Search

The role of interventional radiology has experienced significant expansion in recent years, as the application of magnetic resonance imaging (MRI) and computed tomography (CT) has offered distinct advantages for the diagnosis and treatment of spinal pathologies. Therefore, we conducted a literature search of various articles in English and Spanish across different databases, national, and international libraries, resulting in several case reports demonstrating the application of interventional radiology in various conditions such as kyphosis, lordosis, scoliosis, fractures, etc., providing rapid symptom relief and reducing different complications. Consequently, interventional radiology has emerged as a critically important tool in the clinical setting., El papel de la radiología intervencionista ha presentado una mayor expansión a lo largo de los últimos años, ya que la aplicación de la resonancia magnética (RM) y la tomografía computarizada (TC) ha ofrecido diferentes ventajas para el diagnóstico y tratamiento de las patologías de la columna vertebral. Por ello, realizamos una búsqueda bibliográfica de diferentes artículos en inglés y español en diferentes bases de datos, bibliotecas nacionales e internacionales dando como resultado diferentes reportes de casos en los que se evidencian la aplicación de la radiología intervencionista en diferentes patologías como cifosis, lordosis, escoliosis, fracturas, etc. brindando un alivio rápido de los sintomas y la reducción de diferentes complicaciones. Por lo tanto, la radiología intervencionista se ha posicionado como una herramienta de gran importancia en el ámbito clínico.

Prostate carcinoma is one of the most common cancers worldwide in men, with over 3 million men currently living with prostate carcinoma. In men, routine screening and successful treatment schemes, including radiation, prostatectomy, or hormone therapy, have allowed for high survivability. Dogs are recognized as one of the only mammals to spontaneously develop prostate neoplasia and are an important translational model. Within veterinary medicine, treatment options have historically been limited in efficacy or paired with high morbidity. Recently, less invasive treatment modalities have been investigated in dogs and people and demonstrated promise. Below, current treatment options available in dogs and people are reviewed, as well as a discussion of current and future trends within interventional treatment for canine PC.

Since no uniform treatment protocol for pancreatic irreversible electroporation (IRE) exists, the heterogeneity throughout literature complicates the comparison of results. To reach agreement among experts, a consensus study was performed. Eleven experts, recruited according to predefined criteria regarding previous IRE publications, participated anonymously in three rounds of questionnaires according to a modified Delphi technique. Consensus was defined as having reached >= 80% agreement. Response rates were 100, 64, and 64% in rounds 1 to 3, respectively; consensus was reached in 93%. Pancreatic IRE should be considered for stage III pancreatic cancer and inoperable recurrent disease after previous local treatment. Absolute contraindications are ventricular arrhythmias, implantable stimulation devices, congestive heart failure NYHA class 4, and severe ascites. The inter-electrode distance should be 10 to 20 mm and the exposure length should be 15 mm. After 10 test pulses, 90 treatment pulses of 1,500 V/cm should be delivered continuously, with a 90-mu s pulse length. The first postprocedural contrast-enhanced computed tomography should take place 1 month post-IRE, and then every 3 months. This article provides expert recommendations regarding patient selection, procedure, and follow-up for IRE treatment in pancreatic malignancies through a modified Delphi consensus study. Future studies should define the maximum tumor diameter, response evaluation criteria, and the optimal number of preoperative FOLFIRINOX cycles.

Introduction: Arteriovenous grafts (AVGs) serve as an alternative to native arteriovenous fistulas (AVFs) in the context of hemodialysis patient life planning. AVGs are more susceptible to developing outflow stenosis (due to intimal hyperplasia), thrombosis, and infections. However, an often overlooked contributor to AVG failure is cannulation damage. The objective of this paper is to assess the impact of cannulations on AVGs. We aim to establish a classification of AVG damage by comparing clinical data and ultrasound images with microscopic morphological findings obtained from explanted grafts.Materials and methods: This study is conducted at a single center. We included all patients who underwent AVG creation between 2011 and 2019. Comprehensive data on clinical history, follow-up, and complications were collected and reviewed. Duplex ultrasound (DUS) characteristics were documented, and all grafts explanted during the analysis period underwent optical microscopy evaluation. Finally, clinical data, along with DUS and microscopic findings, were integrated to derive a damage classification.Results: During the study period, 247 patients underwent 334 early cannulation AVGs. The median follow-up duration was 714 days (IQR 392, 1195). One hundred eleven (33%) grafts were explanted. Clinical data and DUS findings were utilized to formulate a four-grade classification system indicating increasing damage.Conclusion: Cannulation damage alone does not solely account for AVG failure. It results from a biological host-mediated process that promotes the growth of intimal hyperplasia at the cannulation sites. This process is not clinically significant within the initial 2 years after AVG creation.

