Awareness of Radiologists and Radiographers toward Patient Care in the Interventional Radiology Department

Background: The hospitals and health care centres are organized around the patient, a model in which healthcare providers partner with patients and families to identify and satisfy patients’ needs and preferences. Providers respect patients’ values and preferences, address their emotional and social needs, and involve them and their families in decision making. According to the best of our knowledge, there is no evidence to prove, radiologists and radiographers are aware enough about the patient safety, care, and code of conduct with their patients in the interventional radiology department. Objective: This article aims to measure the awareness of radiologists and radiographers toward care and safety in an interventional radiology department. Material and Method: This study was carried in period from 15 February to 20 April 2022. One hundred sixty-four radiographers and radiologists participating in this study completed the questionnaire, which equals a response rate of approximately 82%. The questionnaire was fully completed by almost all responders;only a few of them gave partial answers. Results: The first question for radiographers and radiologists was “the sufficient awareness about the patient safety and care during the interventional radiology procedure. Also, the majority of the radiographers and radiologists are providing the patients with sufficient information when he/she ask for help or queries. A large number of radiographers and radiologists were participating in this study explaining the procedures to patients before starting the examinations in a structured way. Finally, the result shows both radiographers and radiologists respect the patient’s rights, privacy, and dignity and also kept the radiation protection during the interventional radiology procedures. Conclusion: This article summarizes the key categories of awareness of patient care issues in the provision of interventional radiology services, from the joint perspectives of radiographers and radiologists, and provides references for further reading in all major relevant areas.

Interventional radiology treatment for pulmonary embolism

Venous thromboembolism(VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism(PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.

The Role of Interventional Radiology in Splenic Trauma

The purpose of this case report is to discuss the different treatment options available in splenic trauma patients by following the story of Mr. H. I will focus particularly on the role of splenic arterial embolisation (SAE)—an interventional radiological procedure—and how it weighs up against its surgical counterparts. In order to give a balanced view this case report includes a literature review around splenic artery embolisation. This report concludes that when managing splenic trauma, interventional radiology (IR) is a useful tool particularly when used in conjunction with surgery. The future of this field needs to allow SAE to become a stand-alone therapy. Furthermore, research needs to investigate which cohorts of patients are best suited to which intervention such that we can capitalise on the advantages of each intervention for the benefit of all.

Interventional Radiology in Côte d’Ivoire: Analysis and Assessment of the Radiological Risk of the Surgical Team

Ionizing radiation is widely used in medical practice for both diagnostic and therapeutic purposes. However, they are not devoid of adverse health effects on exposed operators. Therefore, we propose to assess the radiological risk of the interventional radiology team of the International Polyclinic of Indénié of Abidjan during the procedures of Embolization of uterine fibromyomas. The effective and equivalent doses to the extremities and crystals were estimated by TLD dosimeters positioned at different body areas selected on the basis of a radiological analysis of the exposure of personnel during five procedures. The analysis of fluoroscopic and record times showed variability in or an average fluoroscopy time of 32.37 min with extremes of 25.14 to 56.32 min;average record time of 0.52 min with extremes of 0.12 min to 1 min. The annual effective doses were respectively, 4.04 mSv, 3.42 mSv, 2.84 mSv;2.28 mSv, in the Radiologist (R), Operator Assistant (O2);Anesthesiologist (A2), Manipulator (M2). The annual equivalent doses to the radiologist’s predominant extremities and lenses were left index and left lens with values of 37.07 mSv and 9.46 mSv. The estimated doses in our study are reassuring from a regulatory point of view of dose limits. The results of our work have shown no significant short-term danger to the health of personnel.

Precision interventional radiology

The recent interest in precision medicine among interventionists has led to the establishment of the concept of precision interventional radiology(PIR).This concept focuses not only on the accuracy of interventional operations using traditional image-guided techniques,but also on the comprehensive evaluation of diseases.The invisible features extracted from CT,MRI,or US improve the accuracy and specificity of diagnosis.The integration of multi-omics and molecule imaging provides more information for interventional operations.The development and application of drugs,embolic materials,and devices broaden the concept of PIR.Integrating medicine and engineering brings new image-guided techniques that increase the efficacy of interventional operations while reducing the complications of interventional treatment.In all,PIR,an important part of precision medicine,emphasizing the whole disease management process,including precision diagnosis,comprehensive evaluation,and interventional therapy,maximizes the benefits of patients with limited damage.

