Practice Trends of Fibrinogen Monitoring in Thrombolysis.

There is a lack of evidence or societal guidelines regarding the utility of fibrinogen monitoring during thrombolysis. The purpose of our study was to investigate the current use of monitoring fibrinogen levels during thrombolysis. A voluntary, anonymous online survey was sent to all physician members of the Society of Interventional Radiology, consisting of 23 questions related to practitioner demographics, thrombolysis protocol, and fibrinogen monitoring.

Radiation Risk to the Fluoroscopy Operator and Staff.

Objective: Recent articles discussing cases of brain cancer in interventionalists have raised concerns regarding the hazards of occupational exposure to ionizing radiation. We review the basics of radiation dose and the potential radiation effects, particularly as they pertain to the operator. Then we present the data regarding the risk of each type of radiation effect to the fluoroscopy operator and staff, with special attention on cancer induction, radiation-induced cataracts, and the pregnant operator.

Preprocedure Evaluation of a Dysfunctional Dialysis Access.

Given the many different types of hemodialysis access and the various problems that can occur in each, a structured approach should be taken in the preprocedure evaluation of patients referred for hemodialysis access intervention. Abnormalities detected on surveillance or monitoring trigger referrals for evaluation and intervention in hopes of preventing thrombosis or underdialysis. Familiarity with surveillance and monitoring findings not only facilitates better communication with nephrologists but also helps the interventionalist surmise where the site of stenosis might be and which stenoses are clinically relevant.

Radiation Protection for the Fluoroscopy Operator and Staff.

Objective: The purposes of this article are to review available data regarding the range of protection devices and garments with a focus on eye protection and to summarize techniques for reducing scatter radiation exposure.

Conclusion: Fluoroscopy operators and staff can greatly reduce their radiation exposure by wearing properly fitted protective garments, positioning protective devices to block scatter radiation, and adhering to good radiation practices. By understanding the essentials of radiation physics, protective equipment, and the features of each imaging system, operators and staff can capitalize on opportunities for radiation protection while minimizing ergonomic strain.

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience.

Purpose: To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS).

Materials And Methods: Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded.

Nickel hypersensitivity in patients with inferior vena cava filters: case report and literature and MAUDE database review.

Placement of a prophylactic retrievable inferior vena cava (IVC) filter was requested in a 73-year-old woman with nickel hypersensitivity resulting in a clinical dilemma. Given that all retrievable filters contain nickel, the published literature and the Manufacturer and User Facility Device Experience (MAUDE) database were reviewed; no documented case of IVC filter placement in a patient with nickel hypersensitivity or reported hypersensitivity reaction in a patient after IVC filter placement could be identified. This article presents the uneventful course of the case described and a review of the literature and recommendations on use of nickel-containing devices in patients with nickel hypersensitivity.

Role of interventional radiology in the management of acute gastrointestinal bleeding.

Acute gastrointestinal bleeding (GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology.

Comparative efficacy of new interfaces for intra-procedural imaging review: the Microsoft Kinect, Hillcrest Labs Loop Pointer, and the Apple iPad.

We adapted and evaluated the Microsoft Kinect (touchless interface), Hillcrest Labs Loop Pointer (gyroscopic mouse), and the Apple iPad (multi-touch tablet) for intra-procedural imaging review efficacy in a simulation using MIM Software DICOM viewers. Using each device, 29 radiologists executed five basic interactions to complete the overall task of measuring an 8.1-cm hepatic lesion: scroll, window, zoom, pan, and measure.

ACR Appropriateness Criteria radiologic management of benign and malignant biliary obstruction.

The optimal treatment for patients with biliary obstruction varies depending on the underlying cause of the obstruction, the clinical condition of the patient, and anticipated long-term effects of the procedure performed. Endoscopic and image-guided procedures are usually the initial procedures performed for biliary obstructions. Various options are available for both the radiologist and endoscopist, and each should be considered for any individual patient with biliary obstruction.

Informatics in Radiology: developing a touchless user interface for intraoperative image control during interventional radiology procedures.

Review of prior and real-time patient images is critical during an interventional radiology procedure; however, it often poses the challenge of efficiently reviewing images while maintaining a sterile field. Although interventional radiologists can "scrub out" of the procedure, use sterile console covers, or verbally relay directions to an assistant, the ability of the interventionalist to directly control the images without having to touch the console could offer potential gains in terms of sterility, procedure efficiency, and radiation reduction. The authors investigated a potential solution with a low-cost, touch-free motion-tracking device that was originally designed as a video game controller.

Transjugular intrahepatic portosystemic shunt for treatment of cirrhosis-related chylothorax and chylous ascites: single-institution retrospective experience.

Purpose: To investigate the efficacy and safety of the use of transjugular intrahepatic portosystemic shunt (TIPS) creation to treat cirrhosis-related chylous collections (chylothorax and chylous ascites).

Methods: We retrospectively reviewed data from four patients treated for refractory cirrhosis-related chylous collections with TIPS at our institution over an 8 year period.

Results: One patient had chylothorax, and three patients had concomitant chylothorax and chylous ascites.

ACR Appropriateness Criteria radiologic management of hepatic malignancy.

Management of hepatic malignancy is a challenging clinical problem involving several different medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and locoregional therapies, such as thermal ablation and transarterial embolization.

Endovascular treatment of a congenital thoracic aortic aneurysm in a premature newborn.

Congenital aortic aneurysms are a rare, life-threatening disorder that present complex treatment challenges. The authors describe a congenital thoracic aortic aneurysm treated by endovascular means with stent-assisted coil deployment. Because of rapid in utero aneurysm growth and cardiac dysfunction, a 2.

Improving the tracking and removal of retrievable inferior vena cava filters.

Therapeutic and prophylactic inferior vena cava (IVC) filters should be placed based on currently accepted indications to prevent a fatal pulmonary embolism (PE). The protective effect of filters is offset by the potential for lower extremity deep venous thrombosis (DVT), caval thrombosis, and possible otherwise unnecessary life-long anticoagulation (AC). The duration of treatment for most DVTs or PEs is 3 to 6 months of AC/filter.

ACR appropriateness criteria® radiologic management of thoracic nodules and masses.

Pulmonary and mediastinal masses represent a wide range of pathologic processes with very different treatment options. Although advances in imaging (such as PET and high-resolution CT) help in many cases with the differential diagnosis of thoracic pathology, tissue samples are frequently needed to determine the best management for patients presenting with thoracic masses. There are many options for obtaining tissue samples, each of which has its own set of benefits and drawbacks.

ACR Appropriateness Criteria® on treatment of uterine leiomyomas.

Uterine leiomyomas (fibroids) are the most common tumors in women of reproductive age and a cause of significant morbidity in this patient population. Depending on the fibroid location, they can be the cause of a variety of symptoms, such as abnormal uterine bleeding, constipation, urinary frequency, and pain. Historically, hysterectomy has been the primary treatment option, and uterine fibroids remain the leading cause for hysterectomy in the United States.

Optional inferior vena cava filters in the trauma patient.

Trauma patients are at exceedingly high risk of development of venous thromboembolism (VTE) including deep venous thrombosis and pulmonary embolism (PE). The epidemiology of VTE in trauma patients is reviewed. PE is thought to be the third major cause of death after trauma in those patients who survive longer than 24 hours after onset of injury.