Sample records for radiological hemostatic intervention

  1. Traumatic injuries: radiological hemostatic intervention at admission

    Dondelinger, R.F.; Trotteur, G.; Ghaye, B.; Szapiro, D. [Department of Medical Imaging, University Hospital Sart Tilman, Liege (Belgium)


    Blunt trauma victims and selected patients with penetrating trauma are systematically investigated after resuscitation and hemodynamic stabilization with cross-sectional imaging. Computed tomography is a good predictor of the need for hemostatic arteriographic embolization, based on contrast medium extravasation observed on CT. In centers admitting polytrauma patients, the CT and angiography units should be installed together within the emergency environment. Trauma-dedicated interventional radiologists should be on call for optimal patient management. Posttraumatic retroperitoneal and pelvic bleeding is a primary indication for angiographic hemostasis, together with orthopedic fixation of pelvic bone fractures. Angiography should be carried out rapidly, before the patient decompensates for considerable blood loss. In patients with visceral bleeding, arterial embolization can obviate primary surgery or potentializes surgical intervention and contributes to changing hierarchy of injuries to be treated surgically. Failure to achieve primary hemostasis may occur according to the type of specific organ injury and coagulation and metabolic parameters of the patient. Postembolization complications are few and are usually non-life-threatening and rarely carry definitive sequelae. (orig.)

  2. Interventional radiology

    Steinbrich, W. (ed.) (Basel Univ. (Switzerland). Inst. fuer Medizinische Radiologie); Gross-Fengels, W. (ed.) (Allgemeines Krankenhaus Harburg, Hamburg (Germany). Abt. fuer Klinische Radiologie)


    In interventional radiology adjunctive medical therapy can increase patient's comfort, and should further reduce the risks of the procedures. In order to fulfill the responsibility of the interventionist to the patients and to increase the success rate of the interventions, a profound knowledge of certain drugs is indispensable. This includes, for example, sedatives, analgesics, cardiovascular drugs and agents to prevent infections, thromboembolic complications or restenoses. Moreover, a good monitoring system during complex procedures will increase the safety of radiological interventions. These topics and several more are presented in this book. (orig.). 32 figs.

  3. Society of Interventional Radiology


  4. Interventional Radiology: Stroke


  5. Society of Interventional Radiology

    ... Search Patient information Membership Directory (SIR login) Interventional Radiology General News Multiple procedure payment reduction (MPPR) rate ... contact Eleanore Moye . Learn more . American Board of Radiology Announces Maintenance of Certification Part 3: ABR diplomates ...

  6. Diagnostic and interventional radiology

    Vogl, Thomas J. [Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt am Main (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Reith, Wolfgang [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie; Rummeny, Ernst J. (ed.) [Technische Univ. Muenchen Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Radiologie


    This exceptional book covers all aspects of diagnostic and interventional radiology within one volume, at a level appropriate for the specialist. From the basics through diagnosis to intervention: the reader will find a complete overview of all areas of radiology. The clear, uniform structure, with chapters organized according to organ system, facilitates the rapid retrieval of information. Features include: Presentation of the normal radiological anatomy Classification of the different imaging procedures according to their diagnostic relevance Imaging diagnosis with many reference images Precise description of the interventional options The inclusion of many instructive aids will be of particular value to novices in decision making: Important take home messages and summaries of key radiological findings smooth the path through the jungle of facts Numerous tables on differential diagnosis and typical findings in the most common diseases offer a rapid overview and orientation Diagnostic flow charts outline the sequence of diagnostic evaluation All standard procedures within the field of interventional radiology are presented in a clinically relevant and readily understandable way, with an abundance of illustrations. This is a textbook, atlas, and reference in one: with more than 2500 images for comparison with the reader's own findings. This comprehensive and totally up-to-date book provides a superb overview of everything that the radiology specialist of today needs to know.

  7. Paediatric musculoskeletal interventional radiology

    Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo


    Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. PMID:26235144

  8. Poul Erik Andersen's radiological work on Osteochondrodysplasias and interventional radiology

    Andersen, Poul Erik


    Hospital. His significant experience and extensive scientific work has led to many posts in the Danish Society of Interventional Radiology, the European Society of Radiology and the Cardiovascular and Interventional Radiological Society of Europe, where he is a fellow and has passed the European Board...... of Interventional Radiology - The European qualification in Interventional Radiology....

  9. Interventional radiology for paediatric trauma

    Sidhu, Manrita K. [Everett Clinic, AIC, Seattle Radiologists, Seattle, WA (United States); University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Hogan, Mark J. [The Ohio State University, Section of Vascular and Interventional Radiology, Nationwide Children' s Hospital, Columbus, OH (United States); Shaw, Dennis W.W. [University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Burdick, Thomas [University of Washington School of Medicine, Interventional Radiology, Harborview Medical Center, Seattle, WA (United States)


    Paediatric interventional radiology plays a cornerstone role in the management of paediatric trauma. In the acute setting, interventional radiology techniques allow minimally invasive control of haemorrhage or re-establishment of blood flow. Percutaneous stenting and drainage can allow disruptions in urinary or biliary systems to heal without the need for further surgery. Interventional radiology techniques also have a significant role in treating delayed complications of trauma, including embolization of arterial pseudoaneurysms and pulmonary embolism prophylaxis in individuals immobilized due to the trauma or its operative treatment. (orig.)

  10. White Paper: Curriculum in Interventional Radiology.

    Mahnken, Andreas H; Bücker, Arno; Hohl, Christian; Berlis, Ansgar


    Purpose Scope and clinical importance of interventional radiology markedly evolved over the last decades. Consequently it was acknowledged as independent subspecialty by the "European Union of Medical Specialists" (UEMS). Based on radiological imaging techniques Interventional Radiology is an integral part of Radiology. Materials und Methods In 2009 the German Society for Interventional Radiology and minimally-invasive therapy (DeGIR) developed a structured training in Interventional Radiology. In cooperation with the German Society of Neuroradiology (DGNR) this training was extended to also cover Interventional Neuroradiology in 2012. Tailored for this training in Interventional Radiology a structured curriculum was developed, covering the scope of this modular training. Results The curriculum is based on the DeGIR/DGNR modular training concept in Interventional Radiology. There is also an European Curriculum and Syllabus for Interventional Radiology developed by the "Cardiovascular and Interventional Radiological Society of Europe" (CIRSE). The presented curriculum in Interventional Radiology is designed to provide a uniform base for the training in Interventional Radiology in Germany, based on the competencies obtained during residency. Conclusion This curriculum can be used as a basis for training in Interventional Radiology by all training sites. Key Points: · Interventional Radiology is an integral part of clinical radiology. · The German Society for Interventional Radiology and minimally-invasive therapy (DeGIR) developed a curriculum in Interventional Radiology. · This curriculum is an integrative basis for the training in interventional. Citation Format · Mahnken AH, Bücker A, Hohl C et al. White Paper: Curriculum in Interventional Radiology. Fortschr Röntgenstr 2017; 189: 309 - 311. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Computational radiology for orthopaedic interventions

    Li, Shuo


    This book provides a cohesive overview of the current technological advances in computational radiology, and their applications in orthopaedic interventions. Contributed by the leading researchers in the field, this volume covers not only basic computational radiology techniques such as statistical shape modeling, CT/MRI segmentation, augmented reality and micro-CT image processing, but also the applications of these techniques to various orthopaedic interventional tasks. Details about following important state-of-the-art development are featured: 3D preoperative planning and patient-specific instrumentation for surgical treatment of long-bone deformities, computer assisted diagnosis and planning of periacetabular osteotomy and femoroacetabular impingement, 2D-3D reconstruction-based planning of total hip arthroplasty, image fusion for  computer-assisted bone tumor surgery, intra-operative three-dimensional imaging in fracture treatment, augmented reality based orthopaedic interventions and education, medica...

  12. Interventional neuroradiology techniques in interventional radiology

    Murphy, Kieran; Robertson, Fergus; Watkinson, Anthony


    This book provides accessible technique-specific information on interventional radiology procedures, in a format suitable for reference in the IR treatment room or as a carry-around guide. Offers step-by-step points, key point summaries and illustrations.

  13. Interventional radiology neck procedures.

    Zabala Landa, R M; Korta Gómez, I; Del Cura Rodríguez, J L


    Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.

  14. [Interventional radiology: current problems and new directions].

    Santos Martín, E; Crespo Vallejo, E


    In recent years, vascular and interventional radiology has become one of the fastest growing diagnostic and therapeutic specialties. This growth has been based on a fundamental concept: performing minimally invasive procedures under imaging guidance. This attractive combination has led to the interest of professionals from other clinical specialties outside radiology in performing this type of intervention. The future of vascular and interventional radiology, although uncertain, must be linked to clinical practice and multidisciplinary teamwork.

  15. The interventional radiology business plan.

    Beheshti, Michael V; Meek, Mary E; Kaufman, John A


    Strategic planning and business planning are processes commonly employed by organizations that exist in competitive environments. Although it is difficult to prove a causal relationship between formal strategic/business planning and positive organizational performance, there is broad agreement that formal strategic and business plans are components of successful organizations. The various elements of strategic plans and business plans are not common in the vernacular of practicing physicians. As health care becomes more competitive, familiarity with these tools may grow in importance. Herein we provide an overview of formal strategic and business planning, and offer a roadmap for an interventional radiology-specific plan that may be useful for organizations confronting competitive and financial threats.

  16. Radiation exposure and radiological protection in interventional radiological procedures with special attention to neurointerventional radiology

    Okamoto, Kouichirou; Sakai, Kunio [Niigata Univ. (Japan). School of Medicine; Yoshimura, Shutaro; Oka, Tetsuya; Ito, Jusuke


    It is necessary to interventional radiologists to understand the system of radiological protection recommended by the International Commission on Radiological Protection: justification, optimization, and individual dose and risk limits. Estimation and measurements of the radiation exposure to patients and personnel are important for radiological protection to avoid radiation injuries, such as temporal epilation and cataract. The practical principle of ALARA (as low as reasonably achievable) should be kept in any interventional radiological procedure. (author)

  17. Radiological interventions in malignant biliary obstruction

    Kumble Seetharama Madhusudhan; Shivanand Gamanagatti; Deep Narayan Srivastava; Arun Kumar Gupta


    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be pal iative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction.

  18. Interventional radiology in pediatric oncology

    Hoffer, Fredric A. [Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children' s Research Hospital, 332 N. Lauderdale St., Memphis, TN 38105 (United States)]. E-mail:


    There are many radiological interventions necessary for pediatric oncology patients, some of which may be covered in other articles in this publication. I will discuss a number of interventions including percutaneous biopsy for solid tumor and hematological malignancy diagnosis or recurrence, for the diagnosis of graft versus host disease after stem cell or bone marrow transplantation, and for the diagnosis of complications of immunosuppression such as invasive pulmonary aspergillosis. In the past, tumor localization techniques have been necessary to biopsy or resect small lesions. However improved guidance techniques have allowed for more precise biopsy and the use of thermal ablation instead of excision for local tumor control. A percutaneously placed radio frequency, microwave, laser or cryogen probe can ablate the primary and metastatic tumors of the liver, lung, bone, kidney and other structures in children. This is an alternative treatment for the local control of tumors that may not be amenable to surgery, chemotherapy or radiotherapy. I will also describe how chemoembolization can be used to treat primary or metastatic tumors of the liver that have failed other therapies. This treatment delivers chemotherapy in the hepatic artery infused with emboli to increase the dwell time and concentration of the agents.

  19. Interventional radiology in the lacrimal drainage system

    Ilgit, Erhan T. [Department of Radiology, School of Medicine, Gazi University, Besevler 06510, Ankara (Turkey)]. E-mail:; Oenal, Baran [Department of Radiology, School of Medicine, Gazi University, Besevler 06510, Ankara (Turkey); Coskun, Bilgen [Department of Radiology, School of Medicine, Gazi University, Besevler 06510, Ankara (Turkey)


    This article presents a review of the interventional radiological procedures in the lacrimal drainage system. Balloon dacryocystoplasty and nasolacrimal polyurethane stent placement are the main fluoroscopically guided interventions for the treatment of epiphora by recanalizing the obstructed LDS. These procedures can also be used for dacryolith removal and lacrimal sac abscess treatment.

  20. Acute radiologic intervention in gastrointestinal bleeding

    Lesak, F.


    A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment.

  1. The role of interventional radiology in trauma

    Douglas M. Coldwell


    @@ Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient. In all hospitals, regardless of size, the Interventional Radiologist must consider their relationships with the trauma service in order to quickly and efficiently render aid to the trauma victim. Such consideration should take place in the light of day as it seems that most trauma occurs in the middle of the night or another inconvenient time. The watchwords of trauma IR are speed and efficiency.

  2. Training in Radiation Protection for Interventional Radiology

    Vano, E.; Guibelalde, E.


    Several potential problems have been detected in the safety aspects for the practice of interventional radiology procedures: a) An important increase in the number cases and their complexity and the corresponding increase of installations and specialists involved; b) New X ray systems more sophisticated, with advanced operational possibilities, requiring special skills in the operators to obtain the expected benefits;c) New medical specialists arriving to the interventional arena to profit the benefits of the interventional techniques without previous experience in radiation protection. For that reason, education and training is one of the basic areas in any optimisation programme in radiation protection (RP). the medical field and especially interventional radiology requires actions to promote and to profit the benefit of the new emerging technologies for training (Internet, electronic books, etc). The EC has recently sponsored the MARTIR programme (Multimedia and Audio-visual Radiation Protection Training in Interventional Radiology) with the production of two videos on basic aspects of RP and quality control and one interactive CD-ROM to allow tailored individual training programmes. those educational tools are being distributed cost free in the main European languages. To go ahead with these actions, the EC has decided to promote during 2002, a forum with the main Medical European Societies involved in these interventional procedures. (Author)

  3. Interventional Radiology of Male Varicocele: Current Status

    Iaccarino, Vittorio, E-mail:; Venetucci, Pietro [University of Naples ' Federico II' , Diagnostic Imaging Department-Cardiovascular and Interventional Radiology, School of Medicine (Italy)


    Varicocele is a fairly common condition in male individuals. Although a minor disease, it may cause infertility and testicular pain. Consequently, it has high health and social impact. Here we review the current status of interventional radiology of male varicocele. We describe the radiological anatomy of gonadal veins and the clinical aspects of male varicocele, particularly the physical examination, which includes a new clinical and ultrasound Doppler maneuver. The surgical and radiological treatment options are also described with the focus on retrograde and antegrade sclerotherapy, together with our long experience with these procedures. Last, we compare the outcomes, recurrence and persistence rates, complications, procedure time and cost-effectiveness of each method. It clearly emerges from this analysis that there is a need for randomized multicentre trials designed to compare the various surgical and percutaneous techniques, all of which are aimed at occlusion of the anterior pampiniform plexus.

  4. Interventional radiology: a half century of innovation.

    Baum, Richard A; Baum, Stanley


    The evolution of modern interventional radiology began over half century ago with a simple question. Was it possible to use the same diagnostic imaging tools that had revolutionized the practice of medicine to guide the real-time treatment of disease? This disruptive concept led to rapid treatment advances in every organ system of the body. It became clear that by utilizing imaging some patients could undergo targeted procedures, eliminating the need for major surgery, while others could undergo procedures for previously unsolvable problems. The breadth of these changes now encompasses all of medicine and has forever changed the way we think about disease. In this brief review article, major advances in the field, as chronicled in the pages of Radiology, will be described.

  5. Percutaneous BioOrganic Sealing of Duodenal Fistulas: Case Report and Review of Biological Sealants with Potential Use in Interventional Radiology

    Wadhwa, Vibhor, E-mail: [Johns Hopkins University School of Medicine, Division of Vascular & Interventional Radiology (United States); Leeper, William R., E-mail: [Johns Hopkins University School of Medicine, Department of Surgery (United States); Tamrazi, Anobel, E-mail: [Johns Hopkins University School of Medicine, Division of Vascular & Interventional Radiology (United States)


    Biological sealants are being increasingly used in a variety of surgical specialties for their hemostatic and sealing capabilities. However, their use in interventional radiology has not been widely reported. The authors describe a case of duodenal perforation occurring after 15 years of gastric bypass surgery, in whom surgical diversion was unsuccessfully attempted and the leakage was successfully controlled using percutaneous administration of a combination of biological and organic sealants.

  6. Vascular Closure Devices in Interventional Radiology Practice.

    Patel, Rafiuddin; Muller-Hulsbeck, Stefan; Morgan, Robert; Uberoi, Raman


    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  7. Vascular Closure Devices in Interventional Radiology Practice

    Patel, Rafiuddin, E-mail: [John Radcliffe Hospital, Department of Radiology (United Kingdom); Muller-Hulsbeck, Stefan, E-mail: [Diakonissen Hospital, Diagnostic and Interventional Radiology/Neuroradiology (Germany); Morgan, Robert, E-mail: [St George’s Hospital, Department of Radiology (United Kingdom); Uberoi, Raman, E-mail: [John Radcliffe Hospital, Department of Radiology (United Kingdom)


    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  8. Navigational Tools for Interventional Radiology and Interventional Oncology Applications

    Chehab, Monzer A.; Brinjikji, Waleed; Copelan, Alexander; Venkatesan, Aradhana M.


    The interventional radiologist is increasingly called upon to successfully access challenging biopsy and ablation targets, which may be difficult based on poor visualization, small size, or the proximity of vulnerable regional anatomy. Complex therapeutic procedures, including tumor ablation and transarterial oncologic therapies, can be associated with procedural risk, significant procedure time, and measurable radiation time. Navigation tools, including electromagnetic, optical, laser, and robotic guidance systems, as well as image fusion platforms, have the potential to facilitate these complex interventions with the potential to improve lesion targeting, reduce procedure time, and radiation dose, and thus potentially improve patient outcomes. This review will provide an overview of currently available navigational tools and their application to interventional radiology and oncology. A summary of the pertinent literature on the use of these tools to improve safety and efficacy of interventional procedures compared with conventional techniques will be presented. PMID:26622105

  9. Interventional radiology robot for CT and MRI guided percutaneous interventions.

    Hungr, Nikolai; Fouard, Céline; Robert, Adeline; Bricault, Ivan; Cinquin, Philippe


    This paper introduces a new patient-mounted CT and MRI guided interventional radiology robot for percutaneous needle interventions. The 5 DOF robot uses ultrasonic motors and pneumatics to position the needle and then insert it progressively. The needle position and inclination can be registered in the images using two strategically placed fiducials visible in both imaging modalities. A first prototype is presented and described in terms of its sterilization, CT and MRI compatibility, and precision. Tests showed that 1) it is entirely sterilizable with hydrogen peroxide gas, 2) no image artifacts or deformations are noticeable in the CT and MRI images, 3) does not affect the SNR of MR images, and 4) its mechanical error is less than 5mm.

  10. Interventional radiology procedures in adult patients who underwent liver transplantation

    Roberto Miraglia; Luigi Maruzzelli; Settimo Caruso; Mariapina Milazzo; Gianluca Marrone; Giuseppe Mamone; Vincenzo Carollo; Salvatore Gruttadauria; Angelo Luca; Bruno Gridelli


    Interventional radiology has acquired a key role in every liver transplantation (LT) program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

  11. Role of Interventional Radiology in Endocrine Diseases- Review Article

    Hossein GHANAATI


    Full Text Available Recently, a number of procedures for interventional radiology diagnosis and treatment have been developed by the radiologists. The ‘Interventional Radiology’ refers to the therapeutic procedures performed under imaging guidance. The emergence of this specialty has been made possible by a lot of advances in the technology, imaging systems, and radiologists experience. Interventional radiologists are physicians who are experienced in minimally invasive procedures and targeted treatments which have less risk, less pain and less recovery time in comparison with the surgery. Minimizing the patient discomfort, avoid of general anesthesia, lower incidence of morbidity and mortality, and decreases the length and cost of hospitalization are some advantages of interventional radiology procedures. Similar to all medical fields, interventional procedures have been introduced and developed for the diagnosis and treatment of endocrinology procedures. In this article we aim to review and report our experience about the role of interventional radiology in venous sampling for endocrine diseases (such as parathyroid venous sampling, inferior petrosal sinus sampling, adrenal venous sampling, and venous sampling for islet cell tumors. In addition, interventional treatments of neuroendocrine cancer metastases to the liver, percutaneous ethanol injection therapy for secondary hyperparathyroidism, treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection, radiofrequency ablation of the adrenal gland neoplasms, and also establishing a cGMP pancreatic islet processing facility have been discussed in this article. Keywords: Interventional radiology, Endocrine diseases, Endovascular, Treatment

  12. Physical and cognitive task analysis in interventional radiology

    Johnson, S. [School of Psychology, University of Liverpool, Liverpool (United Kingdom)]. E-mail:; Healey, A. [Royal Liverpool University Hospital, Liverpool (United Kingdom); Evans, J. [Royal Liverpool University Hospital, Liverpool (United Kingdom); Murphy, M. [Royal Liverpool University Hospital, Liverpool (United Kingdom); Crawshaw, M. [Department of Psychology, University of Hull, Hull (United Kingdom); Gould, D. [Royal Liverpool University Hospital, Liverpool (United Kingdom)


    AIM: To identify, describe and detail the cognitive thought processes, decision-making, and physical actions involved in the preparation and successful performance of core interventional radiology procedures. MATERIALS AND METHODS: Five commonly performed core interventional radiology procedures were selected for cognitive task analysis. Several examples of each procedure being performed by consultant interventional radiologists were videoed. The videos of those procedures, and the steps required for successful outcome, were analysed by a psychologist and an interventional radiologist. Once a skeleton algorithm of the procedures was defined, further refinement was achieved using individual interview techniques with consultant interventional radiologists. Additionally a critique of each iteration of the established algorithm was sought from non-participating independent consultant interventional radiologists. RESULTS: Detailed task descriptions and decision protocols were developed for five interventional radiology procedures (arterial puncture, nephrostomy, venous access, biopsy-using both ultrasound and computed tomography, and percutaneous transhepatic cholangiogram). Identical tasks performed within these procedures were identified and standardized within the protocols. CONCLUSIONS: Complex procedures were broken down and their constituent processes identified. This might be suitable for use as a training protocol to provide a universally acceptable safe practice at the most fundamental level. It is envisaged that data collected in this way can be used as an educational resource for trainees and could provide the basis for a training curriculum in interventional radiology. It will direct trainees towards safe practice of the highest standard. It will also provide performance objectives of a simulator model.

  13. [Gastrointestinal bleeding. Diagnostics and therapy by interventional radiology].

    Wingen, M; Günther, R W


    Modern imaging modalities such as (multislice) helical CT allow new diagnostic strategies for gastrointestinal hemorrhage. Today, interventional radiology with superselective transcatheter embolization or TIPS procedures allow minimally invasive therapeutic management which can support or replace surgery. This review is a synopsis of the possibilities and relative merits of diagnostic and therapeutic radiological procedures for gastrointestinal bleeding. Which of them to use should be decided collaboratively by gastroenterologist, surgeon, and radiologist depending on local availability, personal experience, and individual patient factors.

  14. Guide for intervention levels in radiological accidents

    Lee, Jong Tai; Khang, Byung Oui; Lee, Goan Yup; Han, Gee Yang [Korea Atomic Energy Resesrch Institute, Taejon (Korea, Republic of)


    Based on IAEA SS109 and ICRP63, intervention levels and action levels are derived using cost-benefit approach method. Intervention levels are optimized so that the net benefit from protective measures will be maximized. Evacuation, sheltering, relocation, permanent resettlement, administration of stable iodine and food restriction are included in protective measures. Intervention levels are calculated using site specific parameters in Korea. As a results of calculation, general intervention levels are similar to IAEA recommendation and action levels for food restriction are a little higher than IAEA recommendation and Japan guide. Guide on intervention levels in Korea is also suggested based on the calculated results.

  15. Role of Interventional Radiology in Endocrine Diseases- Review Article

    Ghanaati, Hossein; Firouznia, Kavous; Larijani,Bagher; Jalali, Amir Hossein


    Recently, a number of procedures for interventional radiology diagnosis and treatment have been developed by the radiologists. The ‘Interventional Radiology’ refers to the therapeutic procedures performed under imaging guidance. The emergence of this specialty has been made possible by a lot of advances in the technology, imaging systems, and radiologists experience. Interventional radiologists are physicians who are experienced in minimally invasive procedures and targeted treatments which h...

  16. Nanotechnology and its relationship to interventional radiology. Part I: imaging.

    Power, Sarah


    Nanotechnology refers to the design, creation, and manipulation of structures on the nanometer scale. Interventional radiology stands to benefit greatly from advances in nanotechnology because much of the ongoing research is focused toward novel methods of imaging and delivery of therapy through minimally invasive means. Through the development of new techniques and therapies, nanotechnology has the potential to broaden the horizon of interventional radiology and ensure its continued success. This two-part review is intended to acquaint the interventionalist with the field of nanotechnology, and provide an overview of potential applications, while highlighting advances relevant to interventional radiology. Part I of the article deals with an introduction to some of the basic concepts of nanotechnology and outlines some of the potential imaging applications, concentrating mainly on advances in oncological and vascular imaging.

  17. Nanotechnology and its relationship to interventional radiology. Part I: imaging.

    Power, Sarah


    Nanotechnology refers to the design, creation, and manipulation of structures on the nanometer scale. Interventional radiology stands to benefit greatly from advances in nanotechnology because much of the ongoing research is focused toward novel methods of imaging and delivery of therapy through minimally invasive means. Through the development of new techniques and therapies, nanotechnology has the potential to broaden the horizon of interventional radiology and ensure its continued success. This two-part review is intended to acquaint the interventionalist with the field of nanotechnology, and provide an overview of potential applications, while highlighting advances relevant to interventional radiology. Part I of the article deals with an introduction to some of the basic concepts of nanotechnology and outlines some of the potential imaging applications, concentrating mainly on advances in oncological and vascular imaging.

  18. Evaluation of medical radiation exposure in pediatric interventional radiology procedures

    Navarro, Valeria Coelho Costa; Navarro, Marcus Vinicius Teixeira; Oliveira, Aline da Silva Pacheco, E-mail: [Instituto Federal de Educacao, Ciencia e Tecnologia da Bahia (IFBA), Salvador, BA (Brazil); Maia, Ana Figueiredo [Universidade Federal de Sergipe (UFS), Aracaju, SE (Brazil); Oliveira, Adriano Dias Dourado [Sociedade Brasileira de Hemodinamica e Cardiologia Intervencionista, Salvador, BA (Brazil)


    Objective: To evaluate pediatric radiation exposure in procedures of interventional radiology in two hospitals in the Bahia state, aiming at contributing to delineate the scenario at the state and national levels. The knowledge of exposure levels will allow an evaluation of the necessity of doses optimization, considering that peculiarities of radiology and pediatrics become even more significant in interventional radiology procedures which involve exposure to higher radiation doses. Materials and Methods: A total of 32 procedures were evaluated in four rooms of the two main hospitals performing pediatric interventional radiology procedures in the Bahia state. Air kerma rate and kerma-area product were evaluated in 27 interventional cardiac and 5 interventional brain procedures. Results: Maximum values for air kerma rate and kerma-area product and air kerma obtained in cardiac procedures were, respectively, 129.9{sup 2} and 947.0 mGy; and, for brain procedures were 83.3{sup 2} and 961.0 mGy. Conclusion: The present study results showed exposure values up to 14 times higher than those found in other foreign studies, and approximating those found for procedures in adults. Such results demonstrate excessive exposure to radiation, indicating the need for constant procedures optimization and evaluation of exposure rates. (author)

  19. 100 classic papers of interventional radiology: A citation analysis

    Matthew; T; Crockett; Ronan; FJ; Browne; Peter; J; Mac; Mahon; Leo; Lawler


    AIM: To define the 100 citation classic papers of interventional radiology.METHODS: Using the database of Journal Citation Reports the 40 highest impact factor radiology journals were chosen. From these journals the 100 most cited interventional radiology papers were chosen and analysed.RESULTS: The top paper received 2497 citations and the 100 th paper 200 citations. The average number of citations was 320. Dates of publication ranged from 1953- 2005. Most papers originated in the United States(n = 67) followed by Italy(n = 20) and France(n = 10). Harvard University(n = 18) and Osped Civile(n = 11) were the most prolific institutions. Ten journals produced all of the top 100 papers with "Radiology" and "AJR" making up the majority. SN Goldberg and T Livraghi were the most prolific authors. Nearly two thirds of the papers(n = 61) were published after 1990.CONCLUSION: This analysis identifies many of the landmark interventional radiology papers and provides a fascinating insight into the changing discourse within the field. It also identifies topics, authors and institutions which have impacted greatly on the specialty.

  20. Slovenian experience from diagnostic angiography to interventional radiology

    Pavcnik Dusan


    Full Text Available Background. The purpose of writing this article is to document the important events and people in the first 50 years of diagnostic angiography and interventional radiology in Slovenia. During this period not only did the name of the institutions and departments change, but also its governance.

  1. Interventional radiological treatment in complications of pancreatitis

    Memis, Ahmet E-mail:; Parildar, Mustafa


    Percutaneous interventional therapy plays an important role in treating complications of acute and chronic pancreatitis. With the development of cross-sectional imaging and advanced interventional techniques, percutaneous drainage has become the preferred treatment for pancreatic fluid collections such as acute collections, pseudocysts and abscesses. Abscess and pancreatic hemorrhage are the most life threatening complications of pancreatitis. Massive hemorrhage is rare but frequently lethal. As a rule, bleeding complications of pancreatitis require prompt diagnosis and an aggressive surgical approach. In unstable patients with a severely bleeding pseudoaneurysm, hemostasis can be obtained by occlusion with mechanical devices.

  2. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology.

    Khong, P-L; Ringertz, H; Donoghue, V; Frush, D; Rehani, M; Appelgate, K; Sanchez, R


    Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities - radiography and fluoroscopy, interventional radiology, and computed tomography - are subsequently covered in depth. The report concludes with a summary and recommendations. The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation, use

  3. Basic interventional radiology in the abdomen.

    Calero García, R; Garcia-Hidalgo Alonso, M I


    This article describes the different basic nonvascular interventional techniques in the abdomen that all general radiologists should be familiar with. It explains the indications and approaches for the different procedures (punctures, biopsies, drainage of collections, cholecystostomies, and nephrostomies). It also discusses the advantages and disadvantages of the different imaging techniques that can be used to guide these procedures (ultrasound, CT, and fluoroscopy) as well as the possible complications that can develop from each procedure. Finally, it shows the importance of following up patients clinically and of taking care of catheters.

  4. Radiation protection of patients in interventional radiology; Radioprotection du patient en radiologie interventionnelle

    Roche, A. [Departement d' imagerie, Institut Gustave Roussy, 94 - Villejuif (France)


    The purpose of this article is to provide radiologists with key elements of radiation protection for interventional radiology patients. The following points will be discussed: standards of the fluoroscopy units, dedicated dosimetry, risks (especially cutaneous) and means to reduce them, optimization of interventional radiology dose protocols, and national and international regulations. Appropriateness criteria in interventional radiology are national guidelines that should be implemented. (author)

  5. Massive hemoptysis caused by tracheal hemangioma treated with interventional radiology.

    Zambudio, Antonio Ríos; Calvo, Maria Jose Roca; Lanzas, Juan Torres; Medina, J García; Paricio, Pascual Parrilla


    Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.

  6. The current status of interventional radiology in Canada: results of a survey by the Canadian Interventional Radiology Association

    Millward, S.F.; Holley, M.L. [Univ. of Western Ontario, London Health Sciences Centre, Dept. of Radiology, London, Ontario (Canada)


    To evaluate the current status of interventional radiology in Canada. A questionnaire was sent to 28 Canadian interventional radiologists (defined as a physician who performs any type of interventional procedure, including biopsies, but excluding interventional neuroradiology) practising in both tertiary and community hospitals in the major centres in all provinces except Prince Edward Island. Twenty-two (79%) of 28 surveys were completed and returned, providing data about 86 interventional radiologists (IRs). IRs were performing almost all of the following procedures at their institutions: inferior vena cava filter placement, venous angioplasty, dialysis fistula angioplasty, diagnostic and therapeutic pulmonary and bronchial artery procedures, diagnostic and therapeutic procedures of the lower extremity and renal arteries, percutaneous abscess and biliary drainage procedures, percutaneous nephrostomy, and fibroid embolization. A second group of procedures, performed by both IRs and non-radiologists in most institutions, included: all types of central venous catheter placements, pleural drainage, and gastrostomy tube placement. Procedures not being performed by anyone in a number of institutions included: dialysis graft thrombolysis, varicocele embolization, transjugular intrahepatic portosystemic shunts, palliative stenting of the gastrointestinal tract, fallopian tube recannalization, and liver and prostate tumour treatments. The factors most often limiting the respondents' ability to provide a comprehensive interventional service were the interventional radiology inventory budget and the availability of interventional radiology rooms; 50% of respondents indicated the number of available nurses, technologists and IRs was also an important limiting factor. IRs in Canada still play a major role in many of the most commonly performed procedures. However, limited availability of resources and personnel in many institutions may be hampering the ability of IRs to

  7. 介入放射学%Interventional Radiology

    翟仁友; 魏宝杰


    @@ 介入放射学(Interventional Radiology,IVR)是以影像诊断为基础,在医学影像诊断设备(DSA、US、CT、MRI等)的引导下,利用穿刺针、导管及其他介入器材,对疾病进行治疗或采集组织学、细菌学及生理、生化资料进行诊断的学科.

  8. Action research regarding the optimisation of radiological protection for nurses during vascular interventional radiology.

    Mori, Hiroshige


    The optimisation and decision-making processes for radiological protection have been broadened by the introduction of re-examination or feedback after introducing protective measures. In this study, action research was used to reduce the occupational exposure of vascular interventional radiology (IR) nurses. Four radiological protection improvement measures were continuously performed in cooperation with the researchers, nurses and stakeholders, and the nurses' annual effective doses were compared before and after the improvements. First, the dosimetry equipment was changed from one electronic personal dosimeter (EPD) to two silver-activated phosphate glass dosimeters (PGDs). Second, the nurses were educated regarding maintaining a safe distance from the sources of scattered and leakage radiation. Third, portable radiation shielding screens were placed in the IR rooms. Fourth, the x-ray units' pulse rates were reduced by half. On changing the dosimetry method, the two PGDs recorded a 4.4 fold greater dose than the single EPD. Educating nurses regarding radiological protection and reducing the pulse rates by half decreased their effective doses to one-third and two-fifths of the baseline dose, respectively. No significant difference in their doses was detected after the placement of the shielding screens. Therefore, the action research effectively decreased the occupational doses of the vascular IR nurses.

  9. Patient Safety in Interventional Radiology: A CIRSE IR Checklist.


    Interventional radiology (IR) is an invasive speciality with the potential for complications as with other invasive specialities. The World Health Organization (WHO) produced a surgical safety checklist to decrease the morbidity and mortality associated with surgery. The Cardiovascular and Interventional Society of Europe (CIRSE) set up a task force to produce a checklist for IR. Use of the checklist will, we hope, reduce the incidence of complications after IR procedures. It has been modified from the WHO surgical safety checklist and the RAD PASS from Holland.

  10. Vascular interventional radiology. Current evidence in endovascular surgery. 2. ed.

    Cowling, Mark G. (ed.) [Univ. Hospital North Staffordshire, Stoke-on-Trent (United Kingdom). Dept. of Radiology


    Succinct chapters that will allow readers to identify quickly the information that they need. Ideally sized book for storage and use in the interventional suite. Contains sufficient detail for trainees in endovascular therapy/interventional radiology to gain a thorough grasp of the relevant issues. Fully updated to reflect recent advances. This new edition of Vascular Interventional Radiology: Current Evidence in Endovascular Surgery provides a thorough yet succinct and accessible review of the latest knowledge in the field of endovascular surgery. All chapters have been updated to reflect the advances that have occurred during the past five years, and new chapters are included on carotid artery stenting and day case intervention. The chapter on lower limb veno-occlusive disease has been expanded to include management of deep venous thrombosis. Among the other topics considered are the endovascular treatment options in different arterial territories, aneurysm repair techniques, and the management of venous stenosis and venous insufficiency. The aim throughout is to tackle issues of evidence-based practice in order to assist trainees and experienced practitioners in making and implementing treatment decisions. This book will be an invaluable source of information for both interventional radiologists and vascular surgeons with an interest in endovascular techniques.

  11. [Interventional Radiological Treatment of Intercostal Artery Bleedings - a Retrospective Analysis].

    Kupczyk, Patrick; Meyer, Carsten; Thomas, Daniel; Schild, Hans Heinz; Pieper, Claus Christian


    Background Intercostal artery bleedings are potentially fatal injuries. Apart from conservative and surgical treatment options, emergency interventional radiological treatment can also be performed. We report our experience with emergency intercostal artery embolisation. Materials and Methods Patients with acute arterial bleedings from the intercostal artery who were treated interventionally over a period of 7 years were identified retrospectively. Technical and clinical success, clinical and procedural parameters as well as overall survival were analysed. Results Between 2010 and 2017, a total of 27 embolisation procedures was performed in 24 patients (14 male, mean age 65.7 ± 13.9 years). The majority of patients suffered from iatrogenic intercostal artery bleedings (n = 17; 70.1%; especially after thoracocentesis). In five cases, thoracoscopic surgery was attempted prior to intervention but was unsuccessful. Primary technical success was obtained in 25/27 interventions. In two cases, there was re-bleeding via collateral arteries so that re-intervention became necessary (secondary technical success). In 15 cases, secondary surgery after successful interventional treatment was necessary to evacuate the haematoma/haemothorax. Intercostal artery embolisation was clinically successful in 23/24 patients. One patient died despite technically successful embolisation, due to extensive haemothorax. One case of spinal ischaemia was observed as a major complication. Conclusion Intercostal artery embolisation is an effective interventional radiological emergency measure in patients with acute bleeding and is an alternative to surgical treatment even after attempted, unsuccessful surgery. Because of potentially severe complications, the interventional procedure should be performed by an experienced interventionalist. Georg Thieme Verlag KG Stuttgart · New York.

  12. Fatal mediastinal biopsy: How interventional radiology saves the day

    Y Yaacob


    Full Text Available This was a case of a 35-year-old man with mediastinal mass requiring computed tomography (CT-guided biopsy for tissue diagnosis. A posterior approach with an 18-gauge biopsy needle was used to obtain tissue sample. Post biopsy, patient condition deteriorated and multiphase CT study detected active bleeding in arterial phase at the biopsy site with massive hemothorax. Subsequent angiography showed arterial bleeder arising from the apical branch of the right pulmonary artery. Selective endovascular embolization with NBCA (n-Butyl cyanoacrylate was successful. Patient survived the complication. The case highlighted a rare complication in a common radiology procedure and the value of the interventional radiology unit in avoiding a fatal outcome.

  13. Current Trends in Heparin Use During Arterial Vascular Interventional Radiology

    Durran, Alexandra C., E-mail: [Peninsula Radiology Academy, Plymouth International Business Park (United Kingdom); Watts, Christopher, E-mail: [Salisbury District Hospital (United Kingdom)


    Purpose: This study was designed to assess the current use of heparinized saline and bolus doses of heparin in non-neurological interventional radiology and to determine whether consensus could be reached to produce guidance for heparin use during arterial vascular intervention. Methods: An interactive electronic questionnaire was distributed to members of the British Society of Interventional Radiology regarding their current practice in the use, dosage, and timing of heparin boluses and heparinized flushing solutions.ResultsA total of 108 completed questionnaires were received. More than 80% of respondents used heparinized saline with varying concentrations; the most prevalent was 1,000 IU/l (international units of heparin per liter) and 5,000 IU/l. Fifty-one percent of interventionalists use 3,000 IU as their standard bolus dose; however, the respondents were split regarding the timing of bolus dose with {approx}60% administering it after arterial access is obtained and 40% after crossing the lesion. There was no consensus on altering dose according to body weight, and only 4% monitored clotting parameters. Conclusions: There seems to be some coherence among practicing interventionalists regarding heparin administration. We hypothesize that heparinized saline should be used at a recognized standard concentration of 1,000 IU/l as a flushing concentration in all arterial vascular interventions and that 3,000 IU bolus is considered the standard dose for straightforward therapeutic procedures and 5000 IU for complex, crural, and endovascular aneurysm repair work. The bolus should be given after arterial access is obtained to allow time for optimal anticoagulation to be achieved by the time of active intervention and stenting. Further research into clotting abnormalities following such interventional procedures would be an interesting quantifiable follow-up to this initial survey of opinions and practice.

  14. Radiation dose to physicians’ eye lens during interventional radiology

    Bahruddin, N. A.; Hashim, S.; Karim, M. K. A.; Sabarudin, A.; Ang, W. C.; Salehhon, N.; Bakar, K. A.


    The demand of interventional radiology has increased, leading to significant risk of radiation where eye lens dose assessment becomes a major concern. In this study, we investigate physicians' eye lens doses during interventional procedures. Measurement were made using TLD-100 (LiF: Mg, Ti) dosimeters and was recorded in equivalent dose at a depth of 0.07 mm, Hp(0.07). Annual Hp(0.07) and annual effective dose were estimated using workload estimation for a year and Von Boetticher algorithm. Our results showed the mean Hp(0.07) dose of 0.33 mSv and 0.20 mSv for left and right eye lens respectively. The highest estimated annual eye lens dose was 29.33 mSv per year, recorded on left eye lens during fistulogram procedure. Five physicians had exceeded 20 mSv dose limit as recommended by international commission of radiological protection (ICRP). It is suggested that frequent training and education on occupational radiation exposure are necessary to increase knowledge and awareness of the physicians’ thus reducing dose during the interventional procedure.

  15. Is hair loss a reality in neuro-interventional radiology?

    Gavagan, L


    Reports in the literature of radiation-induced hair loss are becoming increasingly common. This work describes a retrospective dose study of patients (n = 958) undergoing diagnostic (primarily cerebral angiograms) and therapeutic (primarily cerebral embolisation) procedures in a neuro-interventional suite. A comparison of patient doses as dose area product (DAP) readings from a single-plane image intensifier system (mean DAP value of 8772 cGy cm(2)) were compared with patient doses from a flat panel biplane system (mean DAP value of 7855 cGy cm(2)). Over 80 % of patients requiring neuro-interventional procedures were found to undergo two procedures or more. An estimated 7 % of therapeutic procedures were found to reach the International Commission on Radiological Protection threshold for temporary epilation.

  16. Virtual simulation as a learning method in interventional radiology

    Avramov Predrag


    Full Text Available Introduction. Radiology is the fastest growing discipline of medicine thanks to the implementation of new technologies and very rapid development of imaging diagnostic procedures in the last few decades. On the other hand, the development of imaging diagnostic procedures has put aside the traditional gaining of experience by working on real patients, and the need for other alternatives of learning interventional radiology procedures has emerged. A new method of virtual approach was added as an excellent alternative to the currently known methods of training on physical models and animals. Virtual reality represents a computer- generated reconstruction of anatomical environment with tactile interactions and it enables operators not only to learn on their own mistakes without compromising the patient’s safety, but also to enhance their knowledge and experience. Discussion. It is true that studies published so far on the validity of endovascular simulators have shown certain improvement of operator’s technical skills and reduction in time needed for the procedure, but on the other hand, it is still a question whether these skills are transferable to the real patients in the angio room. Conclusion. With further improvement of technology, shortcomings of virtual approach to interventional procedures learning will be less significant and this procedure is likely to become the only method of learning in the near future.

  17. Radiation protection in interventional radiology; Strahlenschutz in der interventionellen Radiologie

    Adamus, R.; Loose, R.; Galster, M. [Klinikum Nuernberg Nord, Institut fuer Diagnostische und Interventionelle Radiologie, Nuernberg (Germany); Wucherer, M. [Klinikum Nuernberg Nord, Institut fuer Medizinische Physik, Nuernberg (Germany); Uder, M. [Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Institut fuer Radiologie, Erlangen (Germany)


    The application of ionizing radiation in medicine seems to be a safe procedure for patients as well as for occupational exposition to personnel. The developments in interventional radiology with fluoroscopy and dose-intensive interventions require intensified radiation protection. It is recommended that all available tools should be used for this purpose. Besides the options for instruments, x-ray protection at the intervention table must be intensively practiced with lead aprons and mounted lead glass. A special focus on eye protection to prevent cataracts is also recommended. The development of cataracts might no longer be deterministic, as confirmed by new data; therefore, the International Commission on Radiological Protection (ICRP) has lowered the threshold dose value for eyes from 150 mSv/year to 20 mSv/year. Measurements show that the new values can be achieved by applying all X-ray protection measures plus lead-containing eyeglasses. (orig.) [German] Die Anwendung ionisierender Strahlung in der Medizin scheint sowohl fuer Patienten als auch fuer beruflich exponierte Personen sicher zu sein. Die interventionellen Entwicklungen der letzten Jahre mit sehr durchleuchtungs- und dosisintensiven Eingriffen erfordern allerdings eine Intensivierung des Strahlenschutzes. Es empfiehlt sich, die zur Verfuegung stehenden Moeglichkeiten auszuschoepfen. Neben den Geraeteoptionen muss der Strahlenschutz am Eingriffstisch durch Bleilamellenaufstecker und montiertes Bleiglas intensiv betrieben werden. Besonderen Fokus muss auf den Schutz der Augen zur Kataraktvermeidung gelegt werden. Da dessen Ausbildung nach neuen Erkenntnissen moeglicherweise nicht mehr deterministisch zu sehen ist, hat die Internationale Strahlenschutzkommission (IRCP) den Grenzwert von 150 auf 20 Mikrosievert (mSv)/Jahr erniedrigt. Messungen belegen, dass unter Einhaltung aller Strahlenschutzmassnahmen plus Bleiglasbrille dieser einzuhalten ist. (orig.)

  18. Needlestick Injuries in Interventional Radiology Are Common and Underreported.

    Deipolyi, Amy R; Prabhakar, Anand M; Naidu, Sailendra; Oklu, Rahmi


    Purpose To determine the prevalence of and risk factors for needlesticks in interventional radiology physicians, as well as the attitudes, behaviors, and conditions that promote or interfere with reporting of these injuries. Materials and Methods A total of 3889 interventional radiologists from academic and private practice in the United States were surveyed by emailing all interventional radiologist members of the Society of Interventional Radiology, including attending-level physicians and trainees (April-August 2016). The institutional review board waived the need for consent. Questions inquired about the nature, frequency, and type of needlestick and sharps injuries and whether and to whom these incidents were reported. Stepwise regression was used to determine variables predicting whether injuries were reported. Results In total, 908 (23%) interventional radiologists completed at least a portion of the survey. Eight hundred fourteen (91%) of 895 respondents reported a prior needlestick injury, 583 (35%) of 895 reported at least one injury while treating an HIV-positive patient, and 626 (71%) of 884 reported prior training regarding needlestick injury. There was, on average, one needlestick for every 5 years of practice. Most needlestick or sharps injuries were self inflicted (711 [87%] of 817) and involved a hollow-bore device (464 [56%] of 824). Only 566 (66%) of 850 injuries were reported. The most common reasons for not reporting included perceived lack of utility of reporting (79 [28%] of 282), perceived low risk for injury (56 [20%] of 282), noncontaminated needle (53 [19%] of 282), too-lengthy reporting process (37 [13%] of 282), and associated stigma (23 [8%] of 282). Only 156 (25%) of 624 respondents informed their significant other. Stepwise regression assessing variables affecting the likelihood of reporting showed that male sex (P = .009), low-risk patient (P < .0001), self injury (P = .010), trainee status (P < .0001), and the total number of prior

  19. Reconciling quality and cost: A case study in interventional radiology.

    Zhang, Li; Domröse, Sascha; Mahnken, Andreas


    To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

  20. Competitiveness of the match for interventional radiology and neuroradiology fellowships.

    Chen, Jim Y; Agarwal, Vikas; Orons, Philip D


    Overall resident interest in certain subspecialties changes with time. We sought to investigate the latest 6-year trend in interventional radiology (IR) and neuroradiology fellowship applications and how it has affected competitiveness in obtaining a position. We analyzed statistics published by the National Resident Matching Program in Results and Data: Specialties Matching Service from 2008 to 2013. From these data, we calculated the positions per IR applicant (PPIRA) and positions per neuroradiology applicant (PPNRA) for each year. The number of positions per applicant is one way to assess specialty competitiveness on a supply-and-demand basis. A lower PPIRA or PPNRA indicates a more competitive year. PPIRA has decreased every year, from 1.71 to the present 0.84, and contributed to 52 applicants being unmatched in 2013, up from 9 in 2008. Accordingly, the number of unfilled positions has decreased from 86 in 2008 to 8 in 2013. PPNRA waxed and waned from 2008 to 2010 but stabilized at around 1.15 thereafter. The number of unfilled positions has never dropped below 46. The number of unmatched applicants was consistently in the teens, except in 2011, when it increased to 23. Interest in IR fellowship has increased significantly over the past 6 years, whereas interest in neuroradiology fellowships has plateaued. IR fellowships have become increasingly competitive, leading to many unmatched residents. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. Reconciling quality and cost: A case study in interventional radiology

    Zhang, Li; Mahnken, Andreas [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic and Interventional Radiology, Baldinger Strasse, Marburg (Germany); Domroese, Sascha [University Hospital Giessen and Marburg, Philipps University of Marburg, Division of Controlling, Baldinger Strasse, Marburg (Germany)


    To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 EUR to 294 EUR, and marginal delay costs from approximately 2000 EUR to 500 EUR, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 EUR. The yearly delay cost saved was approximately 150,000 EUR. With increased revenue of 10,000 EUR in project phase 2, the yearly total cost saved was approximately 290,000 EUR. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. (orig.)

  2. Celiac artery stenosis/occlusion treated by interventional radiology

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail:; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)


    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  3. Pediatric interventional radiology and dose-reduction techniques.

    Johnson, Craig; Martin-Carreras, Teresa; Rabinowitz, Deborah


    The pediatric interventional radiology community has worked diligently in recent years through education and the use of technology to incorporate numerous dose-reduction strategies. This article seeks to describe different strategies where we can significantly lower the dose to the pediatric patient undergoing a diagnostic or therapeutic image-guided procedure and, subsequently, lower the dose several fold to the staff and ourselves in the process. These strategies start with patient selection, dose awareness and monitoring, shielding, fluoroscopic techniques, and collimation. Advanced features such as cone-beam technology, dose-reduction image processing algorithms, overlay road mapping, and volumetric cross-sectional hybrid imaging are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Off label use of devices and drugs in interventional radiology

    Zvavanjanja, R.C., E-mail: [Royal Liverpool University Hospital, Liverpool (United Kingdom); Odetoyinbo, T.O.; Rowlands, P.C.; Healey, A.; Abdelsalam, H.; Powell, S.; Evans, J.C.; Hughes, M.L.; Gould, D.A.; McWilliams, R.G. [Royal Liverpool University Hospital, Liverpool (United Kingdom)


    Aim: To establish how often off-label device and drug use occurs in interventional radiology (IR) in a UK tertiary referral hospital and consider the wider implications for the interventional radiologist. Materials and methods: Prospective data were collected during interventional procedures for 1 working week in a university hospital. Out-of-hours procedures and procedures outside the department were excluded. Operators were asked to record the drugs and devices used, the indication, and method of use. The instructions for use/summary of product characteristics were then studied for each device/drug used to assess if the use was on or off-label. Results: During the study period 52 cases were performed and data were available on 26 cases (50%). In 22 of the 26 cases (84%) there was evidence of off-label use of devices or drugs. Off-label use of drugs included treatment of venous malformations with Fibrovein{sup Copyright-Sign} (sodium tetradecyl sulphate), which is licensed for the treatment of varicose veins in the leg, and intra-arterial injection of heparin, which is licensed for intravenous and subcutaneous use. Off-label device use included placing vascular sheaths in the urinary tract, using angiographic catheters to guide wires in the urinary tract, using sheaths for thrombosuction, reshaping of the tip of most guidewires, and using angioplasty balloons to dislodge the arterial plug at fistula thrombectomy. Conclusion: Off-label device and drugs use is common in a UK tertiary hospital IR department and literature suggests this is common in the wider IR community. There are important clinical and legal implications for off-label use for patients and physicians.

  5. Entrance surface dose in cerebral interventional radiology procedures

    Barrera-Rico, M.; Lopez-Rendon, X.; Rivera-Ordonez, C. E.; Gamboa-deBuen, I. [Instituto de Ciencias Nucleares, Universidad Nacional Autonoma de Mexico, 04510 DF (Mexico); Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, 14269 DF (Mexico); Instituto de Ciencias Nucleares, Universidad Nacional Autonoma de Mexico, 04510 DF (Mexico)


    At the Instituto Nacional de Neurologia y Neurocirugia (INNN) diagnostic as well as therapeutic procedures of interventional radiology are carried out. Since the procedures can last from some minutes to several hours, the absorbed dose for the patient could increase dangerously. An investigation had begun in order to determine the entrance surface dose (ESD) using 25 thermoluminiscent dosimeters TLD-100 and 8 strips of 15 Multiplication-Sign 1 cm{sup 2} of Gafchromic XR-QA2 film bound in a holder of 15 Multiplication-Sign 15 cm{sup 2} in the posteroanterior (PA) and lateral (LAT) positions during all the procedure. The results show that maximum ESD could be from 0.9 to 2.9 Gy for the PA position and between 1.6 and 2.5 Gy for the lateral position. The average ESD was between 0.7 and 1.3 Gy for the PA position, and from 0.44 to 1.1 Gy for the lateral position in a therapeutic procedure.

  6. Interventional Radiology Procedures after Pancreatic Resections for Pancreatic and Periampullary Diseases

    Riccardo Casadei


    Full Text Available Context The use of interventional radiology has increased as the first-line management of complications after pancreatic resections. Methods Patients in whom interventional radiology was performed were compared with those in whom interventional radiology was not performed as regards type of pancreatic resection, diagnosis, postoperative mortality and morbidity, postoperative pancreatic fistula postpancreatectomy haemorrhage, bile leakage, reoperation rate and length of hospital stay. Our aim was to evaluate the usefulness of interventional radiology in the treatment of complications after pancreatic resection. Results One hundred and eighty-two (62.8% out of 290 patients experienced postoperative complications. Interventional radiology procedures were performed in 37 cases (20.3%: percutaneous drainage in 28, transhepatic biliary drainage in 8 and arterial embolisation in 3 cases. Technical success was obtained in all casesand clinical success in 75.7%. Reoperation was avoided in 86.5%. In patients with major complications, clinically relevant postoperative pancreatic fistula and bile leaks as well as those with late postpancreatectomy haemorrhage (P=0.030 and patients with postpancreatectomy haemorrhage grade C (P=0.029, interventional radiology was used (P0.001, P0.001 ad P=0.009, respectively significantly more frequently than in the remaining patients. The reoperation and mortality rates were similar in the two groups (P=0.885 and P=0.100,respectively while patients treated with interventional radiology procedures had a significant longer length of hospital stay than those in the non-iterventional radiology group (37.5 ± 23.4 vs. 18.7 ± 11.7 days; P<0.001. Conclusions Interventional radiology procedures were useful, especially for patients with postoperative pancreatic fistulas and bile leaks in whom reoperation was very often avoided.

  7. Nanotechnology and its Relationship to Interventional Radiology. Part II: Drug Delivery, Thermotherapy, and Vascular Intervention.

    Power, Sarah


    Nanotechnology can be defined as the design, creation, and manipulation of structures on the nanometer scale. This two-part review is intended to acquaint the interventionalist with the field of nanotechnology, and provide an overview of potential applications, while highlighting advances relevant to interventional radiology. Part 2 of the article concentrates on drug delivery, thermotherapy, and vascular intervention. In oncology, advances in drug delivery allow for improved efficacy, decreased toxicity, and greater potential for targeted therapy. Magnetic nanoparticles show potential for use in thermotherapy treatments of various tumours, and the effectiveness of radiofrequency ablation can be enhanced with nanoparticle chemotherapy agents. In vascular intervention, much work is focused on prevention of restenosis through developments in stent technology and systems for localised drug delivery to vessel walls. Further areas of interest include applications for thrombolysis and haemostasis.

  8. Nanotechnology and its relationship to interventional radiology. Part II: Drug Delivery, Thermotherapy, and Vascular Intervention.

    Power, Sarah


    Nanotechnology can be defined as the design, creation, and manipulation of structures on the nanometer scale. This two-part review is intended to acquaint the interventionalist with the field of nanotechnology, and provide an overview of potential applications, while highlighting advances relevant to interventional radiology. Part 2 of the article concentrates on drug delivery, thermotherapy, and vascular intervention. In oncology, advances in drug delivery allow for improved efficacy, decreased toxicity, and greater potential for targeted therapy. Magnetic nanoparticles show potential for use in thermotherapy treatments of various tumours, and the effectiveness of radiofrequency ablation can be enhanced with nanoparticle chemotherapy agents. In vascular intervention, much work is focused on prevention of restenosis through developments in stent technology and systems for localised drug delivery to vessel walls. Further areas of interest include applications for thrombolysis and haemostasis.

  9. Imaging and radiology

    Interventional radiology; Diagnostic radiology; X-ray imaging ... DIAGNOSTIC RADIOLOGY Diagnostic radiology helps health care professionals see structures inside your body. Doctors that specialize in the interpretation ...

  10. The clinical practice of interventional radiology: a European perspective.

    Keeling, Aoife N


    The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management\\'s refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

  11. The Radiologist Is in, but Was it Worth the Wait? Radiology Resident Note Quality in an Outpatient Interventional Radiology Clinic.

    Abboud, Salim E; Soriano, Stephanie; Abboud, Rayan; Patel, Indravadan; Davidson, Jon; Azar, Nami R; Nakamoto, Dean A


    Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents.

  12. Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values.

    Vano, E; Fernandez, J M; Resel, L E; Moreno, J; Sanchez, R M


    The purpose of this work is to evaluate radiation doses to the lens of urologists during interventional procedures and to compare them with values measured during interventional radiology, cardiology and vascular surgery. The measurements were carried out in a surgical theatre using a mobile C-arm system and electronic occupational dosimeters (worn over the lead apron). Patient and staff dose measurements were collected in a sample of 34 urology interventions (nephrolithotomies). The same dosimetry system was used in other medical specialties for comparison purposes. Median and 3rd quartile values for urology procedures were: patient doses 30 and 40 Gy cm(2); personal dose equivalent Hp(10) over the apron (μSv/procedure): 393 and 848 (for urologists); 21 and 39 (for nurses). Median values of over apron dose per procedure for urologists resulted 18.7 times higher than those measured for radiologists and cardiologists working with proper protection (using ceiling suspended screens) in catheterisation laboratories, and 4.2 times higher than the values measured for vascular surgeons at the same hospital. Comparison with passive dosimeters worn near the eyes suggests that dosimeters worn over the apron could be a reasonable conservative estimate for ocular doses for interventional urology. Authors recommend that at least the main surgeon uses protective eyewear during interventional urology procedures.

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

    Ramaswamy, Raja S; Choi, Hyung Won; Mouser, Hans C; Narsinh, Kazim H; McCammack, Kevin C; Treesit, Tharintorn; Kinney, Thomas B


    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. The role of interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes. Computed tomography angiography and nuclear scintigraphy can localize the source of bleeding and provide essential information for the interventional radiologist to guide therapeutic management with endovascular angiography and transcatheter embolization. This review article provides insight into the essential role of Interventional Radiology in the management of acute GIB. PMID:24778770

  14. Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology


    to cause cataracts [5, 6]. Statistical analysis of the available data suggests absence of a threshold dose, although if one does exist, it is possible...hands must be near the radiation field (e.g., management of dialysis fistulas and grafts, biliary and genitourinary interventions) [43]. Personal...Radiat Res 167:233–243 7. Nakashima E, Neriishi K, Minamoto A (2006) A reanalysis of atomic-bomb cataract data, 2000–2002: a threshold analysis . Health

  15. Evaluation of radiation protection in interventional radiology; Evaluation de la radioprotection en radiologie interventionnelle

    Le Pape, I.; Aget, H. [Centre Hospitalie Universitaire de Tours, 37 (France); Rondeau du Royer, C. [Inspection Regional du Travail de la region Centre (France)


    The interventional radiology, relatively to the conventional radiology exposes particularly to ionizing radiations, because of the time of utilisation of the radioscopy. It is important to optimize the risk according to the ALARA principle. The efforts must be made on the following fields: the radiation protection means, the periodic and systematic monitoring of material, a regular evaluation of operators irradiation, the training of non radiologist operators, the respect of the legislation on the maximum permissible dose equivalents. (N.C.)

  16. Central venous catheterization: comparison between interventional radiological procedure and blind surgical reocedure

    Song, Won Gyu; Jin, Gong Yong; Han, Young Min; Yu, He Chul [Chonbuk National University Medical School, Chonju (Korea, Republic of)


    To determine the usefulness and safety of radiological placement of a central venous catheter by prospectively comparing the results of interventional radiology and blind surgery. For placement of a central venous catheter, the blind surgical method was used in 78 cases (77 patients), and the interventional radiological method in 56 cases (54 patients). The male to female ratio was 66:68, and the patients' mean age was 48 (range, 18-80) years. A tunneled central venous catheter was used in 74 cases, and a chemoport in 60. We evaluated the success and duration of the procedures, the number of punctures required, and ensuing complications, comparing the results of the two methods. The success rates of the interventional radiological and the blind surgical procedure were 100% and 94.8%, respectively. The duration of central catheterization was 3-395 (mean, 120) day, that of chemoport was 160.9 days, and that of tunneled central venous catheter was 95.1 days. The mean number of punctures of the subclavian vein was 1.2 of interventional radiology, and 2.1 for blind surgery. The mean duration of the interventional radiology and the blind surgical procedure was, respectively, 30 and 40 minutes. The postprocedure complication rate was 27.6% (37 cases). Early complications occurred in nine cases (6.7%): where interventional radiology was used, there was one case of hematoma, and blind surgery gave rise to hematoma (n=2), pneumothorax (n=2), and early deviation of the catheter (n=4). Late complications occurred in 32 cases (23.9%). Interventional radiology involved infection (n=4), venous thrombosis (n=1), catheter displacement (n=2) and catheter obstruction (n=5), while the blind surgical procedure gave rise to infection (n=5), venous thrombosis (n=3), catheter displacement (n=4) and catheter obstruction (n=8). The success rate of interventional radiological placement of a central venous catheter was high and the complication rate was low. In comparison with the blind

  17. Radiology

    Vassallo, Pierre


    Radiology is the fastest developing field of medicine and these unprecedented advances have been mainly due to improving computer technology. Digital imaging is a technology whereby images are acquired in a computer format, so that they can be easily stored and recalled for display on any computer workstation. Digital image acquisition has been used in ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) from the start. The use of digital imaging in conventional X-rays, k...

  18. The Importance of Curriculum-Based Training and Assessment in Interventional Radiology

    Belli, Anna-Maria, E-mail: [St. George’s Hospital, Department of Radiology (United Kingdom); Reekers, Jim A., E-mail: [Academic Medical Centre, Department of Radiology (Netherlands); Lee, Michael, E-mail: [Beaumont Hospital, Department of Radiology (Ireland)


    Physician performance and outcomes are being scrutinised by health care providers to improve patient safety and cost efficiency. Patients are best served by physicians who have undergone appropriate specialist training and assessment and perform large numbers of cases to maintain their skills. The Cardiovascular and Interventional Radiological Society of Europe has put into place a curriculum for training in interventional radiology (IR) and a syllabus with an examination, the European Board of Interventional Radiology, providing evidence of attainment of an appropriate and satisfactory skill set for the safe practice of IR. This curriculum is appropriate for IR where there is a high volume of image-guided procedures in vascular and nonvascular organ systems with cross-use of minimally invasive techniques in patients with a variety of disease processes. Other specialties may require different, longer, and more focused training if their experience is “diluted” by the need to master a different skill set.

  19. The Changing Face of Vascular Interventional Radiology: The Future Role of Pharmacotherapies and Molecular Imaging

    Tapping, Charles R., E-mail:; Bratby, Mark J., E-mail: [Oxford University Hospitals, John Radcliffe Hospital, Department of Radiology (United Kingdom)


    Interventional radiology has had to evolve constantly because there is the ever-present competition and threat from other specialties within medicine, surgery, and research. The development of new technologies, techniques, and therapies is vital to broaden the horizon of interventional radiology and to ensure its continued success in the future. In part, this change will be due to improved chronic disease prevention altering what we treat and in whom. The most important of these strategies are the therapeutic use of statins, Beta-blockers, angiotensin-converting enzyme inhibitors, and substances that interfere with mast cell degeneration. Molecular imaging and therapeutic strategies will move away from conventional techniques and nano and microparticle molecular technology, tissue factor imaging, gene therapy, endothelial progenitor cells, and photodynamic therapy will become an important part of interventional radiology of the future. This review looks at these new and exciting technologies.