Irreversible electroporation (IRE) employs high-voltage electrical pulses for non-thermal image-guided tumor ablation in solid organs. The pulses disrupt the membrane potential of all cells within the ablation zone causing loss of tumour cell homeostasis which results in death. IRE has the advantage of sparing extracellular matrix structures and thereby preserves the anatomical integrity of blood vessels, bile ducts, and ureters. Several prospective phase-I and -II studies demonstrated the safety and cytoreductive efficacy of IRE for the treatment of locally advanced pancreatic, and local prostate tumours. In addition, IRE induces a systemic immune response. When this immune effect can be amplified by combinatory treatment with immunotherapeutic drugs its synergy might form a bridge between local and systemic therapies with potential to develop into a fundamentally new approach to cancer treatment.

BACKGROUND: Little guidance exists for the treatment of pseudoaneurysm following pediatric blunt liver and/or spleen injuries (BLSI). We aimed to describe the incidence of delayed pseudoaneurysm development and the subsequent clinical course of pseudoaneurysm in pediatric BLSI. METHODS: This multicenter retrospective cohort study from Japan included pediatric patients (≤16 years old) who sustained BLSI from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely non-operative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed pseudoaneurysm among the groups and to characterize the clinical course of any pseudoaneurysms. RESULTS: A total of 1, 407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed pseudoaneurysm formation was 80 (5.7%), and the number with delayed pseudoaneurysm rupture was 16 (1.1%) cases in the entire cohort. Patients treated with NOM (1056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed pseudoaneurysms, respectively. Among patients who developed any pseudoaneurysms, 39% of patients underwent prophylactic IR for unruptured pseudoaneurysm, while 13% required emergency angioembolization for delayed pseudoaneurysm rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of pseudoaneurysm without any interventions. CONCLUSION: Our results suggest that the risk of delayed pseudoaneurysm still exists even after acute phase IR as an adjunct to NOM for BLSI in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for pseudoaneurysm management, including rupture cases, given the high incidence of sponta

A woman in her 50s presented to the emergency department with 5 days of abdominal pain, nausea and vomiting. CT imaging of her liver demonstrated three enhancing, cystic lesions in her hepatic parenchyma and a large enhancing lesion in her porta hepatis concerning for a hepatic artery aneurysm. Radiographic-guided drainage was performed on two accessible liver abscesses, and cultures from this drainage grew Listeria monocytogenes Serial imaging of the aneurysm demonstrated that the aneurysm spontaneously thrombosed and did not require further intervention. She was subsequently discharged on intravenous ampicillin with a plan to continue until radiographic resolution of the abscesses.

A 51-year-old female patient presenting dyspnea for more than a year with no previous lung infections or surgery. Initially, a diagnostic computed tomography was made, showing a rare arterio-arterial malformation between the right inferior phrenic and right pulmonary artery leading into a vascular bundle in the middle lung lobe. Due to the patients ? dyspnea and massive extent of malformation, the indication for transcatheter arterial embolization was made. The first transcatheter arterial embolization procedure involved the inferior phrenic and a selective branch of the internal thoracic artery. Interventional angiography as well as computed tomography revealed further extend of the malformation showing a connection of right lateral thoracic, hepatic, and inferior epigastric artery to the fistula. After one month, a second transcatheter arterial embolization of these arteries as well as a second approach of the proximal internal thoracic artery was performed. In the follow-up the patient described a substantial improvement of her dyspnea and showed no signs of infections. A phrenic artery to pulmonary artery fistula is an extremely rare case occurring congenital or acquired. Patients may be asymptomatic or present, among others, dyspnea, hemoptysis, pulmonary infections and congestive heart failure. Symptomatic patients require treatment using transcatheter arterial embolization or surgical resection. The patient had dyspnea and a substantial extent of malformation with possibly complicated clinical course. The recommended less invasive treatment using transcatheter arterial embolization was successfully performed. In conclusion, our patient represented a rare congenital case of systemic and pulmonary artery communication, which we were able to treat sufficiently with coil embolization.

