on the topic of interest. Data were extracted from relevant studies and thresholds were derived from a calculation of 2 standard deviations from the weighted mean of each outcome. A modified Delphi technique was used to achieve consensus agreement on the thresholds. RESULTS: Data from 29 studies, including systematic reviews and meta-analyses, retrospective cohort studies, and single-arm trials were extracted for calculation of the thresholds. The expert writing group agreed on thresholds for local control, overall survival and adverse events associated with image-guided thermal ablation. CONCLUSION: SIR recommends utilizing the indicator thresholds to review and assess the efficacy of ongoing quality improvement programs. When performance falls above or below specific thresholds, consideration of a review of policies and procedures to assess for potential causes, and to implement changes in practices, may be warranted.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Ablação por Cateter , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Melhoria de Qualidade , Radiologia Intervencionista , Estudos RetrospectivosRESUMO
PURPOSE: To state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. MATERIALS AND METHODS: A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS: A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. CONCLUSION: SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Ablação por Cateter , Neoplasias Pulmonares , Canadá , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Radiologia Intervencionista , Estudos RetrospectivosRESUMO
PURPOSE: To perform a systematic review and meta-analysis assessing patency outcomes following drug-coated balloon angioplasty (DCBA) in hemodialysis circuits. MATERIALS AND METHODS: MEDLINE and EMBASE systematic searches were performed from inception to November 2018 to identify comparative studies assessing DCBA vs plain old balloon angioplasty (POBA) in hemodialysis circuits. Abstract selection, data extraction, and quality assessment were performed by 2 independent reviewers. Primary outcome was loss of target lesion patency at 3, 6, 12, and 24 months for autogenous arteriovenous fistula (AVF), prosthetic arteriovenous graft (AVG), and hemodialysis-related central venous stenosis. RESULTS: Twelve studies comprising 908 patients were included. There was a significant improvement in patency among AVF after DCBA vs POBA at 3, 6, 12, and 24 months (odds ratio 0.58 [95% confidence interval, 0.36-0.94]; odds ratio 0.40 [95% confidence interval 0.23-0.70]; odds ratio 0.39 [95% confidence interval, 0.25-0.61]; and odds ratio 0.20 [95% confidence interval, 0.07-0.62]). This benefit persisted on subgroup analysis of randomized controlled trials (RCTs) only. Meta-analysis of results specific to AVG could not be performed, as only 1 RCT was identified that favored DCBA. Hemodialysis-associated central vein stenosis did not demonstrate a significant difference in patency rates between DCBA and POBA on meta-analysis. Twelve-month mortality and same-day complication rates did not differ between arms. CONCLUSIONS: Significant improvement in patency was identified with DCBA in AVF at 3, 6, 12, and 24 months. A single comparative study identified benefit of DCBA use in the AVG group. No significant benefit was identified with DCBA for central stenosis.
Assuntos
Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Dispositivos de Acesso Vascular , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Derivação Arteriovenosa Cirúrgica/mortalidade , Implante de Prótese Vascular/mortalidade , Fármacos Cardiovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/mortalidade , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
PURPOSE: To develop a new adverse event (AE) classification for the interventional radiology (IR) procedures and evaluate its clinical, research, and educational value compared with the existing Society of Interventional Radiology (SIR) classification via an SIR member survey. MATERIALS AND METHODS: A new AE classification was developed by members of the Standards of Practice Committee of the SIR. Subsequently, a survey was created by a group of 18 members from the SIR Standards of Practice Committee and Service Lines. Twelve clinical AE case scenarios were generated that encompassed a broad spectrum of IR procedures and potential AEs. Survey questions were designed to evaluate the following domains: educational and research values, accountability for intraprocedural challenges, consistency of AE reporting, unambiguity, and potential for incorporation into existing quality-assurance framework. For each AE scenario, the survey participants were instructed to answer questions about the proposed and existing SIR classifications. SIR members were invited via online survey links, and 68 members participated among 140 surveyed. Answers on new and existing classifications were evaluated and compared statistically. Overall comparison between the two surveys was performed by generalized linear modeling. RESULTS: The proposed AE classification received superior evaluations in terms of consistency of reporting (P < .05) and potential for incorporation into existing quality-assurance framework (P < .05). Respondents gave a higher overall rating to the educational and research value of the new compared with the existing classification (P < .05). CONCLUSIONS: This study proposed an AE classification system that outperformed the existing SIR classification in the studied domains.