  20. Sedation and patient monitoring in vascular and interventional radiology

    McDermott, V.G.M.; Chapman, M.E.; Gillespie, I. (Royal Infirmary, Edinburgh (United Kingdom))


    A postal survey of British and Irish interventional radiologists was carried out in 1991 to assess current practice with respect to sedation and monitoring of patients during angiography and interventional procedures. The response rate was 65%, 49% of patients are fasted prior to angiography and 68% prior to interventional procedures. Radiologists participate in obtaining consent in 60% of cases. Patients are often (50%) sedated for angiography and usually (62-94% depending on the procedure) sedated for interventional procedures. Nurses are present for most procedures, but are given the task of monitoring the patient's vital signs in only 49% of cases. Anaesthetists are present for less than 10% of interventional procedures. The findings indicate a wide variation in practice and a need to standardize practice at a uniform high level. (author).

  1. In the Lead Again Horizontal-Ellipsis [Journal of Cardiovascular and Interventional Radiology

    Vorwerk, Dierk, E-mail: [Ingolstadt Hospital, Department of Diagnostic and Interventional Radiology (Germany)


    The 2013 ISI journal rankings are out and it is my pleasure to inform our readership that CVIR ranks 43/120 (2012: 46/118) journals in the field of radiology. The 2013 impact factor further improved to 2.138 (2012: 2.093). This means that Cardiovascular and Interventional Radiology again continues to be the highest ranked journal dedicated to the field of interventional radiology in 2013.This is mainly due to the great support we achieve by you as authors and readers of CVIR, your dedication to the profession, and your loyalty both to the journal and to CIRSE. For all of this, we owe you our thanks and respect.

  2. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology.

    Vano, E; Sanchez, R M; Fernandez, J M


    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  3. The role of interventional radiology in the treatment of hepatocellular carcinoma.

    Steiner, K.; Papadopoulou, A.; Yu, D.


    The incidence of hepatocellular carcinoma (HCC) in the UK is increasing. The role of interventional radiology in the treatment of HCC is well established. We discuss the minimally invasive treatment options that are available. It is important that procedures are undertaken in and postprocedure imagi

  4. Imaging diagnosis and interventional radiology in systemic vasculitis with particular emphasis on Takayasu arteritis: Part 2

    Ichiro SAKAMOTO; Kuniaki HAYASHI; Naofumi MATSUNAGA; Kazuto ASHIZAWA; Yohjiro MATSUOKA; Masataka UETANI


    In part 1 of this article, clinical features and imaging findings of Takayasu arteritis (also known as aortitis syndrome) were described in detail. In part 2, treatment of Takayasu arteritis will be first described and discussed. This will be followed by description of clinical features and imaging findings of other systemic vasculitis. Comments on interventional radiology for systemic vasculitis will also be made.

  5. Health literacy in vascular and interventional radiology: a comparative analysis of online patient education resources.

    Hansberry, David R; Kraus, Carl; Agarwal, Nitin; Baker, Stephen R; Gonzales, Sharon F


    The Internet is frequently accessed by patients as a resource for medical knowledge. However, the provided material is typically written at a level well above the recommended 7th grade level. A clear understanding of the capabilities, limitations, risks, and benefits of interventional radiology by patients, both current and prospective, is hindered when the textual information offered to the public is pitched at a level of sophistication too high for general comprehension. In January 2013, all 25 patient education resources from the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) Web site ( ) and all 31 resources from the Society of Interventional Radiology (SIR) Web site ( ) were analyzed for their specific level of readability using ten quantitative scales: Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning fog index, New Fog Count, Coleman-Liau index, FORCAST formula, Fry graph, Raygor Readability Estimate, and New Dale-Chall. Collectively, the patient education resources on the CIRSE Web site are written at the 12.3 grade level, while the resources on the SIR Web site are written at the 14.5 grade level. Educational health care materials available on both the CIRSE and the SIR Web sites are presented in language in the aggregate that could be too difficult for many lay people to fully understand. Given the complex nature of vascular and interventional radiology, it may be advantageous to rewrite these educational resources at a lower reading level to increase comprehension.

  6. Interventional radiological treatment of renal transplant complications: A pictorial review

    Lezzi, Roberto; La, Torre Michele fabio; Santoro, Marco; Dattesi, Robrta; Nestola, Massimiliano; Posa, Alessandro; Romagnoli, Jacopo; CItterio, Franco; Bonomo, Lorenzo [' A. Gemelli' Hospital - Catholic University, Rome (Italy)


    Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management.

  7. Cone-beam CT-guidance in Interventional Radiology

    Braak, S.J.


    OBJECTIVE. CBCT-guidance (CBCT-guidance) is a new stereotactic technique for needle interventions, combining 3D soft-tissue cone-beam CT, needle planningsoftware, and real-time fluoroscopy. Our objective was to evaluate the use, feasibility and outcome of this technique. To determine the effectiv

  8. Sedoanalgesia in interventional radiology; Analgosedierung in der interventionellen Radiologie

    Linsenmaier, U.; Pfeifer, K.J.; Reiser, M. [Klinikum der Universitaet Muenchen, Muenchen (Germany). Inst. fuer Klinische Radiologie; Wagner, P. [Klinikum der Universitaet Muenchen, Muenchen (Germany). Inst. fuer Anaesthesiologie und Intensivmedizin; Ambulantes Operationszentrum, Muenchen Pasing (Germany)


    Purpose: Development of a save and effective protocol for analgosedation of patients undergoing painful interventional procedures. Material and Methods: In a prospective trial a consecutive series of 72 adult patients underwent analgosedation during painful interventions. A radiologist performed the analgosedation, the patients received a combination of a shortly effective piperidine derivative (Alfentanil [Rapifen {sup trademark} ]; 7.5-15 {mu}g/kg body weight) and Benzodiazepine (midazolam [Dormicum {sup trademark} ]; 20 {mu}g/kg body weight). After pre-procedure oxygenation patients were continuously monitored. Pain and discomfort were scored using an established visual-analog pain score (0-10). A control group (n=24) had received midazolam, pentazocine or fentanyl according to the study protocol. Results: All procedures could be carried out by an interventional radiologist and a nurse and/or technologist only. In 69/72 cases adequate analgosedation could be achieved. Injection of alfentanil was titrated, with a rapid onset and short acting effect of the analgesia. Patients reported an average pain score of 2.6 vs. 4.5 in the control group. Over 55% experienced no or mild pain (score 0-3), in the control group only 8% reached this level. Conclusion: A combination of shortly effective alfentanil and midazolam allows interventional radiologists to perform major procedures alone under effective analgosedation. This medication scheme is superior to the medication upon demand. (orig.) [German] Ziel: Die Entwicklung eines einfach zu handhabenden Protokolls fuer Radiologen zur Analgosedierung bei schmerzhaften interventionellen Eingriffen. Methoden: Prospektiv wurden 72 konsekutive Patienten zusammengefasst, bei denen schmerzhafte interventionelle Eingriffe geplant waren. Die Anlagosedierung erfolgte mit einer Kombinationsmedikation aus kurzwirksamem Piperidinderivat (Alfentanil [Rapifen {sup trademark} ]; 7,5-15 {mu}g/kg KG) und Benzodiazepin (Midazolam [Dormicum {sup

  9. Radiologic management of haemoptysis. Diagnostic and interventional bronchial arterial embolisation

    Ittrich, H.; Adam, G. [Univ. Medical Center Hamburg, Hamburg (Germany). Diagnostic and Interventional Radiology Dept. and Clinic; Klose, H. [Univ. Medical Center Hamburg, Hamburg (Germany). Section Pneumology


    Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE.

  10. Needs-Based Innovation in Interventional Radiology: The Biodesign Process.

    Steinberger, Jonathan D; Denend, Lyn; Azagury, Dan E; Brinton, Todd J; Makower, Josh; Yock, Paul G


    There are many possible mechanisms for innovation and bringing new technology into the marketplace. The Stanford Biodesign innovation process is based in a deep understanding of clinical unmet needs as the basis for focused ideation and development. By identifying and vetting a compelling unmet need, the aspiring innovator can "derisk" a project and maximize chances for successful development in an increasingly challenging regulatory and economic environment. As a specialty founded by tinkerers, with a history of disruptive innovation that has yielded countless new ways of delivering care with minimal invasiveness, lower morbidity, and lower cost, interventional radiologists are uniquely well positioned to identify unmet needs and develop novel solutions free of dogmatic convention. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Thermal and hydrodynamic modelling of active catheters for interventional radiology.

    Marchandise, Emilie; Flaud, Patrice; Royon, Laurent; Blanc, Raphaël; Szewczyk, Jérome


    Interventional radiologists desire to improve their operating tools such as catheters. Active catheters in which the tip is moved using shape memory alloy actuators activated using the Joule effect present a promising approach for easier navigation in the small vessels. However, the increase in temperature caused by this Joule effect must be controlled in order to prevent damage to blood cells and tissues. This paper is devoted to the simulation and experimental validation of a fluid-thermal model of an active catheter prototype. Comparisons between computer-predicted and experimentally measured temperatures are presented for both experiments in air and water at 37°C. Good agreement between the computational and experimental results is found, demonstrating the validity of the developed computer model. These comparisons enable us to highlight some important issues in the modelling process and to determine the optimal current for the activation of the catheter.

  12. A survey of interventional radiology awareness among final-year medical students in a European country.

    Leong, Sum


    Interventional radiology (IR) is a rapidly expanding specialty that is facing the challenges of turf wars and personnel shortages. Appropriate exposure of medical students to this field can be vital to recruitment of potential future trainees or referring physicians. The aim of this study was to determine the knowledge and views of final-year medical students in a single EU country regarding various aspects of IR. An electronic survey was sent via e-mail to all final-year medical students in a European country. The students were given a month to respond to the questionnaire. A total of 234 students of 675 (34.5%) replied to the survey. Of the respondents, 35% had previously completed an attachment to the radiology department. The majority of students (63%) thought their knowledge in radiology in general was poor. The percentage of students who correctly identified procedures performed by interventional radiologists was 69% for Hickman line insertion, 79% for fibroid embolization, and 67.5% for lower limb angioplasty. Sixty percent, 30%, and 47% thought that interventional radiologists perform cardiac angioplasties, perform arterial bypasses, and create AV fistulas, respectively. Forty-nine percent felt that interventional radiologists are surgically trained. Eighty-three percent of students were first made aware of angioplasty by a cardiologist. Thirty-one percent thought that interventional radiologists do ward rounds, 24% thought that interventional radiologists have admitting rights, and 26% felt that interventional radiologists run an outpatient practice. A significant number of students (76%) thought that the job prospects in IR are good or excellent but only 40.5% were willing to consider a career in IR. In conclusion, this study indicates that IR remains a nascent but attractive specialty to the majority of medical students. Further development of the existing informal undergraduate curriculum to address shortcomings will ensure that IR continues to attract

  13. Evaluation of patient radiation doses using DAP meter in interventional radiology procedures

    Kang, Byung Sam [Dept. of Radiological Technology. Shingu University, Sungnam (Korea, Republic of); Yoon, Yong Su [Dept. of Health Sciences, Graduate School of Medical Sciences, Kyushu Univeristy, Kyushu (Japan)


    The author investigated interventional radiology patient doses in several other countries, assessed accuracy of DAP meters embedded in intervention equipment in domestic country, conducted measurement of patient doses for 13 major interventional procedures with use of Dose Area Product(DAP) meters from 23 hospitals in Korea, and referred to 8,415 cases of domestic data related to interventional procedures by radiation exposure after evaluation the actual effective of dose reduction variables through phantom test. Finally, dose reference level for major interventional procedures was suggested. In this study, guidelines for patient doses were 237.7 Gy·cm{sup 2} in TACE, 17.3 Gy·cm{sup 2} in AVF, 114.1 Gy·cm{sup 2} in LE PTA and STENT, 188.5 Gy·cm{sup 2} in TFCA, 383.5 Gy·cm{sup 2} in Aneurysm Coil, 64.6 Gy·cm{sup 2} in PTBD, 64.6 Gy·cm{sup 2} in Biliary Stent, 22.4 Gy·cm{sup 2} in PCN, 4.3 Gy·cm{sup 2} in Hickman, 2.8 Gy·cm{sup 2} in Chemo-port, 4.4 Gy·cm{sup 2} in Perm-Cather, 17.1 Gy·cm{sup 2} in PCD, and 357.9 Gy·cm{sup 2} in Vis, EMB. Dose reference level acquired in this study is considered to be able to use as minimal guidelines for reducing patient dose in the interventional radiology procedures. For the changes and advances of materials and development of equipment and procedures in the interventional radiology procedures, further studies and monitoring are needed on dose reference level Korean DAP dose conversion factor for the domestic procedures.

  14. Lessons from surgery and anaesthesia: evaluation of non-technical skills in interventional radiology

    Patel, Salil B; Pilkington, Nicola


    In the medical profession, surgery and anaesthesia are leading the way in identifying human errors that negatively affect patient safety. Evidence suggests that the implementation of non-technical skills assessments reduces such errors. Interventional Radiology is a procedural based speciality and therefore may also benefit from formal assessment of non-technical skills. This literature review supports the use of standardised assessment tools used in surgery and anaesthesia. Using the Downing framework of internal validity, the tools demonstrated good internal consistency but a spectrum of inter-rater variability, which can be partially improved with training. At present, a formal Interventional Radiology non-technical skills assessment tool is probably not suitable to be a stand-alone ‘high stakes’ assessment, but may be a useful adjunct to the existing array of workplace-based assessments. PMID:26664733

  15. Patient dose in interventional radiology examinations for one year; Dosis a pacientes en exploraciones de radiologia intervencionista durante un ano

    Minambres Moro, A.; Fernandez Leton, P.; Garcia Ruiz-Zorrilla, J.; Perez Moreno, J. M.; Zucca Aparicio, D.


    Interventional radiology procedures are radiology tests involving higher dose to patient and can cause the onset of deterministic effects. The aim of this paper is to estimate the dose-area product (PDA) and fluoroscopy time of such examinations performed at our hospital for a year and compare them with published results for other centers.

  16. Interventional radiologic placement of tunneled central venous catheters : results and complications in 557 cases

    Kim, Chan Kyo; Do, Young Soo; Paik, Chul H. [Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)] (and others)


    To evaluate prospectively the results of interventional radiologic placement of tunneled central venous catheters, and subsequent complications. Between April 1997 and April 1998, a total of 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in an interventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23 and transfusion in one. Complications were evaluated prospectively by means of a chart review, chest radiography, central vein angiography and blood/catheter culture. The technical success rate for tunneled central venous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean, 112{+-}4.6) days; Hickman catheters were removed in 252 cases during follow-up. Early complications included 3 cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1 case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 cases of venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%), and 1 case of pseudoaneurysm(0.2%). The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50, respectively. The technical success rate of interventional radiologic placement of tunneled central venous catheters was high. In comparison to conventional surgical placement, it is a more reliable method and leads to fewer complications.

  17. Diagnostic reference levels and complexity indices in interventional radiology: a national programme

    Ruiz-Cruces, R.; Perez-Martinez, M.; Pastor-Vega, J.M.; Canete, S. [University of Malaga, School of Medicine, Malaga (Spain); Vano, E.; Fernandez-Soto, J.M.; Sanchez-Casanueva, R.; Gallego-Beuter, J.J. [Complutense University, San Carlos Hospital, Medical School, Madrid (Spain); Carrera-Magarino, F.; Moreno-Rodriguez, F.; Moreno-Sanchez, T. [Juan Ramon Jimenez University Hospital, Huelva (Spain); Soler-Cantos, M.M.; Canis-Lopez, M. [Reina Sofia University Hospital, Cordoba (Spain); Hernandez-Armas, J.; Diaz-Romero, F.J. [University Hospital of Canary Islands, Tenerife (Spain); Rosales-Espizua, F.; Lopez-Medina, A.; Gonzalez-de-Garay, M. [Basurto Hospital, Bilbao (Spain); Martin-Palanca, A. [Virgen de la Victoria University Hospital, Malaga (Spain); Gil-Agudo, A.; Zarca-Diaz, M.A.; Zapata-Jimenez, J.C. [General University Hospital, Ciudad Real (Spain); Parra-Osorio, V.; Munoz Ruiz-Canela, J.J.; Moreno-Saiz, C.; Galan-Montenegro, P. [Carlos Haya University Hospital, Malaga (Spain)


    To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. The KAP (3rd quartile) in Gy cm{sup 2} for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. (orig.)

  18. Interventional radiography and mortality risks in U.S. radiologic technologists

    Linet, Martha S.; Freedman, D.M.; Sigurdson, Alice J.; Doody, Michele M. [National Cancer Institute, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Bethesda, MD (United States); Hauptmann, Michael [National Cancer Institute, Biostatistics Branch, Division of Cancer Epidemiology and Genetics, Bethesda, MD (United States); Alexander, Bruce H. [University of Minnesota, Division of Environmental Health Sciences, Minneapolis, MN (United States); Miller, Jeremy [Information Management Services, Inc., Rockville, MD (United States)


    With the exponential increase in minimally invasive fluoroscopically guided interventional radiologic procedures, concern has increased about the health effects on staff and patients of radiation exposure from these procedures. There has been no systematic epidemiologic investigation to quantify serious disease risks or mortality. To quantify all-cause, circulatory system disease and cancer mortality risks in U.S. radiologic technologists who work with interventional radiographic procedures, we evaluated mortality risks in a nationwide cohort of 88,766 U.S. radiologic technologists (77% female) who completed a self-administered questionnaire during 1994-1998 and were followed through 31 December 2003. We obtained information on work experience, types of procedures (including fluoroscopically guided interventional procedures), and protective measures plus medical, family cancer history, lifestyle, and reproductive information. Cox proportional hazards regression models were used to compute relative risks (RRs) with 95% confidence intervals (CIs). Between completion of the questionnaire and the end of follow-up, there were 3,581 deaths, including 1,209 from malignancies and 979 from circulatory system diseases. Compared to radiologic technologists who never or rarely performed or assisted with fluoroscopically guided interventional procedures, all-cause mortality risks were not increased among those working on such procedures daily. Similarly, there was no increased risk of mortality resulting from all circulatory system diseases combined, all cancers combined, or female breast cancer among technologists who daily performed or assisted with fluoroscopically guided interventional procedures. Based on small numbers of deaths (n=151), there were non-significant excesses (40%-70%) in mortality from cerebrovascular disease among technologists ever working with these procedures. The absence of significantly elevated mortality risks in radiologic technologists reporting the

  19. Radiological intervention in postoperative complications following liver transplantation; Interventionelle radiologische Verfahren bei postoperativen Komplikationen nach Lebertransplantation

    Berger, H. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern, Univ. Muenchen (Germany); Staebler, A. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern, Univ. Muenchen (Germany); Kunzfeld, A. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern, Univ. Muenchen (Germany); Zuelke, C. [Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Univ. Muenchen (Germany); Anthuber, M. [Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Univ. Muenchen (Germany); Kraemling, H.J. [Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Univ. Muenchen (Germany)


    Purpose: Postoperative complications contribute significantly to the morbidity and mortality of liver transplant patients. The management of these complications requires a multidisciplinary approach in which interventional radiology plays an integral role. Indications, techniques, and results of radiological interventions in the management of the liver transplant patient are presented. Material and methods: During a 10-year period, 52 out of 420 liver transplant recipients underwent radiological interventions, including angioplasty (n=20), embolization (n=2), percutaneous drainage (n=11), and biliary interventions (n=19). Results: Nine out of ten arterial stenoses located at the anastomoses (n=8), within the liver (n=1) and in the coeliac trunk (n=1) were successfully treated by balloon dilatation. Angioplasty of supra- or infrahepatic anastomotic stenoses of the IVC (n=5) provided long-term success only in combination with stent implantation. Portal vein stenoses and chronic thrombosis were treated by balloon dilatation and stent insertion via transhepatic catheterization of the portal vein. Late strictures of bile-duct anastomoses can be managed by ante- or retrograde interventions. If biliary complications are related to inflammatory or septic problems, the prognosis of graft survival is poor. Conclusion: Interventional radiological procedures are very useful in the management of vascular and biliary complications after liver transplantation. These techniques provide a cure in many situations, and thus, surgical interventions may be avoided in selected cases. (orig.) [Deutsch] Die komplexe chirurgisch-technische Operation sowie immunologische und ischaemieverursachte Probleme tragen zur relativ hohen Komplikationsrate nach Lebertransplantation bei, die grundsaetzlich organ- bzw. lebensbedrohlich fuer den Patienten sind. Interventionelle radiologische Techniken sind aufgrund ihres minimal-invasiven Charakters in der klinischen Versorgung dieser Komplikationen

  20. Dosimetry with slow films in Interventional Radiology; Dosimetria con peliculas lentas en Radiologia Intervencionista

    Ten, J.I.; Guibelalde, E.; Fernandez, J.M.; Canevaro, L.; Ramirez, R.; Vano, E. [Grupo de Fisica Medica. Departamento de Radiologia. Facultad de Medicina. Universidad Complutense de Madrid. Martin Lagos s/n CP 28040, Madrid (Spain)


    In this work it is presented a method for evaluation of patients doses in Interventional Radiology (RI). The method proposed in this work allows the simultaneous valoration of the product dose-area (PDA), the dose in the patient skin (DES) and the distribution of the irradiated fields, all of they together with their corresponding dose levels. The latter sometimes can be essential since the possible damages in skin depend not only of the doses, but also the irradiated area. The method has been resulted adequate for to evaluate doses to patients in Interventional Radiology procedures. It was possible to apply it as a routine form seeing that its not interfering significantly in the normal development of the medical intervention. The fundamental advantages of this dosimetric method in relation with the unique PDA measure or with the utilization of TLD is that it provide information about the total irradiated area, distribution and length of fields, collimation and wedge used besides that allow to determine the most irradiated zone. The visualization of the irradiated regions and the length fields utilized suggest the possibility to optimize the realization protocols of the interventional procedure in the cases in which it is considered that the doses have been very elevated. (Author)

  1. Auditing an Online Self-reported Interventional Radiology Adverse Event Database for Compliance and Accuracy.

    Burch, Ezra A; Shyn, Paul B; Chick, Jeffrey F; Chauhan, Nikunj R


    The purpose of this study was to determine whether auditing an online self-reported interventional radiology quality assurance database improves compliance with record entry or improves the accuracy of adverse event (AE) reporting and grading. Physicians were trained in using the database before the study began. An audit of all database entries for the first 3 months, or the first quarter, was performed, at which point physicians were informed of the audit process; entries for the subsequent 3 months, or the second quarter, were again audited. Results between quarters were compared. Compliance with record entry improved from the first to second quarter, but reminders were necessary to ensure 100% compliance with record entry. Knowledge of the audit process did not significantly improve self-reporting of AE or accuracy of AE grading. However, auditing significantly changed the final AE reporting rates and grades. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  2. Process mapping of PTA and stent placement in a university hospital interventional radiology department.

    de Bucourt, Maximilian; Busse, Reinhard; Güttler, Felix; Reinhold, Thomas; Vollnberg, Bernd; Kentenich, Max; Hamm, Bernd; Teichgräber, Ulf K


    To apply the process mapping technique in an interdisciplinary approach in order to visualize, better understand, and efficiently organize percutaneous transluminal angioplasty (PTA) and stent placement procedures in a university hospital's interventional radiology department. After providing an overview of seven established mapping techniques for medical professionals, the process mapping technique was chosen and applied in an interdisciplinary approach including referrers (physicians, nurses, and other staff in referring departments, e.g., vascular surgery), providers (interventional radiologists, nurses, technicians, and staff of the angiography suite), and specialists of the hospital's controlling department. A generally binding and standardized process map was created, describing the entire procedure for a patient in whom the radiological intervention of PTA or stent treatment is contemplated from admission to the department of vascular surgery until discharge after successful treatment. This visualization tool assists in better understanding (especially given natural staff fluctuation over time) and efficiently organizing PTA and stent procedures. Process mapping can be applied for streamlining workflow in healthcare, especially in interdisciplinary settings. By defining exactly what a business entity does, who is responsible, to what standard a process should be completed, and how the success can be assessed, this technique can be used to eliminate waste and inefficiencies from the workplace while providing high-quality goods and services easily, quickly, and inexpensively. Process mapping can be used in a university hospital's interventional radiology department. • Process mapping can describe the patient's entire process from admission to PTA/stent placement until discharge. • Process mapping can be used in interdisciplinary teams (e.g., referrers, providers, and controlling specialists). • Process mapping can be used in order to more efficiently

  3. Safety and effectiveness of moderate sedation for radiologic non-vascular intervention

    Kim, Tae-Hoon [Dankook University Hospital, Chungju (Korea, Republic of)


    The purpose of this study was to prospectively characterize the safety and effectiveness of moderate sedation/analgesia for performing radiologic non-vascular abdominal intervention. During a 3-month period, a total of 63 adult patients with a mean age of 64 years (range:27-82) underwent moderate sedation for 72 radiologic non-vascular interventional procedures. A combination of fentanyl citrate and midazolam hydrochloride, based on the patient's body weight, was intravenously administered until the patient was drowsy and tranquil. The adverse events associated with this moderate sedation were assessed. The visual analog scale format was used to measure the subjective feelings of the patient's pre-pro- cedural anxiety and intraprocedural pain. The mean total dose per kilogram of body weight of fentanyl used in PTBD was 1.148 {mu}g. The mean total dose per kilogram of body weight of midazolam was 0.035 mg in PTBD, PTGBD, AD, PCN, DJS, GS and FRA, 0.039 mg in TDC, and 0.043 mg in BS. A temporary reduction of systolic blood pressure to less than 80 mmHg was observed during 5 procedures (6.9%), whereas a temporary elevation of systolic blood pressure above 150 mmHg was observed during 10 procedures (13.8%). A reduction of arterial oxygen saturation to less than 90% was observed during 14 procedures (19.4%). None of the patients required pharmacologic reversal agents or cardiopulmonary resuscitation. The mean anxiety score recorded before all procedures was 5.2 (distressing). The mean pain score during the procedure, which was recorded after all procedures, was 2.9 (mild). Moderate sedation allows performance of safe and effective radiologic non-vascular intervention, and it is also easy for an interventional radiologist to use. The patients should be continuously monitored to check their vital signs and arterial oxygen saturation during the procedures.

  4. TR Band止血器应用于桡动脉径路冠脉介入术后的效果评价%Effectiveness of TR Band hemostat in trans-radial coronary intervention patients :A systematic review

    费红; 葛文贤; 朱翠清; 胡华英


    Objective To evaluate the effectiveness of TR Band hemostat in trans-radial coronary intervention patients.Methods The randomized controlled trials (RCTs) on the application of TR Band hemostat in trans-radial coronary intervention patients were collected through the databases such as the Cochrane Library,OVID,PubMed,CBM,VIP and Wanfang Data.The quality of studies was critically appraised and data were extracted by two reviewers independently,and Meta-analysis was conducted for the included studies.Results Five RCTs involving 5 028 patients were included.Meta-analysis showed that the application of TR Band hemostat in trans-radial coronary intervention patients could shorten the time of hemostasis by compression,reduce the incidence rate of skin lesions,improve the postoperative patients with comfort,but the efficacy was not significant in puncture site bleeding,hematoma and incidence of radial artery occlusion (RAO).Conclusions The application of TR Band hemostat in trans-radial coronary intervention patients can significantly decrease the incidence of oppression hemostasis time and reduce the incidence rate of skin lesions,improve the postoperative patients with comfort.It is worth being popularized.%目的 评价TR Band压迫止血器在经桡动脉穿刺行冠脉介入治疗(TRI)术后应用的效果.方法 计算机检索Cochrane Library、OVID、PubMed、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库中的文献,并筛选已获文献的参考文献,纳入TRI术后应用TR Band压迫止血器压迫止血的随机对照试验(RCT).由2名研究员独立检索文献,对纳入研究独立进行方法学质量评价,对符合标准的研究行Meta分析.结果 共纳入5项RCT,合计5 028例患者.Meta分析结果显示,TR Band止血器用于TRI术后可缩短压迫止血时间,减少皮损及纤维硬结的发生率,提高患者术后的舒适度,而在穿刺部位渗血、血肿及桡动脉

  5. Interventional radiological treatment of tumor pain; Interventionell-radiologische Behandlung des Tumorschmerzes

    Duex, M. [Krankenhaus Nordwest, Zentralinstitut fuer Radiologie und Neuroradiologie, Frankfurt/Main (Germany)


    Tumor pain occurs in 70-80 % of all cancer patients who have reached an advanced tumor stage. In the case of failure or poor response to chemotherapy and in cases of recurrence following radiotherapy, tumors will often become enlarged with infiltration of organs, nerve roots or bone which causes severe pain to the patient. Interventional radiological minimally invasive local tumor therapy is often the last resort for tumor patients suffering from severe pain. Interventional radiologists have several options to treat tumor pain but firstly the cause of the pain must be identified. This article presents a classification of patients suffering from tumor pain which can help therapists to decide on the correct form of treatment. Treatment options are discussed using typical case histories and it is shown that patients suffering from severe tumor pain must be treated sequentially, which means that treatment is carried out in multiple steps and each cycle of therapy has to be adapted to the stage of the disease. Local pain treatment is fundamentally based on individual case decisions which should be discussed within an interdisciplinary tumor board and the panel should arrive at a consensus decision. In addition, the radiologist performing the procedure should have many years of experience in interventional oncological radiology. By fulfilling these conditions the interventional radiologist can help the patient in a variety of ways because the available treatment options are effective and do not result in much distress for the patient. (orig.) [German] Tumorschmerzen treten bei 70-80 % der Patienten im fortgeschrittenen Stadium der Krebserkrankung auf. Bei Versagen oder schlechtem Ansprechen der systemischen Chemotherapie und bei ausbestrahlten Patienten kommt es haeufig zu einem Groessenprogress des Tumors mit Infiltration von Nachbarorganen, neurogenen Strukturen oder Knochen. Dadurch koennen staerkste Schmerzsyndrome entstehen. Interventionell-radiologische, minimal

  6. The pilot study of radiology nursing intervention in abdominal 3-T Magnetic Resonance examination

    Gui-qing Dong

    Full Text Available Abstract OBJECTIVE The aim of this study was to investigate the effect of radiology nursing intervention in abdominal examination at 3-T MRI. METHOD 60 patients with abdominal diseases were divided into two groups randomly: MR nursing intervention group and control group. All the patients underwent abdominal MR examination at 3-T. The MR nursing interventions were performed in nursing intervention group. The outcomes, including one-time success rate, the ratio of diagnosable MR images and the points of image quality, were compared between these two groups. RESULTS The one-time success rates in control group and MR nursing intervention group were 66.67% and 96.67% with significant difference ( χ2 =9.017, P<0.05. The ratios of diagnosable images in the two groups were 76.67% and 96.67% with significant difference (χ2 =5.192, P<0.05. The points of MR image quality in the two groups were 1.87±0.86 and 2.33±0.55, respectively. There was significant difference between these two groups (t=-2.508, P<0.05. CONCLUSION The effective nursing intervention can make the patients cooperation better in abdominal MR examination and improve the image quality significantly.

  7. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 2: Patient Preparation and Medications).

    Taslakian, Bedros; Sebaaly, Mikhael Georges; Al-Kutoubi, Aghiad


    Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care. Patient care before and after an interventional procedure, identification, and management of early and delayed complications of various procedures are equal in importance to the procedure itself. In this second part, we complete the comprehensive, methodical review of pre-procedural care and patient preparation before vascular and interventional radiology procedures.

  8. Manipulation of mental models of anatomy in interventional radiology and its consequences for design of human–computer interaction

    Varga, E.; Pattynama, P.M.T.; Freudenthal, A.


    Interventional radiology procedures require extensive cognitive processing from the physician. A set of these cognitive functions are aimed to be replaced by technology in order to reduce the cognitive load. However, limited knowledge is available regarding mental processes in interventional radiolo

  9. Interventional radiological imaging and treatment of port catheter dysfunctions; Angiografische Diagnostik und interventionelle Therapie von Portdysfunktionen

    Kausche, S.; Nagel, S.N.; Teichgraeber, Ulf [Charite Universitaetsmedizin Berlin (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie


    To evaluate the impact of interventional radiological imaging and treatment of central venous port catheter complications. Materials and Methods: In this retrospective analysis 429 port catheter dysfunctions were evaluated in 393 port catheter systems for a total of 389 patients over a period of 10 years. The study included 193 (49.1 %) patients with radiologically implanted port catheter systems and 200 (50.9 %) referred patients with surgically implanted port systems. Port catheter dysfunctions were subdivided into early and late complications as well as into non-thrombotic and thrombotic events. After administration of contrast medium, the port system was visualized using digital subtraction angiography. Data were retrospectively collected from the in-house databases and then analyzed descriptively. Results: 429 contrast media injections via port catheters were performed in 393 port catheter systems. There were 359 (83.7 %) late complications and 70 (16.3 %) early complications. In 299 (69.7 %) cases thrombotic events occurred and 130 (30.3 %) non-thrombotic events were recorded. The most common reason for contrast media injection via port catheter system was port catheter-related thrombosis in 269 (62.7 %) cases. 70 (16.3 %) catheter migrations and 30 (7.0 %) fibrin sheath formations were detected. 18 (4.2 %) port needle malfunctions could be resolved through needle exchange. All 15 (3.5 %) catheter disconnections had to be revised in all cases. Also six port explantations were performed in 6 (1.4 %) catheter fractures. Conclusion: The possibilities of angiographic imaging and interventional radiological correction of port catheter dysfunctions must be exploited fully in order to avoid premature port explantation. (orig.)

  10. Assessment of the occupational eye lens dose for clinical staff in interventional radiology, cardiology and neuroradiology.

    Omar, Artur; Kadesjö, Nils; Palmgren, Charlotta; Marteinsdottir, Maria; Segerdahl, Tony; Fransson, Annette


    In accordance with recommendations by the International Commission on Radiological Protection, the current European Basic Safety Standards has adopted a reduced occupational eye lens dose limit of 20 mSv yr(-1). The radiation safety implications of this dose limit is of concern for clinical staff that work with relatively high dose x-ray angiography and interventional radiology. Presented in this work is a thorough assessment of the occupational eye lens dose based on clinical measurements with active personal dosimeters worn by staff during various types of procedures in interventional radiology, cardiology and neuroradiology. Results are presented in terms of the estimated equivalent eye lens dose for various medical professions. In order to compare the risk of exceeding the regulatory annual eye lens dose limit for the widely different clinical situations investigated in this work, the different medical professions were separated into categories based on their distinct work pattern: staff that work (a) regularly beside the patient, (b) in proximity to the patient and (c) typically at a distance from the patient. The results demonstrate that the risk of exceeding the annual eye lens dose limit is of concern for staff category (a), i.e. mainly the primary radiologist/cardiologist. However, the results also demonstrate that the risk can be greatly mitigated if radiation protection shields are used in the clinical routine. The results presented in this work cover a wide range of clinical situations, and can be used as a first indication of the risk of exceeding the annual eye lens dose limit for staff at other medical centres.

  11. Interventional radiological therapy of benign low back pain syndromes; Interventionell radiologische Therapie benigner lumbaler Schmerzsyndrome

    Huegli, R.W.; Jacob, A.L.; Steinbrich, W. [Universitaetsspital Basel (Switzerland). Interventionelle Radiologie


    Spinal affections belong to the most widespread sources of back pain. Beside medical history and clinical examination, the radiological investigation plays an important rote in the clinical workup especially with the modern Cross sectional imaging methods such as computed and magnetic resonance tomography. After exclusion of a malignant disease usually a conservative therapeutic approach is the first line treatment option. If the conservative treatment approach falls a minimalinvasive image guided diagnostic or therapeutic infiltration may be considered. Thereby the interventional radiologist should be a member of the team which decides the clinical strategy. This article describes epidemiology and pathophysiology, common pre-interventional diagnostic strategies, drugs, indications, possible complications and the impact of diagnostic and therapeutic minimally invasive image guided techniques in low back pain. In this context facet joint blockade, periradicular and peridural therapy as well as sacroiliac joint blockades are discussed.

  12. Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies

    Fornazari, Vinicius Adami Vayego; Szejnfeld, Denis; Elito, Julio Júnior; Goldman, Suzan Menasce [Universidade Federal de São Paulo, São Paulo, SP (Brazil)


    The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

  13. Imaging and radiological interventions in extra-hepatic portal vein obstruction

    Sudheer S Pargewar; Saloni N Desai; S Rajesh; Vaibhav P Singh; Ankur Arora; Amar Mukund


    Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.

  14. Imaging and radiological interventions in extra-hepatic portal vein obstruction.

    Pargewar, Sudheer S; Desai, Saloni N; Rajesh, S; Singh, Vaibhav P; Arora, Ankur; Mukund, Amar


    Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.

  15. The novel application of Benford's second order analysis for monitoring radiation output in interventional radiology.

    Cournane, S; Sheehy, N; Cooke, J


    Benford's law is an empirical observation which predicts the expected frequency of digits in naturally occurring datasets spanning multiple orders of magnitude, with the law having been most successfully applied as an audit tool in accountancy. This study investigated the sensitivity of the technique in identifying system output changes using simulated changes in interventional radiology Dose-Area-Product (DAP) data, with any deviations from Benford's distribution identified using z-statistics. The radiation output for interventional radiology X-ray equipment is monitored annually during quality control testing; however, for a considerable portion of the year an increased output of the system, potentially caused by engineering adjustments or spontaneous system faults may go unnoticed, leading to a potential increase in the radiation dose to patients. In normal operation recorded examination radiation outputs vary over multiple orders of magnitude rendering the application of normal statistics ineffective for detecting systematic changes in the output. In this work, the annual DAP datasets complied with Benford's first order law for first, second and combinations of the first and second digits. Further, a continuous 'rolling' second order technique was devised for trending simulated changes over shorter timescales. This distribution analysis, the first employment of the method for radiation output trending, detected significant changes simulated on the original data, proving the technique useful in this case. The potential is demonstrated for implementation of this novel analysis for monitoring and identifying change in suitable datasets for the purpose of system process control.

  16. Brief history of interventional radiology%介入放射学简史

    唐振良; 贾爱芹; 李荦芸; 李春雨


    In 1923,angiography was first successively used for the human body.In 1953,a Swedish doctor Sven-Ivar Seldinger pioneered the Seldinger technique,which laid down the foundation of interventional radiology.In 1963,Charles Dotter first proposed the idea of interventional radiology.In 1964,Charles Dotter opened a new era of percutaneous angioplasty through accidental operation,marking the formation of interventional radiology.On this basis,the techniques of balloon catheter dilation and metal stent implantation was developed.Endovascular stent was proposed in 1969.In 1973,the percutaneous angioplasty has been a breakthrough with the emergence of soft double-lumen balloon catheter.Percutaneous coronary angioplasty is applied in 1977.Since the 1990s,balloon angioplasty relegated to secondary status with the emergence of metal stent.Currently,endovascular stent have entered a new stage with the emergence of temporary stent and stent grafts and biological stent.Transcatheter arterial embolization had been one of the most important basic techniques for interventional radiology since 1965,it had also been a corresponding development with the improvement of embolic agents and catheter technology for the treatment of diseases now.Transjugular intrahepatic portosystemic stent-shunt is a comprehensive interventional radiology technology since 1967,in which the biliary system can be reached through a jugular vein,and the improvement appeared with balloon expandable stent in 1986.Since 1972,non-vascular interventional techniques was another important branch of interventional radiology.Currently,it is applied in the diagnosis and treatment of many diseases of the internal organs like the pancreas,liver,kidney,spinal cord,Fallopian tubes,esophagus and other organs.In 1973,Chinese radiologist first conducted the angiography test.Interventional radiology was introduced into China in the 1980s,it was readily developed through the sponsoring of training class (1981) and academic

  17. Current Status of Interventional Radiology in the Management of Gastro-Entero-Pancreatic Neuroendocrine Tumours (GEP-NETs)

    Orgera, Gianluigi [S. Andrea University Hospital “Sapienza”, Unit of Interventional Radiology (Italy); Krokidis, Miltiadis, E-mail: [Cambridge University Hospitals NHS Trust, Department of Radiology (United Kingdom); Cappucci, Matteo [S. Andrea University Hospital “Sapienza”, Unit of Interventional Radiology (Italy); Gourtsoyianni, Sofia [Guy’s and St Thomas’ NHS Foundation Trust, Department of Radiology (United Kingdom); Tipaldi, Marcello Andrea [S. Andrea University Hospital “Sapienza”, Unit of Interventional Radiology (Italy); Hatzidakis, Adam [University Hospital of Heraklion, Department of Radiology, Medical School of Crete (Greece); Rebonato, Alberto [Santa Maria della Misericordia University Hospital, University of Perugia, Department of Surgical and Biomedical Sciences (Italy); Rossi, Michele [S. Andrea University Hospital “Sapienza”, Unit of Interventional Radiology (Italy)


    Within the group of Gastro-Entero-Pancreatic Neuroendocrine tumours (GEP-NETs), several heterogeneous malignancies are included with a variety of clinical manifestations and imaging characteristics. Often these cases are inoperable and minimal invasive treatment offered by image-guided procedures appears to be the only option. Interventional radiology offers a valid solution in the management of primary and metastatic GEP-NETs. The purpose of this review article is to describe the current status of the role of Interventional Radiology in the management of GEP-NETs.

  18. Monte Carlo calculations for reporting patient organ doses from interventional radiology

    Huo, Wanli; Feng, Mang; Pi, Yifei; Chen, Zhi; Gao, Yiming; Xu, X. George


    This paper describes a project to generate organ dose data for the purposes of extending VirtualDose software from CT imaging to interventional radiology (IR) applications. A library of 23 mesh-based anthropometric patient phantoms were involved in Monte Carlo simulations for database calculations. Organ doses and effective doses of IR procedures with specific beam projection, filed of view (FOV) and beam quality for all parts of body were obtained. Comparing organ doses for different beam qualities, beam projections, patients' ages and patient's body mass indexes (BMIs) which generated by VirtualDose-IR, significant discrepancies were observed. For relatively long time exposure, IR doses depend on beam quality, beam direction and patient size. Therefore, VirtualDose-IR, which is based on the latest anatomically realistic patient phantoms, can generate accurate doses for IR treatment. It is suitable to apply this software in clinical IR dose management as an effective tool to estimate patient doses and optimize IR treatment plans.

  19. Risk for the patient in interventional radiology; Riesgo para el paciente en Radiologia Intevencionista

    Martinez, L. C.


    The growth that the number of procedures which can be classified as interventional radiology techniques has experienced in the last years, has been accompanied by the concern of professionals and public health authorities about the potential effects caused by the radiation employed. Nowadays, these procedures represent, among all the procedures employing radiation, the highest doses to patients, apart from the radiotherapy techniques. Since the early 1990s, some radiation-induced effects on the skin of patients undergoing some of these procedures, from transient erythema to more serious injuries, have been reported. this work reviews the most relevant aspects of the radiation related risks in this kind of procedures and the suggested strategies to minimize them. (Author) 33 refs.

  20. Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature

    Foremny, Gregory B.; Jose, Jean; Subhawong, Ty K. [University of Miami Miller School of Medicine, Department of Radiology, Jackson Memorial Hospital, Miami, FL (United States); Pretell-Mazzini, Juan [University of Miami Miller School of Medicine, Department of Orthopaedic Surgery-Division of Musculoskeletal Oncology, Miami, FL (United States)


    This review compiles the current literature on the bleeding risks in common musculoskeletal interventional procedures and attempts to provide guidance for practicing radiologists in making decisions regarding the periprocedural management of patients on antithrombotic therapy. The practitioner must weigh the risk of bleeding if therapy is continued against the possibility a thromboembolic occurring if anticoagulation therapy is withheld or reversed. Unfortunately, there is little empirical data to guide evidence-based decisions for many musculoskeletal interventions. However, a review of the literature shows that for low-risk procedures, such as arthrograms/arthrocenteses or muscle/tendon sheath injections, bleeding risks are sufficiently small that anticoagulants and antiplatelet therapies need not be withheld. Additionally, relatively higher-risk procedures, such as needle biopsies of bone and soft tissue, may be safely performed without holding antithrombotic therapy, provided pre-procedural INR is within therapeutic range. Thus, while a patient's particular clinical circumstances should dictate optimal individualized management, anticoagulation alone is not a general contraindication to most interventional musculoskeletal radiology procedures. (orig.)

  1. Interventional Radiological Treatment of Perihepatic Vascular Stenosis or Occlusion in Pediatric Patients After Liver Transplantation

    Uller, Wibke, E-mail: [University Medical Center Regensburg, Department of Radiology (Germany); Knoppke, Birgit [KUNO University Children' s Hospital Regensburg, University Medical Center Regensburg (Germany); Schreyer, Andreas G.; Heiss, Peter [University Medical Center Regensburg, Department of Radiology (Germany); Schlitt, Hans J. [University Medical Center Regensburg, Department of Surgery (Germany); Melter, Michael [KUNO University Children' s Hospital Regensburg, University Medical Center Regensburg (Germany); Stroszczynski, Christian [University Medical Center Regensburg, Department of Radiology (Germany); Zorger, Niels [Krankenhaus Barmherzige Brueder, Department of Radiology (Germany); Wohlgemuth, Walter A. [University Medical Center Regensburg, Department of Radiology (Germany)


    Purpose: Evaluation of the efficacy and safety of percutaneous treatment of vascular stenoses and occlusions in pediatric liver transplant recipients. Methods: Fifteen children (mean age 8.3 years) underwent interventional procedures for 18 vascular complications after liver transplantation. Patients had stenoses or occlusions of portal veins (n = 8), hepatic veins (n = 3), inferior vena cava (IVC; n = 2) or hepatic arteries (n = 5). Technical and clinical success rates were evaluated. Results: Stent angioplasty was performed in seven cases (portal vein, hepatic artery and IVC), and sole balloon angioplasty was performed in eight cases. One child underwent thrombolysis (hepatic artery). Clinical and technical success was achieved in 14 of 18 cases of vascular stenoses or occlusions (mean follow-up 710 days). Conclusion: Pediatric interventional radiology allows effective and safe treatment of vascular stenoses after pediatric liver transplantation (PLT). Individualized treatment with special concepts for each pediatric patient is necessary. The variety, the characteristics, and the individuality of interventional management of all kinds of possible vascular stenoses or occlusions after PLT are shown.

  2. Outcomes of patients with acute upper gastrointestinal nonvariceal hemorrhage referred to interventional radiology for potential embolotherapy.

    Sildiroglu, Onur; Muasher, Jamil; Arslan, Bulent; Sabri, Saher S; Saad, Wael E; Angle, John F; Matsumoto, Alan H; Turba, Ulku C


    To report the outcomes following catheter angiography with or without embolization in patients with acute upper gastrointestinal nonvariceal hemorrhage (UGINH). A review of electronic medical records was performed to identify all potential patients for this study between 2001 and 2011. Patients with first-time UGINH who required angiographic localization and endovascular treatment were included. Patients with variceal bleeding and prior surgical or endovascular intervention for the gastrointestinal system were excluded. Society of Interventional Radiology guidelines and American College of Radiology "appropriateness criteria" reporting standards were followed. We identified 74 patients (men/women=46/28) with a mean age of 60 years. Thirty-four patients were found to have active bleeding on angiography. One patient from this group did not undergo embolization because of an angiographic diagnosis of aortoenteric fistula. Technical failure was encountered in 2/34 patients; therefore, the technical success of embolization was 94%. Forty of 74 patients showed no angiographic evidence of active bleeding; 18 patients underwent prophylactic embolization using endoscopically placed clips as targets; and 22 patients had no embolotherapy. Thus, we grouped the patients into 3 groups: (1) therapeutic embolization; (2) prophylactic/empiric embolization; and (3) no embolotherapy groups. The clinical success of embolization was 67% to 68% in the therapeutic embolization group and 67% in the prophylactic embolization group. Early rebleeding rates were 33.8%, 51.6%, 33.3%, and 12% among all the patients, the therapeutic embolization group, the prophylactic embolization group, and the no endovascular treatment group, respectively. Mortality was significantly high in patients with advanced age (P=0.001), cerebrovascular disorders (P=0.037), and positive angiography (P=0.026), even when clinical success was achieved. Acute UGINH remains a clinical challenge with increased mortality

  3. Occupational radiation exposure of the personnel due to interventional radiology; Strahlenexposition des Personals bei interventionellen Massnahmen

    Wucherer, M. [Klinikum der Stadt Nuernberg (Germany). Inst. fuer Medizinische Physik; Schmidt, T.; Loose, R. [Klinikum Nuernberg-Nord (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie


    Applications of interventional radiology continue to be on an upward trend, some countries reporting a 100% increase within 2-4 years, so that the resulting radiation exposure of both patients and personnel is an issue of increasing importance. Whereas those applications in general are of advantage for the patients, they mean just a further health hazard for the medical personnel. It is therefore necessary to exploit all available means to reduce the occupational doses. Modern interventional radiology systems offer a range of measures for this purpose, as e.g. last-image-hold, or pulsed modes. Special attention has to be given to the exposure of hand and head. Particularly the hand is closest to the useful beam, and it should be a mandatory requirement to wear film rings. (orig./CB) [German] Interventionelle Massnahmen weisen immer noch eine Steigerungstendenz auf, teilweise wird in manchen Laendern von einer Verdopplungsrate von 2-4 Jahren berichtet. Eventuelle Folgen der interventionellen Massnahmen, naemlich die damit verbundene Strahlenexposition fuer Patient und Personal, werden zunehmend problematisiert. Waehrend der Patient einen unmittelbaren Nutzen von dem meist miminal invasiven Eingriff hat, ist dies beim Personal nicht der Fall. Es muessen deswegen, besonders beim Untersuchungspersonal, alle Moeglichkeiten ausgeschoepft werden, die Exposition zu reduzieren. Neben den ueblichen bekannten Methoden sind bei modernen Anlagen weitere Massnahmen moeglich. Hierzu zaehlen z.B. Speicherung des letzten Bildes, strahlungslose Einblendung, gepulste Durchleuchtung usw. In Einzelfaellen hat die Exposition des Personals die Jahresgrenzwerte erreicht. Besonderer Aufmerksamkeit ist bei interventionellen Massnahmen der Exposition von Hand und Kopf zu widmen. Die Hand ist, vor allem bei der Punktion und Kathetermanipulation, nahe dem Nutzstrahlenbuendel. Es ist deswegen zu fordern, dass bei den interventionellen Massnahmen Fingerringdosimeter getragen werden. (orig.)

  4. Characterization of a MOSkin detector for in vivo skin dose measurements during interventional radiology procedures

    Safari, M. J.; Wong, J. H. D.; Ng, K. H., E-mail: [Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603 (Malaysia); Jong, W. L. [Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603 (Malaysia); Cutajar, D. L.; Rosenfeld, A. B. [Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia)


    Purpose: The MOSkin is a MOSFET detector designed especially for skin dose measurements. This detector has been characterized for various factors affecting its response for megavoltage photon beams and has been used for patient dose measurements during radiotherapy procedures. However, the characteristics of this detector in kilovoltage photon beams and low dose ranges have not been studied. The purpose of this study was to characterize the MOSkin detector to determine its suitability for in vivo entrance skin dose measurements during interventional radiology procedures. Methods: The calibration and reproducibility of the MOSkin detector and its dependency on different radiation beam qualities were carried out using RQR standard radiation qualities in free-in-air geometry. Studies of the other characterization parameters, such as the dose linearity and dependency on exposure angle, field size, frame rate, depth-dose, and source-to-surface distance (SSD), were carried out using a solid water phantom under a clinical x-ray unit. Results: The MOSkin detector showed good reproducibility (94%) and dose linearity (99%) for the dose range of 2 to 213 cGy. The sensitivity did not significantly change with the variation of SSD (±1%), field size (±1%), frame rate (±3%), or beam energy (±5%). The detector angular dependence was within ±5% over 360° and the dose recorded by the MOSkin detector in different depths of a solid water phantom was in good agreement with the Markus parallel plate ionization chamber to within ±3%. Conclusions: The MOSkin detector proved to be reliable when exposed to different field sizes, SSDs, depths in solid water, dose rates, frame rates, and radiation incident angles within a clinical x-ray beam. The MOSkin detector with water equivalent depth equal to 0.07 mm is a suitable detector for in vivo skin dosimetry during interventional radiology procedures.

  5. The role of interventional radiology in management of patients with end-stage renal disease

    Surlan, M.; Popovic, P


    The aim of the paper is to review the role of interventional radiology in the management of hemodialysis vascular access and complications in renal transplantation. The evaluation of patients with hemodialysis vascular access is complex. It includes the radiology/ultrasound (US) evaluation of the peripheral veins of the upper extremities with venous mapping and the evaluation of the central vein prior to the access placement and radiological detection and treatment of the stenosis and thrombosis in misfunctional dialysis fistulas. Preoperative screening enables the identification of a suitable vessel to create a hemodynamically-sound dialysis fistula. Clinical and radiological detection of the hemodynamically significant stenosis or occlusion demands fistulography and endovascular treatment. Endovascular prophylactic dilatation of stenosis greater than 50% with associated clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. The technical success rates are over 90% for dilatation. One-year primary patency rate in forearm fistula is 51%, versus graft 40%. Stents are placed only in selected cases; routinely in central vein after dilatation, in ruptured vein and elastic recoil. Thrombosed fistula and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89-90%. Primary patency rate is 8-26% per year and secondary 75% per year. The most frequently radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. US is often the method of choice for the diagnostic evaluation and management of the percutaneous therapeutic procedures in early and late transplantation complications. Computed tomography and magnetic resonance are valuable alternatives when US is inconclusive. Renal and perirenal fluid collection are usually treated successfully with

  6. Angioplasty, embolization, biopsy, drainage. Interventional methods in medical radiology. Angioplastie, Embolisation, Punktion, Drainagen. Interventionelle Methoden der Radiologie

    Friedmann, G.; Steinbrich, W.; Gross-Fengels, W. (eds.)


    In the field of diagnostic radiology, interventional radiology has been emerging as a significant tool allowing treatments such as catherization, embolization, and vascular stenting, assisted by the rapid development of digital imaging methods. For this reason, interventional radiology has been chosen as a main topic of the '6th Cologne Symposium on Biomedical Imaging Methods', where interventional methods have been given large space for presentation by experienced specialists, and for a comprehensive survey ranging from basic principles and tools for the variety of applications, the relevant pre- and after-treatment, to specialized techniques for complex tasks. The proceedings give the full texts and illustrations of all papers presented to the symposium. The topcis discussed are as follows: Accompanying drug therapy (1 paper), vascular recanalization (7 papers), local fibrinolytic therapy (1 paper), vascular stenting (4 papers), biopsy and drainage (5 papers), embolization (3 papers), and present status and future direction of interventional radiology in the U.S.A. (1 paper).

  7. The removal of intravascular bullets by interventional radiology: the prevention of central migration by balloon occlusion--case report.

    Sclafani, S J; Shatzkes, D; Scalea, T


    A migratory intravascular bullet fragment located within the hypogastric vein was removed successfully with the aid of interventional radiologic techniques. The authors describe the use of the technique of balloon trapping as part of this procedure. A balloon should be inflated between the foreign body and the heart before retrieval is attempted in order to prevent migration back to the heart during the manipulation.

  8. Lean manufacturing and Toyota Production System terminology applied to the procurement of vascular stents in interventional radiology.

    de Bucourt, Maximilian; Busse, Reinhard; Güttler, Felix; Wintzer, Christian; Collettini, Federico; Kloeters, Christian; Hamm, Bernd; Teichgräber, Ulf K


    OBJECTIVES: To apply the economic terminology of lean manufacturing and the Toyota Production System to the procurement of vascular stents in interventional radiology. METHODS: The economic- and process-driven terminology of lean manufacturing and the Toyota Production System is first presented, including information and product flow as well as value stream mapping (VSM), and then applied to an interdisciplinary setting of physicians, nurses and technicians from different medical departments to identify wastes in the process of endovascular stent procurement in interventional radiology. RESULTS: Using the so-called seven wastes approach of the Toyota Production System (waste of overproducing, waiting, transport, processing, inventory, motion and waste of defects and spoilage) as well as further waste characteristics (gross waste, process and method waste, and micro waste), wastes in the process of endovascular stent procurement in interventional radiology were identified and eliminated to create an overall smoother process from the procurement as well as from the medical perspective. CONCLUSION: Economic terminology of lean manufacturing and the Toyota Production System, especially VSM, can be used to visualise and better understand processes in the procurement of vascular stents in interventional radiology from an economic point of view.

  9. Interventional radiology simulation and measurement of patient doses; Simulacion en radiologia intervencionista y medida de dosis a pacientes

    Herraiz Lablanca, M. d.; Diaz Romero, F.; Hernandez Armas, J.


    In this paper we propose a method of work to calculate the effective dose in any interventional radiology procedure using an Alderson Rando anthropomorphic phantom and dosimeters TLD 100 chip. We applied this method in the case of biliary drainage and allowed us to establish the dose value corresponding reference in the Hospital Universitario de Canarias (HUC).

  10. The Effect of Realtime Monitoring on Dose Exposure to Staff Within an Interventional Radiology Setting

    Baumann, Frederic, E-mail:; Katzen, Barry T. [Baptist Hospital of Miami, Miami Cardiac & Vascular Institute (MCVI) (United States); Carelsen, Bart [Philips HealthCare, Clinical Science Interventional X-ray (Netherlands); Diehm, Nicolas [Kantonsspital Aarau, Clinical and Interventional Angiology (Switzerland); Benenati, James F.; Peña, Constantino S. [Baptist Hospital of Miami, Miami Cardiac & Vascular Institute (MCVI) (United States)


    PurposeThe purpose of this study is to evaluate a new device providing real-time monitoring on radiation exposure during fluoroscopy procedures intending to reduce radiation in an interventional radiology setting.Materials and MethodsIn one interventional suite, a new system providing a real-time radiation dose display and five individual wireless dosimeters were installed. The five dosimeters were worn by the attending, fellow, nurse, technician, and anesthesiologist for every procedure taking place in that suite. During the first 6-week interval the dose display was off (closed phase) and activated thereafter, for a 6-week learning phase (learning phase) and a 10-week open phase (open phase). During these phases, the staff dose and the individual dose for each procedure were recorded from the wireless dosimeter and correlated with the fluoroscopy time. Further subanalysis for dose exposure included diagnostic versus interventional as well as short (<10 min) versus long (>10 min) procedures.ResultsA total of 252 procedures were performed (n = 88 closed phase, n = 50 learning phase, n = 114 open phase). The overall mean staff dose per fluoroscopic minute was 42.79 versus 19.81 µSv/min (p < 0.05) comparing the closed and open phase. Thereby, anesthesiologists were the only individuals attaining a significant dose reduction during open phase 16.9 versus 8.86 µSv/min (p < 0.05). Furthermore, a significant reduction of total staff dose was observed for short 51 % and interventional procedures 45 % (p < 0.05, for both).ConclusionA real-time qualitative display of radiation exposure may reduce team radiation dose. The process may take a few weeks during the learning phase but appears sustained, thereafter.

  11. The consent process in interventional radiology: the role of specialist nurses

    Davies, L.; Laasch, H.-U.; Wilbraham, L.; Marriott, A.; England, R.E.; Martin, D.F. E-mail:


    AIMS: To evaluate the impact of patient education by specialist nurses on patients' understanding of interventional procedures, their anxiety levels and satisfaction with the given information. MATERIALS AND METHODS: Sixty patients attending the radiology department for gastrointestinal interventional procedures were interviewed. Patients were assessed using a combination of categorical and visual analogue scales. Parameters were assessed on admission and after additional information had been given by specialist nurses. After the procedure patients were asked to rate the quality of information given and their overall satisfaction. RESULTS: Four of the 60 patients were excluded due to a Mini Mental Test score of <7. Only 35 (62.5%) claimed to have been given information by the referring consultant. Fifty-three patients received additional information before formally giving consent, 50 (96.2%) from the specialist nurses. Patient anxiety before and after information did not significantly change (p=0.52), but there was significant improvement in levels of satisfaction (p=0.001) and perceived understanding (p<0.001). Patients rated overall quality of information at an average of 9.2/10 and overall satisfaction was high (median=9.1/10). CONCLUSION: The use of specialist nurses to educate patients greatly increases patient understanding. The process of informed consent is improved and patient satisfaction is increased.

  12. Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms.

    Keeling, A N


    Arterial wall disruption, as a consequence of inflammation\\/infection, trauma (penetrating or blunt), or iatrogenic causes, may result in pseudoaneurysm formation. Currently, iatrogenic causes are increasing as a result of the growth of endovascular intervention. The frequency of other causes also seems to be increasing, but this may simply be the result of increased diagnosis by better imaging techniques, such as multidetector contrast-enhanced computed tomography. Clinically, pseudoaneurysms may be silent, may present with local or systemic signs, or can rupture with catastrophic consequences. Open surgical repair, previously the mainstay of treatment, has largely been replaced by image-guided occlusion methods. On the basis of an experience of over 100 pseudoaneurysms, treatments at various anatomical sites, imaging modalities used for accurate diagnosis, current changing therapeutic options for pseudoaneurysm management, approved embolization agents, and clinical follow-up requirements to ensure adequate treatment will be discussed. Image-guided direct percutaneous and endovascular embolization of pseudoaneurysms are established treatment options with favorable success rates and minimal morbidity. The pendulum has now swung from invasive surgical repair of pseudoaneurysms to that of image-guided interventional radiology.

  13. A method to reduce patient's eye lens dose in neuro-interventional radiology procedures

    Safari, M. J.; Wong, J. H. D.; Kadir, K. A. A.; Sani, F. M.; Ng, K. H.


    Complex and prolonged neuro-interventional radiology procedures using the biplane angiography system increase the patient's risk of radiation-induced cataract. Physical collimation is the most effective way of reducing the radiation dose to the patient's eye lens, but in instances where collimation is not possible, an attenuator may be useful in protecting the eyes. In this study, an eye lens protector was designed and fabricated to reduce the radiation dose to the patients' eye lens during neuro-interventional procedures. The eye protector was characterised before being tested on its effectiveness in a simulated aneurysm procedure on an anthropomorphic phantom. Effects on the automatic dose rate control (ADRC) and image quality are also evaluated. The eye protector reduced the radiation dose by up to 62.1% at the eye lens. The eye protector is faintly visible in the fluoroscopy images and increased the tube current by a maximum of 3.7%. It is completely invisible in the acquisition mode and does not interfere with the clinical procedure. The eye protector placed within the radiation field of view was able to reduce the radiation dose to the eye lens by direct radiation beam of the lateral x-ray tube with minimal effect on the ADRC system.

  14. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 1: Patient Assessment and Laboratory Tests)

    Taslakian, Bedros, E-mail: [NYU Langone Medical Center, Department of Radiology (United States); Sebaaly, Mikhael Georges, E-mail:; Al-Kutoubi, Aghiad, E-mail: [American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon)


    Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care after the procedure is completed. After patient referral, contact with the referring physician and multidisciplinary team approach is vital. In addition, clinical history, physical examination, as well as full understanding of the pre-procedural laboratory results and imaging findings can guide the interventional radiologist to implement the most appropriate management plan, avoid unnecessary procedures, and prevent complications to achieve a successful outcome. We provide a comprehensive, methodical review of pre-procedural care and management in patients undergoing vascular and interventional radiology procedures.

  15. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 1: Patient Assessment and Laboratory Tests).

    Taslakian, Bedros; Georges Sebaaly, Mikhael; Al-Kutoubi, Aghiad


    Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care after the procedure is completed. After patient referral, contact with the referring physician and multidisciplinary team approach is vital. In addition, clinical history, physical examination, as well as full understanding of the pre-procedural laboratory results and imaging findings can guide the interventional radiologist to implement the most appropriate management plan, avoid unnecessary procedures, and prevent complications to achieve a successful outcome. We provide a comprehensive, methodical review of pre-procedural care and management in patients undergoing vascular and interventional radiology procedures.

  16. Experimental method for calculation of effective doses in interventional radiology; Metodo experimental para calculo de dosis efectivas en radiologia intervencionista

    Herraiz Lblanca, M. D.; Diaz Romero, F.; Casares Magaz, O.; Garrido Breton, C.; Catalan Acosta, A.; Hernandez Armas, J.