This study presents the performance of two fast Monte Carlo codes, PENELOPE/penEasyIR and MCGPU-IR in order to assess operator doses in interventional radiology. In particular, it aims to validate the calculations when workers are protected with shielding located between the patient and the operator. The experiments are performed in a calibration laboratory and measurements are gathered using Thermo EPD and Mirion DMC personal active dosemeters. Calculation efficiency of the fast Monte Carlo codes is approximately four orders of magnitude greater than for a standard Monte Carlo code. Satisfactory agreement between measurements and calculations is shown., This work was partially supported by EJP-CONCERT for 2014–2018 (662287); the Ministerio de Economía y Competitividad (PCIN-2017-044); and the Spanish Nuclear Safety Council through project EDOCI and the ‘Cátedra Argos’., Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Postprint (author's final draft)

[Objectives] The standard therapy for small renal masses (SRMs) remains partial nephrectomy (PN), which is associated with relatively high morbidity and complication rate. Therefore, percutaneous radiofrequency ablation (PRFA) emerges as an alternative therapy. This study aimed to compare the efficacy, safety, and oncological outcomes of PRFA versus PN., [Methods] A multicenter non-inferiority study with retrospective analysis of 291 patients with SRMs (N0M0), who underwent PN or PRFA (2:1), recruited prospectively from two hospitals in the Andalusian Public Health System, Spain, between 2014 and 2021. Comparisons of treatment features were evaluated using the t test, Wilcoxon-Mann–Whitney U test, chi-square test, Fisher test, and Cochran-Armitage trend test. Kaplan–Meier curves depicted overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) rates in the overall study population., [Results] A total of 291 consecutive patients were identified; 111 and 180 patients underwent PRFA and PN, respectively. Median follow-up time was 38 and 48 months, and mean hospitalization days were 1.04 and 3.57 days, respectively. The variables underpinned with high surgical risk were significantly increased in PRFA compared to those in PN (mean age was 64.56 and 57.47 years, the solitary kidney presence was 12.6% and 5.6%, ASA score ≥ 3 was 36% and 14.5%, respectively). The rest of oncological outcomes were comparable amongst PRFA and PN. Patients undergoing PRFA did not improve OS, LRFS, and MFS compared to those undergoing PN. Limitations comprise retrospective design and limited statistical power., [Conclusion] PRFA for SMRs in high-risk patients is non-inferior in terms of oncological outcomes and safety compared to PN., [Clinical relevance statement] Our study has a direct clinical application as it proves that radiofrequency ablation is an effective and uncomplicated therapeutic option for patients with small renal masses., [Key Points] •There are non-inferiority results in overall survival, local recurrence-free survival, and metastasis-free survival between PRFA and PN. •Our two-center study showed that PRFA is non-inferior to PN in oncological outcomes. •Contrast-enhanced power ultrasound-guided PRFA provides an effective therapy for T1 renal tumors.

We reported imaging findings of arterio-venous malformation complicated by hemorrhage and venous pseudoaneurysm in a young child consulting for headache and emesis: to our knowledge venous pseudoaneurysm in association with ruptured arteriovenous malformation is a rare complication reported in the literature. We present the indications for endovascular treatment, especially with NBCA (N-butyl cyanoacrylate)., SCOPUS: ar.j, info:eu-repo/semantics/published

Interventional radiology, and particularly interventional oncology, represents one of the medical subspecialties in which technological advancements and innovations play an utterly fundamental role. Artificial intelligence, consisting of big data analysis and feature extrapolation through computational algorithms for disease diagnosis and treatment response evaluation, is nowadays playing an increasingly important role in various healthcare fields and applications, from diagnosis to treatment response prediction. One of the fields which greatly benefits from artificial intelligence is interventional oncology. In addition, digital health, consisting of practical technological applications, can assist healthcare practitioners in their daily activities. This review aims to cover the most useful, established, and interesting artificial intelligence and digital health innovations and updates, to help physicians become more and more involved in their use in clinical practice, particularly in the field of interventional oncology.

We present the case of a young man active duty in the military who initially presented with pelvic pain and fullness during sexual activity. Extensive workup showed a large pelvic arteriovenous malformation (AVM). He underwent over 10 interventional radiology procedures to embolise his AVM and suffered multiple postoperative complications resulting in exploratory laparotomies, bowel resections and ultimately a colostomy. Six years after his embolisation procedures, he was found on imaging to have gluteal fluid collections with metallic particles, presumed to be migrated Onyx from his angioembolisations as a result of non-target embolisation. Current literature does not document other instances of Onyx material migrating from an intravascular source to interstitial tissue.

