Comparative Analysis of Radiology Trainee Burnout Using the Maslach Burnout Inventory and Oldenburg Burnout Inventory.

Background: Burnout is an individualized response to imbalances between job demands and resources that has predominantly been evaluated with the Maslach Burnout Inventory (MBI). There are other instruments not validated among healthcare providers that may be comparable to the MBI. Utilizing alternative measurements can allow researchers to assess wellness with a larger array of questions.

A Rare Case of Congenital Internal Carotid Artery Agenesis and Contralateral Internal Carotid Artery Aneurysm.

Agenesis of the internal carotid artery (ICA) is a rare congenital entity. This anomaly is typically occult in nature. However, the effects of an incidental discovery secondary to a contralateral ICA aneurysmal rupture can be devastating.

Republished:Aspiration catheter failure leading to carotid-cavernous fistula during stroke thrombectomy.

Endovascular thrombectomy in acute ischaemic stroke commonly uses aspiration catheters, either alone or in combination with stent retrievers. The Penumbra Aspiration System (Penumbra, Alameda, California, USA) was first approved by the US Food and Drug Administration in 2007, with low reported device-related complications. We present a case of a previously unreported complication related to malfunction of a Penumbra aspiration catheter during stroke thrombectomy resulting in a carotid-cavernous fistula.

Fix the Flat: Applying the Principles of Tire Aerosol Repair to Prevent Exsanguination From a Hemorrhagic Intrahepatic Mass.

Metastatic neoplasias often require increased blood supply for proliferation. Tumors that outgrow their blood supply can undergo necrosis, leading to the formation of mass-like abscesses. Depending on the location, these lesions can form fistulas with nearby organs resulting in poor patient outcomes.

Inferior Vena Cava Syndrome as a Manifestation of Metastatic Carcinoid Tumor.

Small bowel-origin carcinoid tumor is indolent but may metastasize relentlessly to various sites, including the liver. Over the past 9 years, we have treated a 69-year-old woman who has undergone 5 percutaneous liver ablations, 5 hepatic intra-arterial chemoembolizations, an ovarian cryoablation, and a trans-ventral hernia mesenteric cryoablation. These interventions are all related to her inoperable carcinoid malignancy.

A Simple Target Will Save the Day and the Kidney: This Is How We Perform Our Endovascular Fenestrated Graft Procedure.

With the advent of state-of-the-art imaging modalities, increasing population age, and advanced preventive medical treatments, medical device design attempts to keep up with procedural demand. An abdominal aortic aneurysm (AAA) is a recognized, potentially fatal disease process where strides have been made in screening, detection, and treatment since its discovery. With the introduction of percutaneous endograft procedures in 1991, open surgical treatment is nearly a lost art.

Portal Vein Tumor Thrombus: No Longer a Death Sentence.

Hepatocellular carcinoma (HCC) is the most common malignancy of the liver and a leading cause of cancer mortality worldwide. HCC commonly results from longstanding liver cirrhosis, which presents a host of complications and a severely diminished quality of life. Despite advancements in diagnosis, molecular pathogenesis, and management of the complications associated with irreversible liver diseases, HCC remains an aggressive malignancy with high mortality.

Expanding the Frontiers of Treatment: Cryoablation of an Ovarian Mass.

The ovaries are a common site of metastasis from a variety of solid organ malignancies. These tumors most commonly originate from the gastrointestinal tract. Neuroendocrine tumors of the small bowel are unrelenting in their tendency to exhibit this type of distant spread, which poses a challenge for curative treatment.

Covered or Not, Here I Come: Stanford Type B Aortic Dissection Repair With a Covered and Uncovered Stent Hybrid Technique.

The complications resulting from aortic dissections are often devastating. Historically, when a Stanford B aortic dissection extended into the visceral abdominal aorta, only surgical management was considered to limit visceral organ malperfusion. Complications of surgical management for Stanford B aortic dissections are as high as 50%.

Aspiration catheter failure leading to carotid-cavernous fistula during stroke thrombectomy.

Endovascular thrombectomy in acute ischaemic stroke commonly uses aspiration catheters, either alone or in combination with stent retrievers. The Penumbra Aspiration System (Penumbra, Alameda, California, USA) was first approved by the US Food and Drug Administration in 2007, with low reported device-related complications. We present a case of a previously unreported complication related to malfunction of a Penumbra aspiration catheter during stroke thrombectomy resulting in a carotid-cavernous fistula.

Hot Aortic Nodules.

Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Morbidity of the dreaded thrombotic complications of atherosclerosis such as cerebrovascular accident and myocardial infarction may be severe. Early detection of fulminant disease is therefore important for risk stratification and selecting a treatment strategy.

Sphenopalatine Ganglion Block: Treatment of Migraine and Trigeminal Neuralgia Associated With Multiple Sclerosis.

Head and facial pain are a burden to many people both directly and indirectly. This is manifested not only as a personal burden but also as a financial one in the form of sick leaves from work and loss of workplace productivity. These costs stem from emergency department visits, hospitalizations, preventative treatments, and medical management.

Rare Treatment for a Rare Tumor: Cryoablation of a Granular Cell Tumor.

Background: Granular cell tumors (GCTs) or Abrikossoff's tumors are rare neoplasms known to originate from Schwann cells in the peripheral nervous system. These lesions are usually benign; malignancy only occurs in 1-2% of cases. Surgical resection is the traditional treatment method for GCTs, but it poses several risks and disadvantages related to the surgical incompatibility of the patient, the extended recovery time, and the chance of relapse.