    This paper proposes a method that allows you to calculate the effective dose in any interventional radiology procedure using an anthropomorphic mannequin Alderson RANDO and dosimeters TLD 100 chip. This method has been applied to an angio Radiology procedure: the biliary drainage. The objectives that have been proposed are: to) put together a method that, on an experimental basis, allows to know dosis en organs to calculate effective dose in complex procedures and b) apply the method to the calculation of the effective dose of biliary drainage. (Author)

  17. Analysis and assessment of the detriment in interventional radiology using biological dosimetry methods

    Montoro, A.; Almonacid, M.; Villaescusa, J.I. [Hospital Univ. la Fe de Valen cian, Servicio de Proteccion Radiologica, Valencia (Spain); Barquinero, J.F.; Rodriguez, P. [Universitat Autonom a de Barcelona, Servicio de Dosimetria Biologica, Unidad de Antropologia, Departamento de Biologia Animal, Vegetal y Ecologia., Barcelona (Spain); Barrios, L. [Universidad Autonoma de Barcelona, Dept. de Biologia Celular y Fisiologia. Unidad de Biologia Celular, Barcelona (Spain); Verdu, G.; Ramos, M. [Universidad Politecnica de Valencia, Dept. de Ingenieria Quimica y Nuclear, Valencia, (Spain)


    Interventional radiologist and staff members usually are exposed to high levels of scattered radiation. As a result, the exposition to radiation procedures can produce detrimental effects that we would have to know. Effective dose is the quantity that better estimates the radiation risk. For this study we have realized an estimation of the radiological detriment to exposed workers of the Hospital la Fe de Valencia. For it, have been used physical doses registered in detectors T.L.D., and doses estimated by biological dosimetry in lymphocytes of peripheral blood. There has been estimated for every case the probability of effect of skin cancer and of non-solid cancers (leukaemia, lymphoma and myeloma), being compared with the baseline probability of natural effect. Biological doses were obtained by extrapolating the yield of dicentrics and translocations to their respective dose -effect curves. The discrepancies observed between physically recorded doses and biological estimated doses indicate that workers did not always wear their dosimeters or the dosimeters were not always in the radiation field. Cytogenetic studies should be extended to more workers to assess the risk derived from their occupational exposure. (authors)

  18. The Role of Interventional Radiology in the Diagnosis and Management of Male Impotence

    Spiliopoulos, Stavros [Patras University Hospital, Department of Radiology (Greece); Shaida, Nadeem [Cambridge University Hospitals NHS Trust, Addenbrooke' s University Hospital, Department of Radiology (United Kingdom); Katsanos, Konstantinos [Guy' s and St Thomas' NHS Trust, Department of Radiology (United Kingdom); Krokidis, Miltiadis, E-mail: [Cambridge University Hospitals NHS Trust, Addenbrooke' s University Hospital, Department of Radiology (United Kingdom)


    Erectile dysfunction (ED) is defined as the persistent inability to reach or maintain penile rigidity enough for sexual satisfaction. Nearly 30% of the men between ages 40 and 70 years are affected by ED. A variety of pathologies, including neurological, psychological, or endocrine disorders and drug side effects, may incite ED. A commonly identified cause of ED is vascular disease. Initial diagnostic workup includes a detailed physical examination and laboratory tests. Whilst duplex ultrasound is considered the first-line diagnostic modality, intra-arterial digital subtraction angiography is still considered the 'gold standard' for the diagnosis of arteriogenic impotence. Percutaneous endovascular treatment may be offered in patients with vasculogenic ED that has failed to respond to oral medical therapy as an alternative to penile prosthesis or open surgical repair. In arteriogenic ED balloon angioplasty of the aorto-iliac axis, and in veno-occlusive ED, percutaneous venous ablation using various embolization materials has been reported to be safe and to improve sexual performance. Recently, the ZEN study investigated the safety and feasibility of drug-eluting stents for the treatment of arteriogenic ED attributed to internal pudendal artery stenosis with promising preliminary results. This manuscript highlights the role of interventional radiology in the diagnosis and minimally invasive treatment of male impotence.

  19. Successful treatment of hypovascular advanced hepatocellular carcinoma with lipiodol-targetting intervention radiology


    We report a case of hypovascular advanced hepatocellular carcinoma (HCC) successfully treated with a novel combination therapy of percutaneous ethanollipiodol injection (PELI) and intervention radiology (IVR),lipiodol-targetting IVR (Lipi-IVR). The present case had a hypovascular HCC (3 cm in diameter) located in the S6 region of the liver. Although the tumor was not detectable at all by both of early and late phase of helical dynamic computed tomography (CT), it could be detected by ultrasonography (US) as a low echoic space occupying lesion (SOL) beside the gallbladder and right kidney. Serum levels of alpha fetoprotein (AFP)and AFP-L3 were extremely high. Combination therapy of PELI, firstly reported in our department, and IVR (PELI and IVR, lipiodol-targetting IVR) was performed twice for the treatment. PELI could effectively visualize the location of the tumor for IVR treatment and show the presence of a thin blood vessel branching from the right hepatic artery flowing into the lipiodol deposit.After treatment, the serum levels of AFP and AFP-L3 were rapidly decreased to normal and maintained for more than eight months. Thus, this case expressing the tremendous effect might give us insight into the effectiveness of the novel combination therapy of PELI and IVR for the treatment of hypovascular HCC.

  20. Simulators in catheter-based interventional radiology: training or computer games?

    Gould, D.A. [Department of Medical Imaging, University of Liverpool, Liverpool (United Kingdom)]. E-mail:; Kessel, D.O. [Department of Medical Imaging, University of Liverpool, Liverpool (United Kingdom); Healey, A.E. [Hospital for Sick Children, Toronto, Ont. (Canada); Johnson, S.J. [Department of Occupational Psychology, University of Liverpool, Liverpool (United Kingdom); Lewandowski, W.E


    Training in interventional radiology (IR) relies on a traditional apprenticeship; to protect patients, expert supervision is mandatory until knowledge, attitudes and practical skills have been certified as satisfactory. However, the current quality of IR training is threatened by reduced time for trainees to learn, as well as a loss of basic diagnostic, training cases to non-invasive imaging. At the same time, IR techniques are becoming a focus of interest to a range of other clinical specialities. To address this training shortfall there is a need to develop novel training alternatives such as simulator models. Few simulator models in any medical field have been successfully validated to show improved clinical skills in treating patients. To date no endovascular simulator has met this standard. A good simulator must be based around key performance measures (metrics) derived from careful analysis of the procedure to be replicated. Metrics can be determined by trained psychologists from a direct analysis of the content of the job or task to be tested. The identification of these critical measures of performance is a complex process which must be tailored to a training curriculum to be effective. Simulators based on flawed metrics will invariably lead to unsatisfactory assessment. It follows that simulator development must involve the statutory licensing authorities. Equally it is essential that we do not assume that training on a particular simulator will correlate with the ability to perform the task in the real world. This 'transfer of training' must be rigorously proven by validation studies.

  1. Exposures in interventional radiology using Monte Carlo simulation coupled with virtual anthropomorphic phantoms.

    Santos, William S; Neves, Lucio P; Perini, Ana P; Belinato, Walmir; Caldas, Linda V E; Carvalho, Albérico B; Maia, Ana F


    In this work we investigated the way in which conversion coefficients from air kerma-area product for effective doses (CCE) and entrance skin doses (CCESD) in interventional radiology (IR) are affected by variations in the filtration, projection angle of the X-ray beam, lead curtain attached to the surgical table, and suspended shield lead glass in regular conditions of medical practice. Computer simulations were used to model an exposure scenario similar to a real IR room. The patient and the physician were represented by MASH virtual anthropomorphic phantoms, inserted in the MCNPX 2.7.0 radiation transport code. In all cases, the addition of copper filtration also increased the CCE and CCESD values. The highest CCE values were obtained for lateral, cranial and caudal projections. In these projections, the X-ray tube was located above the table, and more scattered radiation reached the middle and upper portions of the physician trunk, where most of the radiosensitive organs are located. Another important result of this study was to show that the physician's protection is 358% higher when the lead curtain and suspended shield lead glasses are used. The values of CCE and CCESD, presented in this study, are an important resource for calculation of effective doses and entrance skin doses in clinical practice.

  2. [Estimation of personal dose based on the dependent calibration of personal dosimeters in interventional radiology].

    Mori, Hiroshige; Koshida, Kichiro; Ichikawa, Katsuhiro


    The purpose of present study is, in interventional radiology (IVR), to elucidate the differences between each personal dosimeter, and the dependences and calibrations of area or personal dose by measurement with electronic dosimeters in particular. We compare space dose rate distributions measured by an ionization survey meter with the value measured by personal dosimeter: an optically stimulated luminescence, two fluoroglass, and two electronic dosimeters. Furthermore, with electronic dosimeters, we first measured dose rate, energy, and directional dependences. Secondly, we calibrated the dose rate measured by electronic dosimeters with the results, and estimated these methods with coefficient of determination and Akaike's Information Criterion (AIC). The results, especially in electronic dosimeters, revealed that the dose rate measured fell by energy and directional dependences. In terms of methods of calibration, the method is sufficient for energy dependence, but not for directional dependence, because of the lack of stable calibration. This improvement poses a question for the future. The study suggested that these dependences of the personal dosimeter must be considered when area or personal dose is estimated in IVR.

  3. Active personal dosemeters in interventional radiology: tests in laboratory conditions and in hospitals.

    Clairand, I; Bordy, J-M; Daures, J; Debroas, J; Denozière, M; Donadille, L; Ginjaume, M; Itié, C; Koukorava, C; Krim, S; Lebacq, A-L; Martin, P; Struelens, L; Sans-Mercé, M; Tosic, M; Vanhavere, F


    The work package 3 of the ORAMED project, Collaborative Project (2008-11) supported by the European Commission within its seventh Framework Programme, is focused on the optimisation of the use of active personal dosemeters (APDs) in interventional radiology and cardiology (IR/IC). Indeed, a lack of appropriate APD devices is identified for these specific fields. Few devices can detect low-energy X rays (20-100 keV), and none of them are specifically designed for working in pulsed radiation fields. The work presented in this paper consists in studying the behaviour of some selected APDs deemed suitable for application in IR/IC. For this purpose, measurements under laboratory conditions, both with continuous and pulsed X-ray beams, and tests in real conditions on site in different European hospitals were performed. This study highlights the limitations of APDs for this application and the need of improving the APD technology so as to fulfil all needs in the IR/IC field.

  4. Doses to operators during interventional radiology procedures: focus on eye lens and extremity dosimetry.

    Koukorava, C; Carinou, E; Simantirakis, G; Vrachliotis, T G; Archontakis, E; Tierris, C; Dimitriou, P


    The present study is focused on the personnel doses during several types of interventional radiology procedures. Apart from the use of the official whole body dosemeters (thermoluminescence dosemeter type), measurements were performed to the extremities and the eyes using thermoluminescent loose pellets. The mean doses per kerma area product were calculated for the monitored anatomic regions and for the most frequent types of procedures. Higher dose values were measured during therapeutic procedures, especially embolisations. The maximum recorded doses during a single procedure were 1.8 mSv to the finger (nephrostomy), 2.1 mSv to the wrist (liver chemoembolisation), 0.6 mSv to the leg (brain embolisation) and 2.4 mSv to the eye (brain embolisation). The annual doses estimated for the operator with the highest workload according to the measurements and the system's log book were 90.4 mSv to the finger, 107.9 mSv to the wrist, 21.6 mSv to the leg and 49.3 mSv to the eye. Finally, the effect of the beam angulation (i.e. projection) and shielding equipment on the personnel doses was evaluated. The measurements were performed within the framework of the ORAMED (Optimization of RAdiation Protection for MEDical staff) project.

  5. Monte Carlo calculations on extremity and eye lens dosimetry for medical staff at interventional radiology procedures.

    Carinou, E; Ferrari, P; Koukorava, C; Krim, S; Struelens, L


    There are many factors that can influence the extremity and eye lens doses of the medical staff during interventional radiology and cardiology procedures. Numerical simulations can play an important role in evaluating extremity and eye lens doses in correlation with many different parameters. In the present study, the first results of the ORAMED (Optimisation of Radiation protection of MEDical staff) simulation campaign are presented. The parameters investigated for their influence on eye lens, hand, wrist and leg doses are: tube voltage, filtration, beam projection, field size and irradiated part of the patient's body. The tube voltage ranged from 60 to 110 kV(p), filtration from 3 to 6 mm Al and from 0 to 0.9 mm Cu. For all projections, the results showed that doses received by the operator decreased with increasing tube voltage and filtration. The magnitude of the influence of the tube voltage and the filtration on the doses depends on the beam projection and the irradiated part of the patient's body. Finally, the influence of the field size is significant in decreasing the doses.

  6. Functional phlebology. Phlebography, function studies, interventional radiology. Funktionelle Phlebologie. Phlebographie, Funktionstests, interventionelle Radiologie

    Weber, J.; May, R.; Biland, L.; Endert, G.; Gottlob, R.; Justich, E.; Luebcke, P.; Mignon, G.; Moltz, L.; Partsch, H.; Petter, A.; Ritter, H.; Soerensen, R.; Widmer, L.K.; Widmer, M.T.; Zemp, E.


    The book presents a complete survey of the problems occurring in the venous system of the legs, pelvis, and abdomen. The material is arranged in the following main chapters: (1) Introduction to the phlebology of the low-pressure system in the lower part of the body; (2) Phlebographic methods; (3) Instrumented function studies and methods; (4) Pathologic findings; (5) Diagnostic methods and vein therapy; (6) Interventional radiology; (7) Expert opinions on venous lesions including insurance aspects. The first chapter encompasses a section briefly discussing the available instrumented diagnostic imaging methods. In view of the novel imaging methods, namely digital subtraction phlebology, sonography, CT and MRI, the classical phlebography remains the gold standard, so to speak: all currently available phlebographic methods for imaging the venes in the legs, pelvis and abdomen are explained and comparatively evaluated. Instrumented function tests such as Doppler effect ultrasound testing, plethysmography, peripheral and central phlebodynamometry (venous pressure measurement) are analysed for their diagnostic value and as alternative or supplementing techniques in comparison to phlebology. (orig./MG) With 843 figs., 101 tabs.

  7. Radiological interventions in inflammatory bowel disease; Interventionelle Verfahren bei entzuendlichen Darmerkrankungen

    Krolak, C.; Rock, C.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum der Universitaet Muenchen (Germany)


    Abscesses, fistulas,hemorrhages and stenoses are common complications of inflammatory bowel diseases.This study provides an overview on various methods of radiological intervention and the clinical usefulness of these methods is analyzed. The success rate of percutaneous abscess drainage (PAD), embolisation of hemorrhages and dilatation of bowel stenoses is reviewed and current literature is adressed.Success rate is defined in terms of cure rate and need for subsequent surgery. After PAD, surgery can be avoided during the observation period in about 50% of patients with abscesses due to Crohn's disease and diverticulitis.Preoperative PAD reduces the degree of invasiveness and thus the risk of surgery.Abscess recurrence is found with the same frecuency following surgery or PAD.Bowel dilatation can be performed both with radiological and with endoscopic guidance.Embolisation of GI-hemorrhage is technically feasible, but the indication should be limited to strictly selected cases. In treating abscesses and fistulas associated with Crohn's disease and diverticulitis, PAD is a valuable treatment option.Embolisation or dilatation are restricted to rare cares. (orig.) [German] Fragestellung Abszesse, Fisteln, Blutungen und Darmstenosen sind typische Komplikationen entzuendlicher Darmerkrankungen. Es werden verschiedene radiologisch-interventionelle Verfahren vorgestellt und ihre Wertigkeit fuer die Behandlung geprueft.Methodik Unter Beruecksichtigung der neueren Literatur werden der Erfolg der perkutanen Abszessdrainage (PAD) hinsichtlich der Ausheilung und Notwendigkeit einer folgenden OP, die perkutane Embolisation und die Dilatation von Darmstenosen bewertet.Ergebnisse Die PAD vermeidet bei 50% der Patienten mit Morbus Crohn und bei 20% der Patienten mit Divertikulitis eine OP im kurzfristigen Verlauf.Die PAD verringert die Invasivitaet einer nachfolgenden OP.Rezidivabszesse treten nach PAD und OP gleich haeufig auf.Die Dilatation entzuendlicher Darmstenosen

  8. Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures.

    Erden, I Aydin; Pamuk, A Gulsun; Akinci, Seda B; Koseoglu, Ayhan; Aypar, Ulku


    With an increase in the frequency of interventional radiology procedures in pediatrics, there has been a corresponding increase in demand for procedural sedation to facilitate them. The purpose of our study was to compare the frequency of adverse effects, sedation level, patient recovery characteristics in pediatric patients receiving intravenous propofol fentanyl combination with or without ketamine for interventional radiology procedures. Our main hypothesis was that the addition of ketamine would decrease propofol/fentanyl associated desaturation. Sixty consenting American Society of Anesthesia physical status I-III pediatric patients undergoing interventional radiology procedures under sedation were studied according to a randomized, double-blinded, institutional review board approved protocol. Group 1 received propofol 0.5 + fentanyl 1 + ketamine 0.5, and group 2 received propofol 0.5 + fentanyl 1 + same volume of %0.9 NaCl intravenously. While apnea was not observed in any of the groups, there were three cases (10%) in group 1, and nine cases (30%) in group 2 with oxygen desaturation (P = 0.052). In group 1, 12 (40%) patients and, in group 2, 21 (70%) patients required supplemental propofol during the procedure (P = 0.021). There was no evidence for difference between groups in terms of other side effects except nystagmus. In conclusion, addition of low dose ketamine to propofol-fentanyl combination decreased the risk of desaturation and it also decreased the need for supplemental propofol dosage in pediatric patients at interventional radiology procedures.

  9. The effects of expanding outpatient and inpatient evaluation and management services in a pediatric interventional radiology practice.

    Edalat, Faramarz; Lindquester, Will S; Gill, Anne E; Simoneaux, Stephen F; Gaines, Jennifer; Hawkins, C Matthew


    Despite a continuing emphasis on evaluation and management clinical services in adult interventional radiology (IR) practice, the peer-reviewed literature addressing these services - and their potential economic benefits - is lacking in pediatric IR practice. To measure the effects of expanding evaluation and management (E&M) services through the establishment of a dedicated pediatric interventional radiology outpatient clinic and inpatient E&M reporting system. We collected and analyzed E&M current procedural terminology (CPT) codes from all patients seen in a pediatric interventional radiology outpatient clinic between November 2014 and August 2015. We also calculated the number of new patients seen in the clinic who had a subsequent procedure (procedural conversion rate). For comparison, we used historical data comprising pediatric patients seen in a general interventional radiology (IR) clinic for the 2 years immediately prior. An inpatient E&M reporting system was implemented and all inpatient E&M (and subsequent procedural) services between July 2015 and September 2015 were collected and analyzed. We estimated revenue for both outpatient and inpatient services using the Medicare Physician Fee Schedule global non-facility price as a surrogate. Following inception of a pediatric IR clinic, the number of new outpatients (5.5/month; +112%), procedural conversion rate (74.5%; +19%), estimated E&M revenue (+158%), and estimated procedural revenue from new outpatients (+228%) all increased. Following implementation of an inpatient clinic reporting system, there were 8.3 consults and 7.3 subsequent hospital encounters per month, with a procedural conversion rate of 88%. Growth was observed in all meaningful metrics following expansion of outpatient and inpatient pediatric IR E&M services.

  10. Medical intervention in radiological emergencies, formation and training; Intervencion medica en emergencias radiologicas, formacion y adiestramiento

    Cardenas H, J. [CPHR, Calle 20 No. 4113, e/41 y 47 Playa, CP 11300, La Habana (Cuba)]. e-mail:


    The work exposes the national experience in the development of training programs in medical aspects of the radiological emergencies. Implemented after valuing the existent situation, identified the necessities and the reach of the training, additionally it was elaborated the content of the training program whose purpose is guided to the invigoration of the medical answer capacity in radiological emergencies The content of the modular program it approaches theoretical- practical aspects on preparation and medical answer in radiological emergencies. The program includes an exercise that simulates a radiological accident, to evaluate during the same one, the answer capacity before this situation. The training concludes with the design of a strategy for the preparation and answer in radiological emergencies in correspondence with the potential accidental scenarios that the participants can face. (Author)

  11. Professional development for radiographers and post graduate nurses in radiological interventions: Building teamwork and collaboration through drama.

    Lundén, M; Lundgren, S M; Morrison-Helme, M; Lepp, M


    The rapid development within Interventional Radiology presents new challenges. Hybrid operating rooms consist of interventional radiology, open surgery, computed tomography, magnetic resonance imaging and other techniques. This means that several disciplines and professionals need to work in new constellations creating a multidisciplinary team around the patient. In accordance with this development, higher professional education must provide new pedagogic strategies to successfully address the knowledge expected in today's complex working life. To explore the use of Applied Drama as a learning medium, focusing on the use of Forum Theatre, to foster team work and collaboration in the field of radiography and learning. A qualitative approach, closely related to Ethnography, was utilized. The Drama Workshop utilising Forum Theatre created a dynamic learning environment and enabled the participants from three professions to understand each other's priorities better. The use of drama within health care education allows the students to take different roles in order to find the best way to co-operate. Forum Theatre is a useful learning medium in order to promote teamwork and collaboration in the radiological intervention field. By choosing a personal working experience, Forum Theatre seem to engage the participants at a deeper level and to experience various communication strategies and how the outcome changed depending on the approach. This can lead to improved teamwork and collaboration. Copyright © 2017 The College of Radiographers. All rights reserved.

  12. Current radiology. Volume 5

    Wilson, G.H.; Hanafee, W.N.


    This book contains 10 selections. They are: Nuclear Magnetic Resonance Imaging, Interventional Vascular Radiology, Genitourinary Radiology, Skeletal Radiology, Digital Subtraction Angiography, Neuroradiology, Computed Tomographic Evaluation of Degenerative Diseases of the Lumbar Spine, The Lung, Otolaringology and Opthalmology, and Pediatric Radiology: Cranial, Facial, Cervical, Vertebral, and Appendicular.

  13. Identifying the Learning Curve for Uterine Artery Embolisation in an Interventional Radiological Training Unit

    Das, Raj, E-mail:, E-mail:; Lucatelli, Pierleone, E-mail:; Wang, Haofan, E-mail:; Belli, Anna-Maria, E-mail: [St George’s Hospital, Department of Radiology (United Kingdom)


    AimA clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill.MethodsTen IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to three groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters).ResultsMean fluoroscopy time was 18.4 (±8.1), 17.3 (±9.0), 16.3 (±8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4 %.ConclusionUAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.

  14. British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry

    Uberoi, Raman, E-mail:; Tapping, Charles Ross [Oxford University Hospitals, John Radcliffe Hospital, Department of Radiology (United Kingdom); Chalmers, Nicholas [Manchester Royal Infirmary, Department of Radiology (United Kingdom); Allgar, Victoria [University of York, Hull and York Medical School (United Kingdom)


    Purpose: The British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry was produced to provide an audit of current United Kingdom (UK) practice regarding placement and retrieval of IVC filters to address concerns regarding their safety. Methods: The IVC filter registry is a web-based registry, launched by the BSIR on behalf of its membership in October 2007. This report is based on prospectively collected data from October 2007 to March 2011. This report contains analysis of data on 1,434 IVC filter placements and 400 attempted retrievals performed at 68 UK centers. Data collected included patient demographics, insertion and retrieval data, and patient follow-up. Results: IVC filter use in the majority of patients in the UK follows accepted CIRSE guidelines. Filter placement is usually a low-risk procedure, with a low major complication rate (<0.5 %). Cook Gunther Tulip (560 filters: 39 %) and Celect (359 filters: 25 %) filters constituted the majority of IVC filters inserted, with Bard G2, Recovery filters, Cordis Trapease, and OptEase constituting most of the remainder (445 filters: 31 %). More than 96 % of IVC filters deployed as intended. Operator inexperience (<25 procedure) was significantly associated with complications (p < 0.001). Of the IVC filters initially intended for temporary placement, retrieval was attempted in 78 %. Of these retrieval was technically successful in 83 %. Successful retrieval was significantly reduced for implants left in situ for >9 weeks versus those with a shorter dwell time. New lower limb deep vein thrombosis (DVT) and/or IVC thrombosis was reported in 88 patients following filter placement, there was no significant difference of incidence between filter types. Conclusions: This registry report provides interventional radiologists and clinicians with an improved understanding of the technical aspects of IVC filter placement to help improve practice, and the potential consequences of IVC filter

  15. Cardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency.

    Reekers, J A


    , who are directly approached by MS patients, contact the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) for advice. Worldwide, several centres are actively promoting and performing balloon dilatation, with or without stenting, for CCSVI. Thus far, no trial data are available, and there is currently no randomized controlled trial (RCT) in progress Therefore, the basis for this new treatment rests on anecdotal evidence and successful testimonies by patients on the Internet. CIRSE believes that this is not a sound basis on which to offer a new treatment, which could have possible procedure-related complications, to an often desperate patient population.

  16. Red emission phosphor for real-time skin dosimeter for fluoroscopy and interventional radiology

    Nakamura, Masaaki, E-mail:; Chida, Koichi; Zuguchi, Masayuki [Department of Radiological Technology, Faculty of Medicine, School of Health Sciences, Tohoku University, 2-1 Seiryou-machi, Aoba-ku, Sendai 980-8575 (Japan)


    Purpose: There are no effective real-time direct skin dosimeters for interventional radiology. Such a scintillation dosimeter would be available if there was a suitable red emission phosphor in the medical x-ray range, since the silicon photodiode is a highly efficient device for red light. However, it is unknown whether there is a suitable red emission phosphor. The purpose of this study is to find a suitable red emission phosphor that can be used in x-ray dosimeters. Methods: Five kinds of phosphors which emit red light when irradiated with electron beams or ultraviolet rays in practical devices were chosen. For the brightness measurement, phosphor was put into transparent plastic cells or coated onto plastic sheets. The phosphors were irradiated with medical range x-rays [60–120 kV(peak), maximum dose rate of 160 mGy min{sup −1}], and the emission was measured by a luminance meter. Several characteristics, such as brightness, dose rate dependence, tube voltage dependence, and brightness stability, were investigated. Results: The luminescence of Y V O{sub 4}:Eu, (Y,Gd,Eu) BO{sub 3}, and Y{sub 2}O{sub 3}:Eu significantly deteriorated by 5%–10% when irradiated with continuous 2 Gy x-rays. The 0.5MgF{sub 2}⋅3.5MgO⋅GeO{sub 2}:Mn phosphor did not emit enough. Only the Y{sub 2}O{sub 2}S:Eu,Sm phosphor had hardly any brightness deterioration, and it had a linear relationship so that the x-ray dose rate could be determined from the brightness with sufficient accuracy. For the tube voltage dependence of the Y{sub 2}O{sub 2}S:Eu,Sm phosphor, the brightness per unit dose rate with 120 kV(peak) x-rays was 30% higher than that with 60 kV(peak) x-rays. Conclusions: Five kinds of phosphors were chosen as an x-ray scintillator for a real-time direct skin dosimeter. The Y V O{sub 4}:Eu, (Y,Gd,Eu)BO{sub 3}, and Y{sub 2}O{sub 3}:Eu phosphors had brightness deterioration caused by the x-rays. Only the Y{sub 2}O{sub 2}S:Eu,Sm phosphor had hardly any brightness deterioration


    A. F. Minov


    Full Text Available The liver is an essential player in the pathway of coagulation in both primary and secondary hemostasis as it is the site of synthesis of all coagulation factors and their inhibitors. Liver diseases are associated with complex changes in coagulation and the delicate balance between pro and antithrombotic factors is preserved but reset to a lower level. There is growing evidence that portal and hepatic vein thrombosis is cause of disease progression in cirrhotic patients and worsens hemostatic abnormalities. These hemostatic abnormalities do not always lead to spontaneous bleeding, which may be triggered only by additional factors, such as infections. Usually therapy for coagulation disorders in liver disease is needed only during bleeding or before invasive procedures. In patients with end stage liver disease liver transplantation is the only treatment available, which can restore normal hemostasis, and correct genetic clotting defects. During liver transplantation hemorrhage may occur due to the pre-existing hypocoagulable state, the collateral circulation caused by portal hypertension and increased fibrinolysis. 

  18. Hemostatic abnormalities in liver cirrhosis

    Kendal YALÇIN


    Full Text Available In this study, 44 patients with liver cirrhosis were investigated for hemostatic parameters. Patients with spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatorenal syndrome and cholestatic liver diseases were excluded. Patients were classified by Child-Pugh criterion and according to this 4 patients were in Class A, 20 in Class B and 20 in C. Regarding to these results, it was aimed to investigate the haematological disturbances in liver cirrhotic patients.In the result there was a correlation between activated partial thromboplastin time, serum iron, ferritin, transferrin, haptoglobin and Child-Pugh classification. Besides there was no correlation between prothrombin time, factor 8 and 9, protein C and S, anti-thrombin 3, fibrinogen, fibrin degradation products, serum iron binding capacity, hemoglobin, leukocyte, mean corpuscular volume and Child-Pugh classification.There were significant difference, in terms of AST, ferritin, haptoglobulin, sex and presence of ascites between groups (p0.05. In the summary, we have found correlation between hemostatic abnormalities and disease activity and clinical prognosis in patients with liver cirrhosis which is important in the management of these patients. This is also important for identification of liver transplant candidiates earlier.

  19. Economic evaluation of angiographic interventions including a whole-radiology in- and outpatient care; Wirtschaftliche Evaluation angiographischer Interventionen einschliesslich einer radiologischen stationaeren und ambulanten Patientenbetreuung

    Nolte-Ernsting, C.; Abel, K.; Krupski, G.; Lorenzen, J.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany)


    Purpose: To determine the economic efficiency of a whole-radiology in- and outpatient treatment with angiographic interventions performed as the main or sole therapy. Materials and Methods: The calculations represent the data of a university radiology department, including the following angiographic interventions (neuroradiology not considered): Vascular intervention (PTA, stent implantation) of kidneys and extremities, recanalization of hemodialysis access, chemoembolization, diagnostic arterioportal liver CT, port implantation, varicocele embolization, PTCD, percutaneous implantation of biliary stent. First, the different angiographic interventions are categorized with reference to the German DRG system 2005. Considering the example of a university hospital, the individual cost of each intervention is calculated and correlated with reimbursements by G-DRG2005 and so-called ''ambulant operation'' (EBM200plus). With these data, profits and losses are calculated for both in- and outpatient care. Results: Radiologic interventions of inpatients yield a profit in the majority of cases. With a base rate of 2900 Euro, the profits in our university hospital range between -872 Euro and +3411 Euro (mean: +1348 Euro). On the other hand, those angiographic interventions suitable for ''ambulant operation'' generate average profits of +372 Euro, if only direct costs are considered. The data of outpatient radiological interventions average between 381 Euro up to 1612 Euro lower than compared with profits obtained from in patient care. (orig.)

  20. Evaluation of an intervention to improve skills in diagnostic radiology of rural physicians over one year in four rural hospitals.

    Tienan Feng

    Full Text Available BACKGROUND: Primary health care and patient triage are two basic functions of rural hospitals. As a routine test, the diagnostic radiology is still unavailable in some rural hospitals in China. Therefore, high-level hospitals are often the first choice of rural residents when they feel unwell. It brings serious social problems. This study was designed to propose an on-the-job drilling schema with integration of practical medical recordings and experienced radiological doctors as tutors to improve skills in diagnostic radiology of rural physicians. METHODS: The information technology was used to help the contact between rural doctors and tutors. In a longitudinal pre/post-test control study design, a cohort of 20 young physicians, each of whom was working in a rural hospital and had a work experience less than two years, were established as the trial group over one year. Another 20 similar counterparts were established as the control group. Participants' performances were evaluated in four categories at five-time point (TP. RESULTS: The trial group significantly outscored the control group on the style of writing at the second TP (d = 2.28; on the accuracy of the image description at final TP (d = 1.11; on the accuracy of the diagnosis at the fourth TP (d = 3.62; and on the correct treatment selection at the third TP (d = 6.45. The aspects with the most improvement were the accuracies of the diagnosis and the treatment selection. CONCLUSION: This study provided the detailed evidences that applying the on-the-job drilling schema has a significant effect on the skills improvement in diagnostic radiology of rural physicians. It was also concluded that the educational intervention based on practical cases was better than that only based on didactic slides presentation.

  1. Patients and personnel radiation protection in interventional radiology and in surgery;La radioprotection des patients et des travailleurs en radiologie interventionnelle et au bloc operatoire

    Menechal, P. [Centre de Recherches en Psychopathologie et Psychologie Clinique - CRPPC, 69 - Lyon (France); Valero, M.; Godet, J.L. [Lyon-3 Univ. Jean Moulin, 69 (France)


    The development of the interventional radiology and acts realised under radiological guiding is a real benefit for patients. The doses delivered can however, generate important detriments (determinist effects). the patients and the personnel are exposed to important doses, heterogeneous and very different doses according the operator, the patient morphology and the treated pathology. This theme is considered by the the nuclear safety Authority as a priority in the medical medium. (N.C.)

  2. A study of inventiveness among Society of Interventional Radiology members and the impact of their social networks.

    Murphy, Kieran J; Elias, Gavin; Jaffer, Hussein; Mandani, Rashesh


    To investigate the nature of inventiveness among members of the Society of Interventional Radiology (SIR) and learn what influenced the inventors and assisted their creativity. The membership directory of the SIR was cross-referenced with filings at the United States Patent and Trademark Organization (USPTO) and the Patent Cooperation Treaty (PCT). The inventors were queried with an online survey to illuminate their institutions of training and practice as well as enabling or inhibiting factors to their inventiveness. Responses were analyzed through the construction of social network maps and thematic and graphical analysis. It was found that 457 members of the SIR held 2,492 patents or patent filings. After 1986, there was a marked and sustained increase in patent filings. The online survey was completed by 73 inventors holding 470 patents and patent filings. The social network maps show the key role of large academic interventional radiology departments and individual inventors in the formation of interconnectivity among inventors and the creation of the intellectual property (IP). Key inhibitors of the inventive process include lack of mentorship, of industry contacts, and of legal advice. Key enablers include mentorship, motivation, and industry contacts. Creativity and inventiveness in SIR members stem from institutions that are hubs of innovation and networks of key innovators; inventors are facilitated by personal motivation, mentorship, and strong industry contacts. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  3. Developing low-dose C-arm CT imaging for temporomandibular joint (TMJ) disorder in interventional radiology

    Zhu, Xiaowei; Cahill, Anne Marie [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Felice, Marc [University of Pennsylvania, Environmental Health and Radiation Safety, Philadelphia, PA (United States); Johnson, Laura [Computed Tomography Division, Siemens Healthcare Sector, Shanghai (China); Sarmiento, Marily [Siemens Medical Solutions, Angiography and X-ray Division, Hoffman Estates, IL (United States)


    Manufacturers have provided C-arm CT imaging technologies for applications in interventional radiology in recent years. However, clinical imaging protocols and radiation doses have not been well studied or reported. The purpose of this study is to develop low-dose settings for clinically acceptable CT imaging of temporomandibular joint in interventional radiology suites, using a C-arm imaging angiography system. CT scans were performed with a flat-panel digital C-arm angiographic system on a 5-year-old anthropomorphic phantom. The CTDI was determined for various rotation times, dose settings and Cu filter selections. The CTDI values were compared with those of conventional low-dose CT for the same phantom. The effectiveness of using Cu filters to reduce dose was also investigated. Images were reviewed by a senior radiologist for clinical acceptance. The manufacturer's default setting gave an equivalent CTDI of 4.8 mGy. Optimizing the dose settings and adding copper filtration reduced the radiation dose by 94%. This represents a 50% reduction from conventional CT. Use of Cu filters and low-dose settings significantly reduced radiation dose from that of standard settings. This phantom study process successfully guided the clinical implementation of low-dose studies for all ages at our institution. (orig.)

  4. C-arm flat detector computed tomography: the technique and its applications in interventional neuro-radiology

    Kamran, Mudassar [John Radcliffe Hospital, Oxford Neurovascular and Neuroradiology Research Unit, Level 6, West Wing, Oxford (United Kingdom); Nagaraja, Sanjoy; Byrne, James V. [John Radcliffe Hospital, Department of Neuroradiology, West Wing, Oxford (United Kingdom)


    Flat detector computed tomography (FDCT) is an imaging tool that generates three-dimensional (3-D) volumes from data obtained during C-arm rotation using CT-like reconstruction algorithms. The technique is relatively new and, at current levels of performance, lags behind conventional CT in terms of image quality. However, the advantage of its availability in the interventional room has prompted neuro-radiologists to identify clinical settings where its role is uniquely beneficial. We performed a search of the online literature databases to identify studies reporting experience with FDCT in interventional neuro-radiology. The studies were systematically reviewed and their findings grouped according to specific clinical situation addressed. FDCT images allow detection of procedural complications, evaluation of low-radiopacity stents and assessment of endosaccular coil packing in intra-cranial aneurysms. Additional roles are 3-D angiography that provides an accurate depiction of vessel morphology with low concentrations of radiographic contrast media and a potential for perfusion imaging due to its dynamic scanning capability. A single scan combining soft tissue and angiographic examinations reduces radiation dose and examination time. Ongoing developments in flat detector technology and reconstruction algorithms are expected to further enhance its performance and increase this range of applications. FDCT images provide useful information in neuro-interventional setting. If current research confirms its potential for assessing cerebral haemodynamics by perfusion scanning, the combination would redefine it as an invaluable tool for interventional neuro-radiology procedures. This facility and its existing capabilities of parenchymal and angiographic imaging would also extend its use to the triage of acute stroke patients. (orig.)

  5. Study of radiation exposure profiles in interventional radiology professionals; Estudo dos perfis de exposicao a radiacao em profissionais de radiologia intervencionista

    Bacchim Neto, Fernando A.; Alves, Allan F.F.; Alvarez, Matheus; Rosa, Maria E.D.; Miranda, Jose R.A.; Freitas, Carlos C.M. de; Moura, Regina; Pina, Diana R. de, E-mail: [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil)


    Interventional Radiology is the radiology area that provides the highest dose values to the medical staff. Recent surveys show that personal dosimeters may underestimate the radiation dose values in interventional physicians, especially in the extremities and crystalline. The objective of this work was to study the exposure levels to radiation from medical staff in different interventional radiology procedures. Therefore, thermoluminescent dosimeters type LiF: Mg, Ti (TLD-100) were used positioned in the main interventional physician and an assistant in the following locations: some inches below the crystalline, thyroid, chest, gonads, hand and foot. By comparing the values obtained with the annual reference dose levels in workers, maximum numbers of annual procedures were found. Altogether, there were 23 procedures evaluated: 10 diagnostics, 9 angioplasties and 4 stents. The maximum number of annual procedures were estimated by discounting the percentages of attenuation of radiological protection. For procedures of the type diagnosis, angioplasty and stent for the main interventionist, the maximum number of annual procedures were 641, 445 and 113 respectively, while for the interventionists assistants were 930, 1202 and 215 respectively. As each interventionist body region is subject to different levels of exposure, detailed studies of exposure in each region provide better conclusions about what actions are necessary to ensure radiological protection professionals.

  6. Dose evaluation in medical staff during diagnostics procedures in interventional radiology; Avaliacao da dose na equipe medica durante procedimentos diagnoticos de radiologia intervencionista

    Bacchim Neto, Fernando A.; Alves, Allan F.F.; Rosa, Maria E.D.; Miranda, Jose R.A. [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Instituto de Biociencias. Departamento de Fisica e Biofisica; Moura, Regina [Faculdade de Medicina de Botucatu, SP (Brazil). Departamento de Cirurgia e Ortopedia; Pina, Diana R., E-mail: [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina. Departamento de Doencas Tropicais e Diagnostico por Imagem


    Studies show that personal dosimeters may underestimate the dose values in interventional physicians, especially in extremities and crystalline. The objective of this work was to study the radiation exposure levels of medical staff in diagnostic interventional radiology procedures. For this purpose LiF:Mg,Ti (TLD-100) dosimeters were placed in different regions of the physician body. When comparing with reference dose levels, the maximum numbers of annual procedures were found. This information is essential to ensure the radiological protection of those professionals. (author)

  7. Transition in occupational radiation exposure monitoring methods in diagnostic and interventional radiology.

    Lönnroth, Nadja; Hirvonen-Kari, Mirja; Timonen, Marjut; Savolainen, Sauli; Kortesniemi, Mika


    Radiation exposure monitoring is a traditional keystone of occupational radiation safety measures in medical imaging. The aim of this study was to review the data on occupational exposures in a large central university hospital radiology organisation and propose changes in the radiation worker categories and methods of exposure monitoring. An additional objective was to evaluate the development of electronic personal dosimeters and their potential in the digitised radiology environment. The personal equivalent dose of 267 radiation workers (116 radiologists and 151 radiographers) was monitored using personal dosimeters during the years 2006-2010. Accumulated exposure monitoring results exceeding the registration threshold were observed in the personal dosimeters of 73 workers (59 radiologists' doses ranged from 0.1 to 45.1 mSv; 14 radiographers' doses ranged from 0.1 to 1.3 mSv). The accumulated personal equivalent doses are generally very small, only a few angiography radiologists have doses >10 mSv per 5 y. The typical effective doses are dosimeters. An active real-time dosimetry system is warranted to support radiation protection strategy where optimisation aspects, including improving working methods, are essential.

  8. Extremity and eye lens doses in interventional radiology and cardiology procedures: first results of the ORAMED project.

    Domienik, J; Brodecki, M; Carinou, E; Donadille, L; Jankowski, J; Koukorava, C; Krim, S; Nikodemova, D; Ruiz-Lopez, N; Sans-Mercé, M; Struelens, L; Vanhavere, F


    The main objective of WP1 of the ORAMED (Optimization of RAdiation protection for MEDical staff) project is to obtain a set of standardised data on extremity and eye lens doses for staff in interventional radiology (IR) and cardiology (IC) and to optimise staff protection. A coordinated measurement program in different hospitals in Europe will help towards this direction. This study aims at analysing the first results of the measurement campaign performed in IR and IC procedures in 34 European hospitals. The highest doses were found for pacemakers, renal angioplasties and embolisations. Left finger and wrist seem to receive the highest extremity doses, while the highest eye lens doses are measured during embolisations. Finally, it was concluded that it is difficult to find a general correlation between kerma area product and extremity or eye lens doses.

  9. Preliminary characterization of dose in personnel of interventional radiology; Caracterizacao preliminar da dose em profissionais de radiologia intervencionista

    Godolfim, Laura Larre; Anes, Mauricio; Bacelar, Alexandre; Lykawka, Rochelle [Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS (Brazil)


    Exposure to X-rays of Interventional Radiology professionals (IR) impacts in the high dose rate received by these individuals, and there are reports of biological effects of this professional activity. Therefore, it is fomented greater control over the doses received by these workers. This research intends to characterize the doses received by the professionals during IR procedures. We evaluated the doses of radiologists, anesthesiologists and nursing staff of the Hospital de Clinicas de Porto Alegre, through measures with dosimeters of the OSL type, distributed in up to six regions of the body of these professionals. Until now were accompanied 33 cholangiography procedures and 29 embolization procedures. As a preliminary result, it was possible to identify a wide variation between doses of the professionals of the same function in each procedure. In overview, the dose of the professionals presented in descending order as a radiologist 1> radiologist 2 > anesthetist > nursing. (author)

  10. Reducing Blood-borne Exposure in Interventional Radiology: What the IR Should Know

    Tso, David K. [University of British Columbia, Department of Radiology (Canada); Athreya, Sriharsha, E-mail: [St. Joseph' s Healthcare Hamilton, Department of Diagnostic Imaging (Canada)


    Interventional radiologists are at risk of exposure to blood-borne pathogens in their day-to-day practice. Percutaneous exposure from unsafe sharps handling, mucocutaneous exposure from body fluid splashes, and glove perforation from excessive wear can expose the radiologist to potentially infectious material. The increasing prevalence of blood-borne pathogens, including hepatitis B and C, and human immunodeficiency virus, puts nurses, residents, fellows, and interventional radiologists at risk for occupational exposure. This review outlines suggestions to establish a culture of safety in the interventional suite.

  11. A comparison of the quality of the information available on the internet on interventional radiology, vascular surgery, and cardiology

    A Alsafi


    Full Text Available Context and Aims: Internet use is rapidly expanding and increasingly plays a substantial role in patient education. We sought to evaluate and compare the quality of information available to patients online on three closely linked specialties: Interventional radiology (IR, cardiology, and vascular surgery. Materials and Methods: We searched the leading three search engines for the terms: "Interventional Radiology", "cardiology," and "vascular surgery," collating the top 50 hits from each search. After excluding duplicates and irrelevant sites, 43, 25, and 36 sites remained, respectively. Sites were analyzed using the LIDA instrument (an online tool for assessing health-related websites and Fleisch Reading Ease Scores (FRES were compared across the different search terms and correlated with the country of origin and certification by the Health on the Net (HON Foundation. Results: There was no significant difference ( P>0.05 in the total LIDA, accessibility, usability or reliability scores between the three specialties. HONCode certification was associated with higher LIDA (83.1±1.6 vs. 71.53±0.8 ( P<0.0001, reliability (75.7±3.6 vs. 49.0±1.6 ( P<0.0001 and FRES (37.4±4.0 vs. 29.7±1.4 ( P=0.0441. Conclusion: Websites are generally well designed and easy to use; the majority however, lacks currency and reliability. Despite similarity in quality of online information, there is a disparity in knowledge of IR; this may be due to low web-traffic figures of IR sites. Wikipedia′s user-generated content, ranks highly in major search engines, as such; this could serve as means of disseminating reliable health information to patients.

  12. MOrtality and infectious complications of therapeutic EndoVAscular interventional radiology: a systematic and meta-analysis protocol.

    Mellouk Aid, Kaoutar; Tchala Vignon Zomahoun, Hervé; Soulaymani, Abdelmajid; Lebascle, Karin; Silvera, Stephane; Astagneau, Pascal; Misset, Benoit


    Endovascular interventional radiology (EIR) is an increasingly popular, mini invasive treatment option for patient with symptomatic vascular disease. The EIR practiced by qualified hands is an effective, well-tolerated procedure that offers relief of patient's symptoms with a low risk of complications. During acute post procedural period, immediate complications may relate to vascular access, restenosis, thromboembolic events, uterine ischemia, infection, necrosis, sepsis, ICU stay, surgical recovery, pain management, treatment failure, and death. Moreover, additional non-life-threatening complications exist, but they are not well described and represent disparate information. A range of databases will be screened consulted to identify the relevant studies: PubMed, EMBASE, The Cochrane Library, NosoBase, and Google Scholar (to identify articles not yet indexed). Scientist librarian used Medical Subject Headings (MeSH) and free terms to construct the search strategy in PubMed. This search strategy will be adapted in other databases. Two coauthors will independently select the relevant studies, extract the relevant data, and assess the risk of bias in the included studies. Any disagreements between the two authors will be solved by a third author. This systematic review will provide a synthesis of EIR complications. The spotlighted results will be analyzed in order to provide a state-of-knowledge synopsis of the current evidence base in relation to the epidemiology of the infectious complications after EIR. In the event of conclusive results, our findings will serve as a reference background to assess guidelines on reality of the problem of the infections linked to endovascular interventional radiology and to formulate of assumptions and propose preventive measures, based on the results of our investigations. These propositions will aim to reduce the risk and/or the severity of these complications in the concerned population in favor a positive medical economics

  13. Optimization approach within an interventional radiology department; Demarche d'optimisation au sein d'un service de radiologie interventionnelle

    Mozziconacci, J.G.; Brot, A.M. [Centre Hospitalier de Bourges, PCR, 18 (France); Jarrige, V. [Centre Hospitalier de Bourges, PSRPM, 18 (France)


    The authors present an approach aimed at optimizing working conditions and radioprotection for the different actors in interventional radiology. This approach comprises a monitoring of personnel dosimetry, a workstation analysis with risk assessment, and the taking into account of patient dosimetry. For each of these aspects, the authors discuss procedures and available devices (dosemeters and other detection or dose measurement equipment)

  14. Monte Carlo simulations of scattered radiation fields in interventional radiology; Simulacion Monte Carlo de campos de radiacion dispersa en radiologia intervencionista

    Duch, M. A.; Zaragoza, F. J.; Sempau, J.; Ginjaume, M.; Vano, E.; Sanchez, R.; Fernandez, J. M.


    The study shows that the MC simulation is a useful tool to facilitate the assessment of the spatial distribution of the dose due to the radiation scattered in interventional radiology procedures, as well as to determine the influence of various operational parameters in the same , avoiding experimental measures that require much time of use the Cath Labs. (Author)

  15. Role of Interventional Radiology in the Emergent Management of Acute Upper Gastrointestinal Bleeding

    Navuluri, Rakesh; Patel, Jay; Kang, Lisa


    Approximately 100,000 cases of upper gastrointestinal bleeding (UGIB) require inpatient admission annually in the United States. When medical management and endoscopic therapy are inadequate, endovascular intervention can be lifesaving. These emergent situations highlight the importance of immediate competence of the interventional radiologist in the preangiographic evaluation as well as the endovascular treatment of UGIB. We describe a case of UGIB managed with endovascular embolization and detail the angiographic techniques used. The case description is followed by a detailed discussion of the treatment approach to UGIB, with attention to both nonvariceal and variceal algorithms. PMID:23997408

  16. Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom

    Wiersema, Arno M., E-mail: [Westfriesgasthuis, Hoorn, Department of Surgery (Netherlands); Vos, Jan-Albert, E-mail: [St Antonius Hospital, Nieuwegein, Department of Radiology, Division of Interventional Radiology (Netherlands); Bruijninckx, Cornelis M. A., E-mail: [Equipe Zorg Bedrijven, Rotterdam, Department of Surgery (Netherlands); Delden, Otto M. van, E-mail: [Academic Medical Centre, University of Amsterdam, Department of Radiology, Division of Interventional Radiology (Netherlands); Reijnen, Michel M. P. J., E-mail: [Rijnstate Hospital, Arnhem, Department of Surgery (Netherlands); Vahl, Anco, E-mail: [Onze Lieve Vrouwe Gasthuis, Amsterdam, Department of Surgery (Netherlands); Zeebregts, Clark J., E-mail: [University of Groningen, Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen (Netherlands); Moll, Frans L., E-mail: [University of Utrecht, Department of Surgery, Division of Vascular Surgery, University Medical Centre Utrecht (Netherlands)


    Purpose: The use of prophylactic antithrombotic drugs to prevent arterial thrombosis during the periprocedural period during (percutaneous) peripheral arterial interventions (PAIs) is still a matter of dispute, and clear evidence-based guidelines are lacking. To create those guidelines, a study group was formed in the Netherlands in cooperation with the Dutch Society of Vascular Surgery and the Society of Interventional Radiology. The study group is called 'Consensus on Arterial PeriProcedural Anticoagulation (CAPPA).' Materials and Methods: The CAPPA study group devised and distributed a comprehensive questionnaire amongst Dutch interventional radiologists (IRs). Results: One hundred forty-two IRs responded (68 %) to the questionnaire. Almost no IR stopped acetyl salicylic acid before interventions, and 40 % stopped clopidogrel before PAI but not before carotid artery stenting (CAS). A flushing solution on the sideport of the sheath was used routinely by 30 % of IRs in PAI and by 50 % of IRs during CAS. A minority of IRs used a heparinised flushing solution (28 %). Unfractionated heparin was used by 95 % of IRs as bolus; 5000 IU was the most used dosage. Timing of administration varied widely. A majority of IRs (75 %) repeated heparin administration after 1 h. Conclusion: A substantial variety exists amongst IRs in the Netherlands regarding the use of prophylactic periprocedural antithrombotic drugs to prevent arterial thrombosis during PAI. When compared with varying results regarding the use of heparin in the United Kingdom, the variety in the Netherlands showed a different pattern. The proven variety in these countries, and also between these countries, emphasises the need for authoritative studies to develop evidence-based practical guidelines.

  17. EU-CIS joint study project 2. Intervention criteria in CIS, risk assessments and non-radiological factors in decision-making

    Hedemann Jensen, P. [Risoe National Lab., Roskilde (Denmark); Demin, V.F. [Russian Reserch Centre `Kurchatov Inst.`, Moscow (Russian Federation); Konstantinov, Y.O. [Research Inst. of Radiation Hygiene, St. Petersburg (Russian Federation); Likhtarev, I.A. [Ukrainian Scientific Centre for Radiation Medicine, Kiev (Ukraine); Rolevich, I.V. [Chernobyl State Commiettee, Minsk (Belarus); Schneider, T. [Centre d`etudes sur l`Evaluation de la Protection dans le domaine Nucleaire, CEPN, Paris (France)


    An extensive radiation risk estimation methodology has recently been developed in Russia and used for estimates of risk in exposed populations in the republics of Russia, Belarus and Ukraine. Results based on demographic data for the three republics are presented and compared with risk estimates from the EU risk model ASQRAD. The intervention criteria in the CIS republics have been evolving since the Chernobyl accident. The development of criteria in each of the three republics has been analysed and the CIS-Criteria have been compared to international guidance on intervention. After a nuclear or radiological emergency both radiological and non-radiological protection factors will influence the level of protective actions being introduced. The role of non-radiological protection factors in the overall optimization of health protection is addressed. It is argued that optimization of the overall health protection is not a question of developing radiation radiation protection philosophy to fully include socio-psychological factors. It is rather a question of including these factors - in parallel with the radiological protection factors - in cooperation between radiation protection experts and psychological specialists under the responsibility of the decision maker. (au) 19 tabs., 10 ills., 45 refs.

  18. Effective dose estimates for cone beam computed tomography in interventional radiology

    Kwok, Y.M.; Irani, F.G.; Tay, K.H.; Yang, C.C.; Padre, C.G.; Tan, B.S. [Singapore General Hospital, Department of Diagnostic Radiology, Singapore (Singapore)


    To compare radiation doses in cone beam computed tomography (CBCT) with those of multi-detector computed tomography (MDCT) using manufacturers' standard protocols. Dose-levels in head and abdominal imaging were evaluated using a dosimetric phantom. Effective dose estimates were performed by placing thermoluminescent dosimeters in the phantom. Selected protocols for two CBCT systems and comparable protocols for one MDCT system were evaluated. Organ doses were measured and effective doses derived by applying the International Commission on Radiological Protection 2007 tissue weighting factors. Effective doses estimated for the head protocol were 4.4 and 5.4 mSv for the two CBCT systems respectively and 4.3 mSv for MDCT. Eye doses for one CBCT system and MDCT were comparable (173.6 and 148.4 mGy respectively) but significantly higher compared with the second CBCT (44.6 mGy). Two abdominal protocols were evaluated for each system; the effective doses estimated were 15.0 and 18.6 mSv, 25.4 and 37.0 mSv, and 9.8 and 13.5 mSv, respectively, for each of the CBCT and MDCT systems. The study demonstrated comparable dose-levels for CBCT and MDCT systems in head studies, but higher dose levels for CBCT in abdominal studies. There was a significant difference in eye doses observed between the CBCT systems. (orig.)

  19. The role of interventional radiology in the management of deep venous thrombosis: advanced therapy.

    O'Sullivan, Gerard J


    Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This "usual treatment" is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical thrombectomy was once the only option in severe cases in which limbs were threatened, but thrombus removal is no longer restricted to emergency cases. Interventional radiologists are now using advanced endovascular techniques to achieve thrombus removal in a minimally invasive manner in a very short treatment time, thereby quickly restoring patency, relieving acute symptoms, and potentially limiting the subsequent development of postthrombotic syndrome when followed with anticoagulation and compression regimens. This article provides an overview of the interventions available for treating DVT. One of the newer "single-session" techniques is isolated pharmacomechanical thrombolysis, which is described here in detail with supporting cases.

  20. Clinical application on CT guiding interventional radiology technology%CT导引介人技术的临床应用

    何建华; 彭述文; 米霞


    Objective The Computer Tomography (CT) guiding interventional radiology technology already became an extremely adequate technology in the large-scale general hospital, which was brought in since 2008-2009 in our hospital, and it has carried out dozens of cases, we improved it into a new kind of technology suitable for our hospital after summing up and studying it. This technology should be extended for popular use among the primary hospitals. Methods TOSHIBA Activion 16 screw CT scanner was used with the puncture needle Cook19G.After skin lung puncture biopsy 12 cases, after skin kidney puncture 25 cases, after skin liver puncture 7 cases. Results Among 12 cases of lung puncture biopsy, 9 cases are periphery the lung cancer, 2 cases are the pulmonary tuberculoses, 1 cases is pneumonia change in sexuality. 32 cases livers, the kidney puncture biopsy is a cyst, after extracts the pouch fluid to involve the hardened treatment, biggest cyst 11 cm, smallest cyst approximately 6cm, the short-term reexamination cyst obviously reduces approximately, after half year of reexaminations, the cyst disappeared basically or completely. No serious complication occurred. Conclusion The CT guiding interventional radiology technology belongs to the interventional radiology technology category, its application scope is broad, involving the whole body various systems, becoming one of the important methods of clinical diagnosis and treatment domain with characteristics of high security, minimally invasive surgery and less complication, etc. It' s worth to be extended popularly in primary hospitals.%目的 归纳、总结并不断改进我院CT导引介入技术,形成适应本院的一种新技术.方法 使用TOSHIBA Activion 16螺旋CT扫描机.穿刺针为Cook19G.经皮肺穿刺活检12例,经皮肾穿刺25例,经皮肝穿刺7例.结果 12例肺穿刺活检,9例为周围型肺癌,2例为肺结核,1例为肺炎性变.32例肝、肾穿刺活检为囊肿,抽取囊液后介入

  1. Calculation of conversion factors for effective dose for various interventional radiology procedures

    Compagnone, Gaetano; Giampalma, Emanuela; Domenichelli, Sara; Renzulli, Matteo; Golfieri, Rita [Medical Physics Department, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna (Italy); Radiology Department, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna (Italy); Medical Physics Department, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna (Italy); Radiology Department, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna (Italy)


    Purpose: To provide dose-area-product (DAP) to effective dose (E) conversion factors for complete interventional procedures, based on in-the-field clinical measurements of DAP values and using tabulated E/DAP conversion factors for single projections available from the literature. Methods: Nine types of interventional procedures were performed on 84 patients with two angiographic systems. Different calibration curves (with and without patient table attenuation) were calculated for each DAP meter. Clinical and dosimetric parameters were recorded in-the-field for each projection and for all patients, and a conversion factor linking DAP and effective doses was derived for each complete procedure making use of published, Monte Carlo calculated conversion factors for single static projections. Results: Fluoroscopy time and DAP values for the lowest-dose procedure (biliary drainage) were approximately 3-fold and 13-fold lower, respectively, than those for the highest-dose examination (transjugular intrahepatic portosystemic shunt, TIPS). Median E/DAP conversion factors from 0.12 (abdominal percutaneous transluminal angioplasty) to 0.25 (Nephrostomy) mSvGy{sup -1} cm{sup -2} were obtained and good correlations between E and DAP were found for all procedures, with R{sup 2} coefficients ranging from 0.80 (abdominal angiography) to 0.99 (biliary stent insertion, Nephrostomy and TIPS). The DAP values obtained in this study showed general consistency with the values provided in the literature and median E values ranged from 4.0 mSv (biliary drainage) to 49.6 mSv (TIPS). Conclusions: Values of E/DAP conversion factors were derived for each procedure from a comprehensive analysis of projection and dosimetric data: they could provide a good evaluation for the stochastic effects. These results can be obtained by means of a close cooperation between different interventional professionals involved in patient care and dose optimization.

  2. Pictorial essay: Interventional radiology in the management of hemodialysis vascular access - A single-center experience

    Suraj Mammen


    Full Text Available Chronic kidney disease (CKD is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5, who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution.

  3. Management of patient and staff radiation dose in interventional radiology: current concepts.

    Bartal, Gabriel; Vano, Eliseo; Paulo, Graciano; Miller, Donald L


    The increasing complexity and numbers of interventional fluoroscopy procedures have led to increasing patient doses of radiation and to increasing concern over staff doses. Hybrid rooms incorporate multiple imaging modalities and are used by multidisciplinary teams in interventional fluoroscopy suites and operating theaters. These rooms present additional radiation protection challenges. The new low annual exposure limit for the lens of the eye also requires specific measures to prevent cataracts in operators. The traditional attitude of radiation protection must be changed to one of proactive management of radiation dose and image quality. Incorporation of a comprehensive dose management program into the departmental quality assurance program is now essential. Physicians, radiographers, and medical physicists play an essential role in the safe use of fluoroscopy in medical practice. Efficient use of all imaging modalities (e.g., fluoroscopy, digital subtraction angiography, cone-beam CT) requires knowledge of the effects of different equipment settings on patient and staff doses as well as the skill and competence to optimize these settings for each procedure and patient. Updates and recommendations on radiation protection and dose management programs, including aspects of education and training, are presented.

  4. 介入放射线诊疗设备应用及不良事件检测%Interventional radiological equipment application and adverse event detection

    芦静; 尹今扬; 胡良运


    目的:介绍介入放射学的设备、材料及其在临床中的应用,更好地掌握介入放射治疗的方法,减少介入放射治疗在临床应用中不良事件的发生。方法:介绍各种影像设备DSA、CT、MRI等的性能及使用方法以及介入放射线设备防护知识,分析产生介入治疗不良事件的原因,给出避免介入治疗不良事件的方案。结果:介入放射医生在介入放射线诊疗中增强了放射线设备防护意识,减少了不良事件的发生。结论:介入放射治疗应用中存在不良事件发生的潜在因素,会损害医生与患者的身体健康以及导致临床诊断事故,为此应做好防犯工作,使介入放射治疗工作得以顺利开展。%Objective:Application of interventional radiology equipment, through the introduction and materials in clinic,to better grasp the method of interventional radiotherapy and interventional radiology treatment,reduce adverse events in clinical application. Methods: Various imaging devices such as DSA, CT, MRI etc, imaging within the body structure, the size of the lesion and its relationship with the surrounding tissue by these devices can be very good;and the development of medical devices that need not operation, can accurately reach the lesion site for treatment. Results:At present, the interventional radiology doctors has to catheters or devices"interventional"vascular branches, the digestive tract and other specific parts, used in the treatment of disease. Conclusion:Interventional radiology is an emerging treatment method as the development of modern science and technology. Interventional also has some adverse events radiotherapy applications, will damage the doctor and the patient's health and the impact of clinical diagnosis and other accidents, so do the crime prevention work is very important, so as to carry out the interventional radiology treatment.

  5. WE-EF-BRD-04: MR in the OR: The Growth and Applications of MRI for Interventional Radiology and Surgery

    Fahrig, R. [Stanford University (United States)


    MRI-guided treatment is a growing area of medicine, particularly in radiotherapy and surgery. The exquisite soft tissue anatomic contrast offered by MRI, along with functional imaging, makes the use of MRI during therapeutic procedures very attractive. Challenging the utility of MRI in the therapy room are many issues including the physics of MRI and the impact on the environment and therapeutic instruments, the impact of the room and instruments on the MRI; safety, space, design and cost. In this session, the applications and challenges of MRI-guided treatment will be described. The session format is: Past, present and future: MRI-guided radiotherapy from 2005 to 2025: Jan Lagendijk Battling Maxwell’s equations: Physics challenges and solutions for hybrid MRI systems: Paul Keall I want it now!: Advances in MRI acquisition, reconstruction and the use of priors to enable fast anatomic and physiologic imaging to inform guidance and adaptation decisions: Yanle Hu MR in the OR: The growth and applications of MRI for interventional radiology and surgery: Rebecca Fahrig Learning Objectives: To understand the history and trajectory of MRI-guided radiotherapy To understand the challenges of integrating MR imaging systems with linear accelerators To understand the latest in fast MRI methods to enable the visualisation of anatomy and physiology on radiotherapy treatment timescales To understand the growing role and challenges of MRI for image-guided surgical procedures My disclosures are publicly available and updated at:

  6. Hospital organization and importance of an interventional radiology inpatient admitting service: Italian single-center 3-year experience.

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore


    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of 1,009,095.35 euros. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  7. Changes in Occupational Radiation Exposures after Incorporation of a Real-time Dosimetry System in the Interventional Radiology Suite.