With the widespread use of three-dimensional printers, organ models created by these printers are now being used in the medical field for preoperative planning of surgeries. In this article, we report two cases in which embolization was expected to be difficult, and the three-dimensional printer-based vascular modeling was helpful in planning the surgery. The first case involved an aneurysm of the splenic artery. We attempted to embolize the aneurysm but were unable to advance the catheter into the distal artery and discontinued the procedure. The second case was a perianal varicose vein, which was initially treated with percutaneous transhepatic obliteration but was recanalized and required embolization. However, we expected difficulty in selecting the inferior mesenteric vein. In both cases, the vascular models were created using a 3D printer from the patients’ computed tomography images. Preoperative planning, including treatment simulation, was based on these models. The time required to print a three-dimensional vascular model was approximately 12 hours at a cost of less than $10 each. Patient-specific vascular models using a three-dimensional printer can be a simple and inexpensive tool that can increase the success of embolization in difficult cases.

Inferior vena cava (IVC) filters are posited to effect flow dynamics, causing turbulence, vascular remodeling and eventual thrombosis; however, minimal data exists evaluating hemodynamic effects of IVC filters in vivo. The purpose of this study was to determine differences in hemodynamic flow parameters acquired with two-dimension (2D)-perfusion angiography before and after IVC filter placement or retrieval. 2D-perfusion images were reconstructed retrospectively from digital subtraction angiography from a cohort of 37 patients (13F/24M) before and after filter placement (n = 18) or retrieval (n = 23). Average dwell time was 239.5 ± 132.1 days. Changes in the density per pixel per second within a region of interest (ROI) were used to calculate contrast arrival time (AT), time-to-peak (TTP), wash-in-rate (WIR), and mean transit time (MTT). Measurements were obtained superior to, inferior to, and within the filter. Differences in hemodynamic parameters before and after intervention were compared, as well as correlation between parameters versus filter dwell time. A P value with Bonferroni correction of <.004 was considered statistically significant. After placement, there was no difference in any 2D-perfusion variable. After retrieval, ROIs within and inferior to the filter showed a significantly shorter TTP (1.7 vs 1.4 s, P = .004; 1.5 vs 1.3 s, P = .001, respectively) and MTT (1.7 vs 1.4 s, P = .003; 1.5 vs 1.2 s, P = .002, respectively). Difference in variables showed no significant correlation when compared to dwell time. 2D-perfusion angiography is feasible to evaluate hemodynamic effects of IVC filters in vivo. TTP and MTT within and below the filter after retrieval were significantly changed, without apparent correlation to dwell time, suggesting a functional hemodynamic delay secondary to filter presence.

Video 1Case presentation including cross-sectional imaging, percutaneous cholangiogram, percutaneous cholangioscopy, and histopathology of cholangioscopy-directed biopsies.

Subclavian vein (SCV) effort thrombosis, also known as Paget-Schroetter syndrome or venous thoracic outlet syndrome, is an uncommon condition that affects individuals with an irregularly narrow thoracic outlet who engage in repetitive overhead motions of the affected arm. Venous injury arises from microtraumas that occur from the repetitive compression of the SCV between the first rib and the overlying clavicle. Additional sources of extrinsic compression can be due to the anterior scalene muscle, subclavius muscle, and costoclavicular ligament. SCV effort thrombosis is a distinct entity from other forms of deep venous thrombosis and requires unique diagnostic and treatment considerations. Early catheter-directed therapy in the form of pharmacomechanical or catheter-directed thrombolysis combined with prompt surgical thoracic outlet decompression offers patients the best chances for early and durable symptom relief.

INTRODUCTION: Image-guided endovascular interventions, performed using the insertion and navigation of catheters through the vasculature, have been increasing in number over the years, as minimally invasive procedures continue to replace invasive surgical procedures. Such endovascular interventions are almost exclusively performed under x-ray fluoroscopy, which has the best spatial and temporal resolution of all clinical imaging modalities. Magnetic resonance imaging (MRI) offers unique advantages and could be an attractive alternative to conventional x-ray guidance, but also brings with it distinctive challenges. AREAS COVERED: In this review, the benefits and limitations of MRI-guided endovascular interventions are addressed, systems and devices for guiding such interventions are summarized, and clinical applications are discussed. EXPERT OPINION: MRI-guided endovascular interventions are still relatively new to the interventional radiology field, since significant technical hurdles remain to justify significant costs and demonstrate safety, design, and robustness. Clinical applications of MRI-guided interventions are promising but their full potential may not be realized until proper tools designed to function in the MRI environment are available. Translational research and further preclinical studies are needed before MRI-guided interventions will be practical in a clinical interventional setting.