Assuntos
Garantia da Qualidade dos Cuidados de Saúde/normas , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/normas , Radiologia Intervencionista/normas , Humanos , Sociedades MédicasRESUMO
A meta-analysis was performed to assess randomized controlled trials comparing local endovascular therapy (with and without intravenous thrombolysis) versus standard care (intravenous thrombolysis alone when appropriate) for acute ischemic stroke. Local endovascular therapy showed a significant improvement in functional independence versus standard care (odds ratio, 1.779; 95% confidence interval, 1.262-2.507; P < .001). This benefit strengthened further on subgroup analyses of trials in which a majority of cases used stent retrievers, trials with intravenous thrombolysis use in both arms when appropriate, and trials that required preprocedural imaging of all patients. There were no significant differences between arms in terms of mortality, hemicraniectomy, intracranial hemorrhage, and cerebral edema rates (P > .05). In conclusion, in the treatment of acute ischemic stroke, local endovascular therapy leads to improved functional independence compared with standard care.
Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Administração Intravenosa , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Circulação Cerebrovascular , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Fibrinolíticos/efeitos adversos , Humanos , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Resultado do TratamentoAssuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exposição por Inalação/prevenção & controle , Máscaras/provisão & distribuição , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Dispositivos de Proteção Respiratória/provisão & distribuição , Infecções Respiratórias/terapia , Aerossóis , Humanos , Exposição por Inalação/efeitos adversos , Exposição Ocupacional/efeitos adversos , Tamanho da Partícula , Infecções Respiratórias/transmissão , Infecções Respiratórias/virologia , Medição de Risco , Fatores de RiscoAssuntos
Biópsia por Agulha/normas , Biópsia Guiada por Imagem/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Radiologia Intervencionista/normas , Fatores Etários , Biópsia por Agulha/efeitos adversos , Consenso , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Segurança do Paciente/normas , Valor Preditivo dos Testes , Fatores de RiscoAssuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/normas , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/normas , Radiografia Intervencionista/normas , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Tomada de Decisão Clínica , Consenso , Criocirurgia/efeitos adversos , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Carga TumoralAssuntos
Artérias , Ensaios Clínicos como Assunto/normas , Embolização Terapêutica/normas , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/normas , Projetos de Pesquisa/normas , Terminologia como Assunto , Artérias/diagnóstico por imagem , Consenso , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Padrões de Prática Médica/normas , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do TratamentoAssuntos
Isquemia Encefálica/terapia , Educação de Pós-Graduação em Medicina , Radiografia Intervencionista/normas , Radiologistas/educação , Radiologistas/normas , Radiologia Intervencionista/educação , Radiologia Intervencionista/normas , Acidente Vascular Cerebral/terapia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Certificação/normas , Competência Clínica/normas , Consenso , Currículo , Técnica Delphi , Educação de Pós-Graduação em Medicina/normas , Humanos , Sociedades Médicas , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: It is important for physicians to be aware of the radiation doses as well as the risks associated with diagnostic imaging procedures that they are ordering. METHODS: A survey was administered to patients, medical students, and referring physicians from a number of specialties to determine background knowledge regarding radiation exposure and risk associated with commonly ordered medical imaging tests. RESULTS: A total of 127 patients, 32 referring physicians, and 30 medical students completed the survey. The majority of patients (92%) were not informed of the radiation risks associated with tests that they were scheduled to receive and had false perceptions about the use of radiation and its associated risks. Physicians and medical students had misconceptions about the use of ionizing radiation in a number of radiologic examinations; for example, 25% and 43% of physicians and medical students, respectively, were unaware that interventional procedures used ionizing radiation, and 28% of physicians were unaware that mammography used ionizing radiation. Computed tomographies and barium studies were thought to be associated with the least ionizing radiation among physicians. CONCLUSION: There is a need for educating the public, medical students, and referring physicians about radiation exposure and associated risk so that (1) patients receiving multiple medical imaging tests are aware of the radiation that they are receiving and (2) physicians and future physicians will make informed decisions when ordering such tests to limit the amount of radiation that patients receive and to promote informed consent among patients.