    Poudel, Sashi; Weir, Lori; Dowling, Dawn; Medich, David C


    A statistical pilot study was retrospectively performed to analyze potential changes in occupational radiation exposures to Interventional Radiology (IR) staff at Lawrence General Hospital after implementation of the i2 Active Radiation Dosimetry System (Unfors RaySafe Inc, 6045 Cochran Road Cleveland, OH 44139-3302). In this study, the monthly OSL dosimetry records obtained during the eight-month period prior to i2 implementation were normalized to the number of procedures performed during each month and statistically compared to the normalized dosimetry records obtained for the 8-mo period after i2 implementation. The resulting statistics included calculation of the mean and standard deviation of the dose equivalences per procedure and included appropriate hypothesis tests to assess for statistically valid differences between the pre and post i2 study periods. Hypothesis testing was performed on three groups of staff present during an IR procedure: The first group included all members of the IR staff, the second group consisted of the IR radiologists, and the third group consisted of the IR technician staff. After implementing the i2 active dosimetry system, participating members of the Lawrence General IR staff had a reduction in the average dose equivalence per procedure of 43.1% ± 16.7% (p = 0.04). Similarly, Lawrence General IR radiologists had a 65.8% ± 33.6% (p=0.01) reduction while the technologists had a 45.0% ± 14.4% (p=0.03) reduction.

  8. Coagulopathy and hemostatic monitoring in cardiac surgery

    Johansson, Pär I; Sølbeck, Sacha; Genet, Gustav


    Cardiac surgery with cardiopulmonary bypass (CPB) causes severe derangements in the hemostatic system, which in turn puts the patient at risks of microvascular bleeding. Excessive transfusion and surgical re-exploration after cardiac surgery are potentially associated with a number of adverse...

  9. Cardiovascular and Interventional Radiological Society of Europe Guidelines on Endovascular Treatment in Aortoiliac Arterial Disease

    Rossi, Michele, E-mail: [Sant’Andrea University Hospital, Interventional Radiology Unit (Italy); Iezzi, Roberto, E-mail: [“Sacro Cuore” Catholic University, Radiology Department (Italy)


    PurposeThese guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions.MethodsAny recommendation contained in the text comes from the highest level and extension of literature review available to date.ResultsThe success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature. Most of the complications can be managed by means of percutaneous techniques.ConclusionThe design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction.

  10. Establishment of an inferior vena cava filter database and interventional radiology led follow-up - retrieval rates and patients lost to follow-up.

    Klinken, Sven; Humphries, Charlotte; Ferguson, John


    To evaluate the rates of inferior vena cava (IVC) filter retrieval and the number of patient's lost to follow-up, before and after the establishment of an IVC filter database and interventional radiology (inserting physician) led follow-up. On the 1st of June 2012, an electronic interventional radiology database was established at our Institution. In addition, the interventional radiology team took responsibility for follow-up of IVC filters. Data were prospectively collected from the database for all patients who had an IVC filter inserted between the 1st June 2012 and the 31st May 2014. Data on patients who had an IVC filter inserted between the 1st of June 2009 to the 31st of May 2012 were retrospectively reviewed. Patient demographics, insertion indications, filter types, retrieval status, documented retrieval decisions, time in situ, trackable events and complications were obtained in the pre-database (n = 136) and post-database (n = 118) cohorts. Attempted IVC filter retrieval rates were improved from 52.9% to 72.9% (P = 0.001) following the establishment of the database. The number of patients with no documented decision (lost to follow-up) regarding their IVC filter reduced from 31 of 136 (23%) to 0 of 118 patients (P = database group (113 as compared to 137 days, P = 0.129). Following the establishment of an IVC filter database and interventional radiology led follow-up, we demonstrate a significant improvement in the attempted retrieval rates of IVC filters and the number of patient's lost to follow-up. © 2017 The Royal Australian and New Zealand College of Radiologists.

  11. Pilot study of the dose in crystalline lens in the interventional radiology practice; Estudio piloto de la dosis en cristalino en la practica de radiologia intervencionista

    Castro, A.; Martinez, A.; Fernandez, A.; Molina, D. [Centro de Proteccion e Higiene de las Radiaciones, Carretera de la Cantera, Victoria II, Km. 21.5 Guanabacoa, La Habana (Cuba); Sanchez, L.; Diaz, A., E-mail: [Hospital Clinico Quirurgico Hermanos Ameijeiras, San Lazaro 701, Centro Habana, La Habana (Cuba)


    The interventional radiology involves considerable exposure levels for the occupationally exposed personnel (OEP). The doses can encompass a wide range of values in dependence of the function that develops the personnel and the complexity of each procedure. In organs like the crystalline lens and skin values can be reached that imply the appearance of deterministic effects if is not fulfilled the appropriate measures of radiological protection. This has been demonstrated through multiple studies, among those that the retrospective study of damages in the crystalline lens and dose has been one of those most commented, known as RELID. The objective of that study was to examine the opacity prevalence in the crystalline lens in workers linked to the interventional cardiology and to correlate it with the occupational exposition. The obtained results contributed to that the ICRP recommend a new limit value of equivalent dose for crystalline lens of 20 mSv in one year. With the objective of analyzing the operational implications, in the radiological surveillance programs that they could originate with the new recommendations was developed a pilot study to evaluate the dose in crystalline lens in the OEP linked to the interventional radiology in a Cuban hospital. For this, an anthropomorphic mannequin RANDO-ALDERSON was used on which thermoluminescent dosimeters were placed below and above of the leaded apron and in different positions at level of the crystalline lens: above, below and to the sides of the leaded lenses that the personnel uses routinely. The mannequin was located on the same positions that occupy the main specialist that execute the procedure, as well as of the nurse to assist him. The measurements were made simulating the more representative procedures about complexity, duration time and exposure rate. The used dosimeters were RADOS model for whole body composed of two thermoluminescent detectors Gr-200 (LiF: Mg, Cu, P) to evaluate personal equivalent dose

  12. Radiological-guided liver-port implantation: evaluation, technical approach, interventional procedure and follow up; Radiologisch-interventionelle Leberportanlage: Evaluierung, Zugangswege, Intervention und Nachkontrolle

    Puls, R.; Stroszczynski, C. [Campus Virchow-Klinikum, Berlin (Germany). Klinik fuer Strahlenheilkunde; Abt. Roentgendiag., Robert-Roessle-Klinik, Campus Berlin-Buch (Germany); Hildebrandt, B.; Riess, H. [Med. Klinik Haematologie/Onkologie, Campus Virchow-Klinikum (Germany); Amthauer, H.; Podrabsky, P.; Hidajat, N. [Campus Virchow-Klinikum, Berlin (Germany). Klinik fuer Strahlenheilkunde; Schlag, P. [Klinik fuer Chirurgie/Onkologische Chirurgie, Robert-Roessle-Klinik, Campus Berlin-Buch (Germany); Humboldt-Universitaet, Berlin (Germany). Universitaetsklinikum Charite; Hosten, N. [Inst. fuer Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt-Univ. Greifswald (Germany)


    Purpose: Description of evaluation, technical approach, interventional procedure and follow up of radiological-guided liver-port implantation. Method: Percutaneous implantation of a liver-port system was performed in twelve patients through a transfemoral approach and in one patient via the superficial epigastric artery after surgical exploration. In four patients we used port systems which are accessible via ventral puncture. Strecker-port systems were implanted in the remaining nine patients. Results: The liver-port implantation was technically successful in all cases. No dislocation of the distal catheter tip, no thrombosis of the hepatic or splenic artery, no leakage near connections of the catheters or connections of catheter and port system and no thrombosis of the femoral arteries were observed. Correction of a kink in the catheter was performed in one patient. Another patient showed prolonged healing of the subcutaneous pocket. Conclusions: Interventional liver-port implantation is a safe procedure and leads to good clinical results. From the view of the radiologist the Strecker-system shows a good performance. The approach via the superficial epigastric artery demands excellent interdisciplinary cooperation. (orig.) [German] Zielstellung: Beschreibung der Evaluierung, Zugangswege, Intervention und Nachkontrolle bei der radiologisch-interventionellen Leberportanlage. Methode: Fuer die perkutane Implantation des Leberports wurden bei zwoelf Patienten die A. femoralis communis und bei einem Patienten die A. epigastrica superficialis nach chirurgischer Exploration als Zugangsweg gewaehlt. Bei vier Patienten wurde ein ventral zu punktierendes herkoemmliches Portkammersystem verwendet. Die uebrigen neun Patienten erhielten ein Strecker-Portsystem. Ergebnisse: Die Portanlage konnte bei allen Patienten technisch erfolgreich durchgefuehrt werden. Waehrend der Nachkontrollen wurden keine Dislokation der distalen Katheterspitze oder Thrombosierung der A. hepatica

  13. Radiological protection in the interventional techniques: experience in the Pain Clinic of the CIMEQ; Proteccion radiologica en las tecnicas intervencionistas: experiencia en la Clinica del Dolor del CIMEQ

    Guerrero C, M. C.; Benitez N, P. P.; Gonzalez G, Y. [Centro de Investigaciones Medico Quirurgicas, Av. 216 Esq. 11B, Playa Siboney, 6096 La Habana (Cuba); Martinez G, A.; Gonzalez R, N. [Centro de Proteccion e Higiene de las Radiaciones, Carretera de la Cantera, Victoria II, Km. 21.5 Guanabacoa, La Habana (Cuba); Sanchez Z, L. R., E-mail: [Hospital C. Q. Hermanos Ameijeiras, San Lazaro 701, Centro Habana, La Habana (Cuba)


    The Pain Clinic of the CIMEQ offers treatment to patients with different pathologies, using interventional techniques as the radiology like visual guide to reach the target structure and to apply the election technique. The personnel that carry out these procedures are inserted in the program of radiological surveillance of the institution, reason for which a radiological event could be detected where the main physician responsible of the service was implied. In this work the results of an investigation are presented realized with the objective of to know the causes of the event and to determine the necessary measures to avoid that this repeats again. The investigation was oriented to three fundamental aspects: medical exam of the affected worker; evaluation of the operational procedures from the radiological protection view point; and dosimetric measurements simulating the real conditions of work for which were used ionization chamber, radiometer and PMMA mannequin. As a result of the medical exam was detected that the main physician of the service did not use during the execution of all the procedures the extremities dosimetry and that he presented a radio induced erythema in the right hand, reason for which he was separated of the activity with ionizing radiations, until the conclusion of the investigation. With relationship to the evaluation of the operational procedures from the radiological protection view point, was verified that the medical physician not carried out any collimation of the beam and he was located in the positions where the dose rate reached the maximum values, frequently introducing the hands in the direct beam; that which implied an overexposure of the superior extremities and a not optimized exposure for whole body. This result was proven with the realized experimental measurements, which gave dose estimated values in extremities of the order of the deterministic effects. The investigation facilitated to introduce modifications in the

  14. Radiologic quality and safety: mapping value into radiology.

    Swensen, Stephen J; Johnson, C Daniel


    The authors have created a radiology quality map to help understand the opportunities for improvement in the radiologic safety, reliability, quality, and appropriateness of examinations and interventions. It entails 9 steps with dozens of specific opportunities for improving care to patients. The radiology profession has an obligation to robustly document and improve quality and safety in its practice.

  15. The ORAMED European project: optimization of the use of operational dosimeters in interventional radiology; Projet europeen oramed: optimisation de l'utilisation des dosimetres operationnels en radiologie interventionnelle

    Clairand, I.; Debroas, J.; Donadille, L.; Itie, C. [Institut de Radioprotection et de Surete Nucleaire, 92 - Fontenay aux Roses (France); Bordy, J.M.; Daures, J.; Denoziere, M. [CEA Saclay, LIST, Laboratoire National Henri Becquerel (LNE-LNHB), 91 - Gif-sur-Yvette (France); Ginjaume, M. [Institute of Energy Technology, Universitat Politecnica de Catalunya (UPC) (Spain); Koukorava, C. [Greek Atomic Energy Commission (GAEC) (Greece); Krim, S.; Lebacq, A.L.; Struelens, L.; Vanhavere, F. [Belgian Nuclear Research Centre (SCK.CEN) (Belgium); Martin, P. [MGP Intruments (MGPi) (France); Sans-Merce, M.; Tosic, M. [Institut Universitaire de Radiophysique Appliquee (IRA) (Switzerland)


    Within the frame of the ORAMED European project which concerns personnel radioprotection in the medical sector, the authors, members of a work group within this project, briefly report the study of the behaviour of some operational dosemeters which have been selected for their potential usability in interventional radiology. They indicate the required performance, evoke the performed tests, and discuss the results which revealed the limits of these dosimeters when used in interventional radiology

  16. Evaluation of hydroxyapatite-putty as a hemostatic agent

    Momota, Y.; Miyamoto, Y.; Takechi, M.; Yuasa, T.; Toh, T.; Nagayama, M. [Tokushima Univ. (Japan). First Dept. of Oral and Maxillofacial Surgery; Ishikawa, K.; Suzuki, K. [Okayama Univ. Dental School (Japan). Dept. of Biomaterials


    Although bone wax is often used as a hemostatic agent for bone in surgery, some problems in biocompatibility have been pointed out. Therefore, we have evaluated hydroxyapatite-putty (HAP-putty) as a hemostatic agent for bone. Adhesive strength of HAP-putty to bone increased with the amount of sodium alginate, reaching maximum value in case of containing 8% sodium alginate. An actual hemostatic ability of HAP-putty was evaluated using rabbits. Bleeding from bone was arrested within 3 minutes. Thus, HAP-putty showed excellent hemostatic ability. Soft tissue response to HAP-putty was evaluated in rabbit subcutaneous tissue. Histological observation revealed slight inflammatory response around HAP-putty. HAP-putty partially transformed to HAP 24 hours after the implantation. In conclusion, HAP-putty could be a useful hemostatic agent for bone due to its good hemostatic ability and excellent biocompatibility. (orig.)

  17. Paediatric interventional radiology


    Jun 29, 2016 ... that most appropriately addresses their clinical needs.2. Biopsy ... occasionally required, such as in cases of rapidly involuting ... FIGURE 1: A 17-year-old male status post–bone marrow transplant requiring central intravenous ...

  18. Bone healing after median sternotomy: a comparison of two hemostatic devices.

    Vestergaard, Rikke F; Jensen, Henrik; Vind-Kezunovic, Stefan; Jakobsen, Thomas; Søballe, Kjeld; Hasenkam, John M


    Bone wax is traditionally used as part of surgical procedures to prevent bleeding from exposed spongy bone. It is an effective hemostatic device which creates a physical barrier. Unfortunately it interferes with subsequent bone healing and increases the risk of infection in experimental studies. Recently, a water-soluble, synthetic, hemostatic compound (Ostene®) was introduced to serve the same purpose as bone wax without hampering bone healing. This study aims to compare sternal healing after application of either bone wax or Ostene®. Twenty-four pigs were randomized into one of three treatment groups: Ostene®, bone wax or no hemostatic treatment (control). Each animal was subjected to midline sternotomy. Either Ostene® or bone wax was applied to the spongy bone surfaces until local hemostasis was ensured. The control group received no hemostatic treatment. The wound was left open for 60 min before closing to simulate conditions alike those of cardiac surgery. All sterni were harvested 6 weeks after intervention.Bone density and the area of the bone defect were determined with peripheral quantitative CT-scanning; bone healing was displayed with plain X-ray and chronic inflammation was histologically assessed. Both CT-scanning and plain X-ray disclosed that bone healing was significantly impaired in the bone wax group (p wax inhibits bone healing and induces chronic inflammation in a porcine model. Ostene® treated animals displayed bone healing characteristics and inflammatory reactions similar to those of the control group without application of a hemostatic agent.

  19. Percutaneous arteriovenous shunting in patients with severe COPD. A new interventional radiological treatment; Perkutane arteriovenoese Shuntanlage bei Patienten mit schwerer COPD. Eine neue interventionelle radiologische Technik

    Schlosser, Thomas; Forsting, M. [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie; Burbelko, M. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Ulrich, M. [Parkkrankenhaus Leipzig (Germany). Klinik fuer Innere Medizin/Angiologie/Kardiologie; Ludwig, F.; Reutiman, T. [ROX Medical, San Clemente, CA (United States); Antoch, G. [Universitaetsklinikum Duesseldorf (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Adamus, R. [Klinikum Nuernberg Nord (Germany). Inst. fuer Radiologie


    Purpose: The aim of this study was to evaluate the technical feasibility and safety of a new interventional radiological technique to create a shunt percutanously between the external iliac vein and artery in patients with severe COPD. Materials and Methods: 40 patients were included in this multicenter trial. In 38 patients the artery was punctured from the vein using a novel crossing needle. A special delivery system was used to implant a novel nitinol device (ACS, ROX Medical) between the artery and the vein to maintain a 4 mm calibrated and structured fistula between the two vessels. Results: Shunt implantation was successful in 38 patients. The perfused arteriovenous shunts could be well documented in DSA and the diameter was measured between 3 and 4 mm in all cases. Peri-interventional non-flow-limiting dissection of the iliac artery occurred in one patient. Post-interventional venous bleeding in two patients was treated successfully by local compression. In one patient a peripheral artery thrombembolism was successfully treated by thrombolysis. Conclusion: The new interventional radiological technique to create an arteriovenous shunt in the iliac vessels presented in this study has proven to be feasible and safe. (orig.)

  20. The development of Operational Intervention Levels (OILs) for Soils - A decision support tool in nuclear and radiological emergency response

    Lee Zhi Yi, Amelia; Dercon, Gerd; Blackburn, Carl; Kheng, Heng Lee


    In the event of a large-scale nuclear accident, the swift implementation of response actions is imperative. For food and agriculture, it is important to restrict contaminated food from being produced or gathered, and to put in place systems to prevent contaminated produce from entering the food chain. Emergency tools and response protocols exist to assist food control and health authorities but they tend to focus on radioactivity concentrations in food products as a means of restricting the distribution and sale of contaminated produce. Few, if any, emergency tools or protocols focus on the food production environment, for example radioactivity concentrations in soils. Here we present the Operational Intervention Levels for Soils (OIL for Soils) concept, an optimization tool developed at the IAEA to facilitate agricultural decision making and to improve nuclear emergency preparedness and response capabilities. Effective intervention relies on the prompt availability of radioactivity concentration data and the ability to implement countermeasures. Sampling in food and agriculture can be demanding because it may involve large areas and many sample types. In addition, there are finite resources available in terms of manpower and laboratory support. Consequently, there is a risk that timely decision making will be hindered and food safety compromised due to time taken to sample and analyse produce. However, the OILs for Soils concept developed based on experience in Japan can help in this situation and greatly assist authorities responsible for agricultural production. OILs for Soils - pre-determined reference levels of air dose rates linked to radionuclide concentrations in soils - can be used to trigger response actions particularly important for agricultural and food protection. Key considerations in the development of the OILs for Soils are: (1) establishing a pragmatic sampling approach to prioritize and optimize available resources and data requirements for

  1. Analysis of dose to crystalline in Interventional radiology: a purpose of one case; Analisis de dosis a cristalino en Radiologia intervencionista: a proposito de un caso

    Carrera M, F.; Moreno R, F.; Velazquez M, F.; Manzano M, F.J.; Moreno S, T. [Hospital `Juan Ramon Jimenez` Ronda Norte s/n 21005. Huelva, Espana (Spain)


    The present work shows the dose values to crystalline for the personnel which works in interventional radiology procedures. It was took data of 436 studies with a total of 2,133.4 minutes in fluoroscopy and 19,563 images. It was showed dose values to crystalline in three situations: without blinding, with blinding of 0.25 and 0.50 mm Pb and by type of study: fluoroscopy, graphie and total. The dose means and ranges to patient for each of these studies also are detailed. (Author)

  2. Complement the hemostatic system: an intimate relationship.

    Weitz, Ilene Ceil


    The complement system is important part of our innate immune system and interacts directly with the hemostatic system. Disorders of complement activation or dysregulation resulting in excess complement generation, such as Paroxysmal Nocturnal Hemoglobinuria (PNH), atypical Hemolytic uremic Syndrome (aHUS) and antiphospholipid syndrome (APLS) have been associated with significant thrombophilia. Terminal Complement (C5b-9) deposition on endothelial and tumor cell membranes has also been reported in a variety of cancer. Recent developments in complement inhibition have given us new insights into the mechanism of thrombosis in these disorders.

  3. Platelet cytoskeleton and its hemostatic role.

    Cerecedo, Doris


    Upon vascular injury, platelets adhere to the exposed extracellular matrix, which triggers the platelet activation and aggregation to form a hemostatic plug to seal the wound. All of these events involve dramatic changes in shape because of the cytoskeleton reorganization. The versatility of the cytoskeleton's main elements depends on the biochemical nature of the elements, as well as on the associated proteins that confer multiple functions within the cell. The list of these associated proteins grows actively, increasing our knowledge concerning the complexity of platelet cytoskeleton machinery. The present review evidences the recently described platelet proteins that promote characteristic modifications in their cytoskeleton organization, with special focus on the dystrophin-glycoprotein complex.

  4. M{sup 2}IRAGE: Management of measurements during radiological interventions geographically assisted in the environment; M{sup 2}IRAGE management des mesures dans le cadre d'interventions radiologiques assistees geographiquement dans l'environnement

    Gerphagnon, O. [SDIS, Service NRBC, 91 - Evry (France); Roche, H.; Lelache, H.; Guelin, M.; Fauquant, J.M. [CEA Saclay, Service de Protection contre les Rayonnements - SPR, 91 - Gif-sur-Yvette (France); Kacenelen, Y. [SDIS, Service C and IG, 91 (France); Armand, Y. [SDIS, SPV Expert Risques Technologiques, 91 (France)


    This report presents the M{sup 2}IRAGE software, a data processing tool designed to share radioactivity measurements and to give a schematised view of a radiological situation and of its evolution, while respecting different legal frameworks, notably the obligation to produce a radiological measurement programme. After a simplified recall of the crisis management organisation, the authors describe the M{sup 2}IRAGE software and hardware architecture, the functions of its main modules (presentation of radioprotection information during field intervention, field mission management, data browsing, and data transmission to field teams). While giving some display examples, the authors describe how an event is managed and processed by this tool: event creation, measurement acquisition, aid to decision, team management. They report and discuss the results of a national exercise which took place in September 2009 in Saclay with a prototype version of M{sup 2}IRAGE

  5. S3 Guideline. Diagnosis and treatment of colorectal carcinoma. Relevance for radiologic imaging and interventions; Aktualisierte S3-Leitlinie zur Diagnostik und Therapie des kolorektalen Karzinoms. Bedeutung fuer die radiologische Diagnostik und Intervention

    Vogl, T.J.; Fischer, S. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Schmiegel, W.; Pox, C. [Bochum Univ. (Germany). Medizinische Universitaetsklinik; Pereira, P.L. [SLK Kliniken, Heilbronn (Germany). Klinik fuer Radiologie, Minimal-Invasive Therapien und Nuklearmedizin; Brambs, H.J. [Universitaetsklinikum Ulm (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Lux, P. [Universitaetsklinikum Erlangen (Germany). Chirurgische Klinik


    The new German S3 guideline 'Colorectal Carcinoma' was created as part of the German Guideline Program in Oncology of the Association of the Scientific Medical Societies in Germany, the German Cancer Society and the German Cancer Aid under the auspices of the German Society for Digestive and Metabolic Diseases and replaces the guideline from 2008. With its evidence-based treatment recommendations, the guideline contains numerous updates and detailed definitions regarding the diagnosis and treatment of colon and rectal cancer. In particular, consensus-based recommendations regarding early detection, preoperative diagnostic method selection, and the use of interventional radiological treatment methods are detailed. The guideline also includes quality indicators so that standardized quality assurance methods can be used to optimize patient-related processes. The present article discusses the significance of the current recommendations for radiological diagnosis and treatment and is intended to enhance the quality of patient information and care by increasing distribution. (orig.)

  6. A feasibility inquiry on the radiodermatitis secondary to an interventional radiology act;Une enquete de faisabilite sur les radiodermites secondaires a un geste de radiologie interventionnelle

    Roudier, C.; Pirard, Ph.; Donadieu, J. [Institut de veille sanitaire, Saint-Maurice (France)


    The radiodermatitis is a burning of skin tissue and subcutaneous tissue in relation with ionizing radiation. In the medical practice, outside radiotherapy excluded of our study, it is observed only with acts of interventional radiology. The consequences of a radiodermatitis can be aesthetic, with appearance of a scar or a definitive alopecia, functional with loss of substance needing sometimes a remedial surgical act and finally oncologic with a risk of localised skin cancer. A radiodermatitis can appear with a radiation dose of 2 grays and its intensity worsens with the dose. Since the late 1970's about 200 cases of radiodermatitis have been reported. the most of cases have been reported between 1993 and 2000 and less than ten cases have been reported since 2000, suggesting a possible reduction of incidence explainable by a concomitant improvement of technological quality of the equipment. In order to confirm this eventual trend az feasibility study has been organised and is reported in this article. Given the results, this complication is still existing. In spite of the small number of observed cases, it is to notice that every procedures of interventional radiology are concerned. The preliminary character of this study encourages the institute of Health surveillance to work on the elaboration of a program of radiodermatitis surveillance. It could be associated to actions of improvement of the prevention and follow-up of patients, of feedback, and making easy an optimization of the practices. (N.C.)

  7. [Controlling instruments in radiology].

    Maurer, M


    Due to the rising costs and competitive pressures radiological clinics and practices are now facing, controlling instruments are gaining importance in the optimization of structures and processes of the various diagnostic examinations and interventional procedures. It will be shown how the use of selected controlling instruments can secure and improve the performance of radiological facilities. A definition of the concept of controlling will be provided. It will be shown which controlling instruments can be applied in radiological departments and practices. As an example, two of the controlling instruments, material cost analysis and benchmarking, will be illustrated.

  8. Biocompatibility and Effectiveness Evaluation of a New Hemostatic Embolization Agent: Thrombin Loaded Alginate Calcium Microsphere

    Fengqi Xuan


    Full Text Available Background. Until now, there has been no ideal embolization agent for hemorrhage in interventional treatment. In this study, the thrombin was encapsulated in alginate calcium microsphere using electrostatic droplet technique to produce new embolization agent: thrombin loaded alginate calcium microspheres (TACMs. Objectives. The present work was to evaluate the biocompatibility and hemostatic efficiency of TACMs. Methods. Cell cytotoxicity, hemolysis, and superselective embolization of dog liver arteries were performed to investigate the biocompatibility of TACMs. To clarify the embolic effect of TACMs mixed thrombus in vivo, hepatic artery injury animal model of 6 beagles was established and transcatheter artery embolization for bleeding was performed. Results. Coculture with VECs revealed the noncytotoxicity of TACMs, and the hemolysis experiment was negligible. Moreover, the histological study of TACMs in liver blood vessel showed signs of a slight inflammatory reaction. The results of transcatheter application of TACMs mixed thrombus for bleeding showed that the blood flow was shut down completely after the TACMs mixed thrombus was delivered and the postprocedural survival rate of animal models at 12 weeks was 100%. Conclusions. With their good biocompatibility and superior hemostatic efficiency, TACMs might be a promising new hemostatic agent with a wide range of potential applications.

  9. Biocompatibility and Effectiveness Evaluation of a New Hemostatic Embolization Agent: Thrombin Loaded Alginate Calcium Microsphere

    Xuan, Fengqi; Rong, Jingjing; Liang, Ming; Zhang, Xuwen; Sun, Jingyang; Zhao, Lijun; Li, Yang; Liu, Dan; Li, Fei; Wang, Xiaozeng


    Background. Until now, there has been no ideal embolization agent for hemorrhage in interventional treatment. In this study, the thrombin was encapsulated in alginate calcium microsphere using electrostatic droplet technique to produce new embolization agent: thrombin loaded alginate calcium microspheres (TACMs). Objectives. The present work was to evaluate the biocompatibility and hemostatic efficiency of TACMs. Methods. Cell cytotoxicity, hemolysis, and superselective embolization of dog liver arteries were performed to investigate the biocompatibility of TACMs. To clarify the embolic effect of TACMs mixed thrombus in vivo, hepatic artery injury animal model of 6 beagles was established and transcatheter artery embolization for bleeding was performed. Results. Coculture with VECs revealed the noncytotoxicity of TACMs, and the hemolysis experiment was negligible. Moreover, the histological study of TACMs in liver blood vessel showed signs of a slight inflammatory reaction. The results of transcatheter application of TACMs mixed thrombus for bleeding showed that the blood flow was shut down completely after the TACMs mixed thrombus was delivered and the postprocedural survival rate of animal models at 12 weeks was 100%. Conclusions. With their good biocompatibility and superior hemostatic efficiency, TACMs might be a promising new hemostatic agent with a wide range of potential applications. PMID:28303245

  10. Hemostatic efficacy and safety of a novel mechnical compression device for femoral arteriotomy

    Hwangbo, Lee; Kwak, Min Kyu; Lee, Seung Chan; KIm, Chang Won [Dept. of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of)


    To evaluate the hemostatic efficacy and safety of a novel mechanical compression device for femoral arteriotomy. We identified 290 patients who underwent vascular intervention with a novel mechanical compression device applied for femoral arteriotomy hemostasis without additional manual compression or other closing devices from October 2013 to January 2014. Among them, 251 patients with complete medical records were enrolled in the study. The immediate technical success and the delayed (4 hour) complication-free hemostasis rates were evaluated. All available clinically relevant information, including major and minor complications, was gathered. The clinical factors associated with the development of complications were analyzed. The immediate and delayed complication-free hemostasis rates were 99.6% (250/251) and 94.0% (236/251). The femoral arteriotomy of one patient with immediate hemostatic failure was compressed manually. No major complications were observed among the immediately successful patients. Fifteen patients developed minor complications. When patients who developed complications were compared to those without complications, the complication group was younger, received a larger vascular sheath, and had a shorter device application time. This novel hemostatic compression device exhibited good hemostasis and low complication rates during femoral arteriotomy.

  11. Radiological English

    Ribes, R. [Hospital Reina Sofia, Cordoba (Spain). Servicio de Radiologia; Ros, P.R. [Harvard Medical School, Boston, MA (United States). Div. of Radiology


    The book is an introductory book to radiological English on the basis that there are a lot of radiologists, radiology residents, radiology nurses, radiology students, and radiographers worldwide whose English level is indeterminate because their reading skills are much higher than their fluency. It is intended to help those health care professionals who need English for their work but do not speak English on a day-to-day basis. (orig.)

  12. Development of a Method for Evaluating the Existing Patient Radiation Protection Protocols in Interventional Radiology Unit of University-Affiliated Hospitals in Isfahan

    Parvaneh Shokrani


    Full Text Available Since the late 1960s, the use of interventional procedures utilizing radiology in medicine has increased significantly and continues to grow. There are also possible longer-term effects for surviving patients-mainly induction of cancers. The International Commission on Radiological Protection considers that there is no dose below which there is zero risk and therefore, minimizing the risk by confining the irradiation field and constraining the dose is highly desirable. There are a lot of national and international organs that work regarding radiation protection. These organs suggest a lot of code for patient radiation protection based on research and evidence. Per-sonnel dose monitoring is performed by the radiation safety officer but radiation protection of the patient is the responsibility of the physician and medical physicist. The aim of this research was the evaluation of patient radiation protection protocols in university hospitals in the city of Isfahan with respect to international protocols."nThis investigation was done in two interventional radiology units of Isfahan university-affiliated hospitals. The following international protocols related to patient protection were used as the standard protocols AAPM Report NO. 70, ICRP Publication 85, and IAEA SAFETY GUIDE No. RS-G-1.5. The recommendations of these protocols were ranked and classified into 3 questionnaires. These questionnaires included recommendations about factors that affect the dose to patients, factors that affect staff doses, and procurement. These questionnaires were used to evaluate the patient radiation protection protocols currently used in Isfahan university hospitals against the above international protocols. In this investigation, we used letter 'A' and 'B' for description of the two hospitals. "nFor interventional radiology units the following agreements and disagreements were observed when the local protocols were compared to the international

  13. Relative frequencies of interventional radiology procedures. Type of procedure, modality, dose, patient's gender and age. Final report; Erfassung der relativen Haeufigkeiten verschiedener Massnahmen in der interventionellen Radiologie. Art der Untersuchung, Modalitaet, Dosis, Geschlecht und Alter der Patienten fuer den stationaeren und ambulanten Bereich. Abschlussbericht

    Heuser, Lothar; Bode-Schnurbus, Lucas [Bochum Univ. Klinikum (Germany). Inst. fuer Diagnostische Radiologie, Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin


    The assessment of the relative frequencies of interventional radiology procedures in Germany includes the following chapters: (1) Introduction and scope. (2) Radiological interventions: diagnostics, pain therapy, liver and kidneys, vascular re-opening and extending measures, devascularization, special neuroradiologic therapies. (3) History of AGIR (workgroup vascular diseases and interventional radiology). (4) Software development. (5) Data pool. (6) Categorization of institutes. (7) Statistics: patients data; radiation protection relevant data; CT guided intervention, MR-guided interventions; ultrasound-guided interventions; process quality; retrospective analysis (2000-2003).

  14. Radiology fundamentals

    Singh, Harjit


    ""Radiology Fundamentals"" is a concise introduction to the dynamic field of radiology for medical students, non-radiology house staff, physician assistants, nurse practitioners, radiology assistants, and other allied health professionals. The goal of the book is to provide readers with general examples and brief discussions of basic radiographic principles and to serve as a curriculum guide, supplementing a radiology education and providing a solid foundation for further learning. Introductory chapters provide readers with the fundamental scientific concepts underlying the medical use of imag

  15. Evaluation of the hemostatic and coagulation effects of AUTO CUT and DRY CUT using a computer-controlled cutting system.

    Szyrach, Mara N I; Tolba, Rene H; Voigtländer, Matthias; Neugebauer, Alexander; Enderle, Markus D


    To evaluate a newly developed computer-controlled cutting system for the generation of standardized resections and to systematically compare the hemostatic properties and tissue effect of 2 cutting modes, namely, AUTO CUT and DRY CUT used in urologic procedures. An isolated perfused kidney model was used to assess blood loss and coagulation depth after resection of tissue specimens of standardized geometry, size, and cutting velocity with a resection loop. Three different effect settings (E1, E3, and E6; 200 W) of the electrosurgical modes AUTO CUT and DRY CUT were compared. Blood loss was determined semiquantitatively by weighing a swab before and after placing it onto the resection area. The coagulation depth was estimated microscopically on cross sections. The computer-controlled cutting system creates resections of standardized geometry and size with a high reproducibility. An effect level-dependent increase in hemostasis and coagulation depth could be demonstrated with the cutting modes DRY CUT and AUTO CUT using this computer-controlled cutting system. The hemostatic effect with DRY CUT is significantly more pronounced than with AUTO CUT (E1, E3: P computer-controlled cutting system creating reproducible resections in combination with the isolated perfused kidney model offers the possibility to systematically investigate bleeding rate and coagulation depth. The stronger hemostatic properties of the DRY CUT mode are more favorable for urologic interventions requiring a higher hemostatic effect than the AUTO CUT mode. Copyright 2010 Elsevier Inc. All rights reserved.

  16. Extracorporeal membrane oxygenation-hemostatic complications.

    Murphy, Deirdre A; Hockings, Lisen E; Andrews, Robert K; Aubron, Cecile; Gardiner, Elizabeth E; Pellegrino, Vincent A; Davis, Amanda K


    The use of extracorporeal membrane oxygenation (ECMO) support for cardiac and respiratory failure has increased in recent years. Improvements in ECMO oxygenator and pump technologies have aided this increase in utilization. Additionally, reports of successful outcomes in supporting patients with respiratory failure during the 2009 H1N1 pandemic and reports of ECMO during cardiopulmonary resuscitation have led to increased uptake of ECMO. Patients requiring ECMO are a heterogenous group of critically ill patients with cardiac and respiratory failure. Bleeding and thrombotic complications remain a leading cause of morbidity and mortality in patients on ECMO. In this review, we describe the mechanisms and management of hemostatic, thrombotic and hemolytic complications during ECMO support.

  17. Mechanistic investigation of a hemostatic keratin biomaterial

    Rahmany, Maria Bahawdory

    Traumatic injury leads to more productive years lost than heart disease, cancer and stroke combined. Trauma is often accompanied and complicated by uncontrolled bleeding. Human hair keratin biomaterials have demonstrated efficacy in controlling hemorrhage in both small and large animal models; however little is known about the mechanism by which these proteins aid in blood clotting. Inspection of the amino acid sequence of known keratins shows the presence of several cellular binding motifs, suggesting a possible mechanism and potentially eliminating the need to functionalize the material's surface for cellular interaction. In addition to small animal studies, the hemostatic activity of keratin hydrogels was explored through porcine hemorrhage models representing both a high flow and low flow bleed. In both studies, keratin hydrogels appeared to lead to a significant reduction in blood loss. The promising results from these in vivo studies provided the motivation for this project. The objective of this dissertation work was to assess the mechanism of action of a hemostatic keratin biomaterial, and more broadly assess the biomaterial-cellular interaction(s). It is our hypothesis that keratin biomaterials have the capacity to specifically interact with cells and lead to propagation of intracellular signaling pathway, specifically contributing to hemostasis. Through application of biochemical and molecular tools, we demonstrate here that keratin biomaterials contribute to hemostasis through two probable mechanisms; integrin mediated platelet adhesion and increased fibrin polymerization. Platelets are the major cell type involved in coagulation both by acting as a catalytic surface for the clotting cascade and adhering to extracellular matrix (ECM) proteins providing a soft platelet plug. Because keratin biomaterials have structural and biochemical characteristics similar to ECM proteins, we utilized several adhesion assays to investigate platelet adhesion to keratin

  18. Method of manufacturing fibrous hemostatic bandages

    Larsen, Gustavo; Spretz, Ruben; Velarde-Ortiz, Raffet


    A method of manufacturing a sturdy and pliable fibrous hemostatic dressing by making fibers that maximally expose surface area per unit weight of active ingredients as a means for aiding in the clot forming process and as a means of minimizing waste of active ingredients. The method uses a rotating object to spin off a liquid biocompatible fiber precursor, which is added at its center. Fibers formed then deposit on a collector located at a distance from the rotating object creating a fiber layer on the collector. An electrical potential difference is maintained between the rotating disk and the collector. Then, a liquid procoagulation species is introduced at the center of the rotating disk such that it spins off the rotating disk and coats the fibers.

  19. Occupational exposure to the whole body, extremities and to the eye lens in interventional radiology in Poland, as based on personnel dosimetry records at IFJ PAN

    Szumska, Agnieszka; Budzanowski, M.; Kopeć, R.


    We report results of measurements of Hp(10) from whole body dosimeters (about 53 thousand readouts), of Hp(0.07) from finger ring dosimeters (23 thousand readouts) and of Hp(3) from eye lens dosimeters (100 readouts), issued in the years 2010-12 to over 150 medical departments in Poland which apply X-rays in radiology, interventional radiology (haemodynamic, angiology, cardiac surgery), urology, orthopaedics, electrophysiology or electro-cardiology. In all measurements thermoluminescence detectors (TLD) were used: the well-known standard MTS-N (LiF:Mg, Ti) for whole body and extremity dosimetry, and the high-sensitivity MCP-N (LiF:Mg, Cu, P) for eye lens dosimetry and environmental monitoring. We analysed the data base of the accredited Laboratory of Individual and Environmental Dosimetry (LADIS) at the Institute of Nuclear Physics PAN which offers its dosimetry service to these departments on a regular basis. We found that in the population of radiation workers that studied over the years 2010-2012 in 84%, 87%, and 34% of Hp(10), Hp(0.07) and Hp(3) measurements, respectively, the level of 0.1 mSv/quarter did not exceed, indicating lack of their occupational exposure. In the remaining 16%, 13% and 66% of individual cases, the 0.1 mSv/quarter exceeded, occasionally reaching several hundreds of mSv/quarter.

  20. Radiology illustrated. Pediatric radiology

    Kim, In-One (ed.) [Seoul National Univ. College of Medicine (Korea, Republic of). Dept. of Radiology


    Depicts characteristic imaging findings of common and uncommon diseases in the pediatric age group. Will serve as an ideal diagnostic reference in daily practice. Offers an excellent teaching aid, with numerous high-quality illustrations. This case-based atlas presents images depicting the findings typically observed when imaging a variety of common and uncommon diseases in the pediatric age group. The cases are organized according to anatomic region, covering disorders of the brain, spinal cord, head and neck, chest, cardiovascular system, gastrointestinal system, genitourinary system, and musculoskeletal system. Cases are presented in a form resembling teaching files, and the images are accompanied by concise informative text. The goal is to provide a diagnostic reference suitable for use in daily routine by both practicing radiologists and radiology residents or fellows. The atlas will also serve as a teaching aide and a study resource, and will offer pediatricians and surgeons guidance on the clinical applications of pediatric imaging.

  1. Achieving hemostasis in dermatology-Part II: Topical hemostatic agents

    Jaimie B Glick


    Full Text Available Bleeding is a common occurrence during any dermatologic surgery that disrupts blood vessels. The complications of excess bleeding can include delayed wound healing, hematoma formation, infection, dehiscence, and necrosis. In part one of this review, we discussed the pre-operative, intra-operative, and post-operative management of patients undergoing dermatologic surgery. In Part two, we discuss traditional and new topical hemostatic agents used to achieve hemostasis in dermatological procedures and surgery. We will evaluate the caustic and non-caustic hemostatic agents as well as hemostatic dressings. The mechanisms of action, side effect profile, and advantages and disadvantages of the topical hemostatic agents are provided. Sources for this article were found searching the English literature in PubMed for the time period 1940 to March 2012. A thorough bibliography search was also performed and key references examined.

  2. Progress in the research and application of polysaccharide hemostatic materials

    Yi JIANG


    Full Text Available Local hemostasis is the first step in wound treatment, and effective hemostatic methods could reduce the number of unnecessary casualties. Hemostatic materials need to have good hemostatic properties, excellent biocompatibility, no toxic side effects, no irritation and easy to prepare. The polysaccharide has many advantages, including rich source, simple structures, absorbable and biodegradable, excellent biocompatibility. At present, it has been found that polysaccharide is easy to modify in structure and recombine. This paper summarizes the characteristics and products of polysaccharide hemostatic materials including celluloses, chitosans, alginate, hyaluronic acid, and starch in order to offer the indications for clinical application and further study. DOI: 10.11855/j.issn.0577-7402.2014.12.16

  3. Proposed method to calculate FRMAC intervention levels for the assessment of radiologically contaminated food and comparison of the proposed method to the U.S. FDA's method to calculate derived intervention levels

    Kraus, Terrence D.; Hunt, Brian D.


    This report reviews the method recommended by the U.S. Food and Drug Administration for calculating Derived Intervention Levels (DILs) and identifies potential improvements to the DIL calculation method to support more accurate ingestion pathway analyses and protective action decisions. Further, this report proposes an alternate method for use by the Federal Emergency Radiological Assessment Center (FRMAC) to calculate FRMAC Intervention Levels (FILs). The default approach of the FRMAC during an emergency response is to use the FDA recommended methods. However, FRMAC recommends implementing the FIL method because we believe it to be more technically accurate. FRMAC will only implement the FIL method when approved by the FDA representative on the Federal Advisory Team for Environment, Food, and Health.

  4. Calibration of an eye lens dosemeter in terms of Hp(3) to be used in interventional radiology

    Borges, F. L. S.; Guimarães, M. C.; Da Silva, T. A.; Nogueira Tavares, M. S.


    Recently, the International Commission on Radiological Protection has reviewed epidemiological evidences suggesting that there were tissue reaction effects in the eye lens below the previously considered absorbed dose threshold. A new statement related to the eye lens was issued that changed the absorbed dose threshold and reduced the dose limits for occupationally exposed persons. As consequence, some planned exposures require eye lens dosimetry and a debate was raised on the adequacy of the dosimetric quantity and on its method of measurement. The aim of this work was to study the methodology for calibrating the EYE-DTM holder with a TLD-100H Harshaw chip detector and to determine its angular and energy dependences in terms of personal dose equivalent, Hp(3).

  5. Ankaferd hemostat in the management of gastrointestinal hemorrhages

    Yavuz Beyazit; Murat Kekilli; Ibrahim C Haznedaroglu; Ertugrul Kayacetin; Metin Basaranoglu


    Gastrointestinal (GI) bleeding refers to any hemorrhage ascribed to the pathologies of the gastrointestinal tract, extending from the mouth to the anal canal. Despite the recent improvements in the endoscopic, hemostatic and adjuvant pharmacologic techniques, the reported mortality is still around 5%-10% for peptic ulcer bleeding and about 15%-20% for variceal hemorrhages. Although endoscopic management reduces the rates of re-bleeding, surgery, and mortality in active bleeding; early recurrence ratios still occur in around 20% of the cases even with effective initial hemostatic measures.In this quest for an alternative pro-hemostatic agent for the management of GI bleedings, Ankaferd blood stopper (ABS) offers a successful candidate, specifically for “difficult-to-manage” situations as evidenced by data presented in several studies. ABS is a standardized mixture of the plants Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica. It is effective in both bleeding individuals with normal hemostatic parameters and in patients with deficient primary and/or secondary hemostasis. ABS also modulates the cellular apoptotic responses to hemorrhagic stress, as well as hemostatic hemodynamic activity. Through its effects on the endothelium, blood cells, angiogenesis, cellular proliferation, vascular dynamics, and wound healing, ABS is now becoming an effective alternative hemostatic medicine for gastrointestinal bleedings that are resistant to conventional anti-hemorrhagic measurements. The aim of this review is to outline current literature experience suggesting the place of ABS in the management of GI bleeding, and potential future controlled trials in this complicated field.

  6. Ankaferd hemostat in the management of gastrointestinal hemorrhages.

    Beyazit, Yavuz; Kekilli, Murat; Haznedaroglu, Ibrahim C; Kayacetin, Ertugrul; Basaranoglu, Metin


    Gastrointestinal (GI) bleeding refers to any hemorrhage ascribed to the pathologies of the gastrointestinal tract, extending from the mouth to the anal canal. Despite the recent improvements in the endoscopic, hemostatic and adjuvant pharmacologic techniques, the reported mortality is still around 5%-10% for peptic ulcer bleeding and about 15%-20% for variceal hemorrhages. Although endoscopic management reduces the rates of re-bleeding, surgery, and mortality in active bleeding; early recurrence ratios still occur in around 20% of the cases even with effective initial hemostatic measures. In this quest for an alternative pro-hemostatic agent for the management of GI bleedings, Ankaferd blood stopper (ABS) offers a successful candidate, specifically for "difficult-to-manage" situations as evidenced by data presented in several studies. ABS is a standardized mixture of the plants Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica. It is effective in both bleeding individuals with normal hemostatic parameters and in patients with deficient primary and/or secondary hemostasis. ABS also modulates the cellular apoptotic responses to hemorrhagic stress, as well as hemostatic hemodynamic activity. Through its effects on the endothelium, blood cells, angiogenesis, cellular proliferation, vascular dynamics, and wound healing, ABS is now becoming an effective alternative hemostatic medicine for gastrointestinal bleedings that are resistant to conventional anti-hemorrhagic measurements. The aim of this review is to outline current literature experience suggesting the place of ABS in the management of GI bleeding, and potential future controlled trials in this complicated field.

  7. Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery.

    Wintermark, Max; Sanelli, Pina C; Albers, Gregory W; Bello, Jacqueline A; Derdeyn, Colin P; Hetts, Steven W; Johnson, Michele H; Kidwell, Chelsea S; Lev, Michael H; Liebeskind, David S; Rowley, Howard A; Schaefer, Pamela W; Sunshine, Jeffrey L; Zaharchuk, Greg; Meltzer, Carolyn C


    In the article entitled "Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery", we are proposing a simple, pragmatic approach that will allow the reader to develop an optimal imaging algorithm for stroke patients at their institution.

  8. Role of Interventional Radiology in the Management of Chylothorax: A Review of the Current Management of High Output Chylothorax

    Lyon, Stuart, E-mail:; Mott, Nigel, E-mail:; Koukounaras, Jim; Shoobridge, Jen [Alfred Hospital, Department of Radiology (Australia); Hudson, Patricio Vargas [Clinica Alemana, Department of Radiology (Chile)


    Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the more invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.

  9. ERRAPRI Project: estimation of radiation risk to patients in interventional radiology, initial results and proposed levels of complexity; Proyecto ERRAPRI: estimacion del riesgo radiologico a los pacientes en radiologia intervencionista. Primeros resultados y propuestas de indices de complejidad

    Ruiz Cruces, R.; Vano, E.; Hernandez-Armas, J.; Carrera, F.; Diaz, F.; Gallego Beuther, J. F.; Ruiz Munoz-Canela, J. P.; Sanchez Casanueva, R.; Perez Martinez, M.; Fernandez Soto, J. M.; Munoz, V.; Moreno, F.; Moreno, C.; Martin-Palanca, A.


    The project ERRAPRI (2009 - 2012) will assess the most relevant aspects of the radiological risk associated with interventional radiology techniques (IR) guided by fluoroscopy in a sample of Spanish hospitals of three autonomous regions. Specific objectives include: assessing procedural protocols, especially the parameters related to radiation dose and diagnostic information obtained to establish balances cost (radiation risk) benefit to the procedures evaluated, and propose an index of complex procedures on several levels, based on the difficulty of making the same, assessing its relationship with the radiation dose values.

  10. Status of radiation protection in interventional radiology. Assessment of inspections in 2009 by the ASN; Etat de la radioprotection en radiologie interventionnelle. Bilan des inspections 2009 par l'ASN



    This report first describes the organization of inspections performed in health institutions, indicates the inspected establishments, the types of fixed installations in interventional radiology, the use of imagery in the operating theatre, and discusses the regulatory arrangements applicable to interventional radiology (in the Public Health Code, in the Labour Code). Then, the report discusses the results of inspections regarding radiation protection in interventional radiology: application of public health code arrangements (justification, patient training in radiation protection, radiological procedures and protocols, patient dosimetry monitoring), application of Labour Code arrangements (designation of the person with expertise in radiation protection, risk assessment and delimitation of monitored and controlled areas, workstation analysis, workers' training in radiation protection, individual protection equipment, workers' dosimetric monitoring, workers' medical monitoring, radiation protection technical controls), significant events, radiation protection in operating theatre. Propositions are stated regarding the differences noticed within or between the health establishments, the methodological and organisational difficulties faced by persons with expertise in radiation protection (PCR), the need of an interdisciplinary team

  11. The role of interventional radiology in the management of kidney transplant complications; Ruolo della radiologia interventistica nel trattamento delle complicanze del trapianto renale

    Carrafiello, Gianpaolo; Lagana, Domenico; Mangini, Monica; Cafaro, Tamara; Recaldini, Chiara; Genovese, Eugenio; Fugazzola, Carlo [Insubria Univ., Varese (Italy). Cattedra di radiologia; Cuffari, Salvatore [Ospedale di circolo, Varese (Italy). Servizio di anestesia e rianimazione


    Purpose. To evaluate the role and the effectiveness of interventional radiology in the treatment of renal transplant complications. Materials and methods. From 1996 to 2004 a total of 288 kidney transplants from cadavers were performed in our Institute. The kidney was always collocated in iliac fossa by creating a vascular anastomosis with the external iliac artery and vein; in all cases the ureter was implanted into the recipient bladder. During the follow-up, 34 complications were observed. Twenty-seven complications in 25 patients (20 males and 5 females; age 35-65 years) were treated by a radiologic procedure: 9 renal artery stenosis and 1 native external iliac artery stenosis (by PTA), 5 ureteral obstructions (by nephrostomy and ureteral stenting), 8 ureteral leaks (by nephrostomy, in 2 cases associated to ureteral stenting) and 4 limphoceles (by percutaneous ultrasound-guided catheter drainage). Results. Primary technical success was obtained in 20/27 cases (74%). Success was obtained with a second interventional procedure in 3/27 cases, 2 limphoceles and 1 ureteral fistula (secondary technical success: 85.2%), with a clinical final success in 23/27 cases (85.2%). We observed a peri-procedural complication rate of 3.7% (1 renal artery post-PTA dissection during a restenosis treatment). Four cases (1 renal arterial post-PTA dissection, 1 ureteral obstructions, 1 ureteral leak and llimphocele) needed a surgical correction (14.8%). Conclusions. Interventional radiology is the first therapeutic approach to treat renal transplant complications. It shows good technical and clinical results and a low complication rate. Surgery had to be considered only if minimally invasive procedures are infeasible or ineffective. [Italian] Scopo. Valutare l'efficacia delle procedure di radiologia interventistica nel trattamento delle complicanze del trapianto renale. Materiale e metodi. Dal 1996 al 2004 sono stati eseguiti, presso il nostro centro 288 trapianti renali da

  12. Highly Absorbent Antibacterial Hemostatic Dressing for Healing Severe Hemorrhagic Wounds

    Ting-Ting Li


    Full Text Available To accelerate healing of severe hemorrhagic wounds, a novel highly absorbent hemostatic dressing composed of a Tencel®/absorbent-cotton/polylactic acid nonwoven base and chitosan/nanosilver antibacterial agent was fabricated by using a nonwoven processing technique and a freeze-drying technique. This study is the first to investigate the wicking and water-absorbing properties of a nonwoven base by measuring the vertical wicking height and water absorption ratio. Moreover, blood agglutination and hemostatic second tests were conducted to evaluate the hemostatic performance of the resultant wound dressing. The blending ratio of fibers, areal weight, punching density, and fiber orientation, all significantly influenced the vertical moisture wicking property. However, only the first two parameters markedly affected the water absorption ratio. After the nonwoven base absorbed blood, scanning electron microscope (SEM observation showed that erythrocytes were trapped between the fibrin/clot network and nonwoven fibers when coagulation pathways were activated. Prothrombin time (PT and activated partial thromboplastin time (APTT blood agglutination of the resultant dressing decreased to 14.34 and 50.94 s, respectively. In the femoral artery of the rate bleeding model, hemostatic time was saved by 87.2% compared with that of cotton cloth. Therefore, the resultant antibacterial wound dressing demonstrated greater water and blood absorption, as well as hemostatic performance, than the commercially available cotton cloth, especially for healing severe hemorrhagic wounds.

  13. Radiation protection of patients in diagnostic and interventional radiology in Asian countries: Impact of an IAEA project

    Rehani, Madan M., E-mail: [International Atomic Energy Agency (IAEA), Vienna International Centre, P.O. Box 100, Vienna (Austria); Ciraj-Bjelac, Olivera, E-mail: [University of Belgrade, Vinca Institute of Nuclear Sciences, Radiation Protection Department, Mike Petrovica Alasa 12-14, P.O. Box 522, 11001 Belgrade (Serbia); Al-Naemi, Huda M., E-mail: [Hamad Medical Corp, Occupational Health and Safety, P.O. Box 1725, Doha (Qatar); Al-Suwaidi, Jamila Salem, E-mail: [Dubai Hospital, Dubai (United Arab Emirates); El-Nachef, Leila, E-mail: [Lebanon Atomic Energy Commission (Lebanon); Khosravi, Hamid Reza, E-mail: [National Radiation Protection Department, Iranian Nuclear Regulatory Authority, Tehran (Iran, Islamic Republic of); Kharita, Mohammad Hassan, E-mail: [Atomic Energy Commission of Syria, Damascus (Syrian Arab Republic); Muthuvelu, Pirunthavany, E-mail: [Ministry of Health Malaysia, Putrajaya Wilayah Persekutuan (Malaysia); Pallewatte, Aruna S., E-mail: [Lady Ridgeway Hospital for Children, Dr Danister de Silva Mawatha, Colombo (Sri Lanka); Juan, Bayani Cruz San, E-mail: [Center for Device Regulation, Radiation Health, and Research Department of Health, Manila (Philippines); Shaaban, Mohamed, E-mail: [Al-Sabah Hospital (Kuwait); Zaman, Areesha, E-mail: [Institute of Nuclear Medicine and Oncology, PAEC, Lahore (Pakistan)


    Recognizing the lack of information on image quality and patient doses in most countries in Asia, the International Atomic Energy Agency (IAEA) initiated a project to assess the status of imaging technology, practice in conventional radiography, mammography, computed tomography (CT) and interventional procedures, and to implement optimisation actions. A total of 20 countries participated. Obsolete practices of use of fluoroscopy for positioning, photofluorography, chest fluoroscopy and conventional tomography were reported by 4 out of 7 countries that provided this information. Low-kV technique for chest radiography is in use in participating countries for 20–85% of cases, and manual processing is in 5–85% of facilities in 5 countries. Instances of the use of adult CT protocol for children in three participating countries were observed in 10–40% of hospitals surveyed. After implementation of a Quality Control programme, the image quality in conventional radiography improved by zero to 13 percentage points in certain countries and dose reduction was from 10% to 85%. In mammography, poor quality, ranging from 10 to 29% of images in different countries was observed. The project increased attention to dose quantities and dose levels in computed tomography, although doses in most cases were not higher than reference levels. In this study 16–19% of patients in interventional cardiology received doses that have potential for either stochastic risk or tissue reaction. This multi-national study is the first of its kind in the Asia, and it provided insight into the situation and opportunities for improvement.

  14. In vivo hemostatic efficacy of polyurethane foam compared to collagen and gelatin

    Broekema, Ferdinand I.; van Oeveren, Wim; Selten, Maaike H. A.; Meijer, Rolf J. H.; de Wolf, Joost T. M.; Bos, Rudolf R. M.


    Topical hemostatic agents are used in all surgical disciplines. Most of these hemostats are based on animal-derived products like collagen and gelatin. They carry the potential risk of pathogen transmission. A newly developed biodegradable, fully synthetic hemostatic agent based on polyurethane foam

  15. In vitro analysis of polyurethane foam as a topical hemostatic agent

    Broekema, Ferdinand I.; van Oeveren, Wim; Zuidema, Johan; Visscher, Susan H.; Bos, Rudolf R. M.


    Topical hemostatic agents can be used to treat problematic bleedings in patients who undergo surgery. Widely used are the collagen- and gelatin-based hemostats. This study aimed to develop a fully synthetic, biodegradable hemostatic agent to avoid exposure to animal antigens. In this in vitro study

  16. Hemostatic action of polyurethane foam with 55% polyethylene glycol compared to collagen and gelatin

    Broekema, Ferdinand I; van Oeveren, Wim; Boerendonk, Andrea; Sharma, Prashant K; Bos, Rudolf R M


    BACKGROUND: For most topical hemostatic agents the mechanism of hemostatic action is not fully understood. OBJECTIVE: This work aimed to investigate the hemostatic mechanism of action and viscoelastic properties of polyurethane foam (PU) in comparison to the widely used collagen and gelatin. METHODS

  17. Hemostatic biomarkers in dogs with chronic congestive heart failure

    Tarnow, Inge; Falk, Torkel; Tidholm, Anna


    Background: Chronic congestive heart failure (CHF) in humans is associated with abnormal hemostasis, and abnormalities in hemostatic biomarkers carry a poor prognosis. Alterations in hemostatic pathways can be involved in the pathogenesis of CHF in dogs, and microthrombosis in the myocardium could...... contribute to increased mortality. Hypothesis: That plasma concentration or activity of hemostatic biomarkers is altered in dogs with CHF and that these factors predict mortality. Animals: Thirty-four dogs with CHF caused by either dilated cardiomyopathy (DCM, n = 14) or degenerative valvular disease (CDVD......, n = 20) compared with 23 healthy age-matched control dogs were included in this study. Dogs with CHF were recruited from 2 referral cardiology clinics, and control dogs were owned by friends or colleagues of the investigators. Methods: Clinical examination and echocardiography were performed in all...

  18. 介入神经放射技术规范化刍议%Stardard recommendation for neurological intervention radiology



    @@ 介入神经放射学(interventional neuroradiology)技术在广东省开展已有10多年了.改革开放给我省带来了繁荣进步,也给介入神经放射学带来了蓬勃发展的春天.由于先进医疗设备的大量引进,高素质人材的涌入,以及人民生活水平的提高,对高新技术的渴求和较强的支付能力,都使我省这一新学科新技术的发展在国内占据了先进地位,为国内同道们所瞩目!

  19. Impact on Patient Safety and Satisfaction of Implementation of an Outpatient Clinic in Interventional Radiology (IPSIPOLI-Study): A Quasi-Experimental Prospective Study

    Lutjeboer, Jacob, E-mail:; Burgmans, Mark Christiaan, E-mail:, E-mail:; Chung, Kaman, E-mail:; Erkel, Arian Robert van, E-mail: [Leiden University Medical Center, Department of Radiology (Netherlands)


    PurposeInterventional radiology (IR) procedures are associated with high rates of preparation and planning errors. In many centers, pre-procedural consultation and screening of patients is performed by referring physicians. Interventional radiologists have better knowledge about procedure details and risks, but often only get acquainted with the patient in the procedure room. We hypothesized that patient safety (PS) and patient satisfaction (PSAT) in elective IR procedures would improve by implementation of a pre-procedural visit to an outpatient IR clinic.Material and MethodsIRB approval was obtained and informed consent was waived. PS and PSAT were measured in patients undergoing elective IR procedures before (control group; n = 110) and after (experimental group; n = 110) implementation of an outpatient IR clinic. PS was measured as the number of process deviations. PSAT was assessed using a questionnaire measuring Likert scores of three dimensions: interpersonal care aspects, information/communication, and patient participation. Differences in PS and PSAT between the two groups were compared using an independent t test.ResultsThe average number of process deviations per patient was 0.39 in the control group compared to 0.06 in the experimental group (p < 0.001). In 9.1 % patients in the control group, no legal informed consent was obtained compared to 0 % in the experimental group. The mean overall Likert score was significantly higher in the experimental group compared to the control group: 2.68 (SD 0.314) versus 2.48 (SD 0.381) (p < 0.001).ConclusionPS and PSAT improve significantly if patients receive consultation and screening in an IR outpatient clinic prior to elective IR procedures.

  20. The Future of Radiology

    Alexander R. Margulis


    Full Text Available It has been my good fortune to live and practice radiology during a long period of momentous change – to see the transformation of the discipline from a supportive service into a mainstream, essential branch of clinical medicine. I remember wearing red goggles to adapt my vision before performing fluoroscopy; observing the horrible, now thankfully obsolete, practice of ventriculography, which was considered advanced neuroradiology; and performing other, now rarely prescribed procedures, such as double-contrast barium enemas and intravenous pyelography. Witnessing the beginnings of interventional radiology, I suggested its name in an editorial. I also had the good fortune to see the introduction of computed tomography (CT and a technology first known as nuclear magnetic resonance imaging. Together with fellow members of a committee of the American College of Radiology and editors of prestigious radiological journals, I took part in changing the name of the latter modality to MRI, freeing it from threatening implications. Looking back on these experiences, one lesson stands out above all: Innovation and transformation never cease. Looking forward, it is clear that radiology, along with the rest of medicine, is now undergoing further momentous changes that will affect the future of all those already practicing as well as those yet to start their careers.

  1. Hypoglycemia and hemostatic parameters in juvenile-onset diabetes

    Hilsted, J; Madsbad, S; Nielsen, J D;


    Hypoglycemia was induced by intravenous infusion of insulin in six juvenile-onset diabetic subjects. Hemostatic parameters were assessed before insulin infusion and 0, 1, and 2 h after discontinuation of insulin infusion. The onset of hypoglycemia coincided with an enhancement of ADP-induced plat......Hypoglycemia was induced by intravenous infusion of insulin in six juvenile-onset diabetic subjects. Hemostatic parameters were assessed before insulin infusion and 0, 1, and 2 h after discontinuation of insulin infusion. The onset of hypoglycemia coincided with an enhancement of ADP...... potentially lead to intravascular coagulation in juvenile-onset diabetic patients....

  2. Safety and usability of hemostats, sealants, and adhesives.

    Burks, Sandra; Spotnitz, William


    Hemostats, sealants, and adhesives are an integral part of surgical patient care. Nurses who have knowledge about these agents can better help ensure safe, efficient surgical patient care. As a caregiver and patient advocate, the perioperative nurse must understand the most current information about these agents and be prepared to facilitate the transfer of this knowledge to all caregivers. Information about these agents, including the contraindications, warnings, and precautions associated with their use as well as their preparation and application, is provided here. Algorithms designed to clarify the best options for using hemostats, sealants, and adhesives are included as well.

  3. Web-based platform for patient dose surveys in diagnostic and interventional radiology in Bulgaria: Functionality testing and optimisation.