Physical examination (PE) of arteriovenous access remains of high clinical value and continues to be recommended by leading societies and guidelines. PE is easy to learn and perform. Once learned, examiners can provide a comprehensive arteriovenous (AV) access examination in 20 to 30 seconds. Therefore, we continue to advocate that AV access PE should be part of the training for all dialysis care providers. Similarly, ultrasound can provide important AV access evaluation and provide key information. It is relatively cheap and can be readily available at the bed side. Additionally, it is well accepted by patients, as it is not expected to be associated with pain or discomfort during the examination. We present in this review the key components of PE, signs and symptoms of AV access dysfunction, and the role of ultrasound in AV access evaluation as a complementary tool to PE.

Objectives: We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. Methods: A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995–2020 were included. Techniques: A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003–2009 and a balloon catheter with gastropexy was used between 2015–2021. For the comparison of proportions, X2 Test or Fisher’s test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. Results: n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. Conclusions: The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.

Migration of ventriculoperitoneal shunt into the pulmonary artery is a rare complication that can lead to shunt malfunction and cardiopulmonary complications. This case illustrates the significance of accidental transvenous placement of the shunt. Identification of the transvenous course of the catheter on cross sectional imaging can predict future catheter migration and also aid at surgical extraction. Formation of knot within the distal portion of the shunt catheter during migration or endovascular retrieval can occur, therefore measures to retrieve with knot and adhesions should be factored in before.

Arteriovenous malformations (AVMs) are a rare congenital vascular disorder. They represent a fast-flow vascular malformation. Clinically, AVMs present a heterogenous expression and can affect every part of the body. Here, we will solely focus on extracranial AVMs. Generally, AVMs progress with the patient's age. Patients often suffer from pulsation, skin discoloration, pain, ulceration, bleeding, and disfigurement. Diagnostic tools include color-coded duplex sonography, MRI and CT imaging, as well as the clinical examination. 4D dynamic perfusion-computed tomography may help in the interventional planning. Digital subtraction angiography is required during interventional therapy. AVMs pose a great challenge to the treating physician. The therapy of this rare disease should be managed in an interdisciplinary center for vascular malformations. It consists of conservative measures, such as compression garments and pain medication, transcatheter or, more rarely, percutanous embolization, and surgical resection. In smaller, localized lesions, resection with primary wound closure may be feasible, whereas extensive AVMs regularly require the reconstruction of the resulting soft tissue defect and possibly affected functional structures by means of free tissue transfer. In the interdisciplinary setting required for an appropriate treatment of AVMs, extensive knowledge of the various therapies, including those from different specialties, is necessary. Therefore, this article aims to provide an overview over both the interventional and surgical therapeutic options.

Splenic artery steal syndrome is a rare complication after liver transplant. It could lead to rapidly evolving major issues such as ischemic cholangiopathy and acute graft failure. Although the pathophysiology is not yet well understood, if diagnosed in time it could be easily managed with interventional radiology treatments. We present a case of a 47-year-old man presented to our institute with radiological findings typical for multifocal hepatocellular carcinoma in a cirrhotic liver. After therapy he underwent transplant. Some days after surgery he developed signs of acute liver failure. Steal syndrome was suspected by laboratory tests and radiology exams. The syndrome was confirmed by angiography and treated. The graft was saved, and the patient is still alive and free of disease. The purpose of this paper is to explain the importance of radiology exams in the diagnosis of splenic steal syndrome, explain its pathogenesis and describe the interventional management of this complication.

Purpose: To illustrate diagnostic and interventional imaging for the characterization and treatment of portal vein thrombosis (PVT). Introduction: The broad spectrum of congenital and acquired PVT manifestations is illustrated, with a focus on the pediatric population; diagnostic and interventional imaging techniques are described. Description: PVT frequently presents as an incidental finding at imaging in the screening for liver diseases or for other unrelated reasons. PVT can be classified based on: extension (intrahepatic, extrahepatic, involving the spleno-mesenteric tract, etc.); degree (partial or complete); onset (acute or chronic); and with or without cavernomatous transformation. This comprehensive review relies on the experience gained from a large series of congenital and acquired PVT in a referral center for pediatric and adult liver transplantation. Diagnostic and interventional imaging techniques are described, including: color–Doppler and contrast-enhanced Ultrasound; CT and MR angiography; retrograde portography; percutaneous transhepatic, transplenic, and transmesenteric portography; transjugular intrahepatic portosystemic shunt creation. Pre- and post-operative imaging assessment of the surgical meso-rex bypass is discussed. The description is enriched with an original series of pictorial imaging findings. Conclusion: PVT is a clinical condition associated with significant morbidity and mortality. Diagnostic and interventional imaging plays a crucial role in both conservative and operative management. Introduction: The broad spectrum of congenital and acquired PVT manifestations is illustrated, with a focus on the pediatric population; diagnostic and interventional imaging techniques are described. Description: PVT frequently presents as an incidental finding at imaging in the screening for liver diseases or for other unrelated reasons. PVT can be classified based on: extension (intrahepatic, extrahepatic, involving the spleno-mesenteric tract, etc