Side-by-Side Stenting Repair of a Traumatic Pseudoaneurysm at a Venous Confluence.

Objectives: The incidence and prevalence of iatrogenic vascular trauma in the United States is staggering. This has led to the advent and implementation of more efficient and effective vascular repair methods. Although open surgical repair may still be considered gold standard, new endovascular solutions have emerged as other viable options.

Mind the gap: A novel endovascular technique to repair a transected vessel.

Level one trauma centers experience horrific injuries on a regular basis. Blunt or penetrating trauma causing vascular injuries are treated by surgeons and interventional radiologists. When a blood vessel is completely transected, the ends of the vessel retract and vasospasm occurs as a normal survival response.

Pipe-Cleaning Plugged Portacaths: How to Unclog an Implanted Port After Development of a Fibrin Sheath.

Industry has long fought the battle to design a vascular catheter that is less thrombogenic. Indwelling catheters provide long-term central venous access, but they develop fibrin sheaths as the vascular system recognizes them as foreign bodies. Peripheral catheters and central catheters can be changed over a guidewire when they form a fibrin sheath or otherwise malfunction.

The Dark Side of Gadolinium: A Study of Arthrographic Contrast at Extreme Concentrations.

Magnetic resonance arthrography is used to optimally image the detailed intraarticular anatomy of the joint space. A common iatrogenic complication of arthrography is the extra-articular injection of the gadolinium solution in the periarticular tissues; however, a less common complication involves the abnormal concentration of gadolinium within the prepared injectate. The following describes the inadvertent injection of a hyper-concentrated intraarticular solution of gadolinium and the subsequent appearance that resulted in the post-procedure magnetic resonance imaging examination.

When Technology Exceeds its Application: The First Reported Reconstruction of the Iliocaval Confluence Using an Aortic Endograft.

Severe venous dysfunction in the setting of subacute iliocaval occlusion is a high cause of morbidity and mortality in patients. Fortunately, the development of the appropriate interventional management has allowed for better patient prognosis, despite device limitations. Severe cases of venous insufficiency, anatomically challenging vasculature, and device failure remain imperative when discussing the caveats for interventional success.

Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology.

The use of traditionally available intra-arterial devices have historically been designed with the adult patient population in mind. Currently, there are not manufactured devices specifically tailored for use during pediatric interventional procedures, pressuring interventional operators to adapt commonplace and readily available devices for interventional management. Experienced interventional operators understand that pediatric and adult interventions can entail vastly different management, affecting patient care and outcomes.

Eye Opener to EtOH Ablation for Juxta-Cardiac Hepatocellular Carcinoma.

Background: Hepatocellular carcinoma (HCC) is notoriously refractory to systemic chemotherapy, mandating an interventional approach. Mortality may be avoided by neutralizing rapidly growing tumors that approach the heart and major vessels. When the risk/benefit ratio of surgery is unacceptable, percutaneous ablation can achieve remarkable results.

Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion.

Stroke is the fifth leading cause of death in the United States and is one of the leading causes of patient disability. Treatments for intracranial intravascular damage as a result of stroke have evolved extensively over recent decades, as management has become increasingly innovative. Various prospective studies and years of data have refined the current guidelines for treatment of acute ischemic stroke (AIS) and also reflect on the novel interventions for stroke management.

Complicated Complication: How Interventional Radiologists Should Manage Acute Iatrogenic Cardiac Tamponade.

Computed tomography guided biopsies are common interventional procedures that are necessary for confirmation of imaging findings. Additionally, percutaneous biopsies are necessary for the elucidation of a patient's clinical findings with disease pathology. Though interventionists perform these procedures regularly without consequence, various complications may arise depending on the tissues biopsied.

Pre-cryoablation Embolization of Renal Tumors: Decreasing Probes and Saving Loads.

The use of adjuvant pre-ablation embolization for renal tumors has been reported in endophytic, centrally located lesions to reduce the risk of injuring the renal collecting system during subsequent cryoablation. In this technical report, we present another utilization of adjuvant pre-ablation embolization, applied for the purpose of decreasing the number of cryoablation probes needed in the ablation intervention. This novel procedural protocol not only decreases the cost of the procedure, but also preserves more normal renal parenchyma, and decreases the risk of injuries related to probe positioning.

Against the Odds: A Novel Technique to Perform Cholangiography from a Percutaneous Approach through the Cystic Duct.

Percutaneous cholangiography is typically performed via a transhepatic approach and is reserved for patients with contraindications to traditional cholangiogram imaging modalities. For those with suspected cholelithiasis or choledocholithiasis who cannot undergo magnetic resonance imaging for diagnosis, percutaneous cholecystostomy with cholangiogram is a viable option. Endoscopic retrograde cholangiopancreatography may also be precluded due to anatomic or obstructive limitations, in which case, percutaneous transhepatic cholangiography (PTC) may be indicated for diagnosis.

Hydro-marking Your Territory: Using a Novel Percutaneous Tagging System to Assist Pulmonary Nodule Identification During Video-assisted Thoracoscopic Surgery.

The management of lung cancer is highly dependent on surgical resection. There are different surgical managements that are utilized on a patient to patient basis. Small lung nodules are particularly difficult to resect and have a higher postoperative complication rate.