    Simeonov, F; Palov, N; Ivanova, D; Kostova-Lefterova, D; Georgiev, E; Zagorska, A; Madzharova, R; Vassileva, J


    In the period 2013-2016 the National Centre of Radiobiology and Radiation Protection (NCRRP) at the Ministry of Health of Bulgaria has developed a web based platform for performing national patient dose surveys and establishing Diagnostic Reference Levels (DRLs). It is accessible via internet browser, allowing the users to submit data remotely. Electronic questionnaires, specific for radiography, fluoroscopy, image guided interventional procedures, mammography and CT, were provided. Short and clear manuals were added to guide users and minimise human errors. The web-based data collection platform is functional and is currently being used for performing the third national dose survey in Bulgaria, launched in 2016. Data analysis is facilitated due to the standardisation of collected data and their storing. Using the platform, the participating facilities can establish their typical dose levels based on the median value, and compare them to DRLs. A disadvantage of the platform is the need to enter data manually, but it is opened for future upgrades for automatic data harvesting and analysis. Various practical approaches were used to overcome the lack of qualified human resources and insufficient understanding of the DRL and dose tracking concept and to motivate facilities to submit data. Copyright © 2017. Published by Elsevier Ltd.

  4. Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists: A single–emergency center experience

    Tsurukiri, Junya; Ohta, Shoichi; Mishima, Shiro; Homma, Hiroshi; Okumura, Eitaro; Akamine, Itsuro; Ueno, Masahito; Oda, Jun; Yukioka, Tetsuo


    INTRODUCTION Comprehensive treatment of a patient in acute medicine and surgery requires the use of both surgical techniques and other treatment methods. Recently, acute vascular interventional radiology techniques (AVIRTs) have become increasingly popular, enabling adequately trained in-house experts to improve the quality of on-site care. METHODS After obtaining approval from our institutional ethics committee, we conducted a retrospective study of AVIRT procedures performed by acute care specialists trained in acute medicine and surgery over a 1-year period, including those conducted out of hours. Trained acute care specialists were required to be certified by the Japanese Association of Acute Medicine and to have completed at least 1 year of training as a member of the endovascular team in the radiology department of another university hospital. The study was designed to ensure that at least one of the physicians was available to perform AVIRT within 1 h of a request at any time. Femoral sheath insertion was usually performed by the resident physicians under the guidance of trained acute care specialists. RESULTS The study sample comprised 77 endovascular procedures for therapeutic AVIRT (trauma, n = 29, and nontrauma, n = 48) among 62 patients (mean age, 64 years; range, 9–88 years), of which 55% were male. Of the procedures, 47% were performed out of hours (trauma, 52%; and nontrauma, 44%). Three patients underwent resuscitative endovascular balloon occlusion of the aorta in the emergency room. No major device-related complications were encountered, and the overall mortality rate within 60 days was 8%. The recorded causes of death included exsanguination (n = 2), pneumonia (n = 2), sepsis (n = 1), and brain death (n = 1). CONCLUSION When performed by trained acute care specialists, AVIRT seems to be advantageous for acute on-site care and provides good technical success. Therefore, a standard training program should be established for acute care specialists

  5. Value of levels of complexity in the estimation of the risk in interventional radiology procedures; Valor de los indices de complejidad en la estimacion del riesgo en procedimientos de radiologia intervencionista

    Ruiz Cruces, R.; Vano, E.; Hernandez Armas, J.; Carrera Magarino, F.; Rosales, F.; Galan, P.; Solar, M. M.; Perez Martinez, M.; Sanchez Casanueva, R.; Moreno Saiz, C.; Caudepon, F.; Diaz, F.; Gallego Solar, J. J.; Martin-Palanca, A.; Ruiz Munoz-Canela, J. J.; Moreno Rodriguez, F.; Gonzalez de Garay, M.; Canis, M.; Lopez Medina, A.; Moreno Sachez, T.; Pastor Vega, J. M.


    The interventional Radiology (IR) refers to guided procedures with X rays, to develop a diagnostic and/or therapeutic action both in vascular diseases as non-vascular. The progressive increase in the complexity and diversity of interventional procedures make it difficult to objectify the criteria about the dosage provided to patients who are these techniques. Control of radiation doses administered to patients to limit the risks associated with the use of x-rays is not more than one way of improving procedures. For this reason, already completed the ERRAPRI project, we have developed complexity rates to better assess the radiological risk associated with the procedures carried out in a sample of Spanish hospitals. (Author)

  6. Determination of radiation dose to patient by biological dosimetry in interventional radiological procedures; Estimacion de la dosis de radiacion a paciente mediante dosimetria biologica en exploraciones complejas de radiodiagnostico

    Serna Berna, A.; Alcaraz, M.; Armero, D.; Navarro, J. L.; Morant, J. J.; Canteras, M.


    Interventional radiology is substituting complex surgical procedures. The requirements of high quality images and long fluoroscopy exposure times gives rise to high levels of radiation doses to patients. This topic is increasingly becoming of high concern. The purpose of this work was to evaluate the micronucleus assay (MN) in lymphocytes for the determination of the dose delivered to 15 patients who underwent interventional radiological procedures. The determination of a dose to patients supposing uniform irradiation was done with a dose-effect calibration curve previously determined for 120 keV X-rays. due to the low level of MN rate compared with background we used a bayesian approach to obtain the net MN counting rate, resulting and average counting rate of 3,2{+-}2,5 MN/500 bi nucleated cell. The group of coronariography patients resulted in higher MN rate 5,1 MN/500 BC vs 2,6 for the rest of patients. Average equivalent uniform dose for the total group of patients was 6,5{+-}2,6 cGy, while for the coronariography group was 8,8 {+-} 4,6 cGy. In conclusion, interventional radiology procedures deliver significant doses to patients and the MN assay as biological dosimeter is a good too to evaluate this range to doses. (Author)

  7. Application of Absorbable Hemostatic Materials Observed in Thyroid Operation

    Li, Yan-Ming; Liang, Zhen-Zhen; Song, Yan


    To observe the application effects of the absorbable hemostatic materials in thyroid operation. Methods: From May 2014 to January 2015, 100 patients with thyroid surgery in our university affiliated hospital were selected as the research object. Randomly divided into experimental group and control group, 50 cases in each group. Application of absorbable hemostatic hemostatic materials in the experimental group during the operation, the control group using the traditional mechanical methods of hemostasis hemostasis to observe the operation time, bleeding volume, postoperative drainage volume, complications and hospital stay of the two groups. Results: The operation time, bleeding volume, postoperative drainage and hospital stay in the experimental group were significantly lower in the study group than in the control group, and the difference between the two groups was statistically significant (P 0.05). Conclusion: Absorbable hemostatic materials can effectively shorten the operation time, reduce intraoperative blood loss and postoperative drainage, reduce the length of hospital stay and improve the success rate of surgery and patient satisfaction, which is worthy to be popularized in clinical thyroid surgery.

  8. A review on common chemical hemostatic agents in restorative dentistry

    Pardis Tarighi


    Full Text Available Control of hemorrhage is one of the challenging situations dentists confront during deep cavity preparation and before impressions or cementation of restorations. For the best bond and least contamination it is necessary to be familiar with the hemostatic agents available on the market and to be able to choose the appropriate one for specific situations. This review tries to introduce the commercially available hemostatic agents, discusses their components and their specific features. The most common chemical agents that are widely used in restorative and prosthodontic dentistry according to their components and mechanism of action as well as their special uses are introduced. PubMed and Google Scholar were searched for studies involving gingival retraction and hemostatic agents from 1970 to 2013. Key search words including: "gingival retraction techniques, impression technique, hemostasis and astringent" were searched. Based on the information available in the literature, in order to achieve better results with impression taking and using resin bonding techniques, common hemostatic agents might be recommended before or during acid etching; they should be rinsed off properly and it is recommended that they be used with etch-and-rinse adhesive systems.

  9. Hemostatic resuscitation in postpartum hemorrhage - a supplement to surgery

    Ekelund, Kim; Hanke, Gabriele; Stensballe, Jakob


    BACKGROUND: Postpartum hemorrhage is a potentially life-threatening albeit preventable condition that persists as a leading cause of maternal death. Identification of safe and cost-effective hemostatic treatment options remains crucial as a supplement to surgery and uterotonic agents. OBJECTIVE...

  10. Surgical hemostatic agents: assessment of drugs and medical devices.

    Aubourg, R; Putzolu, J; Bouche, S; Galmiche, H; Denis, C; d'Andon, A; Maitrot, D; Partensky, C


    Surgical hemostatic agents are indicated to improve hemostasis when conventional techniques (compression, sutures or electrocoagulation) are inadequate. The National French Authority for Health (Haute Autorité de santé [HAS]) set out to assess these products (medical devices and agents) to determine their optimal utility. This evaluation included one class of products containing some form of human fibrinogen and thrombin and eight classes of medical devices and automated devices to prepare autologous fibrin. The assessment was based on a systematic review of the literature and expert opinion of health care professionals. The main measures of effectiveness of hemostatic agents were the success rate as expressed in terms of the time necessary to obtain adequate hemostasis, the volume of intra and/or postoperative blood loss, the need for blood transfusions, complication rate, duration of operations and hospital stay. A meta-analysis and 52 controlled randomized studies were selected involving cardiac or vascular surgery (19), ENT surgery (11), gastrointestinal surgery (5), urology (4), orthopedic surgery (4). Approximately half of the studies retained in this analysis evaluated blood derived agents (fibrin sealants) while the other half evaluated medical devices. The working group considered that there is not any evidence that these surgical hemostatic agents decrease the rates of transfusion, complications, reoperation, mortality, duration of operation and/or hospital stay. The working group considered that the use of surgical hemostatic agents to improve the safety of hemostasis in the absence of identified bleeding as an alternative to adequate conventional hemostasis was not justified. Surgical hemostatic agents can be used in ad hoc settings, as a complement to conventional methods to control persistent bleeding after conventional hemostatic techniques, or when abundant bleeding has led to biologic hemostatic disorders. The working group also distinguished

  11. Hemostatic abnormalities in dogs with naturally occurring heatstroke.

    Bruchim, Yaron; Kelmer, Efrat; Cohen, Adar; Codner, Carolina; Segev, Gilad; Aroch, Itamar


    To investigate hemostatic analyte abnormalities and their association with mortality in dogs with naturally occurring heatstroke. Prospective observational study. University teaching hospital. Thirty client-owned dogs with naturally occurring heatstroke. None. Citrated and EDTA blood samples were collected at presentation and at 4, 12, 24, 36, and 48 hours postpresentation (PP). Hemostatic tests performed included platelet count, prothrombin and activated partial thromboplastin times (PT and aPTT, respectively), antithrombin activity (ATA), total protein C activity (tPCA), fibrinogen, and D-dimer concentrations. The overall survival rate was 60% (18/30 dogs). Older age, higher heart rate and rectal temperature at presentation, and time from onset of clinical signs to presentation were significantly associated with mortality. Hemostatic analytes at presentation were not associated with mortality. Prolonged PT and aPTT at 12-24 hours PP, lower tPCA at 12 hours PP, and hypofibrinogenemia at 24 hours PP were significantly (P ATA were common at all time points, but were not associated with mortality. The frequency of disseminated intravascular coagulation (DIC) increased in nonsurvivors throughout hospitalization, but the development of DIC was not associated with mortality. The number of abnormal coagulation disturbances during the first 24 hours was significantly higher in nonsurvivors (P = 0.04). Hemostatic derangements are common in dogs with naturally occurring heatstroke. Alterations in PT, aPTT, tPCA, and fibrinogen concentrations appear to be associated with the outcome at 12-24 hours PP, exemplifying the need for serial measurement of multiple laboratory hemostatic tests during hospitalization, even when within reference interval on presentation. The development of DIC, as defined in this cohort, was not associated with mortality; however, nonsurvivors had significantly more coagulation abnormalities during the first 24 hours PP. © Veterinary Emergency and

  12. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology.

    Miura, Fumihiko; Asano, Takehide; Amano, Hodaka; Yoshida, Masahiro; Toyota, Naoyuki; Wada, Keita; Kato, Kenichiro; Yamazaki, Eriko; Kadowaki, Susumu; Shibuya, Makoto; Maeno, Sawako; Furui, Shigeru; Takeshita, Koji; Kotake, Yutaka; Takada, Tadahiro


    Intra-abdominal arterial hemorrhage is still one of the most serious complications after pancreato-biliary surgery. We retrospectively analyzed our experiences with 15 patients in order to establish a therapeutic strategy for postoperative arterial hemorrhage following pancreato-biliary surgery. Between August 1981 and November 2007, 15 patients developed massive intra-abdominal arterial bleeding after pancreato-biliary surgery. The initial surgery of these 15 patients were pylorus-preserving pancreatoduodenectomy (PPPD) (7 patients), hemihepatectomy and caudate lobectomy with extrahepatic bile duct resection or PPPD (4 patients), Whipple's pancreatoduodenectomy (PD) (3 patients), and total pancreatectomy (1 patient). Twelve patients were managed by transcatheter arterial embolization and three patients underwent re-laparotomy. Patients were divided into two groups according to the site of bleeding: SMA group, superior mesenteric artery (4 patients); HA group, stump of gastroduodenal artery, right hepatic artery, common hepatic artery, or proper hepatic artery (11 patients). In the SMA group, re-laparotomy and coil embolization for pseudoaneurysm were performed in three and one patients, respectively, but none of the patients survived. In the HA group, all 11 patients were managed by transcatheter arterial embolization. None of four patients who had major hepatectomy with extrahepatic bile duct resection survived. Six of seven patients (85.7%) who had pancreatectomy survived, although hepatic infarction occurred in four. Management of postoperative arterial hemorrhage after pancreato-biliary surgery should be done according to the site of bleeding and the initial operative procedure. Careful consideration is required for indication of interventional radiology for bleeding from SMA after pancreatectomy and hepatic artery after major hepatectomy with bilioenteric anastomosis.

  13. Applying 'Technology Assessment' and 'Evidence Based Medicine' theory to interventional radiology. Part 1: Suggestions for the phased evaluation of new procedures

    Malone, Dermot E.; Maceneaney, Peter M


    AIM: To compare and contrast interventional radiology (IR) clinical and research practices with the technology assessment and evidence-based medicine (EBM) paradigms and make suggestions for the phased evaluation of new IR procedures. MATERIALS AND METHODS: Course literature of the Association of University Radiologists' 'Basic Technology Assessment for Radiologists' course and the McMaster University Health Information Research Unit's 'How to Teach Evidence-Based Medicine 1999' course were used to identify major publications in each discipline. A computer search was performed to seek other relevant literature. A model of traditional development of IR procedures was developed. Suggestions for the phased evaluation of IR procedures were derived. RESULTS: As in diagnostic radiology, several levels of progressively stronger IR study design can be described and related to EBM 'levels of evidence'. These range from case reports and case series through case-control and cohort studies to randomized controlled trials (RCTs). The major weakness in the existing IR literature is the predominance of small, uncontrolled, case series. Randomized controlled trials are likely to provide the best possible evidence of effectiveness. They are expensive and randomization is sometimes unethical or impractical. Case-control and cohort studies have been under-utilized. Evidence-based medicine indices of benefit and harm have not yet been applied in IR and may have clinical advantages over traditional statistical methods. A literature search (10 years) using MeSH terms 'radiology, interventional' and 'efficacy' yielded 30 papers. Combining 'radiology, interventional' and 'evidence-based medicine' yielded no papers. Comparative searches substituting the term 'diagnostic imaging' for 'radiology, interventional' yielded 4883 and 62 papers, respectively. CONCLUSION: Principles of technology

  14. Diagnostic and interventional radiology in the post-operative period and follow-up of patients after rectal resection with coloanal anastomosis

    Severini, A.; Civelli, E.M.; Uslenghi, E.; Cozzi, G.; Salvetti, M.; Milella, M. [Department of Radiology, National Cancer Institute of Milan, via Venezian 1, I-23100 Milan (Italy); Gallino, G.; Bonfanti, G.; Belli, F.; Leo, E. [Department of Surgery, National Cancer Institute of Milan, via Venezian 1, I-23100 Milan (Italy)


    Surgical treatment of carcinoma of the distal third of the rectum with anal sphincter preservation is increasingly used in accredited cancer centers. This study aimed to evaluate the diagnostic usefulness of radiological investigations in the management of patients who had undergone resection with coloanal anastomosis for carcinoma of the rectum, in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. A total of 175 patients who had undergone total rectal resection with end-to-side anastomosis for carcinoma of the distal third of the rectal ampulla, most of whom had received postoperative radiotherapy, were evaluated radiologically. In the postoperative period radiological investigation was ordered only for symptomatic patients to detect pathology of the anastomosis and the pouch sutures and was used direct film abdominal radiography and contrast-enhanced radiography of the rectal stump with a water-soluble radio-opaque agent. Before closure of the colostomy, 2 months after rectal excision or approximately 4 months after if postoperative radiotherapy was given, the anastomosis and pouch of all patients, even asymptomatic ones, were studied with water-soluble contrast enema to check for normal canalization. In the follow-up after recanalization radiological examinations were done to complete the study of the large intestine if the endoscopist was not able to examine it up to the cecum. Of the 175 patients examined radiologically during the postoperative period and/or subsequent follow-up, 95 showed no pathological findings. Seventy-nine patients had fistulas of the coloanal anastomosis or the pouch, 23 of which supplied a presacral collection. In the absence of severe sepsis, the only therapeutic measures were systemic antibiotics and washing of the surgical catheters to maintain efficient operation. In 2 patients in whom transanal drainage was performed radiologically the fistula

  15. Risk management in radiology departments

    Craciun, Horea; Mankad, Kshitij; Lynch, Jeremy


    Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients. PMID:26120383

  16. Risk management in radiology departments

    Horea; Craciun; Kshitij; Mankad; Jeremy; Lynch


    Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as aresult of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients.

  17. Optimization of preparation process and characterization of carboxymethyl chitosan/sodium alginate hemostatic sponge

    Hu, Z.; Ouyang, Q. Q.; Cheng, Y.; Hong, P. Z.; Liao, M. N.; Chen, F. J.; Li, S. D.


    Composite hemostatic sponge was prepared by vacuum freeze-drying using carboxymethyl chitosan and sodium alginate as the main materials and CaCl2 as a crosslinking agent. On the basis of single factor experiments, an orthogonal experiment was carried out to optimize the preparation process of hemostatic sponge. The appearance, water absorption, porosity ratio, and in vitro hemostasis of the sponge were evaluated. The optimum conditions to prepare hemostatic sponge were obtained as follows: mass ratio of sodium alginate to carboxymethyl chitosan 4: 1, mass fraction of CaCl2 2%, and crosslinking temperature 30°C. The hemostatic sponge prepared under such conditions was off-white and porous. Its water absorption and porosity ratio were 3050% and 67.23%, respectively. Meanwhile, the hemostatic sponges had significant in vitro procoagulant activity. Therefore, the hemostatic sponge is expected to be developed as a novel medical material.

  18. Endogenous adipose tissue as a hemostatic: use in microsurgery.

    Akelina, Yelena; Danilo, Peter


    Bleeding is a frequent complication of microsurgical repair of small blood vessels and time is spent while hemostasis is accomplished. We studied the hemostatic effect of endogenous adipose tissue on bleeding from rat femoral arterial anastomoses. We measured bleeding time (time from removal of clamps to cessation of active bleeding) and mean arterial blood velocity (using a micro-Doppler system), the latter immediately after anastomosis, and again 7 days post-anastomosis. Bleeding time for vessels with fat applied to the artery was 50% less than when no fat was applied. Blood velocity by day 7 post-anastomosis returned to values equivalent to those for intact arteries. Histological evaluation of the anastomotic site demonstrated no significant differences in inflammatory response between fat-treated and untreated arteries. These data suggest that endogenous adipose tissue may be a useful hemostatic agent devoid of significant effects on small artery blood velocity or histology. (c) 2008 Wiley-Liss, Inc.

  19. Hemostatic dressings for the first responder: a review.

    Neuffer, Marcus C; McDivitt, Jonathan; Rose, David; King, Kelly; Cloonan, Clifford C; Vayer, Joshua S


    The military is interested in finding a hemostatic dressing that is effective in controlling hemorrhage from combat wounds, relatively inexpensive, and easy to transport. The fibrin dressing has existed for decades, but the military has been reluctant to use the dressing because it is not Food and Drug Administration approved, fairly expensive, and difficult to apply on certain wounds. Newer dressings such as the microporous polysaccharide hemosphere (TraumaDEX), mineral zeolite (QuikClot), poly-N-acetylglucosamine (HemCon), and microporous hydrogel-forming polyacrylamide (BioHemostat) dressings have addressed these deficiencies in that they are relatively inexpensive, easy to transport, and easy to apply. However, the effectiveness of these new dressings on wounds sustained in combat is still questionable according to studies and anecdotal reports from Operation Iraqi Freedom. More research is needed to draw definite conclusions about the effectiveness of these dressings in a combat setting.

  20. Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty.

    Fu, Xin; Tian, Peng; Xu, Gui-Jun; Sun, Xiao-Lei; Ma, Xin-Long


    The present meta-analysis pooled the results from randomized controlled trials (RCTs) to identify and assess the efficacy and safety of thrombin-based hemostatic agent in primary total knee arthroplasty (TKA). Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5), and ScienceDirect (1966-2015.5). Relevant journals and the recommendations of expert panels were also searched by using Google search engine. RCTs assessing the efficacy and safety of thrombin-based hemostatic agent in primary TKA were included. Pooling of data was analyzed by RevMan 5.1 (The Cochrane Collaboration, Oxford, UK). A total of four RCTs met the inclusion criteria. The meta-analysis revealed significant differences in postoperative hemoglobin decline (p < 0.00001), total blood loss (p < 0.00001), drainage volume (p = 0.01), and allogenic blood transfusion (p = 0.01) between the treatment group and the control group. No significant differences were found regarding incidence of infection (p = 0.45) and deep vein thrombosis (DVT; p = 0.80) between the groups. Meta-analysis indicated that the application of thrombin-based hemostatic agent before wound closure decreased postoperative hemoglobin decline, drainage volume, total blood loss, and transfusion rate and did not increase the risk of infection, DVT, or other complications. Therefore, the reviewers believe that thrombin-based hemostatic agent is effective and safe in primary TKA.

  1. Modulation of Hemostatic and Inflammatory Responses by Leptospira Spp.

    Vieira, Mônica L.; Naudin, Clément; Mörgelin, Matthias; Romero, Eliete C.; Nascimento, Ana Lucia T. O.; Herwald, Heiko


    Leptospirosis is a worldwide spread zoonotic and neglected infectious disease of human and veterinary concern that is caused by pathogenic Leptospira species. In severe infections, hemostatic impairments such as coagulation/fibrinolysis dysfunction are frequently observed. These complications often occur when the host response is controlled and/or modulated by the bacterial pathogen. In the present investigation, we aimed to analyze the modulation of the hemostatic and inflammatory host responses by the bacterial pathogen Leptospira. The effects of leptospires and their secreted products on stimulation of human intrinsic and extrinsic pathways of coagulation were investigated by means of altered clotting times, assembly and activation of contact system and induction of tissue factor. We show that both extrinsic and intrinsic coagulation cascades are modulated in response to Leptospira or leptospiral secreted proteins. We further find that the pro-inflammatory mediator bradykinin is released following contact activation at the bacterial surface and that pro-coagulant microvesicles are shed from monocytes in response to infection. Also, we show that human leptospirosis patients present higher levels of circulating pro-coagulant microvesicles than healthy individuals. Here we show that both pathways of the coagulation system are modulated by leptospires, possibly leading to altered hemostatic and inflammatory responses during the disease. Our results contribute to the understanding of the leptospirosis pathophysiological mechanisms and may open new routes for the discovery of novel treatments for the severe manifestations of the disease. PMID:27167223

  2. Radiology today. Volume 4

    Heuck, F.H.W.; Donner, M.W.


    The book discusses the following contents: Advances in Cardiovascular Imaging: Digital Arteriography: Ongoing Developments. Magnetic Resonance Imaging of the Cardiovascular System. Comparison of Vascular CT and MRI. Characterization of Vascular Lesions by Ultrasound - Progress in Vascular Interventions: Laser Angioplasty: A Review. Fibrinolytic Therapy Combined with Clot Extraction. Drugs Useful in Angioplasty. Developments in Cardiovascular Imaging: Blood Flow Measurements with Digital Arteriography. Selection of Imaging Techniques for Venous Thromboembolic Disease. Clinical Usefulness of High-Verus Low-Osmolality Contrast Agents. Developments in Angiographic and Interventional Instrumentation. Progress in Cardiovascular Interventions. Inferior Vena Cava Filters: Types, Placement, and Efficiency. Transluminal Vascular Stenting and Grafting. Venography and Sclerotherapy of Varioceles in Children and Adolescents. A New Catheter System - Important Hip Problems: Radiologic and Pathologic Correlation and Hip Disease. Comparison of Imaging Modalities in Femoral Head Necrosis. Osteoartrosis and Arthritis (Synovitis) of the Hip. Hip Anthrography.

  3. Growth inhibitory activity of Ankaferd hemostat on primary melanoma cells and cell lines

    Turk, Seyhan; Malkan, Umit Yavuz; Ghasemi, Mehdi; Hocaoglu, Helin; Mutlu, Duygu; Gunes, Gursel; Aksu, Salih; Haznedaroglu, Ibrahim Celalettin


    Objective: Ankaferd hemostat is the first topical hemostatic agent about the red blood cell–fibrinogen relations tested in the clinical trials. Ankaferd hemostat consists of standardized plant extracts including Alpinia officinarum, Glycyrrhiza glabra, Thymus vulgaris, Urtica dioica, and Vitis vinifera. The aim of this study was to determine the effect of Ankaferd hemostat on viability of melanoma cell lines. Methods: Dissimilar melanoma cell lines and primary cells were used in this study. These cells were treated with different concentrations of Ankaferd hemostat to assess the impact of different dosages of the drug. All cells treated with different concentrations were incubated for different time intervals. After the data had been obtained, one-tailed T-test was used to determine whether the Ankaferd hemostat would have any significant inhibitory impact on cell growth. Results: We demonstrated in this study that cells treated with Ankaferd hemostat showed a significant decrease in cell viability compared to control groups. The cells showed different resistances against Ankaferd hemostat which depended on the dosage applied and the time treated cells had been incubated. We also demonstrated an inverse relationship between the concentration of the drug and the incubation time on one hand and the viability of the cells on the other hand, that is, increasing the concentration of the drug and the incubation time had a negative impact on cell viability. Conclusion: The findings in our study contribute to our knowledge about the anticancer impact of Ankaferd hemostat on different melanoma cells. PMID:28293423

  4. Radiochromic film calibration EBT2 Gafchromic-R for the evaluation of skin dose in interventional radiology; Calibracion de la pelicula radiocromica Gafchromic EBT2 para la evaluacion de la dosis en piel en radiologia intevencionista

    Manano Herrera, J. A.; Roldan Arjona, J. M.; Martinez-Luna, R. J.; Soler Cantos, M. M.


    The estimate of the dose in the entrance surface (DSE) in interventional radiology procedures is of interest to identify those which by their nature may lead to skin lesions. The purpose of this paper is to analyze the possibility of use of radiochromic film GAFCHROMICrEBT2 in the estimation of the DSE in these procedures. This is a calibration curve obtained in the dose range of this type of scans proving its validity in relation to the dose given in Perspex phantom exposed to similar values ??of fluoroscopy time and number of acquisitions of employees in the above proceedings.

  5. Pulsed X-rays for interventional radiology: tests on active personal dosemeters (APD) (European project FP7 ORAMED WP3); Rayons X pulses pour la radiologie interventionnelle: tests sur dosimetres personnel actifs

    Denoziere, M.; Bordy, J.M.; Daures, J.; Lecerf, N


    this report presents the results of the tests performed on Active Personal dosemeters (A.P.D.) to check their responses in pulsed X-ray beam used in interventional X-ray radiology. this work is one of the goal of O.R.A.M.E.D W.P.3. (Optimization of radiation protection for medical staff)The response of seven A.P.D.s types was measured in terms of dose equivalent Hp (10) for different pulsed X-ray width and dose rate. (author)

  6. Reinventing radiology reimbursement.

    Marshall, John; Adema, Denise


    Lee Memorial Health System (LMHS), located in southwest Florida, consists of 5 hospitals, a home health agency, a skilled nursing facility, multiple outpatient centers, walk-in medical centers, and primary care physician offices. LMHS annually performs more than 300,000 imaging procedures with gross imaging revenues exceeding dollar 350 million. In fall 2002, LMHS received the results of an independent audit of its IR coding. The overall IR coding error rate was determined to be 84.5%. The projected net financial impact of these errors was an annual reimbursement loss of dollar 182,000. To address the issues of coding errors and reimbursement loss, LMHS implemented its clinical reimbursementspecialist (CRS) system in October 2003, as an extension of financial services' reimbursement division. LMHS began with CRSs in 3 service lines: emergency department, cardiac catheterization, and radiology. These 3 CRSs coordinate all facets of their respective areas' chargemaster, patient charges, coding, and reimbursement functions while serving as a resident coding expert within their clinical areas. The radiology reimbursement specialist (RRS) combines an experienced radiologic technologist, interventional technologist, medical records coder, financial auditor, reimbursement specialist, and biller into a single position. The RRS's radiology experience and technologist knowledge are key assets to resolving coding conflicts and handling complex interventional coding. In addition, performing a daily charge audit and an active code review are essential if an organization is to eliminate coding errors. One of the inherent effects of eliminating coding errors is the capturing of additional RVUs and units of service. During its first year, based on account level detail, the RRS system increased radiology productivity through the additional capture of just more than 3,000 RVUs and 1,000 additional units of service. In addition, the physicians appreciate having someone who "keeps up

  7. How to promote the optimization of radioprotection in interventional radiology: the ASN's point of view; Comment favoriser l'optimisation de la radioprotection en radiologie interventionnelle: le point de vue de l'ASN

    Menechal, Ph. [Autorite de Surete Nucleaire, Division de Bordeaux, 75 - Paris (France); Valero, M.; Godet, J.L [Autorite de Surete Nucleaire, Direction des rayonnements ionisants et de la sante, 75 - Paris (France)


    Within a context of development of interventional imagery practices, radioprotection in interventional radiology and in operating theatre suite where ionizing radiation are used has become a matter of concern. Before the publication of a work group created at the initiative of the ASN (the French nuclear safety authority) with a professional group (the GPMED, the permanent group of radioprotection experts for medical and forensics applications of ionizing radiations), the authors, members of the ASN, based on declared events and radioprotection inspection reports, give an overview of the faced challenges and problems and of progresses to be made in terms of radioprotection, dosimetry, procedures, and personnel qualification. They make a distinction between the patient radioprotection issue and the worker radioprotection issue

  8. Hemostatic alterations in liver disease : A review on pathophysiology, clinical consequences, and treatment

    Lisman, Ton; Leebeek, Frank W. G.


    In most patients with acute or chronic liver failure, extensive changes in all pathways contributing to hemostasis are found. These hemostatic alterations concern both pro- and antihemostatic pathways, and therefore the net result of the hemostatic dysbalance is unclear. Although it is generally bel

  9. In vitro analysis of polyurethane foam as a topical hemostatic agent.

    Broekema, Ferdinand I; van Oeveren, Wim; Zuidema, Johan; Visscher, Susan H; Bos, Rudolf R M


    Topical hemostatic agents can be used to treat problematic bleedings in patients who undergo surgery. Widely used are the collagen- and gelatin-based hemostats. This study aimed to develop a fully synthetic, biodegradable hemostatic agent to avoid exposure to animal antigens. In this in vitro study the suitability of different newly developed polyurethane-based foams as a hemostatic agent has been evaluated and compared to commonly used agents. An experimental in vitro test model was used in which human blood flowed through the test material. Different modified polyurethane foams were compared to collagen and gelatin. The best coagulation was achieved with collagen. The results of the polyurethane foam improved significantly by increasing the amount of polyethylene glycol. Therefore, the increase of the PEG concentration seems a promising approach. Additional in vivo studies will have to be implemented to assess the application of polyurethane foam as a topical hemostatic agent.

  10. Enhancement of study on hemostatic and thrombotic disorders



    @@ Hemostasis and thrombosis is a discipline combining various aspects of basic biology and clinical medicine. Hemostatic abnormalities and thrombosis are involved in the pathophysiology of many diseases in clinical medicine. The fundamental and clinical research of the bleeding disorders and thrombotic diseases has been developed very quickly in recent years. More than 100 genes have been found to be related with hemostasis and thrombosis. The genetic diagnosis of bleeding disorders, including hemophilia A, hemophilia B, von Willebrand disease and Glanzmann's thrombasthenia, has been greatly improved in China.1

  11. Orofacial manifestations of hematological disorders: Anemia and hemostatic disorders

    Titilope A Adeyemo


    Full Text Available The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases, with particular reference to anemias and disorders of hemostasis. A computerized literature search using MEDLINE was conducted for published articles on orofacial manifestations of hematological diseases, with emphasis on anemia. Mesh phrases used in the search were: oral diseases AND anaemia; orofacial diseases AND anaemia; orofacial lesions AND anaemia; orofacial manifestations AND disorders of haemostasis. The Boolean operator "AND" was used to combine and narrow the searches. Anemic disorders associated with orofacial signs and symptoms include iron deficiency anemia, Plummer-Vinson syndrome, megaloblastic anemia, sickle cell anemia, thalassaemia and aplastic anemia. The manifestations include conjunctiva and facial pallor, atrophic glossitis, angular stomatitis, dysphagia, magenta tongue, midfacial overgrowth, osteoclerosis, osteomyelitis and paraesthesia/anesthesia of the mental nerve. Orofacial petechiae, conjunctivae hemorrhage, nose-bleeding, spontaneous and post-traumatic gingival hemorrhage and prolonged post-extraction bleeding are common orofacial manifestations of inherited hemostatic disorders such as von Willebrand′s disease and hemophilia. A wide array of anemic and hemostatic disorders encountered in internal medicine has manifestations in the oral cavity and the facial region. Most of these manifestations are non-specific, but should alert the hematologist and the dental surgeon to the possibilities of a concurrent disease of hemopoiesis or hemostasis or a latent one that may subsequently manifest itself.

  12. ICRP PUBLICATION 120: Radiological protection in cardiology.

    Cousins, C; Miller, D L; Bernardi, G; Rehani, M M; Schofield, P; Vañó, E; Einstein, A J; Geiger, B; Heintz, P; Padovani, R; Sim, K-H


    Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions

  13. Radiological Control Manual


    This manual has been prepared by Lawrence Berkeley Laboratory to provide guidance for site-specific additions, supplements, and clarifications to the DOE Radiological Control Manual. The guidance provided in this manual is based on the requirements given in Title 10 Code of Federal Regulations Part 835, Radiation Protection for Occupational Workers, DOE Order 5480.11, Radiation Protection for Occupational Workers, and the DOE Radiological Control Manual. The topics covered are (1) excellence in radiological control, (2) radiological standards, (3) conduct of radiological work, (4) radioactive materials, (5) radiological health support operations, (6) training and qualification, and (7) radiological records.

  14. Protection of the unborn child in diagnostic and interventional radiological procedures; Schutz des ungeborenen Lebens bei diagnostischen und interventionellen radiologischen Verfahren

    Hojreh, A.; Prosch, H.; Karanikas, G.; Trattnig, S. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Homolka, P. [Medizinische Universitaet Wien, Zentrum fuer medizinische Physik und biomedizinische Technik, Wien (Austria)


    The radiation exposure of an unborn child should be principally avoided, whenever it is medically reasonably possible; therefore, the identification of pregnant patients is the first and the most important step in radiation protection of the unborn child. However, in cases of emergency saving the life of the patient has a higher priority than the radiation protection of the unborn child. In this review article, we present a longitudinal section through the national and international literature and guidelines as a basis for radiological management of a (possibly) pregnant patient. We also list some radiological procedures recommended in the literature for a series of maternal indications considering the contraindications of each method during pregnancy and radiation protection of the unborn child. (orig.) [German] Die Strahlenexposition eines ungeborenen Kindes ist prinzipiell, wann immer dieses medizinisch sinnvoll moeglich ist, zu vermeiden. Daher ist die Identifizierung der schwangeren Patientinnen der erste und wichtigste Schritt zum Strahlenschutz des ungeborenen Kindes. In einer Notfallsituation hat allerdings das Leben der Patientin hoechste Prioritaet. In dieser Uebersichtsarbeit praesentieren wir einen Laengsschnitt durch die nationale und internationale Literatur und Leitlinien, die als Grundlage fuer das radiologische Management einer (moeglicherweise) schwangeren Patientin angewendet werden kann. Wir stellen auch einige in der Literatur empfohlene radiologische Verfahren fuer eine Reihe von Indikationen in der Schwangerschaft vor. Dabei werden sowohl die Kontraindikationen der jeweiligen Methode waehrend der Schwangerschaft als auch der Strahlenschutz des ungeborenen Kindes beruecksichtigt. (orig.)

  15. Isolation, Characterization and Evaluation of Collagen from Jellyfish Rhopilema esculentum Kishinouye for Use in Hemostatic Applications

    Cheng, Xiaochen; Liu, Chenguang


    Hemostat has been a crucial focus since human body is unable to control massive blood loss, and collagen proves to be an effective hemostat in previous studies. In this study, collagen was isolated from the mesoglea of jellyfish Rhopilema esculentum Kishinouye and its hemostatic property was studied. The yields of acid-soluble collagen (ASC) and pepsin-soluble (PSC) were 0.12% and 0.28% respectively. The SDS-PAGE patterns indicated that the collagen extracted from jellyfish mesoglea was type I collagen. The lyophilized jellyfish collagen sponges were cross-linked with EDC and interconnected networks in the sponges were revealed by scanning electron microscope (SEM). Collagen sponges exhibited higher water absorption rates than medical gauze and EDC/NHS cross-linking method could improve the stability of the collagen sponges. Compared with medical gauze groups, the blood clotting indexes (BCIs) of collagen sponges were significantly decreased (P < 0.05) and the concentration of collagen also had an influence on the hemostatic property (P < 0.05). Collagen sponges had an improved hemostatic ability compared to the gauze control in tail amputation rat models. Hemostatic mechanism studies showed that hemocytes and platelets could adhere and aggregate on the surface of collagen sponge. All properties make jellyfish collagen sponge to be a suitable candidate used as hemostatic material and for wound healing applications. PMID:28103327

  16. Safety and effectiveness of a synthetic hemostatic patch for intraoperative soft tissue bleeding.

    Schuhmacher, Christoph; Pratschke, Johann; Weiss, Sascha; Schneeberger, Stefan; Mihaljevic, André L; Schirren, Rebekka; Winkler, Michael; Emmanouilidis, Nikos


    Continuous bleeding after using conventional hemostatic methods involving energy, sutures, or clips, is a serious and costly surgical complication. Many topical agents have been developed to promote intraoperative hemostasis, but improvement is needed in both decreasing time to hemostasis and increasing ease of use. Veriset™ hemostatic patch is CE-marked for controlling bleeding on the liver and in soft tissue. In the current study, we aimed to gather further evidence for the safety and effectiveness of Veriset™ hemostatic patch in soft tissue bleeding during a variety of surgical procedures. Thirty patients scheduled for nonemergency surgery, each with an intraoperative soft tissue bleeding site, were treated with Veriset™ hemostatic patch. Time to hemostasis was monitored, and adverse events were assessed during the 90 days after surgery. When Veriset™ hemostatic patch was used, hemostasis occurred within 5 minutes in 29/30 (96.7%) subjects and within 1 minute in 21/30 (70.0%) subjects. No device-related serious adverse events were recorded during the 30 days after surgery, and no reoperations for device-related bleeding complications were performed during the 5 days after surgery. Veriset™ hemostatic patch is a safe and effective hemostat for controlling soft tissue bleeding during a variety of surgical procedures.

  17. Two-layer sheet of gelatin: A new topical hemostatic agent.

    Takagi, Toshitaka; Tsujimoto, Hiroyuki; Torii, Hiroko; Ozamoto, Yuki; Hagiwara, Akeo


    Uncontrolled surgical bleeding is associated with increased morbidity, mortality, and hospital cost. Topical hemostatic agents available today have problems controlling hemostatic effects; furthermore, their handling is difficult and they are unsafe. We devised a new hemostatic agent comprising gelatin sponge and film designed to be applied to the bleeding site, thereby creating a topical hemostatic agent made of gelatin alone. The gelatin was prepared by alkali treatment to eliminate viral activity. Hemostatic effects, surgical handling, and tissue reactions of the materials, namely a two-layer sheet of gelatin, TachoSil, and gelatin sponge, were evaluated using 21 dogs' spleens. The two-layer gelatin sheet and gelatin sponge exhibited superior hemostatic effects (100% hemostasis completed) compared with TachoSil (0-17% hemostasis). The gelatin matrix immediately absorbed blood flowing from wounds and activated the autologous components in the absorbed blood that promoted coagulation at the bleeding site. The two-layer gelatin sheet had the best surgical handling among the evaluated materials. Materials made of gelatin were associated with fewer inflammatory reactions compared with materials of TachoSil. The two-layer sheet of gelatin is a useful topical agent because of its superior hemostatic effects and usability, and is associated with a lower risk of transmitting diseases and inflammatory reactions. Copyright © 2016. Published by Elsevier Taiwan.

  18. An approach to patient dose optimisation in interventional radiology at the Clermont-Ferrand Hospital Centre; Demarche d'optimisation de la dosimetrie des patients en radiologie interventionnelle au CHU de Clermont-Ferrand

    Guersen, Joel; Chabrot, Pascal; Cassagnes, Lucie; Gabrillargues, Jean; Boyer [Centre Hospitalier Universitaire - CHU, Clermont-Ferrand (France)


    In late October 2009, a serious event occurred in the imaging unit of the Clermont- Ferrand university hospital, corresponding to localised pruritic erythematous cutaneous lesions which resemble radiation-induced damage, following a double pelvic arterial embolization, which saved the life of a young female patient. The imaging unit and the General Management of the University Hospital notified ASN of the event and an on-site dosimetric appraisal carried out by IRSN confirmed that there was a very strong probability that the cutaneous symptoms were attributable to radiation. An internal inquiry concluded that there was a problem with optimisation of the machine parameters in the angiography facility concerned. The imaging unit then initiated a Patient dosimetry optimisation process for the 3 vascular radiology and vascular neuro-radiology facilities in the establishment, divided into 3 main phases dealing with: - image acquisition rates; - the high-voltage settings of the facility concerned, following notification of the event to AFSSAPS, implicating the manufacturer; - the radioscopy and radiography image acquisition parameters, following intervention by the IRSN experts at the request of the imaging unit. On the facility concerned, the reduction in the X-ray dose delivered to the patients was initially 30%, then 35% and finally 25%, representing a total reduction by a factor of three. (authors)

  19. Clinical evaluation of serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) levels in patients with hepatocellular carcinoma following interventional radiology.

    Minakuchi, K; Murata, K; Kaminoh, T; Takada, K; Takashima, S; Nakamura, K; Onoyama, Y


    Fourteen patients with unrespectable HCC were treated with various interventional radiology (IVR) procedures. The initial therapeutic response was determined using computed tomography (CT) findings, and determinations of serum alpha-fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist-II (PIVKA-II) levels. When CT studies of the initial response to IVR were compared with changes in the serum AFP and PIVKA-II levels, the AFP level was found to correlate more closely than the PIVKA-II levels. The PIVKA-II level correlated more closely than the AFP level in cases with poor response to IVR. Both of these tumor markers should be measured in combination with the diagnostic imagings for follow-up studies of IVR.

  20. Hemostatic properties of the free-electron laser

    Cram, Gary P., Jr.; Copeland, Michael L.


    We have investigated the hemostatic properties of the free-electron laser (FEL) and compared these properties to the most commonly used commercial lasers in neurosurgery, CO 2 and Nd:YAG, using an acute canine model. Arterial and venous vessels, of varying diameters from 0.1 to 1.0 mm, were divided with all three lasers. Analysis of five wavelengths of the FEL (3.0, 4.5, 6.1, 6.45, and 7.7 microns) resulted in bleeding without evidence of significant coagulation, regardless of whether the vessel was an artery or vein. Hemorrhage from vessels less than 0.4 mm diameter was subsequently easily controlled with Gelfoam® (topical hemostatic agent) alone, whereas larger vessels required bipolar electrocautery. No significant charring, or contraction of the surrounding parenchyma was noted with any of the wavelengths chosen from FEL source. The CO 2 laser, in continuous mode, easily coagulated vessels with diameters of 4 mm and less, while larger vessels displayed significant bleeding requiring bipolar electrocautery for control. Tissue charring was noted with application of the CO 2 laser. In super pulse mode, the CO 2 laser exhibited similar properties, including significant charring of the surrounding parenchyma. The Nd:YAG coagulated all vessels tested up to 1.4 mm, which was the largest diameter cortical artery found, however this laser displayed significant and extensive contraction and retraction of the surrounding parenchyma. In conclusion, the FEL appears to be a poor hemostatic agent. Our results did not show any benefit of the FEL over current conventional means of achieving hemostasis. However, control of hemorrhage was easily achieved with currently used methods of hemostasis, namely Gelfoam® or bipolar electrocuatery. Although only cortical vessels in dogs were tested, we feel this data can be applied to all animals, including humans, and the peripheral, as well as central, vasculature, as our data on the CO 2 and Nd:YAG appear to closely support previous

  1. American diagnostic radiology residency and fellowship programmes.

    Rumack, Carol Masters


    American Diagnostic Radiology Residency and Fellowship programmes are Graduate Medical Education programmes in the United States (US) equivalent to the Postgraduate Medical Education programmes in Singapore. Accreditation Council for Graduate Medical Education (ACGME) accredited diagnostic radiology residency programmes require 5 years total with Post Graduate Year (PGY) 1 year internship in a clinical specialty, e.g. Internal Medicine following medical school. PGY Years 2 to 5 are the core years which must include Radiology Physics, Radiation Biology and rotations in 9 required subspecialty rotations: Abdominal, Breast, Cardiothoracic, Musculoskeletal, Neuroradiology, Nuclear and Paediatric Radiology, Obstetric & Vascular Ultrasound and Vascular Interventional Radiology. A core curriculum of lectures must be organised by the required 9 core subspecialty faculty. All residents (PGY 2 to 4) take a yearly American College of Radiology Diagnostic In-Training Examination based on national benchmarks of medical knowledge in each subspecialty. Because the American Board of Radiology (ABR) examinations are changing, until 2012, residents have to take 3 ABR examinations: (i) ABR physics examination in the PGY 2 to 3 years, (ii) a written examination at the start of the PGY 5 year and (iii) an oral exam at the end of the PGY 5 year. Beginning in 2013, there will be only 2 examinations: (i) the physics and written examinations after PGY 4 will become a combined core radiology examination. Beginning in 2015, the final certifying examination will be given 15 months after the completion of residency. After residency, ACGME fellowships in PGY 6 are all one-year optional programmes which focus on only one subspecialty discipline. There are 4 ACGME accredited fellowships which have a Board Certifi cation Examination: Neuroradiology, Nuclear, Paediatric and Vascular Interventional Radiology. Some ACGME fellowships do not have a certifying examination: Abdominal, Endovascular

  2. A chemical hemostatic technique for bleeding from malignant wounds.

    Kakimoto, Masaki; Tokita, Hiromi; Okamura, Takashi; Yoshino, Koji


    Breast cancer, skin cancer, and head and neck cancer often develops a hemorrhagic malignant wound. Bleeding from the tumor impairs patients' quality of life and can be life threatening, while surgical or electrical hemostasis is often unsuccessful because of the tumor's friability. We performed a chemical hemostatic treatment for breast cancer hemorrhage with zinc chloride paste (Mohs' paste), which is usually applied as a fixative in micrographic surgery for cutaneous neoplasms. Five patients with bleeding from breast cancer under various circumstances were treated with this technique in 2008. The method was successful on first application for all five patients, and hemostasis was maintained long term. This simple technique is effective for bleeding from malignant wounds and should be learned by health professionals performing cancer care.

  3. Hypofractionated radiotherapy as local hemostatic agent in advanced cancer

    Malik Tariq Rasool


    Full Text Available Purpose : Tumor bleeding continues to remain a challenge in an oncological setting, and radiotherapy has been studied as a local hemostatic agent. We studied the role of local radiotherapy in controlling bleeding at our center. Materials and Methods : We reviewed 25 treated cases (cancer urinary bladder: 12, lung cancer: 5, cervical cancer: 4, uterine cancer: 1, rectal cancer: 2, schwanoma: 1 at our center from March 2008 to December 2010. All patients had either an advanced or recurrent disease. Radiotherapy schedule was either 20 Gray in 5 fractions or 15 Gray in 5 fractions and was delivered with Cobalt 60. Results and Conclusion : Of 25 patients, 22 (88% responded, and there was complete cessation of bleeding. Both 15 Gray and 20 Gray dose schedule had equal efficacy. Treatment was well tolerated without any intermission. Radiotherapy is a safe and effective option in controlling tumor bleeding.

  4. Newer Hemostatic Agents Used in the Practice of Dermatologic Surgery

    Brewer, Jerry D.


    Minor postoperative bleeding is the most common complication of cutaneous surgery. Because of the commonality of this complication, hemostasis is an important concept to address when considering dermatologic procedures. Patients that have a bleeding diathesis, an inherited/acquired coagulopathy, or who are on anticoagulant/antiplatelet medications pose a greater risk for bleeding complications during the postoperative period. Knowledge of these conditions preoperatively is of the utmost importance, allowing for proper preparation and prevention. Also, it is important to be aware of the various hemostatic modalities available, including electrocoagulation, which is among the most effective and widely used techniques. Prompt recognition of hematoma formation and knowledge of postoperative wound care can prevent further complications such as wound dehiscence, infection, or skin-graft necrosis, minimizing poor outcomes. PMID:23997764

  5. Educational treasures in Radiology: The Radiology Olympics - striving for gold in Radiology education

    Talanow, Roland


    This article focuses on Radiology Olympics ( - a collaboration with the international Radiology community for Radiology education, Radiolopolis ( The Radiology Olympics honour the movers and shakers in Radiology education and offer an easy to use platform for educating medical professionals based on Radiology cases.

  6. Educational treasures in Radiology: The Radiology Olympics - striving for gold in Radiology education

    Talanow, Roland


    This article focuses on Radiology Olympics ( - a collaboration with the international Radiology community for Radiology education, Radiolopolis ( The Radiology Olympics honour the movers and shakers in Radiology education and offer an easy to use platform for educating medical professionals based on Radiology cases.

  7. [Modified polyurethane foam as a local hemostatic agent after dental extractions].

    Selten, M H A; Broekema, F I; Zuidema, J; van Oeveren, W; Bos, R R M


    In this split mouth experiment, the feasibility ofpolyurethane foam as a local hemostatic agent after dental extractions was studied. Ten healthy patients underwent 2 extractions ofa dental element in 1 treatment session. The 10 patients were subsequently randomly divided in a gelatin group and a collagen group. In the gelatin group, a polyurethane foam (PU) was applied in 1 extraction socket, while in the other socket a commercially available gelatin foam was applied. In the collagen group, a PU was applied in 1 socket, and a collagen wadding in the other. All hemostats were removed after 2 minutes, after which the degree of coagulation was measured using a thrombin/antithrombin test and a fibrinogen test. This study suggests that polyurethane foam has hemostatic capacity. Large scale clinical research is needed to confirm this finding, and should indicate whether this hemostatic capacity is clinically relevant.

  8. Hemostatic efficacy and cardiovascular effects of agents used during endodontic surgery.

    Vickers, Francine J; Baumgartner, J Craig; Marshall, Gordon


    The hemostatic efficacy, as well as the cardiovascular effects, of two hemostatic agents currently used during endodontic surgery was examined. The hemostatic agents used were epinephrine pellets (Racellet pellets) or 20% ferric sulfate (Viscostat). Patients were assigned to one of two experimental groups. Blood pressure and pulse rate were recorded pre- and postoperatively and at three additional times during the surgery (root-end resection, root-end preparation, and filling). The adequacy of hemostasis was rated by the surgical operator. Results indicated that there is no significant change in cardiovascular effects when using either of these hemostatic agents. Except in one case where ferric sulfate was the agent, both agents produced surgical hemostasis that allowed for a dry field for root-end filling.

  9. Screening for hemostatic activities of popular Chinese medicinal herbs in vitro

    Naoki Ohkura


    Conclusion Some popular Chinese medicinal herbs have potential as hemostatic agents and could thus be developed as new strategies for the treatment and prevention of bleeding. [J Intercult Ethnopharmacol 2015; 4(1.000: 19-23

  10. Covariance of metabolic and hemostatic risk indicators in men and women

    Riese, H; Vrijkotte, TGM; Meijer, P; Kluft, C; de Geus, Eco J.


    Background and objective: Multivariate analyses on clusters of metabolic and hemostatic risk indicators implicitly assume good test-retest reliability of these variables, substantial covariance among the various indicators, stability of covariance structure over time, and comparable covariance struc

  11. Early experience with X-ray magnetic resonance fusion for low-flow vascular malformations in the pediatric interventional radiology suite

    Hwang, Tiffany J. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Keck School of Medicine of the University of Southern California, Los Angeles, CA (United States); Girard, Erin [Siemens Corporation, Corporate Technology, Princeton, NJ (United States); Shellikeri, Sphoorti; Vossough, Arastoo; Ho-Fung, Victor; Cahill, Anne Marie [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Setser, Randolph [Siemens Medical Solutions USA, Inc., Hoffman Estates, IL (United States)


    This technical innovation describes our experience using an X-ray magnetic resonance fusion (XMRF) software program to overlay 3-D MR images on real-time fluoroscopic images during sclerotherapy procedures for vascular malformations at a large pediatric institution. Five cases have been selected to illustrate the application and various clinical utilities of XMRF during sclerotherapy procedures as well as the technical limitations of this technique. The cases demonstrate how to use XMRF in the interventional suite to derive additional information to improve therapeutic confidence with regards to the extent of lesion filling and to guide clinical management in terms of intraprocedural interventional measures. (orig.)

  12. Hemostatic Function, Survival, and Membrane Glycoprotein Changes in Young versus Old Rabbit Platelets

    Blajchman, Morris A; Senyi, Andrew F.; Hirsh, Jack; Genton, Edward; George, James N.


    Although in vitro studies have demonstrated functional differences between young and old platelets, in vivo differences have not been precisely established. Therefore the in vivo hemostatic function of young and old platelets and the survival time have been examined in rabbits. The hemostatic function was measured by performing serial ear bleeding times in irradiation-induced thrombocytopenic rabbits. After irradiation with 930 rad the platelet count gradually diminished reaching a nadir (∼20...

  13. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study

    KIMURA, Atsushi; Ohmori, Tsukasa; Sakata, Asuka; Endo, Teruaki; Inoue, Hirokazu; Nishimura, Satoshi; Takeshita, Katsushi


    Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was perfo...

  14. Hemostatic agents for access tract in tubeless percutaneous nephrolithotomy: Is it worth?

    Francisco Sepulveda


    Conclusion: The use of Gelita® and Surgicel® as hemostatic agents in tPNL is safe, but we were not able to demonstrate any significant benefit in terms of postoperative morbidity after comparing the use of these agents in tPNL. We concluded that the uses of hemostatic agents needed to be evaluated in prospective randomized trials to define its benefits.

  15. Laenderyggens degeneration og radiologi

    Jacobsen, Steffen; Gosvig, Kasper Kjaerulf; Sonne-Holm, Stig


    and significant relationships between radiological findings and subjective symptoms have both been notoriously difficult to identify. The lack of consensus on clinical criteria and radiological definitions has hampered the undertaking of properly executed epidemiological studies. The natural history of LBP...

  16. Radioprotection of patients and workers in interventional and operating block radiology; La radioprotection des patients et des travailleurs en radiologie interventionnelle et au bloc operatoire

    Menechal, P. [Autorite de Surete Nucleaire, Div. de Bordeaux, 33 (France); Valero, M.; Megnigbeto, C.; Marchal, C.; Godet, J.L. [Autorite de surete nucleaire, Dir. des rayonnements ionisants et de la sante, 75 - Paris (France)


    Over the last ten years or so, extensive development in radiological and implantable equipment has generated significant growth in radio-guided procedures. The real benefit of these practices to patients explains their development. These procedures can be undertaken using not only dedicated, specific fixed installations and computed tomography scanners, but also mobile installations in facilities not designed for radiography, such as operating blocks. The complexity of these procedures and the times spent implementing the required radiation can lead to major detrimental effects on personnel and patients, if they are not fully controlled. Many specialist medical disciplines now perform invasive procedures guided by images. Optimisation of patient doses mainly depends on the training level of medical teams, the intrinsic performance characteristics of the equipment used, adjustment of the technical parameters and the presence or absence of qualified personnel. Optimisation of professional personnel exposure is complex and depends on the performance conditions of procedures, which can expose workers extensively and non-uniformly. Designation of personnel competent in radioprotection, assessment of risks and definition of controlled areas, analysis of workstations and dosimetric monitoring of operators (especially of body extremities) are difficult to implement. Use of collective and personal protective equipment must be improved. The general manager of the French nuclear safety authority (ASN) has referred the matter to the permanent group of radioprotection experts (GPMED) to ensure that recommendations are drawn up in the short term. (authors)

  17. Composite resin bond strength to caries-affected dentin contaminated with 3 different hemostatic agents.

    Khoroushi, Maryam; Hosseini-Shirazi, Moeen; Farahbod, Foroozan; Keshani, Fatemeh


    Bonding of composite resins to sound and caries-affected dentin in cervical areas may necessitate the use of hemostatic agents to control sulcular fluid and hemorrhage. The aim of this in vitro study was to evaluate the bond strengths of a self-etching adhesive system to sound and caries-affected dentin after the use of 3 different hemostatic agents. Composite resin cylinders were bonded to 48 caries-affected and 48 sound dentin surfaces in 8 groups. Groups 1-4 utilized caries-affected dentin: group 1, uncontaminated control; 2, ViscoStat; 3, ViscoStat Clear; and 4, trichloroacetic acid (TCA). Groups 5-8 utilized sound dentin: group 5, uncontaminated control; 6, ViscoStat; 7, ViscoStat Clear; and 8, TCA. The hemostatic agents were applied for 2 minutes and rinsed. After 500 rounds of thermocycling, shear bond strength tests were carried out. Data were analyzed with 1- and 2-way analyses of variance, t test, and post hoc Tukey tests at a significance level of P composite resin to caries-affected dentin was significantly reduced compared to that with sound dentin. Among the studied hemostatic agents, ViscoStat resulted in a greater decrease in dentin bond strength. Contamination of both sound and caries-affected dentin with hemostatic agents decreased composite resin bond strength. Of the 3 hemostatic agents used, ViscoStat Clear appeared to have the least detrimental effect on bond strength.

  18. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat

    Lewis KM


    Full Text Available Kevin Michael Lewis,1 Carl Erik Kuntze,2 Heinz Gulle3 1Preclinical Safety and Efficacy, Baxter Healthcare Corporation, Deerfield, IL, USA; 2Medical Affairs, Baxter Healthcare SA, Zurich, Switzerland; 3Surgical Sciences and Engineering, Baxter Medical Products GmbH, Vienna, Austria Abstract: The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG. NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies. Keywords: HEMOPATCH, hemostasis, surgical hemostasis, sealing, surgical sealant

  19. Evaluation of radiation exposure in interventional radiology (IR) using active personal dosimeters (APD); Evaluierung der Strahlenexposition in der Interventionellen Radiologie (IR) mit Hilfe von Aktiv-Personen-Dosimetern (APD)

    Neugschwandtner, K. [KH Hietzing mit NZ Rosenhuegel, Wien (Austria). Inst. fuer Krankenhausphysik; TU Wien (Austria). Atominstitut; Freund, R. [KH Hietzing mit NZ Rosenhuegel, Wien (Austria). Inst. fuer Krankenhausphysik; Mertikian, G. [KH Hietzing mit NZ Rosenhuegel, Wien (Austria). Inst. fuer Radiologie; Poljanc, K. [TU Wien (Austria). Atominstitut; Ibi, B. [KA Rudolfstiftung, Wien (Austria). Stabstelle Medizinphysik


    Increased awareness of high personal dose exposure of medical staff in interventional radiology (IR) demands an assessment of radiation protection procedures. Mandatory dose monitoring systems do not allow to relate dose to specific actions of the staff as they just accumulate a total dose per month. Doses of head and limbs are expected to be high as those body parts which are not protected by the lead apron. We decided to use a measuring system by Unfors, RaySafe i2 which is built for real- time- dosimetry of scattered radiation in pulsed X-ray fields. An increased dose of the body side closer to the X-ray source (left body side) was detected. This is due to the position and the posture of the radiologist during intervention. Separating the phases of digital subtraction angiography (DSA) from those of fluoroscopy allowed not only to list the separate accumulated doses, but showed as well a big difference in dose rate. The measurements revealed the need of an improvement of common radiation protection, especially while DSA.

  20. A new topical hemostatic agent TT-173 reduces blood loss in a sheep model of total knee arthroplasty.

    Centeno, Alberto; Rojas, Santiago; Arias, Belén; Miquel, Ignasi; Sánchez, Pilar; Ureta, Claudia; Rincón, Esther; López, Ramón; Murat, Jesús


    Total knee arthroplasty is associated with blood loss during the intervention and may require allogenic blood transfusion. Treatments such as tranexamic acid and fibrin sealants improved the bleeding control in several clinical trials, but the hemorrhage associated with the intervention is still significant. Thus far, very few studies have evaluated hemostatic treatments in animal models of total knee arthroplasty. This work describes a sheep model of bleeding associated with total knee arthroplasty and investigates a new class of hemostatic treatment based on recombinant tissue factor. Sheep were treated with the anticoagulant heparin, and the joint was accessed by a paramedial incision. Ligaments and menisci were eliminated and femoral condyles and tibia plateau were sectioned exposing the trabecular bone. An intra-articular drain was used to recover and quantify the blood loss during the 90-min period after treatment. The efficacy of one milligram and three milligrams of TT-173 was evaluated and compared with tranexamic acid. The occurrence of analytical alterations and systemic absorption was also investigated. Treatment with TT-173 reduced the blood loss in comparison with control or tranexamic acid. No significant differences were observed between the two doses evaluated. Moreover, a dose of six milligrams of TT-173 did not induce any clinical or analytical alteration, and significant systemic absorption was not observed. Data obtained strongly suggest that TT-173 could be useful in reducing the blood loss associated with total knee arthroplasty and without safety concerns derived from the systemic absorption of the product. Copyright © 2017. Published by Elsevier B.V.