Background: Although biliary complications after orthotopic liver transplantation represent a common source of morbidity and mortality, decreasing graft survival, consensus is lacking on their management in the pediatric population. Objective: The aim of this study was to present the prevalence of such biliary complications and their interventional radiologic management with representative images. Materials and methods: This retrospective study reports our experience with percutaneous transhepatic cholangiography in the management of biliary complications after orthotopic liver transplantation in pediatric patients. This study enrolled all pediatric patients (<18 years old) who underwent percutaneous transhepatic cholangiography for the management of biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020. Diagnosis of biliary complications and indication to perform percutaneous transhepatic cholangiography were based on clinical, laboratory or radiologic data. Results: Among the 301 orthotopic liver transplantations, 78 (26%) developed biliary complications that were managed by interventional radiology: these included 52 (17.3%) biliary strictures, 19 (6.3%) bile leaks, 5 (1.7%) biliary stones, 1 (0.3%) iatrogenic biliary obstruction and 1 (0.3%) vanishing syndrome. The median time interval between orthotopic liver transplantation and the diagnosis of biliary complications was 6.0 years (interquartile range [IQR] 8.2 years). Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases, with low rates of complications that were variable among subgroups. Conclusion: A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation. In this large single-center experience, we highlight the value of percutaneous transhepatic cholangiography in their diagnosis and management. Percutaneous treatments in pediatric patients ar

Background: Retrievable inferior vena cava (IVC) filters were developed for the transient prevention of pulmonary embolisms. Despite indications for removal, many filters are unintentionally left in place indefinitely. Adverse events associated with chronic indwelling retrievable filters have generated increased interest in improving their retrieval rates. Objective: This DNP scholarly project aimed to determine if a collaborative IVC filter retrieval protocol developed by the researcher and adopted by the Interventional Radiology (IR) clinical team, increased filter retrieval rates and decreased loss to follow-up of patients who had undergone temporary IVC filter placement. Methods: Seven-step IVC filter retrieval protocol was created and implemented. Following a quasi-experimental comparative design the pilot-study prospectively included all consecutive adult patients who underwent insertion of a retrievable IVC filter for a period of four months. Data collected included patient demographics, filter outcomes, and documented follow-up. Same data variables were collected using a retrospective review of similar patients who had undergone retrievable IVC filters placement 24-months prior to initiation of the new protocol. Chi-square statistical analysis was performed for all variables. Results: Total of 101 IVC filters (97 retrievable, 4 permanent) were inserted during the 28-month pilot-study period. Of the 97 retrieval filters placed (85 retrospective, 12 prospective), the retrieval rates of eligible filters increased from 64.15% to 100% and patients lost to follow-up decreased from 35.85% to 0% following implementation of the new protocol (p= 0.3, both outcomes). However, there was a statistically significant positive correlation between IVC filter conversion to permanent status and malignancy (r(26) = 0.32; p <0.01). As a consequence, this led to an increase in the number of permanent IVC filters placed in the prospective cohort (1.2% vs. 20%; p <0.01). Conc