Current trends and perspectives in interventional radiology for gastrointestinal cancers

Gastrointestinal(GI)cancers often require a multidisciplinary approach involving surgeons,endoscopists,oncologists,and interventional radiologists to diagnose and treat primitive cancers,metastases,and related complications.In this context,interventional radiology(IR)represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques.In the last years,through the development of new devices,IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient.Arterial embolization,ablative techniques,and gene therapy represent useful and innovative IR tools in GI cancer treatment.Moreover,IR can be useful for the management of GI cancer-related complications,such as bleeding,abscesses,GI obstructions,and neurological pain.The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications,as well as to describe the future perspectives of IR in this oncologic field.

Progress in interventional radiology treatment of pulmonary embolism:A brief review

Pulmonary embolism represents a common life-threatening condition.Prompt identification and treatment of this pathological condition are mandatory.In cases of massive pulmonary embolism and hemodynamic instability or right heart failure,interventional radiology treatment for pulmonary embolism is emerging as an alternative to medical treatment(systemic thrombolysis)and surgical treatment.Interventional radiology techniques include percutaneous endovascular catheter directed therapies as selective thrombolysis and thrombus aspiration,which can prove useful in cases of failure or infeasibility of medical and surgical approaches.

Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

Primary biliary tract tumors are malignancies that originate in the liver,bile ducts,or gallbladder.These tumors often present with jaundice of unknown etiology,leading to delayed diagnosis and advanced disease.Currently,several palliative treatment options are available for primary biliary tract tumors.They include percutaneous transhepatic biliary drainage(PTBD),biliary stenting,and surgical interventions such as biliary diversion.Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors.It involves the administration of chemotherapy drugs,such as gemcitabine and cisplatin,which have shown promising results in improving overall survival in patients with advanced biliary tract tumors.PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction.Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction.Surgical interventions,such as biliary diversion,have traditionally been used as palliative options for primary biliary tract tumors.However,biliary diversion only provides temporary relief and does not remove the tumor.Primary biliary tract tumors often present in advanced stages,making palliative treatment the primary option for improving the quality of life of patients.

Safety and efficacy of transcatheter arterial embolization in autosomal dominant polycystic kidney patients with gross hematuria: Six case reports

BACKGROUND To retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating autosomal dominant polycystic kidney disease(ADPKD)patients with gross hematuria.CASE SUMMARY The purpose of this study is to retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating ADPKD patients with gross hematuria.Materials and methods:During the period from January 2018 to December 2019,renal transcatheter arterial embolization was carried out on 6 patients with polycystic kidneys and gross hematuria.Renal arteriography was performed first,and then we determined the location of the hemorrhage and performed embolization under digital subtraction angiography monitoring.Improvements in routine blood test results,routine urine test results,urine color and postoperative reactions were observed and analyzed.Results:Renal transcatheter arterial embolization was successfully conducted in 6 patients.The indices of 5 patients and the color of gross hematuria improved after surgery compared with before surgery.No severe complication reactions occurred.CONCLUSION For autosomal dominant polycystic kidney syndrome patients with gross hematuria,transcatheter arterial embolization was safe and effective.

Interventional urethral balloon dilatation before endoscopic visual internal urethrotomy for post-traumatic bulbous urethral stricture:A case report

BACKGROUND While several treatment options are available for pediatric urethral strictures,the appropriate treatment must be based on several factors.Although endoscopic visual internal urethrotomy(EVIU)could be a first-line treatment option for short pediatric urethral strictures,it is not feasible if the urethroscope cannot pass through the stricture point.Herein,we present a pediatric case of severe posttraumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation.CASE SUMMARY A 12-year-old boy presented at our outpatient clinic with the inability to urinate.He had sustained a straddle injury three months prior.The post-void residual urine volume was 644 mL,and retrograde urethrography confirmed severe stricture of the bulbous urethra.EVIU was planned;however,the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point.The urethral route was subsequently secured via balloon dilatation of the stricture,which was performed in collaboration with specialists from the department of interventional radiology.The urethroscope was then able to pass,and the repeat EVIU was successful.CONCLUSION Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.

Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer

BACKGROUND Obstruction or fullness after feeding is common in gastric cancer(GC)patients,affecting their nutritional status and quality of life.Patients with digestive obstruction are generally in a more advanced stage.Existing methods,including palliative gastrectomy,gastrojejunostomy,endoluminal stent,jejunal nutrition tube and intravenous chemotherapy,have limitations in treating these symptoms.AIM To analyze the efficacy of continuous gastric artery infusion chemotherapy(cGAIC)in relieving digestive obstruction in patients with advanced GC.METHODS This study was a retrospective study.Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine.The oxaliplatin-based intra-arterial infusion regimen was applied in all patients.Mild systemic chemotherapy was used in combination with local treatment.The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors(RECIST)criteria.Digestive tract symptoms and toxic effects were analyzed regularly.A comparison of the Karnofsky Performance Status(KPS)score and Stooler’s Dysphagia Score before and after therapy was made.Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival.RESULTS All patients finished cGAIC successfully without microcatheter displacement,as confirmed by arteriography.The median follow-up time was 24 mo(95%CI:20.24-27.76 mo).The overall response rate was 89.7%after cGAIC according to the RECIST criteria.The postoperative Stooler’s Dysphagia Score was significantly improved.Twentytwo(75.9%)of the 29 patients experienced relief of digestive obstruction after the first two cycles,and 13(44.8%)initially unresectable patients were then considered radically resectable.The median overall survival time(mOS)was 16 mo(95%CI:9.32-22.68 mo).Patients who received radical surgery had a significantly longer mOS than other patients(P value<0.001).Multivariate Cox regression analysis indicated that radical resection after cGAIC,intravenous chemotherapy after cGAIC,and immunotherapy after cGAIC were independent predictors of mOS.None of the patients stopped treatment because of adverse events.CONCLUSION cGAIC was effective and safe in relieving digestive obstruction in advanced GC,and it could improve surgical conversion possibility and survival time.

Post-cholecystectomy iatrogenic bile duct injuries:Emerging role for endoscopic management

Post-cholecystectomy iatrogenic bile duct injuries(IBDIs),are not uncommon and although the frequency of IBDIs vary across the literature,the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy.These injuries caries a great burden on the patients,physicians and the health care systems and sometime are life-threatening.IBDIs are associated with different manifestations that are not limited to abdominal pain,bile leaks from the surgical drains,peritonitis with fever and sometimes jaundice.Such injuries if not witnessed during the surgery,can be diagnosed by combining clinical manifestations,biochemical tests and imaging techniques.Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate.Surgical approach was the ideal approach for such cases,however the introduction of Endoscopic Retrograde Cholangio-Pancreatography(ERCP)was a paradigm shift in the management of such injuries due to accepted success rates,lower cost and lower rates of associated morbidity and mortality.However,the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs.ERCP management of IBDIs can be tailored according to the nature of the underlying injury.For the subgroup of patients with complete bile duct ligation and lost ductal continuity,transfer to surgery is indicated without delay.Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP.For low–flow leaks e.g.gallbladder bed leaks,conservative management for 1-2 wk prior to ERCP is advised,in contrary to high-flow leaks e.g.cystic duct leaks and stricture lesions in whom early ERCP is encouraged.Sphincterotomy plus stenting is the ideal management line for cases of IBDIs.Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy.Future studies will solve many unsolved issues in the management of IBDIs.

More to it than meets the eye: a case report of incomitant esotropia in a child caused by a giant basilar aneurysm

Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.

Budd-Chiari syndrome in children:Challenges and outcome

Budd-Chiari syndrome(BCS)is an uncommon disease of the liver,characterised by obstruction of the hepatic venous outflow tract.The etiological spectrum of BCS as well as venous obstruction pattern show wide geographical and demographic variations across the globe.Compared to adults with BCS,children have primary BCS as the predominant etiology,earlier clinical presentation,and hence better treatment outcome.Underlying prothrombotic conditions play a key role in the etiopathogenesis of BCS,though work-up for the same is often unyielding in children.Use of next-generation sequencing in addition to conventional tests for thrombophilia leads to better diagnostic yield.In recent years,advances in radiological endovascular intervention techniques have revolutionized the treatment and outcome of BCS.Various non-invasive markers of fibrosis like liver and splenic stiffness measurement are being increasingly used to assess treatment response.Elastography techniques provide a novel non-invasive tool for measuring liver and splenic stiffness.This article reviews the diagnostic and therapeutic advances and challenges in children with BCS.

Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome:A comprehensive review

Budd-Chiari syndrome(BCS)is a relatively rare clinical condition with a wide range of symptomatology,caused by the obstruction of the hepatic venous outflow.If left untreated,it has got an high mortality rate.Its management is based on a step-wise approach,depending on the clinical presentation,and includes different treatment from anticoagulation therapy up to Interventional Radiology techniques,such as transjugular intrahepatic portosystemic shunt(TIPS).TIPS is today considered a safe and highly effective treatment and should be recommended for BCS patients,including those awaiting orthotopic liver transplantation.In this review the pathophysiology,diagnosis and treatment options of BCS are presented,with a special focus on published data regarding the techniques and outcomes of TIPS for the treatment of BCS.Moreover,unresolved issues and future research will be discussed.

Non-surgical treatment of hilar cholangiocarcinoma

Cancer of the biliary confluence also known as hilar cholangiocarcinoma(HC)or Klatskin tumor,is a rare type of neoplastic disease constituting approximately 40%-60%of intrahepatic malignancies,and 2% of all cancers.The prognosis is extremely poor and the majority of Klatskin tumors are deemed unresectable upon diagnosis.Most patients with unresectable bile duct cancer die within the first year after diagnosis,due to hepatic failure,and/or infectious complications secondary to biliary obstruction.Curative treatments include surgical resection and liver transplantation in highly selected patients.Nevertheless,very few patients are eligible for surgery or transplant at the time of diagnosis.For patients with unresectable HC,radiotherapy,chemotherapy,photodynamic therapy,and liver-directed minimally invasive procedures such as percutaneous image-guided ablation and intra-arterial chemoembolization are recommended treatment options.This review focuses on currently available treatment options for unresectable HC and discusses future perspectives that could optimize outcomes.

Endovascular treatment of pulmonary embolism: Selective review of available techniques

Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.

Disabling portosystemic encephalopathy in a non-cirrhotic patient: successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein

Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/d L(reference range < 75 mg/d L) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein diet.On the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.

Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer

Pancreatic cancer is a challenging malignancy with limited treatment options and poor life expectancy.The only curative option is surgical resection,but only 15%-20%of patients are resectable at presentation because more than 50%of patients has distant metastasis at diagnosis and the rest of them has locally advanced pancreatic cancer(LAPC).The standard of care first line treatment for LAPC patients is chemotherapy with or without radiation therapy.Recent developments in minimally invasive ablative techniques may add to the treatment armamentarium of LAPC.There are increasing number of studies evaluating these novel ablative techniques,including radiofrequency ablation,microwave ablation,cryoablation and irreversible electroporation.Most studies which included pancreatic tumor ablation,demonstrated improved overall survival in LAPC patients.However,the exact protocols are yet to set up to which stage of the treatment algorithm ablative techniques can be added and in what kind of treatment combinations.Patients with metastatic pancreatic cancer has dismal prognosis with 5-year survival is only 3%.The most common metastatic site is the liver as 90%of pancreatic cancer patients develop liver metastasis.Chemotherapy is the primary treatment option for patients with metastatic pancreatic cancer.However,when the tumor is not responding to chemotherapy or severe drug toxicity develops,locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease progression and improve survival in selected patients.During the last decade new therapeutic options arose with the advancement of minimally invasive technologies to treat pancreatic cancer patients.These new therapies have been a topic of increasing interest due to the severe prognostic implications of locally advanced and metastatic pancreatic cancer and the low comorbid risk of these procedures.This review summarizes new ablative options for patients with LAPC and percutaneous liver-directed therapies for patients with liver-dominant metastatic disease.

鼻咽血管纤维瘤

鼻咽血管纤维瘤好发青春期男性,是高度血管化良性肿瘤,手术治疗为主。我们应用头颈部血管瘤介入技术和鼻内镜及其延伸技术,对我院2003年1月～2006年1月鼻咽血管纤维瘤患者分析如下。