  1. The Arteriovenous Difference in Hemostatic Parameters in Critically Ill Patients with Different Types of Energy Deficiency

    I. B Zabolotskikh


    Full Text Available Objective: to reveal the patterns of hemostatic disorder development in the venous and arterial bed in relation to the type of energy deficiency. Subjects and methods. One hundred and ninety-nine patients who had undergone extensive abdominal surgeries (gastrectomy, pancreatoduodenectomies, hemicolectomies, hepatectomies, etc. were examined. Among the patients, there were 5 groups: a control group without energy deficiency and 4 groups of patients who were recorded to have one of the types of energy deficiency: substrate, hypermetabolic, hypoxic, and enzymatic. Results and discussion. The nature and degree of existing metabolic disturbances and changes in the arteriovenous difference in hemostasiological parameters have a statistically proven relationship (on the basis of ROC analysis. Substrate energy deficiency was characterized by the insignificant changes in the hemostatic system as a whole, which affect only its coagulation component; the arteriovenous difference in hemostasiological parameters was similar to that in the patients without energy deficiency. In hypermetabolic energy deficiency, the venous bed demonstrated the most pronounced hemostatic changes (hypercoagulation, suppressed fibrinolysis, and enhanced platelet aggregation. The hemostatic changes that were more significant than those in the above group were responsible for the formation of a significant arteriovenous difference in the hemostasiological parameters; however, the direction of this difference did not differ from that in the patients without energy deficiency. In hypoxic energy deficiency, hemostatic disorders were heterodirectional in the arterial and venous bed (these were most marked in the arterial bed — hypercoagulation, activated fibrinolysis, and enhanced platelet aggregation therefore there was a significant arteriovenous difference in the hemostasiological parameters, which was opposite as compared to that in the patients without energy deficiency. In

  2. Influence of cooling medium on rat hemostatic system

    N. A. Lycheva


    Full Text Available The purpose of the article is to study the effect of air and water-immersion cooling media on the hemostatic system in the pre-active period of cold trauma.Material and methods. The study was performed on 43 laboratory Wistar rats. Single air hypothermia was modeled by placing animals in individual cells into a cooling chamber at a temperature –25 °С. The animals were in the chamber until the rectal temperature reached 30 °C, which corresponded to a moderate degree of hypothermia in rats. Water immersion hypothermia was modeled by placing animals in individual cells into water with a temperature 5 °C and air 7 °C. The criterion for cessation of exposure was a rectal temperature of 27–30 °C, which also corresponded to a moderate degree of hypothermia. We assessed the state of vascularplatelet and plasma hemostasis, as well as the physiological state of anticoagulant and fibrinolytic systems. The study was performed by using routine techniques and an integral method - thromboelastography.Results. It was established that during water immersion cooling, experimental animals developed thrombocytosis and activated their aggregation function. Laboratory indicators characterizing the initial stages of plasma hemostasis, and external and internal ways of activation did not change at this intensity of hypothermic exposure. At the same time, at the final stage of coagulation, pronounced thrombinemia was recorded, which was confirmed by a significant increase in the concentration of soluble fibrin-monomer complexes and a decrease in the time of their self-assembly. In addition, inhibition of fibrinolytic activity of plasma associated with a decrease in the concentration of antithrombin III was observed. In this case, single air hypothermia, accompanied by the rise in a rectal temperature up to 30 ° C, also caused significant changes in the hemostatic system. Vascular-platelet hemostasis responded to a significant decrease in aggregation activity

  3. Radiology Resident Supply and Demand: A Regional Perspective.

    Pfeifer, Cory M


    Radiology was subject to crippling deficits in the number of jobs available to graduates of training programs from 2012 through 2015. As the specialty transitions to the assimilation of osteopathic training programs and the welcoming of direct competition from new integrated interventional radiology programs, the assessment of growth in radiology training positions over the 10 years preceding this pivotal time will serve to characterize the genesis of the crisis while inspiring stakeholders to avoid similar negative fluctuations in the future. The number of per capita radiology trainees in each region was derived from data published by the National Resident Matching Program, as were annual match statistics over the years 2012 through 2016. Data regarding new interventional radiology and diagnostic radiology enrollees were also obtained from the National Resident Matching Program. The seven states with the most per capita radiology residents were in the Mid-Atlantic and Northeastern United States in both 2006 and 2016, and three of these seven also showed the greatest per capita growth over the course of the 10 years studied. New radiology programs were accredited during the peak of the job shortage. Integrated interventional radiology training created 24 de novo radiology residents in the 2017 match. Fill rates are weakly positively correlated with program size. Unregulated radiology program growth persisted during the decade leading up to 2016. The region with the fewest jobs available since 2012 is also home to the greatest number of per capita radiology residents. Numerous published opinions during the crisis did not result in enforced policy change. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  4. Hepatobiliary Intervention in Children

    Franchi-Abella, Stéphanie [Le Centre Hospitalier Universitaire du Kremlin-Bicêtre (France); Cahill, Anne Marie; Barnacle, Alex M. [Great Ormond Street Hospital, Department of Radiology (United Kingdom); Pariente, Danièle [Le Centre Hospitalier Universitaire du Kremlin-Bicêtre (France); Roebuck, Derek J., E-mail: [Great Ormond Street Hospital, Department of Radiology (United Kingdom)


    Various vascular and nonvascular hepatobiliary interventional radiology techniques are now commonly performed in children’s hospitals. Although the procedures are broadly similar to interventional practice in adults, there are important differences in indications and technical aspects. This review describes the indications, techniques, and results of liver biopsy, hepatic and portal venous interventions and biliary interventions in children.

  5. C臂CT在介入诊疗中的应用%Application of C-arm computed tomography in interventional radiology

    肖运平; 肖恩华


    Recently, C-arm computed tomography (CT), as a new technology of flat detector digital subtraction angiography (DSA) system, has been applied in both vascular and no-vascular interventional procedures. This imaging unit provides the functions of radiography, fluoroscopy, DSA and volumetric CT imaging in a single patient setup, within the interventional suite. This article aims to describe its potentiality ,limitation and prospect in clinical practice. (J Intervent Radiol, 2011 , 20 : 249-252)%C臂CT是平板探测器数字减影血管造影系统的一种新技术,在介入室同一工作床上能提供透视、摄影、DSA及容积CT成像,已在血管性及非血管介入诊疗中开始发挥其独特作用,本文介绍C臂CT在介入诊疗应用中的潜力、限度与前景.

  6. Development of an auxiliary system for the execution of vascular catheter interventions with a reduced radiological risk; system description and first experimental results.

    Placidi, Giuseppe; Franchi, Danilo; Marsili, Luca; Gallo, Pasquale


    Vascular catheterization is a common procedure in clinical medicine. It is normally performed by a specialist using an X-ray fluoroscopic guide and contrast-media. In the present paper, an image-guided navigation system which indicates a path providing guidance to the desired target inside the vascular tree is described with the aim of reducing the exposure of personnel and patients to X-rays during the catheterization procedure. A 3D model of the patient vascular tree, reconstructed with data collected by an angiography before starting the intervention, is used as a guide map instead of fluoroscopic scans. An accurate spatial correspondence between the body of the patient and the 3D reconstructed vascular model is established and, by means of a position indicator installed over the catheter tip, the real-time position/orientation of the tip is indicated correctly. This paper describes the system and the operational procedures necessary to use the proposed method efficiently during a catheter intervention. Preliminary experimental results on a phantom are also reported.

  7. Radiation Protection in Interventional Radiology. Training objectives for the medical specialists; Proteccion radiologia en radiologia intervencionista. Objectivos de formacion para especialistas medicos

    Ruiz-Cruces, R.; Vano, E.; Hernandez Armas, J.; Carrera, F.


    The Directive 97/43 Euratom on medical exposures and the report RP 116 published by the European Commission on Education and Training in radiation protection for medical exposures, established that interventional radiologists should have a more skilled training for handling X-Ray equipment and a better knowledge about the ways of protecting patients and staff against ionising radiation. To analyse the objectives for training in radiation protection recommended in the European Guideline and to show the most important points and modifications for a better practical application of this guide. An inquiry has been performed into the specific objectives recommended by the European Guideline RP 116 about training on Radiation Protection. Twenty interventional radiologists were requested to fill in the test, pointing out the importance of each objective (0-no necessary, 1-medium importance, 2-very important), and they were encouraged to suggest other more interesting for them not included in the European Guideline. The average scores for each of the objectives included in the European Guideline are shown, and an additional relation of suggested topics has been added to the current list. The scoring system show the priority and importance of the objectives that could be taken into account during the next training courses to be held in Spain and it could be used as a base of discussion in some European meeting in order to improve the European Guideline in the future. (Author) 13 refs.

  8. [Topical hemostatic devices in surgery: between science and marketing].

    González, Héctor Daniel; Figueras Felip, Joan


    Topical hemostatic agents have been used in surgery with varying degrees of success. These agents include oxidized cellulose, absorbable gelatin sponges, microfibrillar collagen and fibrin seals. Fibrin seals have become widely used as they improve perioperative hemostasis, reduce the need for red blood cell transfusions and prevent biliary leaks. Their widespread use, however, contrasts with the scarcity of data from controlled studies to support their clinical effectiveness. Therefore, a prospective, randomized, controlled, single-center study was performed in 300 patients who underwent elective hepatectomy, with and without application of fibrin seal on the raw liver surface. None of the variables evaluated (blood loss, transfusions, biliary fistulas and postoperative results) differed between the two groups. We conclude that the application of fibrin seal does not seem justified and that discontinuing its routine use would substantially reduce costs. The use of a new agent, Tachosil, is supported by a single multicenter, prospective, randomized, controlled trial, which is limited by the small number of patients and by the fact that the variable analyzed--time from application to hemostasis--may not be clinically relevant.

  9. Antibacterial hemostatic dressings with nanoporous bioglass containing silver

    Hu G


    Full Text Available Gangfeng Hu,1 Luwei Xiao,2 Peijian Tong,2 Dawei Bi,1 Hui Wang,1 Haitao Ma,1 Gang Zhu,1 Hui Liu21The First People’s Hospital of Xiaoshan, Hangzhou, China; 2Zhejiang Traditional Chinese Medical University, Hangzhou, ChinaAbstract: Nanoporous bioglass containing silver (n-BGS was fabricated using the sol-gel method, with cetyltrimethyl ammonium bromide as template. The results showed that n-BGS with nanoporous structure had a surface area of 467 m2/g and a pore size of around 6 nm, and exhibited a significantly higher water absorption rate compared with BGS without nanopores. The n-BGS containing small amounts of silver (Ag had a slight effect on its surface area. The n-BGS containing 0.02 wt% Ag, without cytotoxicity, had a good antibacterial effect on Escherichia coli, and its antibacterial rate reached 99% in 12 hours. The n-BGS’s clotting ability significantly decreased prothrombin time (PT and activated partial thromboplastin time (APTT, indicating n-BGS with a higher surface area could significantly promote blood clotting (by decreasing clotting time compared with BGS without nanopores. Effective hemostasis was achieved in skin injury models, and bleeding time was reduced. It is suggested that n-BGS could be a good dressing, with antibacterial and hemostatic properties, which might shorten wound bleeding time and control hemorrhage.Keywords: antibacterial, bioglass, cytotoxicity, dressing, hemostasis, nanopore, silver

  10. Development of feather keratin nanoparticles and investigation of their hemostatic efficacy.

    Wang, Ju; Hao, Shilei; Luo, Tiantian; Yang, Qian; Wang, Bochu


    Chicken feathers are considered as the major waste in poultry industry, which are mostly constituted of keratin proteins. Development of feather keratin for biomedical application is very attractive for chicken feather recycling. Human hair keratins have been demonstrated the significant hemostatic efficacy in the previous studies, but there are few reports of feather keratin for the hemostatic application. Here, the chicken feather keratin nanoparticle was developed for use as a hemostatic agent. Keratin was extracted from chicken feather in the present study, and a modified ultrasonic dispersion method was used to prepare keratin nanoparticles. The characterizations of feather keratin extracts and nanoparticles were investigated, including electrophoretic separation, amino acid composition, particle size, zeta potential, morphology, chemical structure and crystal form. Additionally, the hemostatic efficacy in vitro and in vivo of keratin nanoparticles were also studied. The results of hemostatic tests showed that the bleeding time and blood loss in tail amputation and liver scratch rat models can be significantly decreased after application of feather keratin nanoparticles, which demonstrated the potential application of feather keratin nanoparticles for hemostasis.

  11. Medical liability and patient law in Germany. Main features with particular focus on treatments in the field of interventional radiology; Arzthaftung und Patientenrechtegesetz in Deutschland. Die Grundzuege unter besonderer Beruecksichtigung von Behandlungen auf dem Gebiet der Interventionellen Radiologie

    Sommer, S.A.; Geissler, R. [Kapp and Geissler Lawyers, Stuttgart (Germany); Stampfl, U.; Radeleff, B.A.; Kauczor, H.U.; Sommer, Christof M. [Univ. Hospital Heidelberg (Germany). Clinic for Diagnostic and Interventional Radiology; Wolf, M.B. [German Cancer Research Center (DKFZ), Heidelberg (Germany). Radiology (E010); Richter, G.M. [Klinikum Stuttgart (Germany). Clinic for Diagnostic and Interventional Radiology; Pereira, P.L. [SLK Kliniken, Heilbronn (Germany). Radiology, Minimally-invasive Therapies and Nuclearmedicine


    On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology - with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liability of malpractice law.

  12. Essentials of skeletal radiology

    Yochum, T.R.; Rowe, L.J.


    This book discusses the following topics of skeletal radiology: Positioning of patients for diagnostic radiology and normal anatomy; congenital malformations of skeleton; measurements in radiology; spondylolisthesis; metabolic and endocrine diseases of bone and their diagnostic aspects; image processing of vertebrae, skeleton, bone fractures evaluations and epidemiological and social aspects of some bone diseases. Various modalities as CT scanning, NMR imaging, ultrasonography and biomedical radiography are briefly discussed in relation to bone pathology.

  13. Machine Learning and Radiology

    Wang, Shijun; Summers, Ronald M.


    In this paper, we give a short introduction to machine learning and survey its applications in radiology. We focused on six categories of applications in radiology: medical image segmentation, registration, computer aided detection and diagnosis, brain function or activity analysis and neurological disease diagnosis from fMR images, content-based image retrieval systems for CT or MRI images, and text analysis of radiology reports using natural language processing (NLP) and natural language understanding (NLU). This survey shows that machine learning plays a key role in many radiology applications. Machine learning identifies complex patterns automatically and helps radiologists make intelligent decisions on radiology data such as conventional radiographs, CT, MRI, and PET images and radiology reports. In many applications, the performance of machine learning-based automatic detection and diagnosis systems has shown to be comparable to that of a well-trained and experienced radiologist. Technology development in machine learning and radiology will benefit from each other in the long run. Key contributions and common characteristics of machine learning techniques in radiology are discussed. We also discuss the problem of translating machine learning applications to the radiology clinical setting, including advantages and potential barriers. PMID:22465077

  14. Radiological Emergency Response Data

    U.S. Environmental Protection Agency — Quality Data Asset includes all current and historical emergency radiological response event and incident of national significance data and surveillance, monitoring,...

  15. Quality management systems in radiology

    Geoffrey K. Korir


    Full Text Available Background: The use of X-ray imaging is ever increasing in proportion to the need for radiological services and technological capabilities. Quality management that includes patient radiation dose monitoring is fundamental to safety and quality improvement of radiological services.Objective: To assess the level of quality management systems in X-ray medical facilities in Kenya.Methods: Quality management inspection, quality control performance tests and patient radiation exposure were assessed in 54 representative X-ray medical facilities. Additionally, a survey of X-ray examination frequency was conducted in 140 hospitals across the country.Results: The overall findings placed the country’s X-ray imaging quality management systems at 61±3% out of a possible 100%. The most and the least quality assurance performance indicators were general radiography X-ray equipment quality control tests at 88±4%, and the interventional cardiology adult examinations below diagnostic reference level at 25±1%, respectively.Conclusions: The study used a systematic evidence-based approach for the assessment of national quality management systems in radiological practice in clinical application, technical conduct of the procedure, image quality criteria, and patient characteristics as part of the quality management programme.

  16. Radiological chest manifestations in diffuse infiltrative lymphocytosis syndrome (DILS

    F Ismail


    Full Text Available This report focuses on the radiological manifestations of diffuse interstitial lymphocytosis syndrome (DILS in the chest. Awareness of this entity and early diagnosis by radiologists will enable timeous intervention by clinicians.

  17. A framework for organ dose estimation in x-ray angiography and interventional radiology based on dose-related data in DICOM structured reports

    Omar, Artur; Bujila, Robert; Fransson, Annette; Andreo, Pedro; Poludniowski, Gavin


    Although interventional x-ray angiography (XA) procedures involve relatively high radiation doses that can lead to deterministic tissue reactions in addition to stochastic effects, convenient and accurate estimation of absorbed organ doses has traditionally been out of reach. This has mainly been due to the absence of practical means to access dose-related data that describe the physical context of the numerous exposures during an XA procedure. The present work provides a comprehensive and general framework for the determination of absorbed organ dose, based on non-proprietary access to dose-related data by utilizing widely available DICOM radiation dose structured reports. The framework comprises a straightforward calculation workflow to determine the incident kerma and reconstruction of the geometrical relation between the projected x-ray beam and the patient’s anatomy. The latter is difficult in practice, as the position of the patient on the table top is unknown. A novel patient-specific approach for reconstruction of the patient position on the table is presented. The proposed approach was evaluated for 150 patients by comparing the estimated position of the primary irradiated organs (the target organs) with their position in clinical DICOM images. The approach is shown to locate the target organ position with a mean (max) deviation of 1.3 (4.3), 1.8 (3.6) and 1.4 (2.9) cm for neurovascular, adult and paediatric cardiovascular procedures, respectively. To illustrate the utility of the framework for systematic and automated organ dose estimation in routine clinical practice, a prototype implementation of the framework with Monte Carlo simulations is included.

  18. SU-E-I-57: Estimating the Occupational Eye Lens Dose in Interventional Radiology Using Active Personal Dosimeters Worn On the Chest

    Omar, A; Marteinsdottir, M; Kadesjo, N; Fransson, A [Dept. of Medical Physics, Karolinska University Hospital, Stockholm (Sweden)


    Purpose: To provide a general formalism for determination of occupational eye lens dose based on the response of an active personal dosimeter (APD) worn at chest level above the radiation protection apron. Methods: The formalism consists of three factors: (1) APD conversion factor converting the reading at chest level (APDchest) to the corresponding personal dose equivalent at eye level, (2) Dose conversion factor transferring the measured dose quantity, Hp(10), into a dose quantity relevant for the eye lens dose, (3) Correction factor accounting for differences in exposure of the eye(s) compared to the exposure at chest level (e.g., due to protective lead glasses).The different factors were investigated and evaluated based on phantom and clinical measurements performed in an x-ray angiography suite for interventional cardiology. Results: The eye lens dose can be conservatively estimated by assigning an appropriate numerical value to each factor entering the formalism that in most circumstances overestimates the dose. Doing so, the eye lens dose to the primary operator and assisting staff was estimated in this work as D-eye,primary = 2.0 APDchest and D-eye,assisting = 1.0 APDchest, respectively.The annual eye lens dose to three nurses and one cardiologist was estimated to be 2, 2, 2, and 13 mSv (Hp(0.07)), respectively, using a TLD dosimeter worn at eye level. In comparison, using the formalism and APDchest measurements, the respective doses were 2, 2, 2, and 16 mSv (Hp(3)). Conclusion: The formalism outlined in this work can be used to estimate the occupational eye lens dose from the response of an APD worn on the chest. The formalism is general and could be applied also to other types of dosimeters. However, the numerical value of the different factors may differ from those obtained with the APD’s used in this work due to differences in dosimeter properties.

  19. Hemostatic resuscitation with plasma and platelets in trauma

    Pär I Johansson


    Full Text Available Background: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and controversy regarding the optimal management exists although recently, the concept of hemostatic resuscitation, i.e., providing large amount of blood products to critically injured patients in an immediate and sustained manner as part of an early massive transfusion protocol has been introduced. The aim of the present review was to investigate the potential effect on survival of proactive administration of plasma and/or platelets (PLT in trauma patients with massive bleeding. Materials and Methods: English databases were searched for reports of trauma patients receiving massive transfusion (10 or more red blood cell (RBC within 24 hours or less from admission that tested the effects of administration of plasma and/or PLT in relation to RBC concentrates on survival from January 2005 to November 2010. Comparison between highest vs lowest blood product ratios and 30-day mortality was performed. Results: Sixteen studies encompassing 3,663 patients receiving high vs low ratios were included. This meta-analysis of the pooled results revealed a substantial statistical heterogeneity (I 2 = 58% and that the highest ratio of plasma and/or PLT or to RBC was associated with a significantly decreased mortality (OR: 0.49; 95% confidence interval: 0.43-0.57; P<0.0001 when compared with lowest ratio. Conclusion: Meta-analysis of 16 retrospective studies concerning massively transfused trauma patients confirms a significantly lower mortality in patients treated with the highest fresh frozen plasma (FFP and/or PLT ratio when compared with the lowest FFP and/or PLT ratio. However, optimal ranges of FFP: RBC and PLT : RBC should be established in randomized controlled trials.

  20. Hydrophobically modified chitosan gauze: a novel topical hemostat.

    Chaturvedi, Apurva; Dowling, Matthew B; Gustin, John P; Scalea, Thomas M; Raghavan, Srinivasa R; Pasley, Jason D; Narayan, Mayur


    Currently, the standard of care for treating severe hemorrhage in a military setting is Combat Gauze (CG). Previous work has shown that hydrophobically modified chitosan (hm-C) has significant hemostatic capability relative to its native chitosan counterpart. This work aims to evaluate gauze coated in hm-C relative to CG as well as ChitoGauze (ChG) in a lethal in vivo hemorrhage model. Twelve Yorkshire swine were randomized to receive either hm-C gauze (n = 4), ChG (n = 4), or CG (n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy before a 6-mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 min. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for 3 h after which any surviving animal was euthanized. hm-C gauze was found to be at least equivalent to both CG and ChG in terms of overall survival (100% versus 75%), number of dressing used (6 versus 7), and duration of hemostasis (3 h versus 2.25 h). Total post-treatment blood loss was lower in the hm-C gauze treatment group (4.7 mL/kg) when compared to CG (13.4 mL/kg) and ChG (12.1 mL/kg) groups. hm-C gauze outperformed both CG and ChG in a lethal hemorrhage model but without statistical significance for key endpoints. Future comparison of hm-C gauze to CG and ChG will be performed on a hypothermic, coagulopathic model that should allow for outcome significance to be differentiated under small treatment groups. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Hemostatic abnormalities in uncomplicated babesiosis (Babesia rossi) in dogs.

    Liebenberg, C; Goddard, A; Wiinberg, B; Kjelgaard-Hansen, M; van der Merwe, L L; Thompson, P N; Matjila, P T; Schoeman, J P


    Babesiosis in dogs is associated with severe thrombocytopenia; yet infected dogs rarely show clinical signs of hemorrhage. Dogs with uncomplicated babesiosis have normal hemostatic capacity despite severe thrombocytopenia. Nineteen client-owned dogs with uncomplicated babesiosis; 10 healthy controls. A prospective, cross-sectional, observational study. Thromboelastography (TEG), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimers, and antithrombin (AT) measured in both groups. Statistical significance set at P Babesiosis group hematocrit and platelet count significantly lower than controls (0.29 versus 0.50 L/L; P babesiosis group versus controls (mean ± SD); R: 5.9 ± 1.8 versus 4.6 ± 0.9 min (P = .048); K: 2.8 ± 1.1 versus 1.9 ± 0.6 min (P = .003); angle: 55.5 ± 11.7 versus 62.2 ± 4.1 degrees (P = .036); MA: 48.4 ± 9.7 versus 57.2 ± 5.2 mm (P = 0.013); G: 5.1 ± 1.9 versus 6.9 ± 1.5 dyn/cm(2) (P = .019); LY30 (median, range): 0 (0-5.7) versus 0.6% (0-6.1) (P = .152); and LY60: 0 (0-8.8) versus 3.1% (0-13.1) (P = .012). AT activity significantly lower (105.2 ± 16.5 versus 127.8 ± 15.4%; P = .001). Fibrinogen concentration significantly higher in babesiosis group (5.7 ± 1.3 versus. 3.0 ± 0.7 g/L; P babesiosis did not have clinical signs of hemorrhage and TEG variables were normal, which could indicate a normocoagulable state. Copyright © 2012 by the American College of Veterinary Internal Medicine.

  2. [Shared web-based data center for multi-institutional clinical trials: evaluation of UMIN-INDICE (university hospital medical information network-internet data and information center for medical research)in clinical trials of JIVROSG (Japan interventional radiology in oncology study group)].

    Sone, Miyuki; Arai, Yasuaki; Kiuchi, Takahiro; Ishikawa, Hirono; Aoki, Noriaki; Inaba, Yoshitaka; Yoshioka, Tetsuya; Aramaki, Takeshi; Kobayashi, Takeshi; Matsuoka, Toshiyuki; Anai, Hiroshi; Tanigawa, Noboru; Osuga, Keigo; Takeuchi, Yoshito; Okusaka, Takushi; Kanazawa, Susumu; Matsui, Osamu; Endo, Keigo


    A patient registration system is mandatory for establishing the scientific credibility of the multi-center clinical trials. The Japan Interventional Radiology in Oncology Study Group (JIVROSG) was organized in 2002 to establish evidence supporting the procedures used in interventional radiology. The Internet Data and Information Center for Medical Research (INDICE), provided by the University Hospital Medical Information Network(UMIN), has been utilized for patient registration in the clinical trials of JIVROSG. In this study, the safety and efficacy of UMIN-INDICE were evaluated. From 2002 to 2010, 18 clinical trials, including one international trial, were conducted. A total of 736 patients were enrolled from 51 institutions. No significant trouble was encountered during this period. A questionnaire survey demonstrated that 90% of participating researchers could use this system without difficulties. UMIN-INDICE may contribute to promoting clinical trials as an infrastructure of multicenter studies.

  3. Microspheres of carboxymethyl chitosan, sodium alginate and collagen for a novel hemostatic in vitro study.

    Shi, Xinyi; Fang, Qiang; Ding, Miao; Wu, Jing; Ye, Fei; Lv, Zhengbing; Jin, Jia


    To develop biocompatible composite microspheres for novel hemostatic use, we designed and prepared a novel biomaterial, composite microspheres consisting of carboxymethyl chitosan, sodium alginate, and collagen (CSCM). The ultra-structure of CSCM was investigated by scanning electron microscopy assay. In hemostatic function experiment, it was found that CSCM could facilitate platelet adherence, platelet aggregation, and platelet activation in vitro. Besides, the maximum swelling of CSCM submerged in PBS for 50 min was over 300% of that exhibited by commercial hemostatic compound microporous polysaccharide haemostatic powder (CMPHP). In addition, CSCM exhibited good biodegradability and non-cytotoxicity. These results demonstrated that CSCM may be useful in platelet plug formation, and this study would provide important information for further research on hemostasis experiment in vivo. © The Author(s) 2015.

  4. [The effect of prostatilen on the hemostatic indices in chronic prostatitis (a clinical and experimental study)].

    al-Shukri, S Kh; Petrishchev, N N; Gorbachev, A G; Mikhaĭlova, I A; Bobkov, Iu A; Kuz'min, I V; Borovets, S Iu; Savel'eva, I B; Korokhodkina, M V


    Prostatilen effects on hemostasis were studied in 120 intact and 240 chronic prostatitis rats, 34 patients with chronic prostatitis. Intact rats responded to prostatilen by inhibition of platelet-vascular and coagulation hemostatic mechanisms and activation of fibrinolysis. Experimental chronic prostatitis in rats induced hemostatic shifts to hypercoagulation. These parameters returned to normal after 5- and 10-day course of prostatilen administration. A single prostatilen dose was unable to produce the above action. As to patients with chronic prostatitis, there were also prostatilen-induced platelet-vascular hemostatic normalization and fibrinolysis activation. Hemocoagulation was affected in a less degree. Prostatilen effects were unrelated to the disease stage. Normalization of hemostasis seems to be one of the factors of prostatilen therapeutic efficacy in chronic prostatitis. This peptide is found effective as a pathogenetic treatment of chronic prostatitis.

  5. American College of Radiology

    American College of Radiology Login About Us Media Center Contact Us Follow us Shopping Cart (0) ACR Catalog Donate My ACR Join ACR ... ACR Catalog Education Center eLearning Exams & Assessments AIRP™ Radiology Leadership Institute ® Quality & Safety Accreditation Appropriateness Criteria ® Practice ...

  6. Physics of Radiology

    Johns, Harold Elford


    Authority, comprehensivity and a consummate manner of presentation have been hallmarks of The Physics of Radiology since it first saw publication some three decades past. This Fourth Edition adheres to that tradition but again updates the context. It thoroughly integrates ideas recently advanced and practices lately effected. Students and professionals alike will continue to view it, in essence, as the bible of radiological physics.

  7. Targeted Thromboelastographic (TEG) Blood Component and Pharmacologic Hemostatic Therapy in Traumatic and Acquired Coagulopathy.

    Walsh, Mark; Fritz, Stephanie; Hake, Daniel; Son, Michael; Greve, Sarah; Jbara, Manar; Chitta, Swetha; Fritz, Braxton; Miller, Adam; Bader, Mary K; McCollester, Jonathon; Binz, Sophia; Liew-Spilger, Alyson; Thomas, Scott; Crepinsek, Anton; Shariff, Faisal; Ploplis, Victoria; Castellino, Francis J


    Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation. This review describes the utility of VETs, in particular, TEG, to provide TTHAT in trauma and acquired non-trauma-induced coagulopathy.

  8. Topical Hemostatic Agents: What the Oral and Maxillofacial Surgeon Needs to Know.

    Vezeau, Patrick J


    Hemostasis is a key step in safe and predictable surgery. Knowledge of normal blood clotting mechanisms and abnormal diathesis is necessary to anticipate potential problems during and after surgery. As an adjunct to bleeding control, topical hemostatic agents have long been used in all surgical disciplines. This article provides a brief review of hemostasis and a topical summary of different classes of topical hemostatic agents useful to oral and maxillofacial surgery, including indications and potential complications/side effects. This rapidly evolving field promises to yield future agents with increased efficacy, cost efficiency, and decreased complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis

    Henriksen, Hanne Herborg; Rahbar, Elaheh; Baer, Lisa A


    BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. W...

  10. A Novel Swine Model for Evaluation of Potential Intravascular Hemostatic Agents


    1996. Efficacy of hemostatic agents in improving surgical hemostasis. Transfus Med Rev 10:171– 182. 14. Hannon JP, Bossone CA, Rodkey WG. 1985...experimental hemorrhagic shock: a pilot study. J Trauma 52:703–707. 30. Mabry CD, Thompson BW, Read RC, Campbell GS. 1981. Activated clotting time




    The impaired hemostasis of aspirin-treated patients is an annoying problem during and after cardiopulmonary bypass, The hemostatic function of platelets comprises two mechanisms: the shear-induced and the cyclooxygenase pathways, Because the latter is inhibited in aspirin-treated patients, the hemos

  12. Hemostasis and the diseased liver : a study on hemostatic disorders in liver disease and liver transplantation

    C.M. Bakker (Minke)


    textabstractIn this thesis studies on hemostatic disorders in liver cirrhosis and liver transplantation have been described. Aims of the work were to further investigate; 1. Whether (low-grade) DIC occurs in liver cirrhosis applying new quantitative tests, measuring thrombin-antithrombin Ill complex

  13. Waist circumference and VO2max are associated with metabolic and hemostatic risk in premenopausal nurses

    Elich, H; Riese, H; De Geus, EJC

    In 21 nurses (34.4+/-3.9 yr), VO2max, physical activity, body composition and lifestyle parameters were measured to determine which of these characteristics are related to metabolic and hemostatic risk for cardiovascular disease. Physical activity was assessed with the 7-day recall interview VO2max

  14. Aspects of the Molecular Markers of Hemostatic Mechanism in Clinical Medicine

    HE Shi-lin; 贺石林


    @@ Thrombosis is the pathological process resulting from the inappropriate and propagation of the hemostatic response. The principle determinants of thrombosis can be categorized in contemporary terms according to Virchow' s paradigm: abnormalities in endothelial function ( vessel function ), rheotogy ( blood flow ), or blood component,either alone or in combination, can promote thrombus formation.

  15. Comparative Testing of Hemostatic Dressing in a Large Animal Model (Sus Scorofa) with Severe hepatic Injuries


    hemostatic dressings in a large animal model (Sus scrofa ) with severe hepatic injuries PRINCIPAL INVESTIGATOR (PI) / TRAINING COORDINATOR (TC): Date Sus scrofa 36 18 18 Note. Many fewer animals than approved were used because one of the original treatment groups (Lypressin- soaked gauze

  16. Radiologic Imaging in Meckel Diverticulum Complications

    Erin Leslee Dames


    Full Text Available In 1809, Johann Friedrich Meckel the Younger described the most common congenital small bowel anomaly, which was named after him; however, the radiologic manifestations and interventional guidelines related to this entity are still limited to a few large-scale case series as well as proposed therapeutic protocols for the general population. Despite the fact that this entity is more commonly found within the first decade of life, imaging and management protocols remain controversial in the pediatric population, particularly within the asymptomatic group. We present an article depicting the radiologic and histologic findings in a series of Meckel's diverticulum within the pediatric population seen within our institution. We present this series to underscore the importance of high clinical suspicion in the early diagnosis and management of Meckel's diverticulum and to examine further the radiologic and therapeutic protocols within the pediatric population based on our local experience.

  17. Laenderyggens degeneration og radiologi

    Jacobsen, Steffen; Gosvig, Kasper Kjaerulf; Sonne-Holm, Stig


    Low back pain (LBP) is one of the most common conditions, and at the same time one of the most complex nosological entities. The lifetime prevalence is approximately 80%, and radiological features of lumbar degeneration are almost universal in adults. The individual risk factors for LBP and signi......Low back pain (LBP) is one of the most common conditions, and at the same time one of the most complex nosological entities. The lifetime prevalence is approximately 80%, and radiological features of lumbar degeneration are almost universal in adults. The individual risk factors for LBP...... and significant relationships between radiological findings and subjective symptoms have both been notoriously difficult to identify. The lack of consensus on clinical criteria and radiological definitions has hampered the undertaking of properly executed epidemiological studies. The natural history of LBP...

  18. Radiologic Technology Program Standards.

    Georgia Univ., Athens. Dept. of Vocational Education.

    This publication contains statewide standards for the radiologic technology program in Georgia. The standards are divided into 12 categories; Foundations (philosophy, purpose, goals, program objectives, availability, evaluation); Admissions (admission requirements, provisional admission requirements, recruitment, evaluation and planning); Program…

  19. Malignant biliary obstruction: treatment with interventional radiology

    翟仁友; 钱晓军; 戴定可; 于平


    Objective To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction. Methods From January 1995 to Febuary 2001, 243 consecutive patients (161 men and 82 women; aged 26-91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.Results One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1-2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage,20 patients had two stents installed from top to bottom to create stenting of adequate ength, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8,P<0.001) with an average patency of 9.7 months(log rank 4.7,P<0.05).Conclusion Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may prolong the duration of stent patency and the survival of patients.

  20. Novel mouse hemostasis model for real-time determination of bleeding time and hemostatic plug composition



    Summary Introduction Hemostasis is a rapid response by the body to stop bleeding at sites of vessel injury. Both platelets and fibrin are important for the formation of a hemostatic plug. Mice have been used to uncover the molecular mechanisms that regulate the activation of platelets and coagulation under physiologic conditions. However, measurements of hemostasis in mice are quite variable, and current methods do not quantify platelet adhesion or fibrin formation at the site of injury. Methods We describe a novel hemostasis model that uses intravital fluorescence microscopy to quantify platelet adhesion, fibrin formation and time to hemostatic plug formation in real time. Repeated vessel injuries of ~ 50–100 μm in diameter were induced with laser ablation technology in the saphenous vein of mice. Results Hemostasis in this model was strongly impaired in mice deficient in glycoprotein Ibα or talin-1, which are important regulators of platelet adhesiveness. In contrast, the time to hemostatic plug formation was only minimally affected in mice deficient in the extrinsic tissue factor (TFlow) or the intrinsic factor IX coagulation pathways, even though platelet adhesion was significantly reduced. A partial reduction in platelet adhesiveness obtained with clopidogrel led to instability within the hemostatic plug, especially when combined with impaired coagulation in TFlow mice. Conclusions In summary, we present a novel, highly sensitive method to quantify hemostatic plug formation in mice. On the basis of its sensitivity to platelet adhesion defects and its real-time imaging capability, we propose this model as an ideal tool with which to study the efficacy and safety of antiplatelet agents. PMID:25442192

  1. Hygiene in radiology

    Kapp-Schwoerer, A.; Daschner, F.


    A survey is given of the hygienic management in radiological departments with special regard to the handling of injections and infusions. It includes prevention of bacterial as well as viral infections. In radiological departments disinfection of X-ray tables is necessary only in exceptional cases. A special proposal for disinfection is added. A safe method of sterilisation of flexible catheders is included, which proved to prevent bacterial infection.

  2. Radiologic science for technologists

    Bushong, S.C.


    This book provides in-depth coverage of physics, biology and protection for the radiologic technology student. It presents a significant portion of all of the science required of radiologic technology students under one cover. Chapter content reflects a readable and practical organization with outlines listed on the first page of each chapter and sample problems at the end. New to this edition are: new and expanded sections on radiation techniques, digital imaging, and magnetic resonance imaging and ultrasound.

  3. Advanced Hemostatic Dressing Development Program: Animal Model Selection Criteria and Results of a Study of Nine Hemostatic Dressings in a Model of Severe Large Venous Hemorrhage and Hepatic Injury in Swine


    may be related to enhanced platelet procoagulant activity and annexin V binding.46 Another derivative of gallic acid , bis- muth subgallate, appears described. We studied the effects of nine hemostatic dressings on blood loss using a model of severe venous hemorrhage and hepatic injury in swine...Methods: Swine were treated using one of nine hemostatic dressings. Dress- ings used the following primary active ingredients: microfibrillar


    Rade R. Babić


    Full Text Available The development of information systems in health care is approaching the process of integration of various systems used in a single computer so that we witness today the omnipresent idea of merging the functions of the clinical-hospital (CHIS and radiology (RIS information system. Radiological Information System (RIS is a technology solution to complete computerization and modernization of the work of the radiology center, and transition from film to paper and ful electronic management and digital recordings. RIS creates the digital radiology center where information is always available at the right place and at the right time. Within the realisation of RIS, it is necessary to follow the standards and systems relating to the specific RIS, which are: DICOM (Digital Imaging and Communications in Medicine, PACS (Picture Archiving and Communication System, HL7 (Health Level Seven. The relevant links of modern RIS are teleradiology and mobile radiology. The authors conclude that the introduction of RIS, HIS and other information systems are reflected in the automation, reduction of possible errors, increase in diagnostic and therapeutic quality, lower costs for materials, the increase in efficiency, saving time and others.

  5. Radiological protection; Proteccion radiologica

    Azorin N, J. [Universidad Autonoma Metropolitana, Unidad Iztapalapa, Division de Ciencias Basicas e Ingenieria, Av. San Rafael Atlixco 186, Col. Vicentina, 09340 Mexico, D. F. (Mexico); Azorin V, J. C. [Universidad de Guanajuato, Campus Leon, Division de Ciencias e Ingenieria, Loma del Bosque 103, Lomas del Campestre, 37150 Leon de los Aldama, Guanajuato (Mexico)


    This work is directed to all those people related with the exercise of the radiological protection and has the purpose of providing them a base of knowledge in this discipline so that they can make decisions documented on technical and scientist factors for the protection of the personnel occupationally exposed, the people in general and the environment during the work with ionizing radiations. Before de lack of a text on this matter, this work seeks to cover the specific necessities of our country, providing a solid presentation of the radiological protection, included the bases of the radiations physics, the detection and radiation dosimetry, the radiobiology, the normative and operational procedures associates, the radioactive wastes, the emergencies and the transport of the radioactive material through the medical and industrial applications of the radiations, making emphasis in the relative particular aspects to the radiological protection in Mexico. The book have 16 chapters and with the purpose of supplementing the given information, are included at the end four appendixes: 1) the radioactive waste management in Mexico, 2-3) the Mexican official standards related with the radiological protection, 4) a terms glossary used in radiological protection. We hope this book will be of utility for those people that work in the investigation and the applications of the ionizing radiations. (Author)

  6. Radiology illustrated. Uroradiology. 2. ed.

    Kim, Seung Hyup (ed.) [Seoul National University Hospital, Seoul (Korea, Republic of). Dept. of Radiology


    Uroradiology is an up-to-date, image-oriented reference in the style of a teaching file that has been designed specifically to be of value in clinical practice. All aspects of the imaging of urologic diseases are covered, and case studies illustrate the findings obtained with the relevant imaging modalities in both common and uncommon conditions. Most chapters focus on a particular clinical problem, but normal findings, congenital anomalies, and interventions are also discussed and illustrated. In this second edition, the range and quality of the illustrations have been enhanced, and many schematic drawings have been added to help readers memorize characteristic imaging findings through pattern recognition. The accompanying text is concise and informative. Besides serving as an outstanding aid to differential diagnosis, this book will provide a user-friendly review tool for certification or recertification in radiology. (orig.)

  7. The Development of Radiology among Slovenes

    Zvonka Zupanič Slavec


    1993. The Clinical Radiology Institute, Ljubljana University Medical Centre, performs ambulatory and hospital radiological management at the secondary and tertiary levels for patients from the region of Ljubljana and from the rest of the country. A sophisticated radiology is also at the University Medical Centre Maribor. In the first decade of the 21st century radiology developed particularly quickly, bringing recent developments in international radiology to Slovenia, especially in the field of interventional radiology.

  8. Organizational decentralization in radiology.

    Aas, I H Monrad


    At present, most hospitals have a department of radiology where images are captured and interpreted. Decentralization is the opposite of centralization and means 'away from the centre'. With a Picture Archiving and Communication System (PACS) and broadband communications, transmitting radiology images between sites will be far easier than before. Qualitative interviews of 26 resource persons were performed in Norway. There was a response rate of 90%. Decentralization of radiology interpretations seems less relevant than centralization, but several forms of decentralization have a role to play. The respondents mentioned several advantages, including exploitation of capacity and competence. They also mentioned several disadvantages, including splitting professional communities and reduced contact between radiologists and clinicians. With the new technology decentralization and centralization of image interpretation are important possibilities in organizational change. This will be important for the future of teleradiology.

  9. An essential primer for understanding the role of topical hemostats, surgical sealants, and adhesives for maintaining hemostasis.

    Gabay, Michael; Boucher, Bradley A


    A wide variety of topical hemostats are approved as adjunctive therapies in the maintenance of hemostasis during surgical procedures in which conventional methods are insufficient or not practical. A multidisciplinary approach to the selection and application of these agents requires input from all members of the surgical team including surgeons, perioperative nurses, blood bank specialists, and pharmacists. However, pharmacist knowledge regarding topical hemostats may be limited based on lack of formal education within college of pharmacy curricula as well as their use being predominantly in the operating room setting. Furthermore, some of these agents might be procured through central supply rather than the hospital pharmacy. Topical hemostats include agents that act as a mechanical barrier to bleeding and provide a physical matrix for clotting, biologically active agents that catalyze coagulation, combination therapies, and synthetic sealants and adhesives. Although many of the topical hemostats were approved for use before the requirement for clinical trials, this review provides an overview of the available clinical evidence regarding the appropriate uses and safety considerations associated with these agents. Proper use of these agents is vital to achieving the best clinical outcomes. Specifically, knowledge of the contraindications and potential adverse events associated with topical hemostats can help prevent unwanted outcomes. Therefore, an understanding of the benefits and potential risks associated with these agents will allow hospital pharmacists to assist in the development and implementation of institutional policies regarding the safe and effective use of hemostatic agents commonly used in the surgical suite.

  10. Radiology illustrated. Hepatobiliary and pancreatic radiology

    Choi, Byung Ihn (ed.) [Seoul National Univ. Hospital (Korea, Republic of). Dept. of Radiology


    Clear, practical guide to the diagnostic imaging of diseases of the liver, biliary tree, gallbladder, pancreas, and spleen. A wealth of carefully selected and categorized illustrations. Highlighted key points to facilitate rapid review. Aid to differential diagnosis. Radiology Illustrated: Hepatobiliary and Pancreatic Radiology is the first of two volumes that will serve as a clear, practical guide to the diagnostic imaging of abdominal diseases. This volume, devoted to diseases of the liver, biliary tree, gallbladder, pancreas, and spleen, covers congenital disorders, vascular diseases, benign and malignant tumors, and infectious conditions. Liver transplantation, evaluation of the therapeutic response of hepatocellular carcinoma, trauma, and post-treatment complications are also addressed. The book presents approximately 560 cases with more than 2100 carefully selected and categorized illustrations, along with key text messages and tables, that will allow the reader easily to recall the relevant images as an aid to differential diagnosis. At the end of each text message, key points are summarized to facilitate rapid review and learning. In addition, brief descriptions of each clinical problem are provided, followed by both common and uncommon case studies that illustrate the role of different imaging modalities, such as ultrasound, radiography, CT, and MRI.

  11. Radiology's value chain.

    Enzmann, Dieter R


    A diagnostic radiology value chain is constructed to define its main components, all of which are vulnerable to change, because digitization has caused disaggregation of the chain. Some components afford opportunities to improve productivity, some add value, while some face outsourcing to lower labor cost and to information technology substitutes, raising commoditization risks. Digital image information, because it can be competitive at smaller economies of scale, allows faster, differential rates of technological innovation of components, initiating a centralization-to-decentralization technology trend. Digitization, having triggered disaggregation of radiology's professional service model, may soon usher in an information business model. This means moving from a mind-set of "reading images" to an orientation of creating and organizing information for greater accuracy, faster speed, and lower cost in medical decision making. Information businesses view value chain investments differently than do small professional services. In the former model, producing a better business product will extend image interpretation beyond a radiologist's personal fund of knowledge to encompass expanding external imaging databases. A follow-on expansion with integration of image and molecular information into a report will offer new value in medical decision making. Improved interpretation plus new integration will enrich and diversify radiology's key service products, the report and consultation. A more robust, information-rich report derived from a "systems" and "computational" radiology approach will be facilitated by a transition from a professional service to an information business. Under health care reform, radiology will transition its emphasis from volume to greater value. Radiology's future brightens with the adoption of a philosophy of offering information rather than "reads" for decision making. Staunchly defending the status quo via turf wars is unlikely to constitute a

  12. Radiological worker training



    This Handbook describes an implementation process for core training as recommended in Implementation Guide G441.12, Radiation Safety Training, and as outlined in the DOE Radiological Control Standard (RCS). The Handbook is meant to assist those individuals within the Department of Energy, Managing and Operating contractors, and Managing and Integrating contractors identified as having responsibility for implementing core training recommended by the RCS. This training is intended for radiological workers to assist in meeting their job-specific training requirements of 10 CFR 835. While this Handbook addresses many requirements of 10 CFR 835 Subpart J, it must be supplemented with facility-specific information to achieve full compliance.

  13. Westinghouse radiological containment guide

    Aitken, S.B. [Idaho National Engineering Lab., Idaho Falls, ID (United States); Brown, R.L. [Westinghouse Hanford Co., Richland, WA (United States); Cantrell, J.R. [Westinghouse Savannah River Co., Aiken, SC (United States); Wilcox, D.P. [West Valley Nuclear Services Co., Inc., West Valley, NY (United States)


    This document provides uniform guidance for Westinghouse contractors on the implementation of radiological containments. This document reflects standard industry practices and is provided as a guide. The guidance presented herein is consistent with the requirements of the DOE Radiological Control Manual (DOE N 5480.6). This guidance should further serve to enable and encourage the use of containments for contamination control and to accomplish the following: Minimize personnel contamination; Prevent the spread of contamination; Minimize the required use of protective clothing and personal protective equipment; Minimize the generation of waste.

  14. Radiological sciences dictionary

    Dowsett, David


    The Radiological Sciences Dictionary is a rapid reference guide for all hospital staff employed in diagnostic imaging, providing definitions of over 3000 keywords as applied to the technology of diagnostic radiology.Written in a concise and easy to digest form, the dictionary covers a wide variety of subject matter, including:· radiation legislation and measurement · computing and digital imaging terminology· nuclear medicine radionuclides and radiopharmaceuticals· radiographic contrast agents (x-ray, MRI and ultrasound)· definitions used in ultrasound and MRI technology· statistical exp

  15. Design of a realistic radiation field for the calibration of dosimeters used in interventional radiology cardiology (medical personnel dosimetry); Conception d'un champ de rayonnements realiste pour l'etalonnage des dosimetres utilises en radiologie cardiologie interventionnelle (dosimetrie du personnel medical)

    Bordy, J.M.; Daures, J.; Denoziere, M.; Gouriou, J. [CEA Saclay, LIST, Laboratoire National Henri Becquerel, 91 - Gif-sur-Yvette (France); Itie, Ch.; Donadile, L. [Institut de Radioprotection et de Surete Nucleaire (IRSN), 92263 Fontenay-aux-Roses (France); Struelens, L. [Belgian Nuclear Research Centre (SCK.CEN) (Belgium); Schultz, F. [Delft University of Technology, Applied Physics-RRR-RIH, Pays Bas (Netherlands)


    The authors present the principle to determine the reference value in terms of individual dose equivalent for a calibration installation specifically designed to emulate a radiation field faced at a workstation during interventional cardiology or radiology. They present the workstation configuration which includes the patient and the surgeon. They report the study of the calibration installation where the patient and surgeon are replaced by 'phantoms', and indicate the various fluence spectra obtained at different locations corresponding to different parts of the human body. They compare the simulated and measured spectra

  16. Hemostatic Function of Apheresis Platelets Stored at 4 deg C and 22 deg C


    activation: CD62P is released from platelet !- granules ; PS is externalized from the inner leaflet of the platelet membrane; and CD40L is a FIG. 4. Enzyme...HEMOSTATIC FUNCTION OF APHERESIS PLATELETS STORED AT 4-C AND 22-C Kristin M. Reddoch,* Heather F. Pidcoke,† Robbie K. Montgomery,† Chriselda G. final form 23 Oct 2013 ABSTRACT Introduction: Platelet refrigeration decreases the risk of bacterial contamination and may preserve function better

  17. Comparative Testing of New Hemostatic Agents in a Swine Model of Extremity Arterial and Venous Hemorrhage


    the wounded individual and the one giving aid, and inexpensive. Several advanced hemostatic agents have been developed with varying mechanisms of action ...Fine chitosan granules Smectite granules Mechanism of Action Absorption Zeolite granules rapidly absorb water upon contact with blood. concentraling...administer lidocaine . thus allowing vasospasm to occur as would be expected in a traumatic injury. This resulted in less pretreatment blood loss than

  18. Preparation of Chitosan-Based Hemostatic Sponges by Supercritical Fluid Technology

    Hu-Fan Song


    Full Text Available Using ammonium bicarbonate (AB particles as a porogen, chitosan (CS-based hemostatic porous sponges were prepared in supercritical carbon dioxide due to its low viscosity, small surface tension, and good compatibility with organic solvent. Fourier transform infrared spectroscopy (FTIR spectra demonstrated that the chemical compositions of CS and poly-(methyl vinyl ether-co-maleic anhydride (PVM/MA were not altered during the phase inversion process. The morphology and structure of the sponge after the supercritical fluid (SCF process were observed by scanning electron microscopy (SEM. The resulting hemostatic sponges showed a relatively high porosity (about 80% with a controllable pore size ranging from 0.1 to 200 µm. The concentration of PVM/MA had no significant influence on the porosity of the sponges. Comparative experiments on biological assessment and hemostatic effect between the resulting sponges and Avitene® were also carried out. With the incorporation of PVM/MA into the CS-based sponges, the water absorption rate of the sponges increased significantly, and the CS-PVM/MA sponges showed a similar water absorption rate (about 90% to that of Avitene®. The results of the whole blood clotting experiment and animal experiment also demonstrated that the clotting ability of the CS-PVM/MA sponges was similar to that of Avitene®. All these results elementarily verified that the sponges prepared in this study were suitable for hemostasis and demonstrated the feasibility of using SCF-assisted phase inversion technology to produce hemostatic porous sponges.

  19. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis.

    Henriksen, Hanne H; Rahbar, Elaheh; Baer, Lisa A; Holcomb, John B; Cotton, Bryan A; Steinmetz, Jacob; Ostrowski, Sisse R; Stensballe, Jakob; Johansson, Pär I; Wade, Charles E


    The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. 75 patients received pre-hospital plasma and/or RBCs (PH group; nearly half received both RBCs and plasma) whereas 182 patients only received in-hospital blood products (RBCs, Plasma and Platelets) within 6 hours of admission (IH group). PH patients had lower Glasgow coma scale (GCS) scores, more penetrating injuries, lower systolic blood pressures, lower hemoglobin levels, lower platelet counts and greater acidosis upon ED admission than the IH group (all p plasma, more pre-hospital plasma transfusion was tendency towards improved rTEG variables. When adjusting for pre-hospital RBC, pre-hospital plasma was associated with significantly higher rTEG MA (p = 0.012) at hospital admission. After adjusting for pre-hospital RBCs, pre-hospital plasma transfusion was independently associated with increased rTEG MA, as well as arrival indices of shock and hemodynamic instability. Besides more severe injury and worse clinical presentation, the group that received pre-hospital transfusion had early and late mortality similar to patients not transfused pre-hospital. These data suggest that early administration of plasma can provide significant hemostatic and potential

  20. A Simple and Effective Technique for Anatomical Approximation of the Upper Pericardium Using Hemostatic Clips.

    Husain, Mubassher; Acharya, Metesh Nalin; Cummings, Ian; Raja, Shahzad Gull

    Closure of the pericardium is important to protect bypass grafts, the great vessels, and the heart from injury due to sternal dehiscence. Furthermore, it is reported to reduce the formation of pericardial adhesions and thus facilitate entry into the chest at resternotomy. We here describe a simple, reproducible, and effective technique for tension-free approximation of the upper pericardium by applying small hemostatic clips to the preserved thymic fascia overlying the pericardium.

  1. Hemostatic agents for access tract in tubeless percutaneous nephrolithotomy: Is it worth?

    Sepulveda, Francisco; Aliaga, Alfredo; Fleck, Daniela; Fernandez, Mario; Mercado, Alejandro; Vilches, Roberto; Moya, Francisco; Ledezma, Rodrigo; Reyes, Diego; Marchant, Fernando


    Introduction: The role of hemostatic agents as an adjunct for closure of the nephrostomy tract in tubeless percutaneous surgery (tubeless percutaneous nephrolithotomy [tPNL]) has been previously evaluated, observing a potential benefit in terms of reduced bleeding and urinary leakage. We assessed the rate of postoperative complications after the use of hemostatic agents for sealing the nephrostomy tract in patients undergoing tPNL at our institution. Subjects and Methods: We performed a retrospective analysis of 52 consecutive patients undergoing tPNL at our center between January 2010 and December 2013. No substance was placed within the tract in 25 patients (Group 1). A cylinder of Surgicel® in addition to 1 unit of Gelita® were placed within the access tract in 27 patients (Group 2). We accounted for demographic variables, stone size, operative time, postoperative pain, development of hematoma, postoperative hematocrit drop, urinary leakage, residual lithiasis, and hospital stay length. Results: Age and sex differed significantly between the two groups (P = 0.0002 and P = 0.048 respectively). However, there were no significant differences in terms of body mass index and stone burden. No significant differences between groups were found with regards to operative time, postoperative hematocrit drop, postoperative pain and presence of residual lithiasis. Conclusion: The use of Gelita® and Surgicel® as hemostatic agents in tPNL is safe, but we were not able to demonstrate any significant benefit in terms of postoperative morbidity after comparing the use of these agents in tPNL. We concluded that the uses of hemostatic agents needed to be evaluated in prospective randomized trials to define its benefits. PMID:27141194

  2. The Effects of Hemostatic Agents and Hypothermia Control in a Porcine Model


    down technique for continuous arterial blood pressure monitoring. A right central venous catheter was inserted using the modified Seldinger...technique for central venous pressure monitoring. Heart rate, arterial blood pressure, electrocardiogaphy, oxygen saturation, end tidal CO2, and rectal...QCG is effective in hemorrhage control. Our studies support the decision of the military to use QCG as the first- line hemostatic agent for use in

  3. Nanocomplexation of thrombin with cationic amylose derivative for improved stability and hemostatic efficacy

    Zhuang B


    Full Text Available Baoxiong Zhuang,1,* Zhihua Li,1,* Jiadong Pang,2,* Wenbin Li,1 Pinbo Huang,1 Jie Wang,1 Yu Zhou,1 Qing Lin,1 Quanbo Zhou,1 Xiao Ye,1 Huilin Ye,1 Yimin Liu,1 Li-Ming Zhang,2 Rufu Chen1 1Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2DSAPM Lab and PCFM Lab, Institute of Polymer Science, Department of Polymer and Materials Science, School of Chemistry and Chemical Engineering, Sun Yat-sen University, Guangzhou, People’s Republic of China *Authors share co-first authorship Abstract: As a topical hemostatic agent, thrombin has wide application for many surgical treatments. However, native thrombin always suffers from its physical and chemical instabilities. In this work, a nanocomplexation strategy was developed for modifying the stability and hemostatic efficacy of thrombin, in which a water-soluble cationic amylose derivative containing poly(l-lysine dendrons was prepared by a click reaction and then used to complex thrombin in an aqueous system. For resultant thrombin nanocomplexes, their morphology and particle size distribution were investigated. Their stabilities were studied in terms of activity retention percentages under different storage time, pH values, and illumination time. In addition, their ability to achieve in vitro fibrinogen and blood coagulation were evaluated. Via a rat hepatic hemorrhage model and a rat iliac artery hemorrhage model, these thrombin nanocomplexes were confirmed to have good tissue biocompatibility and in vivo hemostatic effectiveness. Keywords: thrombin, nanoparticles, amylose derivative, complexation, stability, hemostatic activity

  4. Radiological Approach to Forefoot Pain

    Sai Chung Ho


    Full Text Available Forefoot pain is a common clinical complaint in orthopaedic practice. In this article, we discuss the anatomy of the forefoot, clinical and radiological approaches to forefoot pain, and common painful forefoot disorders and their associated radiological features.

  5. 324 Building Baseline Radiological Characterization

    R.J. Reeder, J.C. Cooper


    This report documents the analysis of radiological data collected as part of the characterization study performed in 1998. The study was performed to create a baseline of the radiological conditions in the 324 Building.

  6. Development and assessment of kerateine nanoparticles for use as a hemostatic agent

    Luo, Tiantian [Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030 (China); Hao, Shilei, E-mail: [Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030 (China); Chen, Xiaoliang [Department of Nuclear Medicine, Institution of Chongqing Cancer, Chongqing 400030 (China); Wang, Ju; Yang, Qian; Wang, Yazhou; Weng, Yulan; Wei, Huimin; Zhou, Jin [Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030 (China); Wang, Bochu, E-mail: [Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030 (China)


    Uncontrolled bleeding frequently occurs in some emergencies which can result in severe injury and even death. Keratin hydrogel has been found that it had good ahemostatic efficacy in the previous studies. However, an ideal hemostatic agent should not require mixing or preparation in advance, and hydrogel is not easy to store and carry. In the present study, the kerateine was firstly extracted from human hair, and then was prepared nanoparticles by a modified emulsion diffusion method. The synthesized nanoparticles showed spherical morphology with an average diameter of approximately 200 nm. The results of Fourier transform infrared spectroscopy and X-ray diffraction indicated that the chemical structure of kerateine did not change but the crystal form may be transformed in the nanoparticles. In addition, kerateine nanoparticles displayed a faster clotting time in vitro study than the kerateine extracts. Furthermore, kerateine nanoparticles significantly reduced the blood loss and coagulation time in the liver puncture and tail amputation in rat models. Our results indicated that kerateine nanoparticles could quickly form a high viscosity gel onto the wound and accelerate the blood coagulation based on their high specific surface area. Therefore, kerateine nanoparticles have great potential for hemostatic application. - Highlights: • The kerateine nanoparticles were prepared via modified ultrasonic solidification method. • The kerateine nanoparticle can stop the tail and liver bleeding within 2 min and 1 min, respectively. • The kerateine nanoparticles showed a stronger hemostatic efficacy than powders because of higher specific surface area.

  7. Local hemostatic measures in anticoagulated patients undergoing oral surgery: a systematized literature review

    Fábio Wildson Gurgel Costa


    Full Text Available PURPOSE: To conduct a systematized review of the literature about the main local hemostatic measures to control postoperative bleeding in anticoagulated patients. METHODS: A systematized review of literature was performed in the electronic database Medline (PubMed without restriction of the publication date. The eligibility criteria were studies involving maintenance of the anticoagulant therapy, prospective studies, retrospective studies, randomized clinical trials, controlled clinical studies, comparative studies, multicentric studies or case-control studies. Studies discontinuing anticoagulant therapy, case reports, literature reviews, in vitro studies, animal experiments and articles written in language not compatible with the search strategy adopted in this work were excluded. RESULTS: Twenty-four articles that met the adopted eligibility criteria were selected, enrolling 3891 subjects under anticoagulant therapy. A total of 171 cases of hemorrhage was observed. Tranexamic acid was the main local hemostatic measure used to controlling of postoperative bleeding. CONCLUSION: The local hemostatic measures proved to be effective according to previously published studies. Nevertheless, further clinical studies should be conducted to confirm this effectiveness.

  8. Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding

    Marco; Bustamante-Balén; Gema; Plumé


    Acute gastrointestinal bleeding(AGIB) is a prevalent condition with significant influence on healthcare costs. Endoscopy is essential for the management of AGIB with a pivotal role in diagnosis, risk stratification and management. Recently, hemostatic powders have been added to our endoscopic armamentarium to treat gastrointestinal(GI) bleeding. These substances are intended to control active bleeding by delivering a powdered product over the bleeding site that forms a solid matrix with a tamponade function. Local activation of platelet aggregation and coagulation cascade may be also boosted. There are currently three powders commercially available: hemostatic agent TC-325(Hemospray), EndoClotTM polysaccharide hemostatic system, and Ankaferd Bloodstopper. Although the available evidence is based on short series of cases and there is no randomized controlled trial yet, these powders seem to be effective in controlling GI bleeding from a variety of origins with a very favorable side effects profile. They can be used either as a primary therapy or a secondline treatment, and they seem to be especially indi-cated in cases of cancer-related bleeding and lesions with difficult access. In this review, we will comment on the mechanism of action, efficacy, safety and technical challenges of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area.

  9. Hemostatic system changes predictive value in patients with ischemic brain disorders

    Raičević Ranko


    Full Text Available The aim of this research was to determine the importance of tracking the dynamics of changes of the hemostatic system factors (aggregation of thrombocytes, D-dimer, PAI-1, antithrombin III, protein C and protein S, factor VII and factor VIII, fibrin degradation products, euglobulin test and the activated partial thromboplastin time – aPTPV in relation to the level of the severity of ischemic brain disorders (IBD and the level of neurological and functional deficiency in the beginning of IBD manifestation from 7 to 10 days, 19 to 21 day, and after 3 to 6 months. The research results confirmed significant predictive value of changes of hemostatic system with the predomination of procoagulant factors, together with the insufficiency of fibrinolysis. Concerning the IBD severity and it's outcome, the significant predictive value was shown in the higher levels of PAI-1 and the lower level of antithrombin III, and borderline significant value was shown in the accelerated aggregation of thrombocytes and the increased concentration of D-dimer. It could be concluded that the tracking of the dynamics of changes in parameters of hemostatic system proved to be an easily accessible method with the significant predictive value regarding the development of more severe. IBD cases and the outcome of the disease itself.

  10. Evaluation of hemostatic field dressing for bacteria, mycobacteria, or fungus contamination.

    Murray, Clinton K; Brunstetter, Tyson; Beckius, Miriam; Dunne, James R; Mende, Katrin


    Infectious complications have a major impact on wounded warriors. Pathogens causing infections include multidrug-resistant bacteria, fungi, and mycobacteria. The potential sources for these pathogens include nosocomial transmission, the environment (e.g., dirt), or the patients (skin flora) themselves. The purpose of this pilot study was to explore the possibility that hemostatic field dressings might act as an inoculation source of pathogens into wounds. To accomplish this, hemostatic field dressings were assessed for the presence of bacterial, fungal, or mycobacterial contamination. We evaluated two samples of QuikClot Combat Gauze and two samples of CELOX Gauze subjected to normal stresses associated with storage after receipt from the manufacturer. We then evaluated 16 samples of QuikClot Combat Gauze that were collected from personnel deployed in Afghanistan and had undergone routine mechanical stress. Samples underwent screening with Trypticase Soy Broth, blood agar plates, MacConkey agar plates, CHROMagar Staphylococcus aureus plates, chocolate agar plates, Potato Flake agar, Lowenstein-Jensen media, and Middlebrook 7H11 media. No bacteria, fungi, or mycobacteria were recovered from the dressings. It does not appear that hemostatic field dressings are contaminated, even after subjected to field conditions. Further research is needed to identify inoculation sources of fungi and mycobacteria, which cause infections.

  11. Rapid hemostatic and mild polyurethane-urea foam wound dressing for promoting wound healing.

    Liu, Xiangyu; Niu, Yuqing; Chen, Kevin C; Chen, Shiguo


    A novel rapid hemostatic and mild polyurethane-urea foam (PUUF) wound dressing was prepared by the particle leaching method and vacuum freeze-drying method using 4, 4-Methylenebis(cyclohexyl isocyanate), 4,4-diaminodicyclohexylmethane and poly (ethylene glycol) as raw materials. And X-ray diffraction (XRD), tensile test, differential scanning calorimetry (DSC) and thermogravimetry (TG) were used to its crystallinity, stress and strain behavior, and thermal properties, respectively. Platelet adhesion, fibrinogen adhesion and blood clotting were performed to evaluate its hemostatic effect. And H&E staining and Masson Trichrome staining were used to its wound healing efficacy. The results revealed the pore size of PUUF is 50-130μm, and its porosity is 71.01%. Porous PUUF exhibited good water uptake that was benefit to adsorb abundant wound exudates to build a regional moist environment beneficial for wound healing. The PUUF wound dressing exhibit better blood coagulation effect than commercial polyurethane dressing (CaduMedi). Though both PUUF and CaduMedi facilitated wound healing generating full re-epithelialization within 13days, PUUF was milder and lead to more slight inflammatory response than CaduMedi. In addition, PUUF wound dressing exhibited lower cytotoxicity than CaduMedi against NIH3T3 cells. Overall, porous PUUF represents a novel mild wound dressing with excellent water uptake, hemostatic effect and low toxicity, and it can promote wound healing and enhance re-epithelialization. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Radiological Safety Handbook.