Background: Procedure cancellations in outpatient interventional radiology (IR) can lead to delays in diagnosis, lost revenue and underutilization of department resources. Current practice at some centers is the use of registered nurses (RN) to conduct outpatient pre-procedure telephone screening. However, same-day procedure deviations requiring cancellations remains high. This quality improvement (QI) project evaluated the effectiveness of an advanced practice registered nurse (APRN) driven pre-procedure clinic to assess same-day cancellations, days to procedure, and cost-effectiveness compared to RN telephone screening for biopsies. Objectives: To determine if an APRN interventional radiology pre-procedure clinic will reduce cancellation rates, days to procedure, and lost revenue in comparison to nurse telephone screening for outpatient biopsies. Methods: Using a comparative design, 111 patients (47 APRN pre-procedure clinic group and 64 historical RN telephone group) were examined via retrospective medical record reviews between August 1, 2019 to January 1, 2020 [RN group] and August 1, 2020 to January 1, 2021 [APRN group]. Patient information extracted were demographics, insurance type, anesthesia classification, biopsy type, cancellation and reason, and days to procedure referral. Estimated lost revenue was calculated based on procedures cancelled and summed per group based on procedure reimbursement, facility and clinic fees, and professional fees [physician, RN or APRN]. Descriptive and inferential statistics were used to assess group differences. Results: There were no statistically significant differences between patient groups for demographics and clinical conditions (similar types of biopsy procedures). The most common reasons for cancellation in both groups were patient factors, including elevated blood pressure and acute illnesses. There were significantly more cancellations in the RN group (18/28%) in comparison to the APRN group (9/14%; p=0.018). Addi

A 6-year-old neutered male German shepherd dog was evaluated for obtundation, blindness, and bilateral exophthalmos. A magnetic resonance imaging scan of the brain was performed and identified an arteriovenous malformation (AVM) with several feeding arterial branches, and venous drainage through the cavernous sinus. Venous vessels rostral to the AVM were severely distended and extended into the retrobulbar spaces. Liquid embolization by injection of ethylene vinyl alcohol copolymer was performed from access points in the maxillary arteries and internal carotid arteries. No intraprocedural complications were encountered, and the dog was discharged the next day. Bilateral enucleation eventually was performed because of exposure keratopathy. At 31 months post-embolization, owners reported that the dog was doing very well clinically with high activity level and normal appetite, and the dog also appeared to be pain free. Although intracranial AVMs are very rare in companion animals, successful treatment using liquid embolization is possible and should be considered.

Endovascular techniques have expanded to include balloon and stent-assistance, flow diversion and individualized endovascular occlusion devices, to widen the treatment spectrum for more complex aneurysm morphologies. While usually well-tolerated by patients, endovascular treatment of intracranial aneurysms carries the risk of complications, with procedure-related ischemic complications being the most common. Several antiplatelet agents have been studied in a neurointerventional setting for both prophylaxis and in the setting of intraprocedural thrombotic complications. Knowledge of these antiplatelet agents, evidence for their use and common dosages is important for the practicing neurointerventionist to ensure the proper application of these agents. Part one of this two-part review focused on basic platelet physiology, pharmacology of common antiplatelet medications and future directions and therapies. Part two focuses on clinical applications and evidence based therapeutic regimens.Copyright © 2021, Springer-Verlag GmbH, DE part of Springer Nature.

Introduction: Social media provides opportunities for Interventional Radiologists to share research, communicate with colleagues, provide health information and advertise their clinical practice. This study aims to examine the online and social media presence of currently practicing Australian Interventional Radiologists. Method(s): Systematic Google searches were undertaken in May 2019 and updated in May 2020 to identify practicing Interventional Radiologists in Australia. Comprehensive searches of practice websites and social media platforms (Facebook, LinkedIn, Twitter, ResearchGate, YouTube) were undertaken for each Interventional Radiologist. Result(s): There were 265 Interventional Radiologists identified as currently practising in Australia, including 209 Interventional Radiologists (excluding Interventional Neuroradiologists), 49 Interventional Neuroradiologists and 7 that practise across both Interventional Radiology and Interventional Neuroradiology. 72% of Interventional Radiologists had at least one social media account, with LinkedIn the most widely used social media platform (60%). There was a significant negative correlation between the total number of social media accounts and years in practice (P = 0.04). Across the states, a higher population per IR was positively correlated with a higher average number of social media accounts per IR (P = 0.04). Interventional Neuroradiologists had a significantly higher average number of social media accounts compared to Interventional Radiologists (1.94 vs 1.29, P < 0.01). Conclusion(s): Most Australian Interventional Radiologists have a readily identifiable social media presence. There is potential for further utilisation of social media for academic, educational and business purposes.Copyright © 2021 The Royal Australian and New Zealand College of Radiologists

Endovascular techniques have expanded to include balloon and stent-assistance, flow diversion and individualized endovascular occlusion devices, to widen the treatment spectrum for more complex aneurysm morphologies. While usually well-tolerated by patients, endovascular treatment of intracranial aneurysms carries the risk of complications, with procedure-related ischemic complications being the most common. Several antiplatelet agents have been studied in a neurointerventional setting for both prophylaxis and in the setting of intraprocedural thrombotic complications. Knowledge of these antiplatelet agents, evidence for their use and common dosages is important for the practicing neurointerventionist to ensure the proper application of these agents. Part one of this two-part review focused on basic platelet physiology, pharmacology of common antiplatelet medications and future directions and therapies. Part two focuses on clinical applications and evidence based therapeutic regimens.Copyright © 2021, Springer-Verlag GmbH, DE part of Springer Nature.