    Army Ordnance Center and School, Aberdeen Proving Ground, MD.

    Written to be used concurrently with the U.S. Army's Radiological Safety Course, this publication discusses the causes, sources, and detection of nuclear radiation. In addition, the transportation and disposal of radioactive materials are covered. The report also deals with the safety precautions to be observed when working with lasers, microwave…

  13. Radiology of spinal curvature

    De Smet, A.A.


    This book offers the only comprehensive, concise summary of both the clinical and radiologic features of thoracic and lumbar spine deformity. Emphasis is placed on idiopathic scoliosis, which represents 85% of all patients with scoliosis, but less common areas of secondary scoliosis, kyphosis and lordosis are also covered.

  14. Radiologic Technology Program Guide.

    Georgia Univ., Athens. Dept. of Vocational Education.

    This guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a radiologic technology program. The guide contains four major sections. The General Information section contains an introduction giving an overview and defining purpose and objectives; a program description,…

  15. Radiologic manifestations in alcaptonuria

    Justesen, P.; Andersen, P.E.


    Alcaptonuria is a rare, hereditary disorder of amino acid metabolism, secondary to lack of homogentisic acid oxydase. As a consequence, there is an accumulation of homogenitisic acid, which is excreted in the urine and deposited in the connective tissues. This deposition results in ochronotic pigmentation and arthropathy, of which some characteristic radiological findings are demonstrated.

  16. Ethical problems in radiology: radiological consumerism.

    Magnavita, N; Bergamaschi, A


    One of the causes of the increasing request for radiological examinations occurring in all economically developed countries is the active role played by the patient-consumer. Consumerism places the radiologist in an ethical dilemma, between the principle of autonomy on the one hand and the ethical principles of beneficence, nonmaleficence and justice on the other. The choice made by radiologists in moral dilemmas is inspired by an adherence to moral principles, which in Italy and elsewhere refer to the Judaeo-Christian tradition or to neo-Darwinian relativism. Whatever the choice, the radiologist is bound to adhere to that choice and to provide the patient with all the relevant information regarding his or her state of health.

  17. Computer assisted radiology and surgery. CARS 2010



    The conference proceedings include contributions to the following topics: (1) CARS Clinical Day: minimally invasive spiral surgery, interventional radiology; (2) CARS - computer assisted radiology and surgery: ophthalmology, stimulation methods, new approaches to diagnosis and therapy; (3) Computer assisted radiology 24th International congress and exhibition: computer tomography and magnetic resonance, digital angiographic imaging, digital radiography, ultrasound, computer assisted radiation therapy, medical workstations, image processing and display; (4) 14th Annual conference of the International Society for computer aided surgery; ENT-CMF head and neck surgery computer-assisted neurosurgery, cardiovascular surgery, image guided liver surgery, abdominal and laparoscopic surgery, computer-assisted orthopedic surgery, image processing and visualization, surgical robotics and instrumentation, surgical modeling, simulation and education; (5) 28th International EuroPACS meeting: image distribution and integration strategies, planning and evaluation, telemedicine and standards, workflow and data flow in radiology; (6) 11th CARS/SPIE/EuroPACS joint workshop on surgical PACS and the digital operating, management and assessment of OR systems and integration; (7) 12th International workshop on computer-aided diagnosis: special session on breast CAD, special session on thoracic CAD, special session on abdominal brain, lumbar spine CAD; (8) 16th computed Maxillofacial imaging congress: computed maxillofacial imaging in dental implantology, orthodontics and dentofacial orthopedics; approaches to 3D maxillofacial imaging; surgical navigation; (9) 2nd EuroNOTES/CARS workshop on NOTES: an interdisciplinary challenge; (10) 2nd EPMA/CARS workshop on personalized medicine and ICT.; (11)poster sessions.

  18. Science and Values in Radiological Protection

    Lochard, J. [Centre d' Etude sur l' Evaluation de la Protection dans le Domaine Nucleaire (CEPN), 92 - Fontenay-aux-Roses (France); Eggermont, G. [Belgian Association of Radiation Protection (Belgium); Britt-Marie, Drottz Sjoberg [Norwegian University of Science and Technology (Norway); Tirmarche, M. [Institut de radioprotection et de surete nucleaire (IRSN), 92 - Fontenay-aux-Roses (France); Geard, Ch.R. [Center for Radiological Research of Columbia University (United States); Atkinson, M. [Institute of Radiation Biology, Helmholtz Zentrum Munich (Germany); Murith, Ch. [Federal Office of Public Health (Switzerland); Grant, K.G. [RESOLVE (United States); Luccioni, C. [Conservatoire National des Arts et Metiers (CNAM), 75 - Paris (France); Mays, C. [NEA, 75 - Paris (France); Sisko, Salomaa [Finnish Centre for Radiation and Nuclear Safety (STUK), Helsinki (Finland); Kelly, N.G.; Oughton, D. [Norwegian University of Life Sciences (Norway); Shannoun, F. [WHO, Geneva (Switzerland); Grant, K.G. [RESOLVE (United States); Cooper, J. [Health Protection Agency (United Kingdom); Mays, C. [NEA, 75 - Paris (France); Weiss, V. [Bundesamt fur Strahlenschutz (Germany); Oughton, D. [Norwegian University of Life Sciences (Norway); Kazuo, Sakai [National Institute of Radiological Science (Japan); Carroll, S. [Swedish Biodiversity Centre, University of Agricultural Sciences and Uppsala University (Sweden)


    protection professionals can better identify and respond to civil society concerns. Session 1: Setting the scene: Holistic presentations of science, values, regulation and public health policy, NGO viewpoints.. An informed view of 'where we stand' on each case topic following the Helsinki workshop. Presentations: Radon as a public health issue (Margot Tirmarche); The continuing story of CT scan risks (Charles R. Geard). Break-out sessions 1. part - Issues surrounding current approaches. This session deepens the discussion and widens the process begun at Helsinki, regarding the new data, phenomena and observations that stimulate us to ask whether current public health and regulatory approaches in each topical area are still adequate, or whether they may need revision. The focus of this session is thus on scientific aspects which may induce a need for paradigm change. Presentation: Radon as a public health issue (Christophe Murith). Evening session 1: Stakeholder platform opportunity (Ola Holmberg). One of the workshop objectives is to foster dialogue between radiological protection professionals, researchers, regulators, and other stakeholders from interested publics in order to deepen discussion on points of interest. In order to maximize stakeholders' benefit in attending the workshop, a platform for communicating and discussing relevant stakeholder views and concerns is offered in this evening context. The on-topic interventions are intended to cover relevant subjects that may not be directly addressed during the rest of the workshop (e.g., risk communication, etc.). This evening session focusses on aspects of dose regulations in radiodiagnostic and radiotherapeutic fields, ALARA in medicine and other issues related to medical exposures. Discussion is intended to be linked to introductory talk in Session 1 on Public Health Perspective in Radiological Protection in Challenging Topical Areas. Presentation: Paediatric CT examinations in nineteenth developing

  19. ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017: Automation of reading of radiological features from magnetic resonance images (MRIs) of the lumbar spine without human intervention is comparable with an expert radiologist.

    Jamaludin, Amir; Lootus, Meelis; Kadir, Timor; Zisserman, Andrew; Urban, Jill; Battié, Michele C; Fairbank, Jeremy; McCall, Iain


    Investigation of the automation of radiological features from magnetic resonance images (MRIs) of the lumbar spine. To automate the process of grading lumbar intervertebral discs and vertebral bodies from MRIs. MR imaging is the most common imaging technique used in investigating low back pain (LBP). Various features of degradation, based on MRIs, are commonly recorded and graded, e.g., Modic change and Pfirrmann grading of intervertebral discs. Consistent scoring and grading is important for developing robust clinical systems and research. Automation facilitates this consistency and reduces the time of radiological analysis considerably and hence the expense. 12,018 intervertebral discs, from 2009 patients, were graded by a radiologist and were then used to train: (1) a system to detect and label vertebrae and discs in a given scan, and (2) a convolutional neural network (CNN) model that predicts several radiological gradings. The performance of the model, in terms of class average accuracy, was compared with the intra-observer class average accuracy of the radiologist. The detection system achieved 95.6% accuracy in terms of disc detection and labeling. The model is able to produce predictions of multiple pathological gradings that consistently matched those of the radiologist. The model identifies 'Evidence Hotspots' that are the voxels that most contribute to the degradation scores. Automation of radiological grading is now on par with human performance. The system can be beneficial in aiding clinical diagnoses in terms of objectivity of gradings and the speed of analysis. It can also draw the attention of a radiologist to regions of degradation. This objectivity and speed is an important stepping stone in the investigation of the relationship between MRIs and clinical diagnoses of back pain in large cohorts. Level 3.

  20. Radiological analysis of osteoporosis

    Lemaire, C


    This paper is intended to provide medical radiation technologists with an overview of how radiology can play a role in the detection of osteoporosis. Osteoporosis is defined as disease where there is a generalized or localized deficiency of bone matrix. This deficiency causes bones to become weak resulting in an increased risk of fracture. Current methods to detect bone deficiency involve the use of bone densitometry. Over the years both radioactivity and ionizing radiation have been used to measure bone density. Currently the preferred method of choice for bone densitometry is a dual energy x-ray absorptiometry unit. This unit has the greatest reliability and precision with a low absorbed dose to the patient. With early detection of the disease, treatment can begin and further bone loss prevented. In the future, radiology will continue to be a valuable asset in the diagnosis and management of osteoporosis. (author)

  1. Radiologic aspects of lunatomalacia

    Rasmussen, F.; Schantz, K.


    A radiological classification of lunatomalacia, based upon the chronological radiologic manifestations in 93 patients is presented. Compression fractures were not seen as the initial event. Fifty-seven per cent of the patients had a short ulna (ulna minus variant). The presence of ulna minus variant was expecially observed in the younger patients. In 16 patients suffering from a lunate fracture and in 20 patients with lunate or perilunate luxations, lunatomalacia did not develop. Immobilization as treatment of the disorder resulted in a progressive course in all patients, but one, an 8-year-old girl. The lesion of the lunate was arrested and tended to heal following radial osteotomy in all patients. (orig.)

  2. Data mining in radiology.

    Kharat, Amit T; Singh, Amarjit; Kulkarni, Vilas M; Shah, Digish


    Data mining facilitates the study of radiology data in various dimensions. It converts large patient image and text datasets into useful information that helps in improving patient care and provides informative reports. Data mining technology analyzes data within the Radiology Information System and Hospital Information System using specialized software which assesses relationships and agreement in available information. By using similar data analysis tools, radiologists can make informed decisions and predict the future outcome of a particular imaging finding. Data, information and knowledge are the components of data mining. Classes, Clusters, Associations, Sequential patterns, Classification, Prediction and Decision tree are the various types of data mining. Data mining has the potential to make delivery of health care affordable and ensure that the best imaging practices are followed. It is a tool for academic research. Data mining is considered to be ethically neutral, however concerns regarding privacy and legality exists which need to be addressed to ensure success of data mining.

  3. Radiology and Ethics Education.

    Camargo, Aline; Liu, Li; Yousem, David M


    The purpose of this study is to assess medical ethics knowledge among trainees and practicing radiologists through an online survey that included questions about the American College of Radiology Code of Ethics and the American Medical Association Code of Medical Ethics. Most survey respondents reported that they had never read the American Medical Association Code of Medical Ethics or the American College of Radiology Code of Ethics (77.2% and 67.4% of respondents, respectively). With regard to ethics education during medical school and residency, 57.3% and 70.0% of respondents, respectively, found such education to be insufficient. Medical ethics training should be highlighted during residency, at specialty society meetings, and in journals and online resources for radiologists.

  4. Data mining in radiology

    Amit T Kharat


    Full Text Available Data mining facilitates the study of radiology data in various dimensions. It converts large patient image and text datasets into useful information that helps in improving patient care and provides informative reports. Data mining technology analyzes data within the Radiology Information System and Hospital Information System using specialized software which assesses relationships and agreement in available information. By using similar data analysis tools, radiologists can make informed decisions and predict the future outcome of a particular imaging finding. Data, information and knowledge are the components of data mining. Classes, Clusters, Associations, Sequential patterns, Classification, Prediction and Decision tree are the various types of data mining. Data mining has the potential to make delivery of health care affordable and ensure that the best imaging practices are followed. It is a tool for academic research. Data mining is considered to be ethically neutral, however concerns regarding privacy and legality exists which need to be addressed to ensure success of data mining.

  5. Data mining in radiology

    Kharat, Amit T; Singh, Amarjit; Kulkarni, Vilas M; Shah, Digish


    Data mining facilitates the study of radiology data in various dimensions. It converts large patient image and text datasets into useful information that helps in improving patient care and provides informative reports. Data mining technology analyzes data within the Radiology Information System and Hospital Information System using specialized software which assesses relationships and agreement in available information. By using similar data analysis tools, radiologists can make informed decisions and predict the future outcome of a particular imaging finding. Data, information and knowledge are the components of data mining. Classes, Clusters, Associations, Sequential patterns, Classification, Prediction and Decision tree are the various types of data mining. Data mining has the potential to make delivery of health care affordable and ensure that the best imaging practices are followed. It is a tool for academic research. Data mining is considered to be ethically neutral, however concerns regarding privacy and legality exists which need to be addressed to ensure success of data mining. PMID:25024513

  6. Disabling Radiological Dispersal Terror

    Hart, M


    Terror resulting from the use of a radiological dispersal device (RDD) relies upon an individual's lack of knowledge and understanding regarding its significance. Disabling this terror will depend upon realistic reviews of the current conservative radiation protection regulatory standards. It will also depend upon individuals being able to make their own informed decisions merging perceived risks with reality. Preparation in these areas will reduce the effectiveness of the RDD and may even reduce the possibility of its use.

  7. Microcephaly: a radiological review

    Tarrant, Ailbhe; Garel, Catherine; Germanaud, David; Lenoir, Marion; Pointe, Hubert Ducou le [Universite Paris VI Pierre et Marie Curie, Radiology Department, Hopital d' Enfants Armand-Trousseau, Paris (France); Villemeur, Thierry Billette de; Mignot, Cyril [Universite Paris V Rene Descartes, CNRS (UMR 8104), Inserm, U567, Institut Cochin, Paris (France); Universite Paris VI Pierre et Marie Curie, Paediatric Neurology Department, Hopital d' Enfants Armand-Trousseau, Paris (France)


    Microcephaly results from inadequate brain growth during development. It may develop in utero, and therefore be present at birth, or may develop later as a result of perinatal events or postnatal conditions. The aetiology of microcephaly may be congenital (secondary to cerebral malformations or metabolic abnormalities) or acquired, most frequently following an ischaemic insult. This distinct radiological and pathological entity is reviewed with a specific focus on aetiology. (orig.)

  8. Radiological safety and control

    Chang, Sea Young; Yoo, Y. S.; Lee, J. C.; Lee, T. Y.; Lee, J. L.; Kim, B. W.; Lee, B. J.; Chung, K. K.; Chung, R. I.; Kim, J. S.; Lee, H. S.; Han, Y. D.; Lee, J. I.; Lee, K. C.; Yoon, J. H.; Sul, C. W.; Kim, C. K.; Yoon, K. S.; Seo, K. W.; Yoon, Y. C. [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)


    This report describes the annual results of radiological safety and control program of 1995. This program consists of working area monitoring including HANARO, personnel radiation monitoring, education for radiation protection. As a result, the objectives of radiation protection have been achieved satisfactorily through the activities mentioned above. Also, the calibration services were provided to insure accurate radiation measurement in the radiation working places. 21 figs., 39 tabs., 5 refs. (Author) .new.

  9. Pitfalls in diagnostic radiology

    Peh, Wilfred C.G. (ed.) [Khoo Teck Puat Hospital (Singapore). Dept. of Diagnostic Radiology


    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  10. Longitudinal association of hemostatic factors with risk for cancers of the breast, colorectum, and lung among postmenopausal women.

    Kabat, Geoffrey C; Salazar, Christian R; Zaslavsky, Oleg; Lane, Dorothy S; Rohan, Thomas E


    The aim of this study was to examine whether hemostatic factors associated with coagulation and inflammation pathways are associated with cancer risk in postmenopausal women. We used data from the Women's Health Initiative study to examine the association of plasma fibrinogen levels, factor VII antigen activity, and factor VII concentration measured at baseline and during follow-up with the risk for cancers of the breast, colorectum, and lung. Among 5287 women who were followed up for a median of 11.4 years, 275 cases of breast cancer, 102 cases of colorectal cancer, and 90 cases of lung cancer were identified. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for the association of hemostatic factors with each cancer. Hemostatic factors were not associated with breast cancer in either baseline or longitudinal analyses. Baseline hemostatic factors showed weak associations with colorectal cancer; however, no association was seen in longitudinal analyses. Fibrinogen was positively associated with lung cancer in both baseline and longitudinal analyses; the association was seen only in never and former smokers, not in current smokers. We found no evidence of an association between hemostatic factors and breast or colorectal cancer in postmenopausal women. The positive association of fibrinogen levels with lung cancer requires confirmation in larger studies.

  11. Progress in diagnosis of breast cancer: Advances in radiology technology

    J Mari Beth Linder


    Full Text Available Breast cancer is the leading cause of cancer in females between the ages of 15 and 54, and the second leading cause of cancer death in women in the United States. Diagnosis begins with detection by breast examination (clinical breast exam or breast self-exam or by radiologic studies, like mammography. Many advances in the diagnosis of breast cancer have taken place in recent years. This article will review the history of radiologic advances in the diagnosis of breast cancer. Use of technological advancements in digital breast tomosynthesis, magnetic resonance imaging, and ultrasound in breast cancer diagnosis will be presented. Advantages and disadvantages of these diagnostic interventions when compared to older, traditional X-ray films will be discussed. It is important for all nurses, including radiology and oncology nurses, to be well informed about these varied diagnostic modalities, and appreciate the fact that advances in radiologic imaging technologies can yield improved outcomes for breast cancer patients.

  12. Comparison of hemostasis using bipolar hemostatic forceps with hemostasis by endoscopic hemoclipping for nonvariceal upper gastrointestinal bleeding in a prospective non-randomized trial.

    Kataoka, Mikinori; Kawai, Takashi; Hayama, Yasutaka; Yamamoto, Kei; Nonaka, Masaya; Aoki, Takaya; Yagi, Kenji; Fukuzawa, Mari; Fukuzawa, Masakatsu; Moriyasu, Fuminori


    We previously reported on the safety and efficacy of bipolar hemostatic forceps for treating nonvariceal upper gastrointestinal (UGI) bleeding. However, no prospective or randomized studies have evaluated the efficacy of bipolar hemostatic forceps. The aim of this study was to evaluate the hemostatic efficacy of using bipolar hemostatic forceps compared with the hemostatic efficacy of the commonly used method of endoscopic hemoclipping for treating nonvariceal UGI bleeding. A total of 50 patients who required endoscopic hemostasis for UGI bleeding were divided into two groups: those who underwent endoscopic hemostasis using bipolar hemostatic forceps (Group I) and those who underwent endoscopic hemostasis by endoscopic hemoclipping (Group II). We compared the two groups in terms of hemostasis success rate and time required to achieve hemostasis and stop recurrent bleeding. All (100 %) of 27 patients in Group I and 18 (78.2 %) of 23 patients in Group II were successfully treated using bipolar hemostatic forceps or by endoscopic hemoclipping alone, respectively, indicating a significantly higher success rate for Group I than for Group II (p bleeding. Bipolar hemostatic forceps was more effective than endoscopic hemoclipping for treating nonvariceal UGI bleeding.

  13. Hemostatic efficacy evaluation of radiation crosslinked carboxymethyl kappa-carrageenan and chitosan with varying degrees of substitution

    Tranquilan-Aranilla, Charito; Barba, Bin Jeremiah D.; Vista, Jeanina Richelle M.; Abad, Lucille V.


    Carboxymethyl derivatives of kappa-carrageenan and chitosan, with varying degrees of substitution, were synthesized by multi-step reaction technique and evaluated for hemostatic efficacy through in vitro assays. FTIR analysis confirmed the presence of carboxymethyl group while 1H NMR spectroscopy indicated degrees of substitution ranging from 1.15-1.58 and 0.45-0.51 for carboxymethyl-κ-carrageenan and carboxymethylchitosan, respectively. Derivatives formed into paste consistency (30% w/v) were successfully crosslinked by gamma irradiation at 30 kGy. The data obtained from whole blood clotting and platelet adhesion assays showed a significant increase in hemostatic capability of κ-carrageenan and chitosan as a consequence of carboxymethylation and crosslinking modifications. In addition, the level of efficacy was comparable to that of a chitosan-based commercial product. These results suggest the potential of κ-carrageenan and chitosan derivatives for development into hemostatic agents.

  14. French days of radiology (J.F.R.) 2005; Journees francaises de radiologie (JFR) 2005



    Five parts are presented, the nuclear safety authority informs the radiologists on the evolution of the regulation in radiation protection and its practical application; statements of medical and dental radiodiagnosis equipments; licensing for use of radiodiagnosis installation; to use the diagnosis reference levels in radiology to optimize the practices; radiation protection in interventional radiology. (N.C.)

  15. French days of radiology (J.F.R.) 2005; Journees francaises de radiologie (JFR) 2005



    Five parts are presented, the nuclear safety authority informs the radiologists on the evolution of the regulation in radiation protection and its practical application; statements of medical and dental radiodiagnosis equipments; licensing for use of radiodiagnosis installation; to use the diagnosis reference levels in radiology to optimize the practices; radiation protection in interventional radiology. (N.C.)

  16. Adsorption of tranexamic acid on hydroxyapatite: Toward the development of biomaterials with local hemostatic activity

    Sarda, Stéphanie, E-mail: [CIRIMAT, Université de Toulouse, CNRS, INPT, UPS, Université Toulouse 3 Paul Sabatier, Toulouse (France); Errassifi, Farid [CIRIMAT, Université de Toulouse, CNRS, INPT, UPS, Université Toulouse 3 Paul Sabatier, Toulouse (France); Marsan, Olivier [CIRIMAT, Université de Toulouse, CNRS, INPT, UPS, ENSIACET, Toulouse (France); Geffre, Anne; Trumel, Catherine [Université de Toulouse, INP, ENVT, UMS006, Laboratoire Central de Biologie Médicale, Toulouse (France); INSERM-UPS, UMS 006, Laboratoire Central de Biologie Médicale, Toulouse (France); Drouet, Christophe [CIRIMAT, Université de Toulouse, CNRS, INPT, UPS, ENSIACET, Toulouse (France)


    This work proposes to combine tranexamic acid (TAX), a clinically used antifibrinolytic agent, and hydroxyapatite (HA), widely used in bone replacement, to produce a novel bioactive apatitic biomaterial with intrinsic hemostatic properties. The aim of this study was to investigate adsorptive behavior of the TAX molecule onto HA and to point out its release in near physiological conditions. No other phase was observed by X-ray diffraction or transmission electron microscopy, and no apparent change in crystal size was detected. The presence of TAX on the powders was lightly detected on Raman spectra after adsorption. The adsorption data could be fitted with a Langmuir–Freundlich equation, suggesting a strong interaction between adsorbed molecules and the formation of multilayers. The concentration of calcium and phosphate ions in solution remained low and stable during the adsorption process, thus ion exchange during the adsorption process could be ruled out. The release of TAX was fast during the first hours and was governed by a complex process that likely involved both diffusion and dissolution of HA. Preliminary aPTT (activated partial thromboplastin time) hemostasis tests offered promising results for the development of osteoconductive apatitic biomaterials with intrinsic hemostatic properties, whether for dental or orthopedic applications. - Highlights: • Interaction of tranexamic acid (TAX)/hydroxyapatite was studied. • The adsorption data could be fitted with a Langmuir–Freundlich equation. • The release of TAX, fast during the first hours, was governed by a complex process. • Preliminary aPTT hemostasis tests show promising results. • The aim is to develop biomaterials with local hemostatic activity.

  17. Efficacy of three topical hemostatic agents applied by medics in a lethal groin injury model.

    Sohn, Vance Y; Eckert, Matthew J; Martin, Matthew J; Arthurs, Zachary M; Perry, Jason R; Beekley, Alec; Rubel, Eric J; Adams, Richard P; Bickett, Gerald L; Rush, Robert M


    Advanced topical hemostatic agents are increasingly utilized to control traumatic hemorrhage. We sought to determine the efficacy of three chitosan based hemostatic agents in a lethal groin injury model when applied by combat medic first responders. After creation of a standardized femoral artery injury in a goat model, medics attempted hemorrhage control with standard gauze dressing followed by randomization to one of three hemostatic agents in this two tiered study. In the first tier, medics were randomized to either a chitosan based one-sided wafer (OS) or a dual-sided, flexible, roll (DS). In the second tier, medics were randomized to the flexible DS dressing or a chitosan powder (CP). Efficacy of gauze, each chitosan agent, proper application, and participant surveys were obtained and included for analysis using univariate techniques. From January 2007 to June 2007, 55 (45%) DS, 36 (29%) OS, and 32 (26%) CP agents were used to treat 123 actively bleeding arterial injuries in 62 animals. Standard gauze failed to stop hemorrhage in 122 (99%) groins. Although all three chitosan agents were marginally effective at 2 min, the recommended time for application, hemostasis improved after 4 min. The DS dressing was the most effective, controlling hemorrhage 76% at 4 min. Of the failures, 3 (23%) DS and 9 (53%) OS were due to improper application. End-user survey results demonstrated that medics preferred the DS dressing 77% and 60% over the OS and CP, respectively. Chitosan based bandages are significantly more effective at hemorrhage control compared to standard gauze field dressings. The dual-sided chitosan dressing demonstrated better hemorrhage control than the one-sided dressing and the chitosan powder, and was less likely to fail despite application errors.

  18. Alterações do sistema hemostático nos pacientes com diabetes melito tipo 2 Hemostatic changes in patients with type 2 diabetes mellitus

    Anna Letícia Soares


    . Diabetics have abnormalities of the endothelium, platelets, clotting factors, natural anticoagulants and the fibrinolytic system; all these changes are directly and/or indirectly caused by hyperglycemia. Thus, analytes such as von Willebrand factor, factor VIII, fibrinogen and D-dimer are markers that should be interpreted differently in diabetic patients. Laboratory evidence of hemostatic abnormalities in diabetic patients supports clinical observations that diabetes is a state of hypercoagulability and hypofibrinolysis. Strategies for clinical intervention and medications are not well established considering the results of the hemostatic markers.

  19. [The effect of contrast baths on the hemostatic function of patients with ischemic heart disease].

    Sorokina, E I; Ali, O


    Contrast baths effects on hemostasis were studied in 72 patients with postinfarction cardiosclerosis and stable angina pectoris. Hemostasis was assessed by recalcification time, blood plasma tolerance to heparin, fibrinolytic activity, functional activity of antithrombin, soluble fibrin-monomeric complex, platelet count and aggregation. The results were compared to those in patients exposed to laser irradiation. Hydrotherapy with contrast baths was hemostatically effective in 70.9% of patients. Blood coagulation and platelet aggregation improved, the risk of intravascular microthrombogenesis diminished. Contrast baths had more pronounced beneficial effects on coagulation in ischemic heart disease of NYHA functional class II.

  20. Surgical wound healing using hemostatic gauze scaffold loaded with nanoparticles containing sustained-release granulocyte colony-stimulating factor

    Yuan W


    Full Text Available Weien Yuan1,2, Zhenguo Liu11Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 2School of Pharmacy, Shanghai Jiao Tong University, Shanghai, People's Republic of ChinaBackground: The therapeutic strategies for malignant melanoma are still cancer chemotherapy, radiotherapy, and tumor resection. However, these therapeutic strategies often lead to a reduced neutrophilic granulocyte count or loss of more blood after surgical tumor resection. In this study, we developed a formulation of hemostatic gauze impregnated with sustained-release granulocyte colony-stimulating factor (G-CSF with increasing of the neutrophilic granulocyte count in the blood following chemotherapy and decreasing blood loss after surgical tumor resection.Methods: We designed a formulation with both hemostatic properties and increased neutrophil content to be used in cancer chemotherapy, radiotherapy, and tumor resection, comprising a hemostatic gauze as a scaffold and (G-CSF-loaded dextran nanoparticles coated with polylactic-co-glycolic acid (PLGA solution fabricated by direct spray-painting onto the scaffold and then vacuum-dried at room temperature. The performance of this system was evaluated in vitro and in vivo.Results: Nearly zero-order release of G-CSF was recorded for 12–14 days, and the cumulative release of G-CSF retained over 90% of its bioactivity in a NFS-60 cell line proliferation assay when the scaffold was incubated in phosphate-buffered saline (pH 7.4 at 37°C. The in vivo hemostatic efficacy of this formulation was greater than that of native G-CSF, the scaffold directly spray-painted with G-CSF solution or PLGA organic solution as a coating, or when a blank scaffold was covered with the coating.Conclusion: Our results suggest that this formulation has both hemostatic properties and increased neutrophil activity.Keywords: hemostatic gauze scaffold, granulocyte colony-stimulating factor, bioactivity

  1. Renewal of radiological equipment.


    In this century, medical imaging is at the heart of medical practice. Besides providing fast and accurate diagnosis, advances in radiology equipment offer new and previously non-existing options for treatment guidance with quite low morbidity, resulting in the improvement of health outcomes and quality of life for the patients. Although rapid technological development created new medical imaging modalities and methods, the same progress speed resulted in accelerated technical and functional obsolescence of the same medical imaging equipment, consequently creating a need for renewal. Older equipment has a high risk of failures and breakdowns, which might cause delays in diagnosis and treatment of the patient, and safety problems both for the patient and the medical staff. The European Society of Radiology is promoting the use of up-to-date equipment, especially in the context of the EuroSafe Imaging Campaign, as the use of up-to-date equipment will improve quality and safety in medical imaging. Every healthcare institution or authority should have a plan for medical imaging equipment upgrade or renewal. This plan should look forward a minimum of 5 years, with annual updates. Teaching points • Radiological equipment has a definite life cycle span, resulting in unavoidable breakdown and decrease or loss of image quality which renders equipment useless after a certain time period.• Equipment older than 10 years is no longer state-of-the art equipment and replacement is essential. Operating costs of older equipment will be high when compared with new equipment, and sometimes maintenance will be impossible if no spare parts are available.• Older equipment has a high risk of failure and breakdown, causing delays in diagnosis and treatment of the patient and safety problems both for the patient and the medical staff.• Every healthcare institution or authority should have a plan for medical imaging equipment upgrade or replacement. This plan should look forward a

  2. Radiological aspects of Gaucher disease

    Katz, Robert; Booth, Tom; Hargunani, Rikin; Wylie, Peter; Holloway, Brian [Royal Free Hospital, Radiology Department, London (United Kingdom)


    Advances in imaging and the development of commercially available enzyme therapy have significantly altered the traditional radiology of Gaucher disease. The cost of treatment and need for monitoring response to therapy have magnified the importance of imaging. There are no recent comprehensive reviews of the radiology of this relatively common lysosomal storage disease. This article describes the modern imaging, techniques and radiological manifestations of Gaucher disease. (orig.)

  3. Radiological safety and control

    Seo, Kyeong Won; You, Young Soo; Chang, Sea Young; Yoon, Yeo Chang; Yoon, Suk Chul; Kim, Jang Yeol; Lee, Tae Young; Lee, Bong Jae; Kim, Bong Hwan; Lee, Jong Il; Jeong, Juk Yeon; Lee, Sang Yeol; Jeong, Kyung Ki; Jeong, Rae Ik; Kim, Jong Su; Han, Young Dae; Lee, Hyung Sub; Kim, Chang Kyung [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)


    This report describes the annual results of radiological safety and control program. This program includes working area monitoring (WAM), personnel radiation monitoring (PRM), education for radiation protection (ERP), preparing for KMRR operation and developing QA program on personal dose evaluation. As a result, the objectives of radiation protection have been achieved satisfactorily through the WAM, PRM and ERP. The QA program on personal dose evaluation has been approved by the MOST according to the Ministerial Ordinance (No. 1992-15). KAERI has also been authorized as a specialized processor for personal dose evaluation. 32 tabs., 20 figs. (Author) .new.

  4. Radiological evaluation of chondroblastoma

    Hudson, T.M.; Hawkins, I.F. Jr.


    Eleven new and six recurrent chondroblastomas were studied with multiple radiological imaging methods (plain radiography, conventional tomography, computed tomography, radionuclide bone scanning, and angiography). When the plain radiographic appearance was typical, conventional tomography or computed tomography (CT) was helpful, but other studies were not. Periosteal reaction and angiographic hypervascularity were common and did not indicate cortical breakthrough. For large, aggressive, or atypical lesions, conventional tomography and CT were helpful in delineating anatomic extent, and angiography was of value in demonstrating major vessel displacement. Radionuclide bone scanning was not useful.

  5. Marginal integrity of low-shrinkage and methacrylate-based composite resins: Effect of three different hemostatic agents

    Khoroushi, Maryam; Sahraneshin-Samani, Mahsa


    Background Moisture control is very important in restorative procedures in dentistry. Use of hemostatic agents helps control moisture; however, they might result in changes on enamel and dentin surfaces, affecting composite resin bond quality. The aim of this in vitro study was to evaluate the marginal microleakage of two different composite resins with the use of three different hemostatic agents. Material and Methods Standardized Class V cavities were prepared on the buccal and lingual surfaces of 48 premolars with cervical margins 1 mm apical to the cementoenamel junction (CEJ). The samples were randomly divided into 8 groups. In groups 1 to 4, an etch-and-rinse adhesive (Adper Single Bond) was applied as the bonding system, followed by exposure to different hemostatic agent: group 1: no hemostatic agent (control); group 2: ViscoStat; group 3: ViscoStat Clear; and group 4: trichloracetic acid, as hemostatic agents. The cavities were restored with Z-250 composite resin. In group 5 to 8 Silorane System Adhesive (Filtek P90 Adhesive) was applied as a bonding agent, followed by exposure to different hemostatic agents in a manner similar to that in groups 1to 4. The cavities were restored with Filtek P90, a low-shrinkage composite resin. The samples in each group were evaluated for dye penetration under a stereomicroscope at ×36 after 24 hours and a 500-round thermocycling procedure at enamel and dentin margins. Statistical analysis was carried out using Kruskal-Wallis and Mann-Whitney tests (α=0.05). Results Z-250 composite resin exhibited significantly higher dentin microleakage scores compared to Filtek P90 (P = 0.004). Trichloracetic acid increased dentin microleakage with Filtek P90 (P=0.033). Conclusions Under the limitations of this in vitro study, application of hemostatic agents did not affect microleakage of the two tested composite resins except for trichloracetic acid that increased marginal microleakage when used with Filtek P90. Key words

  6. Radiological Calibration and Standards Facility

    Federal Laboratory Consortium — PNNL maintains a state-of-the-art Radiological Calibration and Standards Laboratory on the Hanford Site at Richland, Washington. Laboratory staff provide expertise...

  7. Radiology illustrated. Spine

    Kang, Heung Sik; Lee, Joon Woo [Seoul National Univ. Bundang Hospital, Seongnam, Kyonggi-do (Korea, Republic of). Dept. of Radiology; Kwon, Jong Won [Samsung Medical Center, Seoul (Korea, Republic of). Dept. of Radiology


    Offers a practical approach to image interpretation for spinal disorders. Includes numerous high-quality radiographic images and schematic illustrations. Will serve as a self-learning book covering daily routine cases from the basic to the advanced. Radiology Illustrated: Spine is an up-to-date, superbly illustrated reference in the style of a teaching file that has been designed specifically to be of value in clinical practice. Common, critical, and rare but distinctive spinal disorders are described succinctly with the aid of images highlighting important features and informative schematic illustrations. The first part of the book, on common spinal disorders, is for radiology residents and other clinicians who are embarking on the interpretation of spinal images. A range of key disorders are then presented, including infectious spondylitis, cervical trauma, spinal cord disorders, spinal tumors, congenital disorders, uncommon degenerative disorders, inflammatory arthritides, and vascular malformations. The third part is devoted to rare but clinically significant spinal disorders with characteristic imaging features, and the book closes by presenting practical tips that will assist in the interpretation of confusing cases.

  8. Sexual Harassment in Radiology.

    Camargo, Aline; Liu, Li; Yousem, David M


    To gauge the prevalence of sexual harassment (SH) and to understand the issues regarding its disclosure among radiologists. A questionnaire on ethics and SH was sent by e-mail to 1,569 radiologists and radiology trainees in an institutional database maintained for continuing medical education purposes on three separate occasions between September 17 and October 31, 2016. The link to the survey was also posted on social media sites via the authors' divisional and institutional accounts on Facebook, Twitter, Instagram, and Aunt Minnie, as well as on ACR and RSNA web blogs. Overall, 9.75% (39 of 400) respondents stated they had suffered SH, with more female (22 of 90 = 24.4%) than male victims (11 of 249 = 4.4%) (P victims said they would likely report SH (P witnessed SH. By percentage responding, female radiologists are more frequently victims and witnesses of sexual harassment but are less likely to report such cases. Steps need to be taken to eliminate a culture that leads radiologists to tolerate SH without addressing it. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. Radiology – Changing Role in Healthcare

    Md Khalilur Rahman


    also as a major contributor to treatment and recovery. Working in tandem with other disciplines, radiology has had a major impact on achievements in such significant areas as early cancer detection, speedy trauma analysis, precise stroke localization and many others.7 Interventional radiology, one of the subspecialty areas of radiology, uses the imaging modalities of diagnostic radiology to guide minimally invasive surgical procedures, such as that in laparoscopic gallstone surgery. The number of interventional radiology examinations has shown a huge rise, increasing by over 50% since 2007. Therapeutic radiology, better known as radiation oncology uses radiation to treat diseases such as cancer using a form of treatment called radiation therapy.5,8 The last few decades have witnessed dramatic innovations and improvisations in imaging technology. In all sense radiological advances have revolutionized the practice of modern medicine. Imaging now uses a wide range of modalities that vary in their mode of image acquisition. In order to request the correct imaging technique and thereby improve patient management, it is useful for the practicing clinician to be conversant with all imaging techniques available, their advantages as well as limitations, indications and contraindications of each modality.

  10. White Paper: Radiological Curriculum for Undergraduate Medical Education in Germany.

    Ertl-Wagner, B; Barkhausen, J; Mahnken, A H; Mentzel, H J; Uder, M; Weidemann, J; Stumpp, P


    Purpose: Radiology represents a highly relevant part of undergraduate medical education from preclinical studies to subinternship training. It is therefore important to establish a content base for teaching radiology in German Medical Faculties. Materials and Methods: The German Society of Radiology (DRG) developed a model curriculum for radiological teaching at German medical universities, which is presented in this article. There is also a European model curriculum for undergraduate teaching (U-level curriculum of the European Society of Radiology). In a modular concept, the students shall learn important radiological core principles in the realms of knowledge, skills and competences as well as core scientific competences in the imaging sciences. Results: The curriculum is divided into two modules. Module 1 includes principles of radiation biology, radiation protection and imaging technology, imaging anatomy as well as the risks and side effects of radiological methods, procedures and contrast media. This module is modality-oriented. Module 2 comprises radiological diagnostic decision-making and imaging-based interventional techniques for various disease entities. This module is organ system-oriented. Conclusion: The curriculum is meant as a living document to be amended and revised at regular intervals. The curriculum can be used as a basis for individual curricular development at German Medical Faculties. It can be integrated into traditional or reformed medical teaching curricula. Key Points: • Radiology is an integral and important part of medical education.• The German Society of Radiology (DRG) developed a model curriculum for teaching radiology at German Medical Faculties to help students develop the ability to make medical decisions based on scientific knowledge and act accordingly.• This curriculum can be used for individual curricular development at medical departments. It is divided into two modules with several chapters. Citation Format

  11. Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique.

    Afifi, Yousri; Mahmud, Ayesha; Fatma, Alfia


    Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%. Hemorrhage is a key concern in the management of such pregnancies. Traditional treatment options include a conservative approach, failing which patients are offered surgical options such as cornual resection at laparotomy, which carries a high risk of hysterectomy. In recent years newer laparoscopic cornual resection or cornuotomy techniques have been used successfully to achieve better outcomes with fewer complications. We present the double-impact devascularization (DID) technique for laparoscopic management of cornual ectopic pregnancies. This technique permits hemostatic control by compression effect, which in turn allows reduction in procedure-related patient morbidity and mortality. We also provide an overview of other reported methods of hemostatic control used in similar laparoscopic procedures. DID appears to be a useful, safe, minimally invasive technique that can be used in both laparoscopic and open surgical procedures.

  12. The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery

    E. Lacarriere


    Full Text Available Objective The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. Patients and Methods Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. Results At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. Conclusions Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules.

  13. Development and assessment of kerateine nanoparticles for use as a hemostatic agent.

    Luo, Tiantian; Hao, Shilei; Chen, Xiaoliang; Wang, Ju; Yang, Qian; Wang, Yazhou; Weng, Yulan; Wei, Huimin; Zhou, Jin; Wang, Bochu


    Uncontrolled bleeding frequently occurs in some emergencies which can result in severe injury and even death. Keratin hydrogel has been found that it had good ahemostatic efficacy in the previous studies. However, an ideal hemostatic agent should not require mixing or preparation in advance, and hydrogel is not easy to store and carry. In the present study, the kerateine was firstly extracted from human hair, and then was prepared nanoparticles by a modified emulsion diffusion method. The synthesized nanoparticles showed spherical morphology with an average diameter of approximately 200 nm. The results of Fourier transform infrared spectroscopy and X-ray diffraction indicated that the chemical structure of kerateine did not change but the crystal form may be transformed in the nanoparticles. In addition, kerateine nanoparticles displayed a faster clotting time in vitro study than the kerateine extracts. Furthermore, kerateine nanoparticles significantly reduced the blood loss and coagulation time in the liver puncture and tail amputation in rat models. Our results indicated that kerateine nanoparticles could quickly form a high viscosity gel onto the wound and accelerate the blood coagulation based on their high specific surface area. Therefore, kerateine nanoparticles have great potential for hemostatic application.

  14. Rare acquired hemostatic disorders as a cause of prolonged bleeding – presentation of two case reports

    Polona Novak


    Full Text Available BACKGROUNDPatient’s anamnesis is of primary importance in determining hemostatic disorders. Based on anamnestic data, a clinician may decide for further laboratory tests. We must consider an acquired bleeding disorder in a patient with unusual, unexpected and prolonged bleeding episodes. In this article we will describe two rare acquired hemostatic disordes.TWO CASE REPORTSOur first patient had prolonged bleeding after a pacemaker implantation. We diagnosed him with acquired von Willebrand syndrome. Further on, the patient required a planned surgical procedure. In our second case we describe a patient with unusual and excessive skin bruising and prolonged bleeding after teeth extractions. He was diagnosed with acquired hemophilia.CONCLUSIONIn the assessment of a patient with a potential acquired bleeding disorder we must first rule out the most common causes, such as iatrogenic ones. But, because of high morbidity and mortality rates, we must also be aware of some rare acquired bleeding disorders. In case of uncertainty, we should consult with a hematologist.

  15. Hemostatic status in liver transplantation: association between preoperative procoagulants/anticoagulants and postoperative hemorrhaging/thrombosis.

    Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Nakazawa, Akiko; Nishioka, Yujiro; Kaneko, Junichi; Aoki, Taku; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro


    The delicate rebalanced hemostatic status of liver transplant recipients may lead to both hemorrhagic and thrombotic tendencies in this population. The aim of this study was to investigate the association between pretransplant procoagulants/anticoagulants and posttransplant bleeding and thrombosis among living donor liver transplant recipients. The study subjects were 403 consecutive recipients with chronic liver disease. Perioperative variables, including preoperative values for procoagulants and anticoagulants, were assessed to determine their association with posttransplant hemorrhaging and thrombosis. There were 35 hemorrhagic complications (9%) and 21 thrombotic complications (5%). In logistic regression analyses, a higher Model for End-Stage Liver Disease score (P = 0.01) and a lower fibrinogen value (P sensitivity = 0.9, specificity = 0.8). In conclusion, the decreases in both procoagulants and anticoagulants in liver transplant recipients may additively result in a delicate hemostatic balance and predispose patients to both hemorrhagic and thrombotic complications. A lower preoperative protein C value (postoperative thrombotic complications in liver transplant recipients. © 2014 American Association for the Study of Liver Diseases.

  16. Outcome of radiologically placed tunneled haemodialysis catheters.

    Sayani, Raza; Anwar, Muhammad; Tanveer-ul-Haq; Al-Qamari, Nauman; Bilal, Muhammad Asif


    To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure. Case series. Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011. All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed. Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% (5 catheters). Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 (72.4%) predominantly had uneventful course during the study period. Twelve patients developed infection (17.3%); two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters (10.1%) failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was accidentally damaged in the ward and had to be removed. Radiological guided tunneled

  17. Common Data Elements in Radiology.

    Rubin, Daniel L; Kahn, Charles E


    Diagnostic radiologists generally produce unstructured information in the form of images and narrative text reports. Although designed for human consumption, radiologic reports contain a wealth of information that could be valuable for clinical care, research, and quality improvement if that information could be extracted by automated systems. Unfortunately, the lack of structure in radiologic reports limits the ability of information systems to share information easily with other systems. A common data element (CDE)-a unit of information used in a shared, predefined fashion-can improve the ability to exchange information seamlessly among information systems. In this article, a model and a repository of radiologic CDEs is described, and three important applications are highlighted. CDEs can help advance radiologic practice, research, and performance improvement, and thus, it is crucial that CDEs be adopted widely in radiologic information systems. (©) RSNA, 2016.

  18. Radiological Work Planning and Procedures

    Kurtz, J E


    Each facility is tasked with maintaining personnel radiation exposure as low as reasonably achievable (ALARA). A continued effort is required to meet this goal by developing and implementing improvements to technical work documents (TWDs) and work performance. A review of selected TWDs from most facilities shows there is a need to incorporate more radiological control requirements into the TWD. The Radioactive Work Permit (RWP) provides a mechanism to place some of the requirements but does not provide all the information needed by the worker as he/she is accomplishing the steps of the TWD. Requiring the engineers, planners and procedure writers to put the radiological control requirements in the work steps would be very easy if all personnel had a strong background in radiological work planning and radiological controls. Unfortunately, many of these personnel do not have the background necessary to include these requirements without assistance by the Radiological Control organization at each facility. In add...

  19. Radiological changes of adult sprue

    Neutard, E.; Kluge, F.


    Radiological findings of 10 adult patients with sprue were compared with histology. Patients suffering from subtotal villous atrophy were showing distinct radiological changes. The most important finding of sprue is the dilatation of the small intestine. Further typical changes are segmentations and fragmentations as well as mucous hypertrophy and the sign of moulage. In a 57-year-old female patient who was suffering from sprue for 35 years, a carcinoma of the small bowl was found and was resected during laparatomy. Sprue is a premalignant disease; therefore radiological investigations are of special importance. Therapy by a diet without gluten can reduce the radiological changes to normal very bad changes rarely can be reduced totally. Radiological changes are not significant, but the diagnosis can be made in most cases by investigation with barium.

  20. Radiology illustrated. Gastrointestinal tract

    Choi, Byung Ihn (ed.) [Seoul National University Hospital (Korea, Republic of). Dept. of Radiology


    Radiology Illustrated: Gastrointestinal Tract is the second of two volumes designed to provide clear and practical guidance on the diagnostic imaging of abdominal diseases. The book presents approximately 300 cases with 1500 carefully selected and categorized illustrations of gastrointestinal tract diseases, along with key text messages and tables that will help the reader easily to recall the relevant images as an aid to differential diagnosis., Essential points are summarized at the end of each text message to facilitate rapid review and learning. Additionally, brief descriptions of each clinical problem are provided, followed by case studies of both common and uncommon pathologies that illustrate the roles of the different imaging modalities, including ultrasound, radiography, computed tomography, and magnetic resonance imaging.

  1. Abdominal hernias: Radiological features

    Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto


    Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678

  2. Radiologic findings in neurofibromatosis

    Kim, Dai Young; Jeon, Seok Chol; Lee, Kwan Se; Yeon, Kyung Mo; Choo, Dong Woon [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Neurofibromatosis is an uncommon but certainly not a rare hereditary disorder, probably of neuralcrest origin, involving not only neuroectoderm and mesoderm but also endoderm and characterized by cafe au lait spots and cutaneous and subcutaneous tumors, with secondary mesodermal defects responsible for protean osseous abnormalities and various manifestations in other systems. This paper is a study of confirmed 143 cases of neurofibromatosis collected for past 8 years. In this analysis, special attention was given to the selected 37 cases which showed abnormal findings on radiological examinations. Overall male to female ratio was 1 : 1.3. The most frequent kind of abnormalities was vertebral kyphoscoliosis in 12 cases. Among the more pathognomonic but uncommon abnormalities to neurofibromatosis, we experienced each 2 cases of lambdoid defect, pseudoarthrosis and renovascular hypertension, and 1 cases of sphenoid bone absence.

  3. "Patient care in radiology"

    Bro Brask, Kirsten; Birkelund, Regner


    and semistructured interviews and analyzed according to the guidelines for meaning condensation by Giorgi. The imaging staff found that care is expressed in an administrative, an instrumental, and a compassionate sense. The imaging staff perceived care in a way that clearly differs from the traditional perception...... of care understood as the close relations between people. In their self-understanding, the staff found that care not only comprised the relational aspect but also that it was already delivered during the preparatory phases before the actual meeting with the patient and up until the image...... was electronically forwarded. And, care expressed in between was perceived as care in the traditional sense and termed as “patient care in radiology.”...

  4. Optimal Radiologic Report

    Esmaeel Shokrollahi


    Full Text Available The radiological report is the medical document that qualifies the radiologist as a clinician and as a specialist, because through it radiologists expresse their professionalism."nThere is nothing more debatable than the report and how it should be written. It is conditioned by many variables that derive from the wide variety of sensitivities and personal or local cultures. In addition, there has never been a specific school in which these rules are taught."nIn the assessment of each written material, two things are explained:"n1. Methodology of the writing process itself as an act"n2. Characters of the written material "nIn assessing the method of writing a radiological report, two dimensions are discussed: "n1. Hardware: including data gathering, their processing and preparing them to be seen, the me-thod of reporting, conditions of workspace, instru-ments and all the physical parts of the work."n2. Software: how someone watches the images, me-thodology of thought and logical reasoning, and ultimately, how pictures are transferred to understandable, meaningful and useful written material."nIn assessing the characters of the written material itself, we should note:"n1. The configuration includes the structure of the words and grammar, style of writing, order of things to come after each other. This is the carrier of the content. "n2. The content is the main reason of the writing which contains the whole meaning and all parts of what one wants his or her audience to get from the note.

  5. Radiology of bacterial pneumonia

    Vilar, Jose E-mail:; Domingo, Maria Luisa; Soto, Cristina; Cogollos, Jonathan


    Bacterial pneumonia is commonly encountered in clinical practice. Radiology plays a prominent role in the evaluation of pneumonia. Chest radiography is the most commonly used imaging tool in pneumonias due to its availability and excellent cost benefit ratio. CT should be used in unresolved cases or when complications of pneumonia are suspected. The main applications of radiology in pneumonia are oriented to detection, characterisation and follow-up, especially regarding complications. The classical classification of pneumonias into lobar and bronchial pneumonia has been abandoned for a more clinical classification. Thus, bacterial pneumonias are typified into three main groups: Community acquired pneumonia (CAD), Aspiration pneumonia and Nosocomial pneumonia (NP).The usual pattern of CAD is that of the previously called lobar pneumonia; an air-space consolidation limited to one lobe or segment. Nevertheless, the radiographic patterns of CAD may be variable and are often related to the causative agent. Aspiration pneumonia generally involves the lower lobes with bilateral multicentric opacities. Nosocomial Pneumonia (NP) occurs in hospitalised patients. The importance of NP is related to its high mortality and, thus, the need to obtain a prompt diagnosis. The role of imaging in NP is limited but decisive. The most valuable information is when the chest radiographs are negative and rule out pneumonia. The radiographic patterns of NP are very variable, most commonly showing diffuse multifocal involvement and pleural effusion. Imaging plays also an important role in the detection and evaluation of complications of bacterial pneumonias. In many of these cases, especially in hospitalised patients, chest CT must be obtained in order to better depict these associate findings.

  6. Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.

    Vurst, T.J. van der; Bodegom, M.E.; Rakic, S.


    Presacral venous hemorrhage is a severe complication in low rectal surgery. This complication was encountered in 5 of 165 patients (3 percent) who underwent a presacral dissection for rectal mobilization. Conventional hemostatic measures often are ineffective to arrest this hemorrhage, and a number

  7. Prehospital use of hemostatic dressings in emergency medical services in the Netherlands: A prospective study of 66 cases

    Grotenhuis, R. te; Grunsven, P.M. van; Heutz, W.M.; Tan, E.C.T.H.


    BACKGROUND: Uncontrolled haemorrhage is the leading cause of potentially preventable death in both civilian and military trauma patients. Animal studies and several case series have shown that hemostatic dressings reduce haemorrhage and might improve survival. One of these products is HemCon

  8. The use of fresh whole blood transfusions by the SOF medic for hemostatic resuscitation in the austere environment.

    Bowling, F; Pennardt, Andre


    The leading cause of death on the battlefield is uncontrolled hemorrhage. Non-compressible (truncal) hemorrhage is the cause over two thirds of these deaths. This makes truncal hemorrhage the leading cause of potentially survivable death on the battlefield. Over one third of the casualties who arrive at the emergency department (ED) or combat surgical hospital (CSH) in need of a blood transfusion are already suffering from acute traumatic coagulopathy which is associated with an 80% mortality. Early aggressive treatment and prevention of this coagulopathy through hemostatic resuscitation has been shown to increase survival. Hemostatic resuscitation involves the very early use of blood and blood products as primary resuscitation fluids to both treat intrinsic acute traumatic coagulopathy and prevent the development of dilutional coagulopathy. Few, if any, of the products used in hemostatic resuscitation are currently available to the Special Operations Forces (SOF) medic. Warm fresh whole blood transfusions could be a powerful tool for the SOF medic to use in order to begin hemostatic resuscitation in the field.

  9. Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.

    Vurst, T.J. van der; Bodegom, M.E.; Rakic, S.


    Presacral venous hemorrhage is a severe complication in low rectal surgery. This complication was encountered in 5 of 165 patients (3 percent) who underwent a presacral dissection for rectal mobilization. Conventional hemostatic measures often are ineffective to arrest this hemorrhage, and a number

  10. Tracing novel hemostatic compounds from heating products of total flavonoids in Flos Sophorae by spectrum-effect relationships and column chromatography.

    Chen, Yeqing; Yu, Hongli; Wu, Hao; Pan, Yaozong; Wang, Kuilong; Liu, Liping; Jin, Yangping; Zhang, Chenchao


    Flos Sophorae and its processed product have been clinically used to treat hemorrhage. In this study, the total ion chromatographic fingerprints of the heating products of total flavonoids in Flos Sophorae were established by high-performance liquid chromatography with tandem mass spectrometry and the hemostatic activities were studied by hemostatic screening tests in vivo. The spectrum-effect relationships between fingerprints and hemostatic activities were investigated using canonical correlation analysis to trace the peaks responsible for the hemostatic effects. The predicted active peaks in fingerprints were isolated by column chromatography and their structures were identified by NMR spectroscopy and mass spectrometry. The hemostatic activities of them were verified by platelet aggregation and procoagulation assays in vitro. Canonical correlation analysis results showed that peak 8 and peak 11 were correlated most closely, thus probably being the main hemostatic compounds. Through column chromatography separation, peak 8 (compound I) and peak 11 (compound II) were obtained with purities of 95.61 and 93.38%, respectively, and were discovered new hemostatic compounds named as huaicarbon A (I) and huaicarbon B (II), respectively. This study provides a universal model to trace the active compounds of other herbs which have bioactivity enhancement after processing by spectrum-effect relationships and column chromatography.

  11. Radiological anatomy - evaluation of integrative education in radiology.

    Dettmer, S; Schmiedl, A; Meyer, S; Giesemann, A; Pabst, R; Weidemann, J; Wacker, F K; Kirchhoff, T


    Evaluation and analysis of the integrative course "Radiological Anatomy" established since 2007 at the Medical School Hannover (MHH) in comparison with conventional education. Anatomy and radiology are usually taught separately with a considerable time lag. Interdisciplinary teaching of these associated subjects seems logical for several reasons. Therefore, the integrative course "Radiological Anatomy" was established in the second year of medical education, combining these two closely related subjects. This interdisciplinary course was retrospectively evaluated by consideration of a student questionnaire and staff observations. The advantages and disadvantages of integrative teaching in medical education are discussed. The course ratings were excellent (median 1; mean 1.3 on a scale of 1 to 6). This is significantly (p radiology increased during the course (88 %). According to the students' suggestions the course was enhanced by a visitation in the Department of Radiology and the additional topic central nervous system. Integrative teaching of anatomy and radiology was well received by the students. Both, anatomical and radiological comprehension and the motivation to learn were improved. However, it should be considered, that the amount of work and time required by the teaching staff is considerably increased compared to traditional teaching. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Status of radiological services in Addis Ababa public hospitals.

    Shimelis, Dagmawit; Tsige, Mesfin; Atnafu, Asfaw


    believe this finding can be used as an indirect indicator of the possible worse scenario in the regional and peripheral hospitals. Therefore a nation- wide survey & plannedgovernment intervention is recommended to improve the radiological service.

  13. Kaolin-based hemostatic dressing improves hemorrhage control from a penetrating inferior vena cava injury in coagulopathic swine.

    Koko, Kiavash R; McCauley, Brian M; Gaughan, John P; Nolan, Ryan S; Fromer, Marc W; Hagaman, Ashleigh L R; Choron, Rachel L; Brown, Spencer A; Hazelton, Joshua P


    Retrohepatic inferior vena cava (RIVC) injuries are often lethal due to challenges in obtaining hemorrhage control. We hypothesized that packing with a new kaolin-based hemostatic dressing (Control+; Z-Medica, Wallingford, CT) would improve hemorrhage control from a penetrating RIVC injury compared with packing with standard laparotomy sponges alone. Twelve male Yorkshire pigs received a 25% exchange transfusion of blood for refrigerated normal saline to induce a hypothermic coagulopathy. A laparotomy was performed and a standardized 1.5 cm injury to the RIVC was created which was followed by temporary abdominal closure and a period of uncontrolled hemorrhage. When the mean arterial pressure reached 70% of baseline, demonstrating hemorrhagic shock, the abdomen was re-entered, and the injury was treated with perihepatic packing using standard laparotomy sponges (L; n = 6) or a new kaolin-based hemostatic dressing (K; n = 6). Animals were then resuscitated for 6 hours with crystalloid solution. The two groups were compared using the Wilcoxon rank sum test and Fisher exact test. A p value of 0.05 or less was considered statistically significant. There was no difference in the animal's temperature, heart rate, mean arterial pressure, cardiac output, and blood loss at baseline or before packing was performed (all p > 0.05). In the laparotomy sponge group, five of six pigs survived the entire study period, whereas all six pigs treated with kaolin-based D2 hemostatic dressings survived. Importantly, there was significantly less blood loss after packing with the new hemostatic kaolin-based dressing compared with packing with laparotomy sponge (651 ± 180 mL vs. 1073 ± 342 mL; p ≤ 0.05). These results demonstrate that the use of this new hemostatic kaolin-based dressing improved hemorrhage control and significantly decreased blood loss in this penetrating RIVC model. This is basic science research based on a large animal model, level V.

  14. The frequency of reexpansion pulmonary edema after trocar and hemostat assisted thoracostomy in patients with spontaneous pneumothorax.

    Cha, Kyoung Chul; Kim, Hyun; Ji, Ho Jin; Kwon, Woo Cheol; Shin, Hyung Jin; Cha, Yong Sung; Lee, Kang Hyun; Hwang, Sung Oh; Lee, Christopher C; Singer, Adam J


    Several risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy. We performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses. Ninety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24 ± 10 vs. 26 ± 14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups. Closed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat- assisted drainage in patients with spontaneous pneumothorax.

  15. Adhesions, inflammatory response and foreign body giant cells infiltration of the topical hemostats TachoSil®, Hemopatch™ and Veriset™ – An Animal Study

    Nissen, Line S; Hunter, Jacob; Schrøder, Henrik Daa


    Background: When liver bleeding cannot be controlled by conventional methods, a topical hemostatic patch can be applied during surgery. In recent years new hemostats have become available. The aim of this study was to investigate the degree of adhesion and inflammation for three topical hemostatic...... patches, TachoSil®, Hemopatch™ and Veriset™. Methods: In 60 adult male Sprague Dawley rats liver two lesions were induced with a scalpel. Each rat was treated with two of the three patches tested. After 1, 2 and 3 months the animals were euthanized and macroscopic evaluation of adhesions and histological...

  16. [Nursing care in patients undergoing radiological surgery. A case report].

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis


    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.

  17. Crystalline dose of interventional radiologists; Dosis en cristalino de radiologicos intervencionistas

    Hernandez Concepcion, E.; Diaz Romero, F.; Catalan Acosta, A.; Hernandez Armas, J.


    The measured dose area product in radiology equipment used in angio radiology during different diagnostic and therapeutic can be used to estimate the value of the dose in the lens of doctors or medical personnel carrying out such interventions. (Author)

  18. Characteristics and trends of radiology research: a survey of original articles published in AJR and Radiology between 2001 and 2010.

    Lim, Kyoung Ja; Yoon, Dae Young; Yun, Eun Joo; Seo, Young Lan; Baek, Sora; Gu, Dong Hyeon; Yoon, Soo Jeong; Han, Ari; Ku, You Jin; Kim, Sam Soo


    To determine the characteristics and trends of the original articles published in two major American radiology journals, AJR American Journal of Roentgenology (AJR) and Radiology, between 2001 and 2010. This was a retrospective bibliometric analysis that did not involve human subjects and was exempt from institutional review board approval. All 6542 original articles published in AJR and Radiology between 2001 and 2010 were evaluated. The following information was abstracted from each article: radiologic subspecialty, radiologic technique used, type of research, sample size, study design, statistical analysis, study outcome, declared funding, number of authors, affiliation of the first author, and country of the first author. In addition, all the variables examined were presented along with the trend over time. The most common subspecialty of study was abdominal (1219 of 6542, 18.6%), followed by vascular/interventional (804 of 6542, 12.3%). A total of 3744 (57.2%) original articles used magnetic resonance (MR) imaging or computed tomography (CT), 5495 (84.1%) were clinical research articles, 3060 (46.8%) had sample size of more than 50, 4087 (62.5%) were retrospective, 4714 (72.1%) performed statistical analysis, 6225 (95.2%) showed positive study outcome, 4784 (73.1%) were not funded, 3942 (60.3%) had four to seven authors, and 5731 (87.6%) were written by the primary author who was from a department of radiology or radiology-related specialties. The United States published 45.5% (2975 of 6542) of the articles, followed by Japan (n = 525, 8.0%), Germany (n = 485, 7.4%), and South Korea (n = 455, 7.0%). In the time trend analysis, the following variables showed a significantly positive trend: cardiac subspecialty, CT and MR imaging as the radiologic techniques, type of research as other (nonbasic, nonclinical), sample size of more than 50, four to seven as the number of authors, medicine-related department of the first author, and South Korea and Italy as

  19. Radiological aspects of rheumatoid arthritis

    Schacherl, M.


    An introductory summary of the imaging-diagnosis will be given. The necessity of acquiring a catalogue of application to particular imaging methods is emphasized. Discussion of step by step diagnosis regarding rheumatologic questions is given on example of the hand. Technically insufficient radiographs and bad habits during diagnostic analysis are pointed out. Radiologic problems in differentiating arthritis/osteoarthrosis will be mentioned. The discussion of these points is followed by outlining the radiology of rheumatoid arthritis and the complexity of this disease. Introduction of a new stage classification. Finally twelve basic radiologic types of rheumatoid arthritis will be presented.

  20. Radiology system evolution in the new millennium.

    Nauert, R C


    For many decades the practice of radiology grew slowly in America and was largely a secondary function under the control of hospitals. In more recent times it has vastly expanded its array of diagnostic, interventional, and therapeutic abilities. There is increasing consumer logic for direct access. Motivations have grown to create large independent entities with broadly diverse capabilities in order to succeed in the new millennium. Most regional markets are evolving rapidly in terms of managed care penetration, health system formation, physician practice consolidation and aggressive purchaser behavior by employers and consumers. To understand the enormity of healthcare evolution, it is useful to look at the industry's paradigm shifts in recent decades. Virtually every aspect of organizational infrastructure, delivery approaches, and the business environment has evolved markedly during the past fifty years. These changes will accelerate. To succeed financially, radiology groups must strengthen their market positions, technical capabilities, continuums of care and geographic dominance. Equally important is the wisdom of diversifying incomes into related services and businesses that provide additional related revenues. Key factors for successful development include facility market growth, full coverage of managed care contracts, high efficiency and aggressive diversification. A fully evolved system generates significant revenues and profitability by protecting and strengthening its financial position in this environment. That is accomplished through the development of strategically located radiology groups, aggressive alliances with medical practices in allied disciplines, and managed radiology departments and facilities for partner health systems. Organizational success ultimately depends on the ability to accept capitated payments under risk-bearing arrangements. The strategic business plan should be organized with the appropriate levels of detail needed to

  1. Viscoelastic hemostatic assays in the management of the pediatric trauma patient.

    Leeper, Christine M; Gaines, Barbara A


    Viscoelastic hemostatic assays (VHA), such as TEG and ROTEM, are whole blood tests that depict functional coagulation both numerically and graphically. The development of rapid VHA technology, which allows for the first data points to result within minutes of test initiation, has increased the utility of these tests in the treatment of trauma patients. Both adult and pediatric centers have integrated VHAs into trauma resuscitation and transfusion protocols. Literature regarding the use of VHAs for injured children is limited. Here, we discuss the mechanics and interpretation of VHAs as well as the use of VHAs in data-driven resuscitation of pediatric trauma patients. Novel research on fibrinolysis states after injury as well as hypercoagulable state diagnosed with VHAs are presented. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Hemostatic strategies for minimizing mortality in surgery with major blood loss

    Johansson, Per Ingemar


    : In the past 18 months, nine retrospective studies and three before and after studies have evaluated the implementation of massive transfusion protocols in massively transfused patients receiving more than 10 units of red blood cells (RBCs) within 24 h from arrival. All studies demonstrate that patients...... receiving a high fresh frozen plasma (FFP):RBC or platelet:RBC ratio have improved survival, with patients receiving both high FFP:RBC and platelet:RBC ratios exhibiting the highest survival rate. When whole blood thrombelastography is used to guide transfusion therapy in massively bleeding patients...... aggressive hemostatic resuscitation strategies in massively bleeding patients seems reasonable, and optimally, thrombelastography should be used to monitor coagulopathy and guide FFP and platelet transfusions....

  3. Hemostatic potential of natural/synthetic polymer based hydrogels crosslinked by gamma radiation

    Barba, Bin Jeremiah D.; Tranquilan-Aranilla, Charito; Abad, Lucille V.


    Various raw materials and hydrogels prepared from their combination were assessed for hemostatic capability using swine whole blood clotting analysis. Initial screening showed efficient coagulative properties from κ-carrageenan and its carboxymethylated form, and α-chitosan, even compared to commercial products like QuikClot Zeolite Powder. Blending natural and synthetic polymers formed into hydrogels using gamma radiation produced materials with improved properties. KC and CMKC hydrogels were found to have the lowest blood clotting index in granulated form and had the higher capacity for platelet adhesion in foamed form compared to GelFoam. Possible mechanisms involved in the evident thrombogenicity of the materials include adsorption of platelets and related proteins that aid in platelet activation (primary hemostasis), absorption of water to concentrate protein factors that control the coagulation cascade, contact activation by its negatively charged surface and the formation of gel-blood clots.

  4. Cardiac radiology: centenary review.

    de Roos, Albert; Higgins, Charles B


    During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

  5. Granulomatous mastitis: radiological findings

    Ozturk, M.; Mavili, E.; Kahriman, G.; Akcan, A.C.; Ozturk, F. [Depts. of Radiology, Surgery, and Pathology, Erciyes Univ. Medical Faculty, Kayseri (Turkey)


    Purpose: To evaluate the radiological, ultrasonographic, and magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis. Material and Methods: Between April 2002 and June 2005, the mammography, ultrasound, color Doppler ultrasound, non enhanced MR, and dynamic MR findings of nine patients with the preliminary clinical diagnosis of malignancy and the final diagnosis of granulomatous mastitis were evaluated. Results: On mammography, asymmetrical focal densities with no distinct margins, ill-defined masses with spiculated contours, and bilateral multiple ill-defined nodules were seen. On ultrasound, in four patients a discrete, heterogenous hypoechoic mass, in two patients multiple abscesses, in one patient bilateral multiple central hypo peripheral hyperechoic lesions, in two patients heterogeneous hypo- and hyperechoic areas together with parenchymal distortion, and in one patient irregular hypoechoic masses with tubular extensions and abscess cavities were seen. Five of the lesions were vascular on color Doppler ultrasound. On MR mammography, the most frequent finding was focal or diffuse asymmetrical signal intensity changes that were hypointense on T1W images and hyperintense on T2W images, without significant mass effect. Nodular lesions were also seen. On dynamic contrast-enhanced mammography, mass-like enhancement, ring-like enhancement, and nodular enhancement were seen. The time-intensity curves differed from patient to patient and from lesion to lesion. Conclusion: The imaging findings of idiopathic granulomatous mastitis have a wide spectrum, and they are inconclusive for differentiating malignant and benign lesions.

  6. [Controlling in outpatient radiology].

    Baum, T


    Radiology is among the medical disciplines which require the highest investment costs in the healthcare system. The need to design efficient workflows to ensure maximum utilization of the equipment has long been known. In order to be able to establish a sound financial plan prior to a project or equipment purchase, the costs of an examination have to be broken down by modality and compared with the reimbursement rates. Obviously, the same holds true for operative decisions when scarce human resources have to be allocated. It is the task of controlling to review the economic viability of the different modalities and ideally, the results are incorporated into the management decision-making processes. The main section of this article looks at the recognition and allocation of direct and indirect costs in a medical center (Medizinisches Versorgungszentrum - MVZ) in the German North Rhine region. The profit contribution of each examination is determined by deducting the costs from the income generated by the treatment of patients with either private or statutory health insurance.

  7. Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study

    Ozbek, Orhan, E-mail: [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Acar, Kadir [Selcuk University, Division of Hematology, Department of Internal Medicine, Meram School of Medicine (Turkey); Koc, Osman [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Saritas, Kadir [Afyon Kocatepe University, Department of General Surgery, Veterinary Faculty (Turkey); Toy, Hatice [Selcuk University, Department of Pathology, Meram School of Medicine (Turkey); Solak, Yalcin [Selcuk University, Division of Nephrology, Department of Internal Medicine, Meram School of Medicine (Turkey); Ozbek, Seda [Selcuk University, Department of Radiology, Selcuklu School of Medicine (Turkey); Kucukapan, Ahmet; Guler, Ibrahim [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Gaipov, Abduzhappar; Turk, Suleyman [Selcuk University, Division of Nephrology, Department of Internal Medicine, Meram School of Medicine (Turkey); Haznedaroglu, Ibrahim Celaleddin [Hacettepe University, Division of Hematology, Department of Internal Medicine, Faculty of Medicine (Turkey)


    Renal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.

  8. A shape memory foam composite with enhanced fluid uptake and bactericidal properties as a hemostatic agent.

    Landsman, T L; Touchet, T; Hasan, S M; Smith, C; Russell, B; Rivera, J; Maitland, D J; Cosgriff-Hernandez, E


    Uncontrolled hemorrhage accounts for more than 30% of trauma deaths worldwide. Current hemostatic devices focus primarily on time to hemostasis, but prevention of bacterial infection is also critical for improving survival rates. In this study, we sought to improve on current devices used for hemorrhage control by combining the large volume-filling capabilities and rapid clotting of shape memory polymer (SMP) foams with the swelling capacity of hydrogels. In addition, a hydrogel composition was selected that readily complexes with elemental iodine to impart bactericidal properties to the device. The focus of this work was to verify that the advantages of each respective material (SMP foam and hydrogel) are retained when combined in a composite device. The iodine-doped hydrogel demonstrated an 80% reduction in bacteria viability when cultured with a high bioburden of Staphylococcus aureus. Hydrogel coating of the SMP foam increased fluid uptake by 19× over the uncoated SMP foam. The composite device retained the shape memory behavior of the foam with more than 15× volume expansion after being submerged in 37°C water for 15 min. Finally, the expansion force of the composite was tested to assess potential tissue damage within the wound during device expansion. Expansion forces did not exceed 0.6N, making tissue damage during device expansion unlikely, even when the expanded device diameter is substantially larger than the target wound site. Overall, the enhanced fluid uptake and bactericidal properties of the shape memory foam composite indicate its strong potential as a hemostatic agent to treat non-compressible wounds.

  9. Goal-directed hemostatic therapy using the rotational thromboelastometry in patients requiring emergent cardiovascular surgery

    Danièle Sartorius


    Full Text Available Aims and Objectives: We assessed the clinical impact of goal-directed coagulation management based on rotational thromboelastometry (ROTEM in patients undergoing emergent cardiovascular surgical procedures. Materials and Methods: Over a 2-year period, data from 71 patients were collected prospectively and blood samples were obtained for coagulation testing. Administration of packed red blood cells (PRBC and hemostatic products were guided by an algorithm using ROTEM-derived information and hemoglobin level. Based on the amount of PRBC transfused, two groups were considered: High bleeders (≥5 PRBC; HB and low bleeders (<5 PRBC; LB. Data were analyzed using Chi-square test, unpaired t-test and analysis of variance as appropriate. Results: Pre-operatively, the HB group (n = 31 was characterized by lower blood fibrinogen and decreased clot amplitude at ROTEM compared with the LB group (n = 40. Intraoperatively, larger amounts of fibrinogen, fresh frozen plasma and platelets were required to normalize the coagulation parameters in the HB group. Post-operatively, the incidence of major thromboembolic and ischemic events did not differ between the two groups (<10% and the observed in-hospital mortality was significantly less than expected by the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM score, 22% vs. 35% in HB and 5% vs. 13% in LB group. Conclusions: ROTEM-derived information is helpful to detect early coagulation abnormalities and to monitor the response to hemostatic therapy. Early goal-directed management of coagulopathy may improve outcome after cardiovascular surgery.

  10. The possible role of hydrogen sulfide as a modulator of hemostatic parameters of plasma.

    Olas, Beata; Kontek, Bogdan


    Hydrogen sulfide (H2S) is a well known toxic gas at high levels. However, at physiological levels, H2S may play a role in the pathogenesis of various cardiovascular diseases. The objective was to study the effects of exogenous H2S on the hemostatic parameters (coagulation and fibrinolytic activity) of human plasma. Human plasma was incubated (5, 15 and 30 min) with NaHS as a H2S donor at the final concentration of 0.01-100 μM. Hemostatic factors, such as maximum velocity of clot formation, fibrin lysis half-time, the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) were estimated. Moreover, the aim of our study was to establish the influence of NaHS (10 μM; 5, 15 and 30 min) on the clot formation using the purified fibrinogen. We demonstrated that coagulation/fibrinolytic properties of human plasma incubated with NaHS were changed. APPT, PT and TT of plasma treated with NaHS at tested concentrations--0.01-100 μM were prolonged. We observed that NaHS (0.01-100 μM) reduced fibrin polymerization in whole plasma and 10 μM NaHS also reduced polymerization of purified fibrinogen. In the presence of NaHS (at the low tested concentration--1 μM) the decrease was about 18% (in plasma, p<0.05). Our experiments also showed that NaHS (0.01-100 μM) stimulated the fibrin lysis in whole plasma. However, the time-dependent (5, 15 and 30 min) reduction of fibrin/fibrinogen polymerization and stimulation of fibrin lysis by NaHS (10 μM) was not observed. In conclusion, the present study demonstrates the anticoagulant properties of exogenous H2S in vitro.

  11. Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2

    Peters Ansgar J


    Full Text Available Abstract Objective The influence hemostatitc parameters on the morphological extent and severity of coronary artery disease were studied in patients with and without DM type 2. Background It is known that patients with diabetes (DM have abnormal metabolic and hemostatic parameters Methods Of 150 consecutive patients with angiographically proven coronary artery disease 29 presented with DM. Additionally to parameters of lipid-metabolism fibrinogen, tissue-plasminogenactivator (t-PA, plasminogen-activator-inhibitor (PAI, plasmin-a-antiplasmin (PAP, prothrombin-fragment 1+2 (F1+2, thrombin-antithrombin (TAT, von-willebrand-factor (vWF, platelet factor 4 (PF4, glykomembranproteine 140 (GMP140 and the rheologic parameters plasma viscosity and red blood cell aggregation were evaluated. The extent and severity of CAD was evaluated according to the criteria of the American Heart Association. Results Patients with DM presented with a higher number of conventional risk factors as compared to non-diabetic patients. Additionally there were significant differences for F1+2, red blood cell aggregation and PAI. Diabetic patients showed a more severe extent of coronary arteriosclerosis, which also could be found more distally. A significant relationship between blood-glucose, thrombocyte-activation (vWF, endogenous fibrinolysis (PAI and the severity of CAD and a more distal location of stenoses could be found (r = 0.6, p Conclusion Patients with coronary artery disease and DM type 2 showed marked alterations of metabolic, hemostatic, fibrinolytic and rheologic parameters, which can produce a prothrombogenic state. A direct association of thrombogenic factors on coronary morphology could be shown. This can be the pathophysiologic mechanism of more severe and distal pronounced coronary atherosclerosis in these patients.

  12. Nile tilapia skin collagen sponge modified with chemical cross-linkers as a biomedical hemostatic material.

    Sun, Leilei; Li, Bafang; Jiang, Dandan; Hou, Hu


    Nile tilapia skin collagen sponges were fabricated by freeze-drying technology and modified with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide in the presence of N-hydroxysuccinimide (EDC/NHS), genipin+PBS, genipin+ethanol, tea polyphenol (TP), nordihydroguaiaretic acid (NDGA) and diphenyl phosphoryl azide (DPPA). Physicochemical and biological properties, micromorphology and compatibility before and after modification were investigated to evaluate collagen sponge as a hemostatic biomedical material. The mechanical property of collagen sponges strengthened after cross-linking. The elongation at break of cross-linked collagen sponges decreased except for EDC/NHS, which was close to that of non-crosslinked. The collagen sponge cross-linked with EDC/NHS exhibited the highest hygroscopicity in comparison with other cross-linkers. The resistance to collagenase biodegradation of collagen sponges after cross-linking strengthened significantly except for NDGA. Collagen sponges cross-linked with EDC/NHS, TP and NDGA maintained high porosity (97-98%), similar to non-crosslinked (98.42%). Collagen sponges could shorten the blood coagulation time. From the variations of the FTIR spectrum pattern and SEM, DPPA could change the secondary structure of collagen and destroy the spongy structure of collagen sponge, which was not suitable for the cross-linking of collagen sponge. Whereas, EDC/NHS was recognized as a perfect cross-linker owing to its excellent properties and porous microstructure. All fabricated collagen sponges were recognized to be biocompatible by the hemolysis assay in vitro. Therefore, collagen sponge modified with EDC/NHS could be used as a perfect biomedical hemostatic material. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Radiological Assistance Program (RAP) Regions

    Department of Homeland Security — The U.S. Department of Energy (DOE) created the Radiological Assistance Program (RAP) in the 1950s to make DOE resources and expertise available to organizations...

  14. National Radiological Fixed Lab Data

    U.S. Environmental Protection Agency — The National Radiological Fixed Laboratory Data Asset includes data produced in support of various clients such as other EPA offices, EPA Regional programs, DOE,...

  15. Development of Mobile Radiological Monitor


    <正>Mobile radiological monitor is used to detect gamma rays and neutron for personal and vehicle. It can be installed on a microbus as a mobile monitoring system. One large plastic scintillation detector is

  16. The Radiological Research Accelerator Facility

    Hall, E.J.


    The Radiological Research Accelerator Facility (RARAF) is based on a 4-MV Van de Graaff accelerator, which is used to generate a variety of well-characterized radiation beams for research in radiobiology, radiological physics, and radiation chemistry. It is part of the Center for Radiological Research (CRR) -- formerly the Radiological Research Laboratory (RRL) -- of Columbia University, and its operation is supported as a National Facility by the US Department of Energy (DOE). As such, RARAF is available to all potential users on an equal basis, and scientists outside the CRR are encouraged to submit proposals for experiments at RARAF. The operation of the Van de Graaff is supported by the DOE, but the research projects themselves must be supported separately. Experiments performed from May 1991--April 1992 are described.

  17. The Radiological Research Accelerator Facility

    Hall, E.J.; Marino, S.A.


    The Radiological Research Accelerator Facility (RARAF) is based on a 4-MV Van de Graaff accelerator, which is used to generate a variety of well-characterized radiation beams for research in radiobiology, radiological physics, and radiation chemistry. It is part of the Center for Radiological Research (CRR) - formerly the Radiological Research Laboratory of Columbia University, and its operation is supported as a National Facility by the US Department of Energy (DOE). As such, RARAF is available to all potential users on an equal basis and scientists outside the CRR are encouraged to submit proposals for experiments at RARAF. The operation of the Van de Graaff is supported by the DOE, but the research projects themselves must be supported separately. This report provides a listing and brief description of experiments performed at RARAF during the May 1, 1992 through April 30, 1993.

  18. Peer review in cardiothoracic radiology.

    Kanne, Jeffrey P


    A variety of peer review methods can be used as part of quality assurance and quality improvement in cardiothoracic radiology. Traditionally, peer review in radiology is a retrospective process relying primarily on review of previously interpreted studies at the time of follow-up or additional imaging. However, peer review can be enhanced with other methods such as double reads, focused practice review, practice audit, and correlation with operative and pathologic findings. Furthermore, feedback from referring physicians can be extremely useful in improving the quality of a radiology practice. This article discusses peer review in radiology with a focus on cardiothoracic imaging. Types of peer review, advantages and shortcomings, and future challenges are addressed.

  19. Analysis of Radiological Case Presentations and their Impact on Therapy and Treatment Concepts in Internal Medicine.

    Dendl, Lena-Marie; Teufel, Andreas; Schleder, Stephan; Rennert, Janine; Stroszczynski, Christian; Mueller-Schilling, Martina; Schreyer, Andreas G


    Purpose Evaluation of clinical impact regarding diagnostic and therapeutic changes influenced by interdisciplinary radiological case presentations. Materials and Methods Prospective evaluation of radiological-gastrointestinal clinical case conferences over a 1-year period at a tertiary care center. We documented the preparation (phase 1) and clinical case conference (phase 2) regarding their impact on the radiology report and further diagnostic work-up and therapy. Results 1067 examinations were evaluated in 69 clinical case conferences including 487 cases. We calculated a mean time of 35.8 minutes per conference with 5.1 minutes per case for preparation. During phase 1, major changes compared to the previous report were found in 1.2 % of cases, and no change was found in 91.4 % of cases. In phase 2 an additional relevant finding was found in 0.6 % of cases, while there was no major change to the reports in 99 % of cases. We recommended further radiological diagnostic workup in 9 % of cases and interventional radiological examination in 2.7 % of cases, while no change was documented in 83.2 %. Further radiological or surgical therapy was recommended in 7 % and 6.8 % of cases, respectively. There was no change in therapy in 78.5 % of cases. Conclusion The analysis of an interdisciplinary radiological case presentation in internal medicine shows that the case discussion with the radiologist results in a change in patient management in 37.3 % of cases (16.8 % diagnosis, 21.5 % therapy). Overall, interdisciplinary radiological clinical case conferences help to improve the management and quality of patient care. Our data support the broad implementation of radiological clinical case conferences. Key Points · The second opinion obtained during the preparation of a radiological case presentation does not change the written report in most cases.. · "Talking radiology" in radiological case presentations results in a significant change in

  20. 21 CFR 892.1980 - Radiologic table.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiologic table. 892.1980 Section 892.1980 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1980 Radiologic table. (a) Identification. A radiologic...

  1. Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery).

    Magnone, Stefano; Coccolini, Federico; Manfredi, Roberto; Piazzalunga, Dario; Agazzi, Roberto; Arici, Claudio; Barozzi, Marco; Bellanova, Giovanni; Belluati, Alberto; Berlot, Giorgio; Biffl, Walter; Camagni, Stefania; Campanati, Luca; Castelli, Claudio Carlo; Catena, Fausto; Chiara, Osvaldo; Colaianni, Nicola; De Masi, Salvatore; Di Saverio, Salomone; Dodi, Giuseppe; Fabbri, Andrea; Faustinelli, Giovanni; Gambale, Giorgio; Capponi, Michela Giulii; Lotti, Marco; Marchesi, Gianmariano; Massè, Alessandro; Mastropietro, Tiziana; Nardi, Giuseppe; Niola, Raffaella; Nita, Gabriela Elisa; Pisano, Michele; Poiasina, Elia; Poletti, Eugenio; Rampoldi, Antonio; Ribaldi, Sergio; Rispoli, Gennaro; Rizzi, Luigi; Sonzogni, Valter; Tugnoli, Gregorio; Ansaloni, Luca


    Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients

  2. Financial accounting for radiology executives.

    Seidmann, Abraham; Mehta, Tushar


    The authors review the role of financial accounting information from the perspective of a radiology executive. They begin by introducing the role of pro forma statements. They discuss the fundamental concepts of accounting, including the matching principle and accrual accounting. The authors then explore the use of financial accounting information in making investment decisions in diagnostic medical imaging. The paper focuses on critically evaluating the benefits and limitations of financial accounting for decision making in a radiology practice.

  3. Radiological training for tritium facilities



    This program management guide describes a recommended implementation standard for core training as outlined in the DOE Radiological Control Manual (RCM). The standard is to assist those individuals, both within DOE and Managing and Operating contractors, identified as having responsibility for implementing the core training recommended by the RCM. This training may also be given to radiological workers using tritium to assist in meeting their job specific training requirements of 10 CFR 835.

  4. FDH radiological design review guidelines

    Millsap, W.J.


    These guidelines discuss in more detail the radiological design review process used by the Project Hanford Management Contractors as described in HNF-PRO-1622, Radiological Design Review Process. They are intended to supplement the procedure by providing background information on the design review process and providing a ready source of information to design reviewers. The guidelines are not intended to contain all the information in the procedure, but at points, in order to maintain continuity, they contain some of the same information.

  5. Preparation of porous carboxymethyl chitosan grafted poly (acrylic acid) superabsorbent by solvent precipitation and its application as a hemostatic wound dressing.

    Chen, Yu; Zhang, Yong; Wang, Fengju; Meng, Weiwei; Yang, Xinlin; Li, Peng; Jiang, Jianxin; Tan, Huimin; Zheng, Yongfa


    The volume phase transition of a hydrogel initiated by shrinking may result in complex patterns on its surface. Based on this unique property of hydrogel, we have developed a novel solvent precipitation method to prepare a kind of novel superabsorbent polymers with excellent hemostatic properties. A porous carboxymethyl chitosan grafted poly (acrylic acid) (CMCTS-g-PAA) superabsorbent polymer was prepared by precipitating CMCTS-g-PAA hydrogel with ethanol. Its potential application in hemostatic wound dressing was investigated. The results indicate that the modified superabsorbent polymer is non-cytotoxic. It showed a high swelling capacity and better hemostatic performance in the treatments of hemorrhage model of ear artery, arteria cruralis and spleen of the New Zealand white rabbit than the unmodified polymer and other commonly used clinic wound dressings. The hemostatic mechanism of the porous CMCTS-g-PAA polymer was also discussed.

  6. Radiological Control Manual. Revision 0, January 1993


    This manual has been prepared by Lawrence Berkeley Laboratory to provide guidance for site-specific additions, supplements, and clarifications to the DOE Radiological Control Manual. The guidance provided in this manual is based on the requirements given in Title 10 Code of Federal Regulations Part 835, Radiation Protection for Occupational Workers, DOE Order 5480.11, Radiation Protection for Occupational Workers, and the DOE Radiological Control Manual. The topics covered are (1) excellence in radiological control, (2) radiological standards, (3) conduct of radiological work, (4) radioactive materials, (5) radiological health support operations, (6) training and qualification, and (7) radiological records.

  7. Radiological protection in pediatric radiodiagnostic; Proteccion Radiologica en Radiodiagnostico Pediatrico

    Espana Lopez, M. L.; Gomez Mardones, G.; Garcia Gastonon; Bermudez Luna, R.; Garcia Esparza, E.; Solis Muniz, I.


    Diagnostic x-ray examinations remains the most frequent use of ionizing radiation in medicine, and represent the most significant source of medical exposure. Justification and optimization process are worthy of special considerations for the pediatric patient, in view of their longer life expectancy and the increased risk for stochastic effects. the aim of the present study is to review the state of the art of the radiation protection in pediatric radiology. Proper equipment, periodic quality control, pediatric protocols, experienced operator, experienced operator, dosimetric estimations, superficial shielding and evaluation of image quality are required to achieve patient doses. As low As Reasonably Achievable in pediatric radiology. Technical advances haves increased the number of possibilities to reduce patient doses, but their optimal use implies a deep knowledge of the different technology. Practical dosimetry, dose indicators and dose reference levels are essential elements of patient protection, and must be reviewed for the pediatric patient, especially in higher radiation doses procedures, such CT and interventional examinations. Although the most effective way to reduce the radiation dose is to eliminate the unnecessary referrals, Radiology Department and Medical Physics and Radiological Protection Department, must be involved in the optimizations procedures in order to achieve ALARA patients dose in pediatric radiology reflects the reality in our country. (Author) 37 refs.

  8. Radiologic analysis of amebiasis

    Kim, S. Y.; Lee, Y. H.; Park, C. Y. [Yonsei University College of Medicine, Seoul (Korea, Republic of)


    The amebiasis is a common diseases in Korea as well as worldwide especially frequent in tropical area such as India, Africa and South America. The diagnosis of amebiasis remain difficult and complex, despite of many diagnostic method, for example, direct stool test for ameba, many immunologic studies and biopsy. Authors analyzed radiologically the patient who have had confirmed as a amebiasis from June, 1976 to September, 1979 at Yonsei University, College of Medicine, Severance Hospital. The results as follows: 1. The amebic liver abscess was a most common from of the amebiasis in Korea, which were 40 cases among 56 cases. Plain abdomen showed huge hepatomegaly, compression and displacement in hepatic flexure of colon, and reflex gas distension in almost cases. Chest P-A showed nonspecific right lower lung findings from secondary to right upper abdominal pathology, such as elevated right diaphragm (61.3%), pleural effusion (60.0%), right lower lung consolidation (37.5%) and abscess cavities (5.0%). Liver scan showed large space occupying lesion, most commonly situated in right lobe of liver (68.6%). 2. Among total 15 cases of the amebic colitis, positive findings on barium enema were 80%. Barium enama showed spas and irritability (89.2%), narrowing of lumen and lack of distensibility (71.4%) and deformity of cecum (20.0%). Involved site was cecum, ascending colon, rectosigmoid, transeverse and descending colon in order of frequency. Unusual involvement of terminal ileum was 2 cases. 3. Combined cases of amebic liver abscess and colitis were 4 cases (27.7%)

  9. DOE standard: Radiological control


    The Department of Energy (DOE) has developed this Standard to assist line managers in meeting their responsibilities for implementing occupational radiological control programs. DOE has established regulatory requirements for occupational radiation protection in Title 10 of the Code of Federal Regulations, Part 835 (10 CFR 835), ``Occupational Radiation Protection``. Failure to comply with these requirements may lead to appropriate enforcement actions as authorized under the Price Anderson Act Amendments (PAAA). While this Standard does not establish requirements, it does restate, paraphrase, or cite many (but not all) of the requirements of 10 CFR 835 and related documents (e.g., occupational safety and health, hazardous materials transportation, and environmental protection standards). Because of the wide range of activities undertaken by DOE and the varying requirements affecting these activities, DOE does not believe that it would be practical or useful to identify and reproduce the entire range of health and safety requirements in this Standard and therefore has not done so. In all cases, DOE cautions the user to review any underlying regulatory and contractual requirements and the primary guidance documents in their original context to ensure that the site program is adequate to ensure continuing compliance with the applicable requirements. To assist its operating entities in achieving and maintaining compliance with the requirements of 10 CFR 835, DOE has established its primary regulatory guidance in the DOE G 441.1 series of Guides. This Standard supplements the DOE G 441.1 series of Guides and serves as a secondary source of guidance for achieving compliance with 10 CFR 835.

  10. The HPCSA and radiology

    JP van Niekerk


    Full Text Available There is general agreement that adequate radiation control is essential. But in my opinion there are more important issues that were not in the remit of the committee, namely the proliferation of many diagnostic and therapeutic interventions that are reliant on expensive equipment. Such equipment is often acquired because of its potential revenue generation and that often results in self-referral – a sure way of driving up medical costs through unnecessary procedures.

  11. Pilot Study of a Patient-Centered Radiology Process Model.

    Swan, J Shannon; Furtado, Vanessa F; Keller, Lisa A; Lotti, Judith Borsody; Saltalamacchia, Catherine A; Lennes, Inga T; Salazar, Gloria M


    The Radiology Process Model (RPM) was previously described in terms of its conceptual basis and proposed survey items. The current study describes the first pilot application of the RPM in the field and the results of initial psychometric analysis. We used an Institutional Review Board-approved pilot RPM survey in 100 patients having outpatient interventional radiology procedures. The 24 survey items had 4 or 5 levels of severity. We assessed for missing data, items that patients found confusing, any suggestions by patients for additional items and clarity of items from patient feedback. Factor analysis was performed and internal consistency measured. Construct validity was assessed by correlation of patient responses to the items as a summated scale with a visual analog scale (VAS) they completed indicating their interventional radiology experience. The visual analog scale and the RPM summated scale were strongly correlated (r = 0.7). Factor analysis showed four factors: interactions with facility and doctors/staff, time-sensitive aspects, pain, and anxiety. The items showed high internal consistency (alpha: 0.86) as a group and approximately 0.7 to 0.9 by the factors. Analysis shows that two items could be deleted (cost and communication between radiologist and referrers). Revision of two items and potential addition of others are discussed. The RPM shows initial evidence of psychometric validity and internal consistency reliability. Minor changes are anticipated before wider use. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. CARS 2008: Computer Assisted Radiology and Surgery. Proceedings



    The proceedings contain contributions to the following topics: digital imaging, computed tomography, magnetic resonance, cardiac and vascular imaging, computer assisted radiation therapy, image processing and display, minimal invasive spinal surgery, computer assisted treatment of the prostate, the interventional radiology suite of the future, interventional oncology, computer assisted neurosurgery, computer assisted head and neck and ENT surgery, cardiovascular surgery, computer assisted orthopedic surgery, image processing and visualization, surgical robotics, instrumentation and navigation, surgical modelling, simulation and education, endoscopy and related techniques, workflow and new concepts in surgery, research training group 1126: intelligent surgery, digital operating room, image distribution and integration strategies, regional PACS and telemedicine, PACS - beyond radiology and E-learning, workflow and standardization, breast CAD, thoracic CAD, abdominal CAD, brain CAD, orthodontics, dentofacial orthopedics and airways, imaging and treating temporomandibular joint conditions, maxillofacial cone beam CT, craniomaxillofacial image fusion and CBCT incidental findings, image guided craniomaxillofacial procedures, imaging as a biomarker for therapy response, computer aided diagnosis. The Poster sessions cover the topics computer aided surgery, Euro PACS meeting, computer assisted radiology, computer aided diagnosis and computer assisted radiology and surgery.

  13. Effect of aluminum chloride hemostatic agent on microleakage of class V composite resin restorations bonded with all-in-one adhesive

    Mohammadi, Narmin; Bahari, Mahmood; Pournaghi-Azar, Fatemeh; Mozafari, Aysan


    Objectives: Since hemostatic agents can induce changes on enamel and dentin surfaces and influence composite resin adhesion, the aim of the present study was to evaluate the effect of the aluminum chloride hemostatic agent on the gingival margin microleakage of class V (Cl V) composite resin restorations bonded with all-in-one adhesive. Study design: Cl V cavities were prepared on the buccal surfaces of 60 sound bovine permanent incisors. Gingival margins of the cavities were placed 1.5 mm apical to the cemento-enamel junction (CEJ). The teeth were randomly divided into two groups of 30. In group 1, the cavities were restored without the application of a hemostatic agent; in group 2, the cavities were restored after the application of the hemostatic agent. In both groups all-in-one adhesive and Z250 composite resin were used to restore the cavities with the incremental technique. After finishing and polishing, the samples underwent a thermocycling procedure, followed by immersion in 2% basic fuschin solution for 24 hours. The samples were sectioned and gingival microleakage was evaluated under a stereomicroscope. The non-parametric Mann-Whitney U test was used to compare microleakage between the two groups. Statistical significance was defined at Padhesive with aluminum chloride hemostatic agent significantly increases restoration gingival margin microleakage. Key words:All-in-one adhesive resin, composite resin restoration, hemostatic agent, microleakage. PMID:22322497

  14. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    Park, Sung Il; Kim, Dong Ik; Jun, Pyoung; Yoon, Pyeong Ho; Hwang, Geum Ju; Cheon, Young Jik; Lim, Joon Seok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)


    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20.

  15. Radiological impacts of phosphogypsum.

    Al Attar, Lina; Al-Oudat, Mohammad; Kanakri, Salwa; Budeir, Youssef; Khalily, Hussam; Al Hamwi, Ahmad


    This study was carried out to assess the radiological impact of Syrian phosphogypsum (PG) piles in the compartments of the surrounding ecosystem. Estimating the distribution of naturally occurring radionuclides (i.e. (226)Ra, (238)U, (232)Th, (210)Po and (210)Pb) in the raw materials, product and by-product of the Syrian phosphate fertilizer industry was essential. The data revealed that the concentrations of the radionuclides were enhanced in the treated phosphate ore. In PG, (226)Ra content had a mean activity of 318 Bq kg(-1). The uranium content in PG was low, ca. 33 Bq kg(-1), because uranium remained in the phosphoric acid produced. Over 80% of (232)Th, (210)Po and (210)Pb present partitioned in PG. The presence of PG piles did not increase significantly the concentration of (222)Rn or gamma rays exposure dose in the area studied. The annual effective dose was only 0.082 mSv y(-1). The geometric mean of total suspended air particulates (TSP) ca. 85 μg m(-3). The activity concentration of the radionuclides in filtrates and runoff waters were below the detection limits (ca. 0.15 mBq L(-1) for (238)U, 0.1 mBq L(-1) for (232)Th and 0.18 mBq L(-1) for both of (210)Po and (210)Pb); the concentration of the radionuclides in ground water samples and Qattina Lake were less than the permissible limits set for drinking water by the World Health Organisation, WHO, (10, 1 and 0.1 Bq L(-1) for (238)U, (232)Th and both of (210)Po and (210)Pb, respectively). Eastern sites soil samples of PG piles recorded the highest activity concentrations, i.e. 26, 33, 28, 61 and 40 Bq kg(-1) for (226)Ra, (238)U, (232)Th, (210)Po and (210)Pb, respectively, due to the prevailing western and north-western wind in the area, but remained within the natural levels reported in Syrian soil (13-32 Bq kg(-1) for (226)Ra, 24.9-62.2 Bq kg(-1) for (238)U and 10-32 Bq kg(-1) for (232)Th). The impact of PG piles on plants varied upon the plant species. Higher concentrations of the radionuclides were

  16. A novel hemostatic sealant composed of gelatin,transglutaminase and thrombin effectively controls liver trauma-induced bleeding in dogs

    Xia XIE; Jiang-ke TIAN; Fa-qin LV; Rong WU; Wen-bo TANG; Yu-kun LUO; Ya-qin HUANG


    Aim:A novel hemostatic sealant based on the in situ gel formation of gelatin catalyzed by thrombin and crosslinked by transglutaminase was designed.The aim of this study was to investigate the efficacy of the hemostatic sealant in control of bleeding caused by liver trauma in dogs.Methods:Hepatic trauma that mimicked the grade Ⅲ-Ⅳ rupture of liver was made in 20 dogs.The traumatic lesion was topically administered the hemostatic sealant (treatment group,n=10),or a thrombin solution (control group,n=10).The time to achieve hemostasis and the blood loss were measured.Contrast-enhanced ultrasound (CEUS) examination was performed in each animal on d 3,d 7,and d 10 d postoperatively to study the healing of the lesions.Results:The mean time to achieve hemostasis in the treatment group was significantly shorter than that in the control group (1.20±0.33 vs 6.70±0.64 min,P<0.05).The mean blood loss in the treatment group was significantly less than that in the control group (47.22±8.61 vs 79.29±11.97 mL,P<0.05).In CEUS examination,the traumatic lesions in the treatment group became significantly smaller on d 3,and disappeared on d 7,whereas the lesions in the control group still existed on d 10.Ascites were never found during 10 d follow-up in the treatment group but were observed on d 3 and d 7 in the control group.Conclusion:Compared with thrombin,the novel hemostatic sealant shows much better efficacy in hemostasis and may promote wound healing in dog liver trauma.

  17. Radiological findings in NAO syndrome

    Al-Otaibi, Leftan; Hugosson, Claes O. [Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh (Saudi Arabia); Al-Mayouf, Sulalman M.; Majeed, Mahmoud; Al-Eid, Wea' am; Bahabri, Sultan [Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Riyadh (Saudi Arabia)


    Background: Diseases exhibiting osteolysis in children are rare hereditary conditions. Several types have been recognised with different clinical manifestations. One type includes subcutaneous nodules, arthropathy and osteolysis and has been termed NAO syndrome. Previous radiological reports have described the affected bones, usually the carpal and tarsal regions, but a detailed analysis of the radiological findings of both the axial as well as the appendicular skeleton has not been reported. Objectives: To describe the radiological findings in a large group of children with an autosomal recessive disease characterized by nodules, familial arthropathy and osteolysis. Materials and methods: The study comprises 14 patients from 9 families and all patients had the triad of nodulosis, arthropathy and osteolysis (NAO). Results: The most common radiological manifestations were osteopenia, undertubulation of long bones, arthritic changes, sclerotic sutures of the calvaria, osteolysis and muscle contractures. Other common findings were squared vertebrae, broad medial clavicles and brachycephaly. Progress of disease was documented in more than half of the patients. Conclusions: Our study is the first report of the detailed radiological findings of NAO syndrome. In NAO syndrome, both the axial and appendicular skeleton are involved (orig.)

  18. Head-neck-radiology; Kopf-Hals-Radiologie

    Cohnen, Mathias (ed.) [Staedtische Kliniken Neuss Lukaskrankenhaus GmbH (Germany). Institut fuer klinische Radiologie


    The book on head-neck-radiology covers the following issues: (1) Methodic fundamentals: conventional radiography, angiography, sonography, computerized tomography, digital volume tomography, NMR imaging, nuclear medicine. (2) Base of the skull. (3) Petrous bone. (4) Pharynx. (5) Paranasal sinuses. (6) Eye socket. (7) Temporomandibular joint. (8) Salivary gland. (9) Oral cavity. (19) Parynx. (11) Neck soft tissue and lymph nodes. (12) Thyroid and parathyroid. (13) Teeth and jaw. (14) Interventions.

  19. The use of sedation in the radiology department

    Patatas, K. [Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds (United Kingdom); St James University Hospital, Leeds (United Kingdom)], E-mail:; Koukkoulli, A. [St James University Hospital, Leeds (United Kingdom)


    The use of intravenous sedation and analgesia in patients undergoing interventional diagnostic and therapeutic procedures is increasing. Sedation by non-anaesthetists is considered to be safe, provided that they have received adequate training and have the necessary equipment, facilities, and personnel. This article aims to increase awareness of the safe use of sedative drugs in radiology and provide a practical guideline for minimal and moderate sedation.

  20. Rapid hemostasis at the femoral venous access site using a novel hemostatic pad containing kaolin after atrial fibrillation ablation.

    Sairaku, Akinori; Nakano, Yukiko; Oda, Noboru; Makita, Yuko; Kajihara, Kenta; Tokuyama, Takehito; Kihara, Yasuki


    Hemostasis at the femoral venous access site after atrial fibrillation (AF) ablation is often prolonged because of aggressive anticoagulation and the use of several large-sized sheaths. A newly developed hemostatic pad containing a natural mineral called kaolin causes blood to clot quickly. We evaluated the efficacy of this pad for hemostasis at the venous access site after AF ablation. Patients who were scheduled to undergo AF ablation were randomized to be treated with manual compression with (n = 59) or without kaolin-impregnated pads (n = 59) as hemostatic approaches at the femoral venous access site following sheath removal. Hemostasis time, rebleeding frequency, massive hematoma, device-related complications, and deep venous thrombosis (DVT) were compared between the two groups. Hemostasis time in the patients treated with kaolin-impregnated pads was significantly shorter than in those treated without (6.1 ± 2.3 vs. 14.5 ± 4.0 min; p kaolin-impregnated pads was the only independent variable reducing hemostasis time (β = -0.78; p kaolin-impregnated pads; p = 0.35). Only one patient had a massive groin hematoma, and no patient had device-related complications or DVT. Kaolin-impregnated hemostatic pads safely and effectively decreased hemostasis time for the femoral venous access site in patients undergoing AF ablation. However, whether its use allows earlier postprocedural ambulation is difficult to predict.

  1. Kidney function and multiple hemostatic markers: cross sectional associations in the multi-ethnic study of atherosclerosis

    Peralta Carmen A


    Full Text Available Abstract Background Defined as estimated glomerular filtration rate (eGFR Methods We tested cross-sectional associations between (eGFR and multiple hemostatic markers among 6751 participants representing a broad spectrum of kidney function in the Multi-Ethnic Study of Atherosclerosis (MESA. Kidney function was measured using cystatin C (eGFRcys or creatinine, using CKD Epidemiology Collaboration (eGFRcr. Hemostatic markers included soluble thrombomodulin (sTM, soluble tissue factor (sTF, D-Dimer, von Willebrand factor (vWF, factor VIII, plasmin-antiplasmin complex (PAP, tissue factor pathway inhibitor (TFPI, plasminogen activator inhibitor-1 (PAI-1, and fibrinogen. Associations were tested using multivariable linear regression with adjustment for demographics and comorbidities. Results In comparison to persons with eGFRcys >90 ml/min/1.73 m2, subjects with eGFRcys 2 had adjusted levels of sTM, sTF, D-Dimer, PAP, Factor VIII, TFPI, vWF and fibrinogen that were respectively 86%, 68%, 44%, 22%, 17%, 15%, 12% and 6% higher. Subjects with eGFRcys 60-90 ml/min/1.73 m2 had adjusted levels that were respectively 16%, 14%, 12%, 6%, 6%, 6%, 11% and 4% higher (p Conclusions Throughout a broad spectrum of kidney function, lower eGFR was associated with higher levels of hemostatic markers. Dysregulation of hemostasis may be a mechanism by which reduced kidney function promotes higher cardiovascular risk.

  2. Use of the novel hemostatic textile Stasilon® to arrest refractory retroperitoneal hemorrhage: a case report

    Jones Samuel W


    Full Text Available Abstract Introduction Stasilon® is a novel hemostatic woven textile composed of allergen-free fibers of continuous filament fiberglass and bamboo yarn. The development of this product resulted from controlled in vitro thrombogenic analysis of an array of potentially hemostatic textile materials and it has been cleared for both external and internal use by the United States Food and Drug Administration for the arrest of hemorrhage. The goal of the study was to assess the hemostatic and adhesive properties of Stasilon® in the setting of life-threatening refractory hemorrhage. Case presentation A 39-year-old Caucasian man presented with severe necrotic pancreatitis that failed multiple aggressive attempts to control associated bleeding with electrocautery, suture ligation, and sequential anatomic packing with cotton-based sponges. Subsequent retroperitoneal packing with Stasilon® produced a non-adherent wound-dressing interface and resulted in the achievement of persistent hemostasis in the operative field. Conclusion In our patient, Stasilon® was demonstrated to be effective in the arrest of refractory hemorrhage.

  3. Preparation and evaluation of chitosan/ellagic acid/erythrocyte membrane lipid hemostatic composite sponge

    贺庆; 敖强; 王臻; 刘伟强; 龚锴; 公衍道; 张秀芳


    BACKGROUND: Some previous studies have indicated that the hemostatic effect of chitosan is limited when dealing with severe injuries. Therefore, the procoagulant activity of chitosan-based hemostatic agents needs to be enhanced. OBJECTIVE: To prepare a novel chitosan/el agic acid/erythrocyte membrane lipid composite sponge and to evaluate its procoagulant activity and cytotoxicity.METHODS: Chitosan sponge and chitosan acetate sponge were prepared by freeze-drying method. Then chitosan/el agic acid/erythrocyte membrane lipid composite sponge was prepared by electrostatic adsorption method. Procoagulant activity of the chitosan, chitosan acetate, and chitosan/el agic acid/erythrocyte membrane lipid sponges was evaluated by the plasma recalcification time method. Hemostatic effect of these sponges was evaluated in the Sprague Dawley rat liver bleeding model, and the cytotoxicity to L929 cel line was evaluated. RESULTS AND CONCLUSION: The plasma recalcification time, bleeding time and blood loss of the chitosan/el agic acid/erythrocyte membrane lipid composite sponge group were significantly lower than those of the chitosan sponge and chitosan acetate sponge groups (P < 0.01). Cel culture experiment showed that the chitosan/el agic acid/erythrocyte membrane lipid composite sponge did not have cytotoxicity. The results indicate that the chitosan/el agic acid/erythrocyte membrane lipid composite sponge has the enhanced procoagulant activity and non-cytotoxicity.%  背景:部分文献报道壳聚糖对严重创伤的止血效果有限,因此以壳聚糖为基础止血剂的促凝血活性还有待进一步增强。目的:制备一种新型的壳聚糖/鞣花酸/红细胞膜脂复合海绵,评价其促凝血活性和细胞毒性。方法:通过冻干法制备壳聚糖海绵和壳聚糖乙酸盐海绵,然后再通过静电吸附法制备壳聚糖/鞣花酸/红细胞膜脂复合海绵。血浆复钙时间法观察3种海绵的促凝血活性,并检测3

  4. Radiological control manual. Revision 1

    Kloepping, R.


    This Lawrence Berkeley National Laboratory Radiological Control Manual (LBNL RCM) has been prepared to provide guidance for site-specific additions, supplements and interpretation of the DOE Radiological Control Manual. The guidance provided in this manual is one methodology to implement the requirements given in Title 10 Code of Federal Regulations Part 835 (10 CFR 835) and the DOE Radiological Control Manual. Information given in this manual is also intended to provide demonstration of compliance to specific requirements in 10 CFR 835. The LBNL RCM (Publication 3113) and LBNL Health and Safety Manual Publication-3000 form the technical basis for the LBNL RPP and will be revised as necessary to ensure that current requirements from Rules and Orders are represented. The LBNL RCM will form the standard for excellence in the implementation of the LBNL RPP.

  5. Implications Of Computer Assisted Radiology

    Lemke, Heinz U.


    Within the field of radiology, assistance with computer and communication systems may be applied to generation, storing, transmission, viewing, analyzing and interpreting of images. As a result, digital image management and communication systems will be applied at various levels in the health care system. Four groups of people are somehow involved or affected by this process. These are, first of all, the patients and the medical personnel, but also the scientific-engineering community and the group of professions involved with financing and/or administering these systems. Each group approaches computer assisted radiology from a particular point of view. The paper outlines some aspects as regards the different perceptions of these groups, which need to be clarified in order to successfully realise computer assisted radiology.

  6. Radiology information management system, TOSRIM

    Tani, Yuichiro; Uchiyama, Akira; Kimura, Hirohito (Toshiba Corp., Kawasaki, Kanagawa (Japan))


    This is a report on a new type of distributed computer system for radiology departments named 'TOSRIM' (Toshiba radiology information management system), which is designed to be installed between medical diagnosis equipment and a host computer system in a hospital. Recently, a new type of host computer system has been developed which enables doctors to order any of the hospital's entire activities using terminals. By connecting 'TOSRIM' to this type of host computer system, many of the activities of a radiology department can be carried out via terminals without the use of examination requirement forms. As well as being connected to medical diagnosis equipment, 'TOSRIM' can also be connected to a medical imaging system which stores and displays medical images. By means of these connections, doctors will be able to diagnose medical images using display terminals without the need for films. (author).

  7. Making decisions using radiology in lower GI hemorrhage.

    Zahid, Assad; Young, Christopher John


    Acute lower gastrointestinal bleeding (LGIB) is a common diagnosis in current practice that may warrant hospitalization and invasive management. There is a shift in the paradigm in the management of this condition away from traditional extensive operative intervention to minimally invasive radiological techniques. These newer modalities offer an opportunity to provide more accurate information on location of bleeding and subsequent management. The increased ease of access to interventional radiology units in major teaching hospitals represents an opportunity to adopt its use in the management of gastrointestinal bleeding. Further, with technological improvements, it is becoming an increasingly favoured option. Traditional endoscopic techniques have been fraught with poor vision in the acute setting, requiring the colon to be purged to aide in better visualization. The use of these newer technologies have been the subject of many reviews which highlight their efficacy in providing a road map to the bleeding site and eventual intervention. We aim to review the literature regarding the use of radiology in the management of LGIB, to provide surgeons with a discourse with regards to the approach in synthesizing the data and applying it when deciding its use.

  8. Evaluation of Stress Scores Throughout Radiological Biopsies



    Full Text Available Background Ultrasound-guided biopsy procedures are the most prominent methods that increase the trauma, stress and anxiety experienced by the patients. Objectives Our goal was to examine the level of stress in patients waiting for radiologic biopsy procedures and determine the stress and anxiety level arising from waiting for a biopsy procedure. Patients and Methods This prospective study included 35 female and 65 male patients who were admitted to the interventional radiology department of Kartal Dr. Lütfi Kirdar training and research hospital, Istanbul between the years 2014 and 2015. They filled out the adult resilience scale consisting of 33 items. Patients who were undergoing invasive radiologic interventions were grouped according to their phenotypic characteristics, education level (low, intermediate, and high, and biopsy features (including biopsy localization: neck, thorax, abdomen, and bone; and the number of procedures performed, 1 or more than 1. Before the biopsy, they were also asked to complete the depression-anxiety-stress scale (DASS 42, state-trait anxiety inventory scale (STAI-I, and continuous anxiety scale STAI-II. A total of 80 patients were biopsied (20 thyroid and parathyroid, 20 thorax, 20 liver and kidney, and 20 bone biopsies. The association between education levels (primary- secondary, high school and postgraduate and the number of biopsies (1 and more than 1 with the level of anxiety and stress were evaluated using the above-mentioned scales. Results Evaluation of sociodemographic and statistical characteristics of the patients showed that patients with biopsy in the neck region were moderately and severely depressed and stressed. In addition, the ratio of severe and extremely severe anxiety scores was significantly high. While the STAI-I and II scores were lined up as neck > bone > thorax > abdomen, STAI-I was higher in neck biopsies compared to thorax and abdomen biopsies. Regarding STAI-I and II scales, patients

  9. Managing Generational Differences in Radiology.

    Eastland, Robin; Clark, Kevin R


    Diversity can take many forms. One type of recent focus is generational differences and intergenerational issues. Much research exists regarding generational differences in the workplace and in healthcare as a whole. Very little has been done on generational differences within the field of radiology. An analysis of current research of generational differences within radiology, nursing, and healthcart in general was performed to identify current trends and establish similarities and discordance in available studies. An emphasis was placed on how generational differences influence education, teamwork, and patient care, along with what challenges and opportunities exist for managers, leaders, and organizations.

  10. 介入技术在完全性前置胎盘和胎盘植入中的临床应用价值%Clinical Value of Interventional Radiologic Technique Combined with Cesarean Delivery in Placenta Previa and Placenta Accrete Patients

    谢娅; 张颖; 彭铮


    Objective:To investigate the clinical value of interventional radiologic technique combined with cesarean delivery. Method:40 consecutive patients in our hospital with complete placenta previa or suspected placenta accrete were prospectively assessed from June 2011 to December 2013. 20 cases were treated by traditional cesarean delivery methods, termination of pregnancy as the control group. 20 patients were treated by obstetric joint intervention carried out new DSA in the operating room for abdominal aortic balloon placed+cesarean delivery+the iliac artery and uterine artery embolization, as the DSA group,the different outcomes of the two groups were compared. Result:There were no statistical significance in the neonatal Apgar scores of the two groups(P>0.05);intraoperative and postpartum blood loss,blood transfusion amount in the DSA group were significantly lower than the control group,the differences had statistical significance(P0.05);DSA组术中及产后失血量、输血量均明显低于对照组,差异均有统计学意义(P<0.05);DSA组子宫切除率显著低于对照组,母乳喂养率显著高于对照组,差异均有统计学意义(P<0.05)。结论:剖宫产术中腹主动脉放置球囊联合术后髂内动脉子宫动脉栓塞技术能够显著降低产时产后出血量、输血量、子宫切除率,并提高母乳喂养率。

  11. Radiology in 2030: A Guide for Strategic Planning

    Sh. Akhlaghpoor


    Full Text Available Imaging science and technology are major contributors to the discovery of new knowledge in diagnosis and treatment of disease. Given such rapid past advances, is it not likely the future rate of progress will be at least as great? As part of the strategic plan is to estimate future change, it is necessary to have a vision for what will happen in radiology in next 20 years. There are several questions that we should find answer for them: 1. Which type of information clinicians will request from radiologists? 2. How will imaging devices of the future differ from those of the present? 3. What appearance might medical images of the future have? Only 30 years ago, radiologists depended heavily on plain radiographs, tomography, and catheter angiography.Presently, very high-resolution crosssectional imaging studies, four-dimensional sonography, and functional imaging techniques (such as brain activation studies and perfusion imaging are common place. Physicians in the future will increasingly seek clinical information that is physiological, and not solely anatomical, in nature.Functional and molecular imaging will be the area of great development in future. Broadly, multidisciplinary, molecular imaging incorporates methods and concepts from molecular and cell biology, imaging sciences, chemistry, highthroughput"nbiology (eg, genomics, proteomics, nanotechnology, pharmacology, and bioinformatics. It is through molecular imaging that radiology is expected"nto play a critical role in advancing molecular medicine and potentially revolutionize patient care and biomedical research. Other promising options will be minimally invasive image-guided therapy and interventional radiology The convergence of molecular imaging and interventional radiology benefits both fields. This lecture is an effort to explain a roadmap for future in the field of Radiology.

  12. [Radiological media and modern supporting tools in radiology].

    Sachs, A; Pokieser, P


    Radiology is a field with a high demand on information. Nowadays, a huge variety of electronic media and tools exists in addition to the classical media. Asynchronous and synchronous e-learning are constantly growing and support radiology with case collections, webinars and online textbooks. Various internet resources, social media and online courses have been established. Dynamic websites show a variety of interactive elements and it is easier and faster to access large amounts of data. Social media have an exponentially growing number of users and enable an efficient collaboration as well as forming professional networks. Massive open online courses (MOOCs) complete the offer of education and increase the opportunity to take part in educational activities. Apart from the existing variety of resources it is essential to focus on a critical selection for using these radiological media. It is reasonable to combine classical and electronic media instead of a one-sided use. As dynamic as the progress in the field of radiological media and its tools may be, the personal contact remains and should be maintained.

  13. Radiology in Medical Education: A Pediatric Radiology Elective as a Template for Other Radiology Courses.

    Hilmes, Melissa A; Hyatt, Eddie; Penrod, Cody H; Fleming, Amy E; Singh, Sudha P


    Traditionally, the pediatric radiology elective for medical students and pediatric residents constituted a morning teaching session focused mainly on radiography and fluoroscopy. A more structured elective was desired to broaden the exposure to more imaging modalities, create a more uniform educational experience, and include assessment tools. In 2012, an introductory e-mail and formal syllabus, including required reading assignments, were sent to participants before the start date. A rotating weekly schedule was expanded to include cross-sectional imaging (ultrasound, CT, MR) and nuclear medicine. The schedule could accommodate specific goals of the pediatric resident or medical student, as requested. Starting in 2013, an online pre-test and post-test were developed, as well as an online end-of-rotation survey specific to the pediatric radiology elective. Taking the Image Gently pledge was required. A scavenger hunt tool, cue cards, and electronic modules were added. Pre-test and post-test scores, averaged over 2 years, showed improvement in radiology knowledge, with scores increasing by 27% for medical students and 21% for pediatric residents. Surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments. We have successfully created an elective experience in radiology that dedicates time to education while preserving the workflow of radiologists. We have developed tools to provide a customized experience with many self-directed learning opportunities. Our tools and techniques are easily translatable to a general or adult radiology elective. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Hemostatic assessment of dogs associated with hepatic parasite load of Leishmania infantum chagasi

    Mariana de Medeiros Torres


    Full Text Available Abstract Leishmania infantum chagasi liver parasite load was compared to hemostatic abnormalities, as well as to clinical, laboratorial, and histopathological findings in dogs with visceral leishmaniasis. The liver parasite load of 30 dogs L. infantum chagasi naturally-infected was evaluated by quantitative real- time PCR and the results were compared with serum biochemistry and primary and secondary hemostasis findings. Moreover, hepatic histological lesions were described in these dogs. Prolonged bleeding time, prothrombin time (PT, and activated partial thromboplastin time (APTT, were observed in the group with visceral leishmaniasis. Eleven dogs presented inflammatory liver lesions, with predominance of mild multifocal mononuclear periportal hepatitis. No association between the presence of parasites and abnormalities in screening tests was observed by Spearman’s rank correlation coefficient. The clinical progression in leishmaniasis is associated with the occurrence of hemorrhagic diathesis, which depends not only on the presence of the parasite but also the inflammatory process, compromised immunological response, hepatic and renal failure in symptomatic dogs.

  15. Shortened activated partial thromboplastin time, a hemostatic marker for hypercoagulable state during acute coronary event.

    Abdullah, Wan Zaidah; Moufak, Shaimaa K; Yusof, Zurkurnai; Mohamad, Mohd Sapawi; Kamarul, I M


    Various factors may contribute to a hypercoagulable state and acute vascular thrombosis. A prospective study was conducted involving 165 coronary heart disease (CHD) patients from the Cardiology Unit, Hospital Universiti Sains Malaysia. The purpose of this study was to investigate the relationship among factor VIII (FVIII), prothrombin time (PT), activated partial thromboplastin time (APTT), and activated protein C resistance (APC-R) state among CHD patients and to look for potential clinical applications from these laboratory findings. There were 110 cases diagnosed as acute coronary syndrome (ACS), whereas another 55 were stable coronary artery disease (SCAD) patients. PT, APTT, FVIII, and APC-R assays were performed on all subjects. There was a significant difference between the FVIII level and the APTT results (P value < 0.0001). A negative relationship was found between the FVIII level and the APTT from linear regression analysis (R(2) = 10%, P value < 0.0001). For each 1% increase in the FVIII level, the APTT was reduced by 0.013 s (95% confidence interval (CI) between -0.019 and -0.007). Interestingly, none of the SCAD patients had abnormally short APTT. Approximately 68.4% of cases with a positive APC-R assay were found to have a high FVIII level. In conclusion, the APTT test is a potential hemostatic marker for hypercoagulable state including in arterial thrombosis.

  16. A new candidate as a hemostatic agent for difficult situations during variceal bleeding: Ankaferd blood stopper

    Ersan Ozaslan


    Full Text Available Variceal bleeding is the most challenging emergent situation among the causes of upper gastrointestinal bleeding. Despite substantial improvement, a need remains for therapeutic armamentarium of such cases, which is easy, effective and without side-effect. Ankaferd blood stopper (ABS is a standardized herbal extract acting as a hemostatic agent on the bleeding or injured areas. In this observational study, a total of four patients with variceal bleeding were treated with endoscopic ABS application. The lesions were bleeding gastric varices (n:3 and bleeding duodenal varix (n:1. ABS was selected as a bridge to definitive therapies due to unavailability or inappropriateness of bleeding lesions to conventional measures. ABS was instilled or flushed onto the bleeding areas by sclerotherotherapy needle or heater probe catheter. Periprocedural control of the bleeding was achieved in all instances. Thereafter, on an elective basis, two patients with gastric varices underwent cyanoacrylate injection, while third underwent Transjugular intrahepatic portosystemic shunt and embolization. The patient with duodenal varix refused further therapy, after a few hours after admission and was discharged. He again presented the same day with rebleeding, but died before any attempt could be made to control his bleeding. ABS seems to be effective in cases of variceal bleeding as a bridge to therapy. Its major advantages are the ease of use and lack of side-effects.

  17. Histologic study of use of microfibrillar collagen hemostat in rat dental sockets

    Magro-Érnica Natasha


    Full Text Available The aim of this paper was to evaluate if the placement of microfibrillar collagen hemostat (MCH into a dental socket interfered with healing. General anesthesia was administered to 30 adult male Albinus Wistar rats and the maxillary right central incisor was extracted. In the control group after each tooth was extracted, the socket was sutured. In the MCH group after each tooth was extracted, MCH was placed into the socket before suturing. Postoperatively, 5 animals were sacrificed from each group at 7, 21 and 28 days. The right maxilla was removed from each animal and histologic slides were stained with Masson's trichromic and hematoxylin and eosin. Quantitative and qualitative analyses were done. The percentage of bone area in the dental socket was quantified using the Image Lab 98 image analysis system. The bone area formation for the control and MCH groups was: 8.1% and 3.3% at 7 days, 34.4% and 33% at 21 days and 41% and 41.3% at 28 days, respectively. We concluded that MCH interferes with the beginning of dental socket healing but does not interfere with the final healing of the dental socket.

  18. Qualitative/Chemical Analyses of Ankaferd Hemostat and Its Antioxidant Content in Synthetic Gastric Fluids

    Koluman, Ahmet; Akar, Nejat; Malkan, Umit Y.; Haznedaroglu, Ibrahim C.


    Introduction. Ankaferd hemostat (ABS) is the first topical haemostatic agent involving the red blood cell-fibrinogen interactions. The antihemorrhagic efficacy of ABS has been tested in controlled clinical trials. The drug induces the formation of an encapsulated complex protein web with vital erythroid aggregation. The aim of this study is to detect the essential toxicity profile and the antioxidant molecules inside ABS. Methods. The pesticides were analyzed by GC-MS and LC-MS. The determination by ICP-MS after pressure digestion was performed for the heavy metals. HPLC was used for the detection of mycotoxins. Dioxin Response Chemically Activated Luciferase Gene Expression method was used for the dioxin evaluation. TOF-MS and spectra data were evaluated to detect the antioxidants and other molecules. Results. TOF-MS spectra revealed the presence of several antioxidant molecules (including tocotrienols, vitamin E, tryptophan, estriol, galangin, apigenin, oenin, 3,4-divanillyltetrahydrofuran, TBHQ, thymol, BHA, BHT, lycopene, glycyrrhetinic acid, and tomatine), which may have clinical implications in the pharmacobiological actions of ABS. Conclusion. The safety of ABS regarding the presence of heavy metals, pesticides, mycotoxins, GMO and dioxins, and PCBs was demonstrated. Thus the present toxicological results indicated the safety of ABS. The antioxidant content of ABS should be investigated in future studies. PMID:26925418

  19. Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

    Kohei Kobatake


    Full Text Available Objectives To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy. Subjects and Methods The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants and to the non-insertion group (group B: 130 participants. In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy. Results Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0% vs. 11 (8.5%, P=0.029. The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis. Conclusion Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort.

  20. Effect of Age on the Hemostatic Function in Patients with Degenerative Diseases of the Large Joints

    Igor L. Shlykov, PhD¹, ScD¹


    Full Text Available Background: Aging is associated with an increased hypercoagulable state. Degenerative diseases of the large joints are also accompanied by increased coagulation activity. We investigated the effect of age on the hemostatic function in patients with osteoarthritis. Material and Methods: The study included 192 patients with osteoarthritis admitted to the clinic for primary hip or knee arthroplasty. The patients were categorized into 5 age groups: the age group under 40 years, the 41–to-50 -year age group, the 51–to-60-year age group, the 61-to-70- year age group, and the age group over 70 years. The general blood clotting tests, platelet number, fibrinogen, antithrombin, protein C, TAT, D-dimer, vonWillebrand factor (vWF, PAI-1, ß-thromboglobulin were determined. Results: Among patients with osteoarthritis, the antithrombin III level significantly decreased by the age of 50; however, above the age of 60 there was a distinct decrease in platelet count, and over the age of 70 the activity of the extrinsic coagulation pathway and the plasminogen level dropped significantly. TAT and D-dimer levels were elevated in most of the patients. Conclusion: The decrease in platelet count coupled with the activity of the extrinsic coagulation pathway in elderly osteoarthritic patients may increase blood loss during total arthroplasty; also, the drop in the anticoagulant and fibrinolytic potential may play a negative role in strengthening the prothrombotic state during the postoperative period.