Background: Retrievable inferior vena cava (IVC) filters were developed for the transient prevention of pulmonary embolisms. Despite indications for removal, many filters are unintentionally left in place indefinitely. Adverse events associated with chronic indwelling retrievable filters have generated increased interest in improving their retrieval rates. Objective: This DNP scholarly project aimed to determine if a collaborative IVC filter retrieval protocol developed by the researcher and adopted by the Interventional Radiology (IR) clinical team, increased filter retrieval rates and decreased loss to follow-up of patients who had undergone temporary IVC filter placement. Methods: Seven-step IVC filter retrieval protocol was created and implemented. Following a quasi-experimental comparative design the pilot-study prospectively included all consecutive adult patients who underwent insertion of a retrievable IVC filter for a period of four months. Data collected included patient demographics, filter outcomes, and documented follow-up. Same data variables were collected using a retrospective review of similar patients who had undergone retrievable IVC filters placement 24-months prior to initiation of the new protocol. Chi-square statistical analysis was performed for all variables. Results: Total of 101 IVC filters (97 retrievable, 4 permanent) were inserted during the 28-month pilot-study period. Of the 97 retrieval filters placed (85 retrospective, 12 prospective), the retrieval rates of eligible filters increased from 64.15% to 100% and patients lost to follow-up decreased from 35.85% to 0% following implementation of the new protocol (p= 0.3, both outcomes). However, there was a statistically significant positive correlation between IVC filter conversion to permanent status and malignancy (r(26) = 0.32; p <0.01). As a consequence, this led to an increase in the number of permanent IVC filters placed in the prospective cohort (1.2% vs. 20%; p <0.01). Conc

Background: Procedure cancellations in outpatient interventional radiology (IR) can lead to delays in diagnosis, lost revenue and underutilization of department resources. Current practice at some centers is the use of registered nurses (RN) to conduct outpatient pre-procedure telephone screening. However, same-day procedure deviations requiring cancellations remains high. This quality improvement (QI) project evaluated the effectiveness of an advanced practice registered nurse (APRN) driven pre-procedure clinic to assess same-day cancellations, days to procedure, and cost-effectiveness compared to RN telephone screening for biopsies. Objectives: To determine if an APRN interventional radiology pre-procedure clinic will reduce cancellation rates, days to procedure, and lost revenue in comparison to nurse telephone screening for outpatient biopsies. Methods: Using a comparative design, 111 patients (47 APRN pre-procedure clinic group and 64 historical RN telephone group) were examined via retrospective medical record reviews between August 1, 2019 to January 1, 2020 [RN group] and August 1, 2020 to January 1, 2021 [APRN group]. Patient information extracted were demographics, insurance type, anesthesia classification, biopsy type, cancellation and reason, and days to procedure referral. Estimated lost revenue was calculated based on procedures cancelled and summed per group based on procedure reimbursement, facility and clinic fees, and professional fees [physician, RN or APRN]. Descriptive and inferential statistics were used to assess group differences. Results: There were no statistically significant differences between patient groups for demographics and clinical conditions (similar types of biopsy procedures). The most common reasons for cancellation in both groups were patient factors, including elevated blood pressure and acute illnesses. There were significantly more cancellations in the RN group (18/28%) in comparison to the APRN group (9/14%; p=0.018). Addi

A 6-year-old neutered male German shepherd dog was evaluated for obtundation, blindness, and bilateral exophthalmos. A magnetic resonance imaging scan of the brain was performed and identified an arteriovenous malformation (AVM) with several feeding arterial branches, and venous drainage through the cavernous sinus. Venous vessels rostral to the AVM were severely distended and extended into the retrobulbar spaces. Liquid embolization by injection of ethylene vinyl alcohol copolymer was performed from access points in the maxillary arteries and internal carotid arteries. No intraprocedural complications were encountered, and the dog was discharged the next day. Bilateral enucleation eventually was performed because of exposure keratopathy. At 31 months post-embolization, owners reported that the dog was doing very well clinically with high activity level and normal appetite, and the dog also appeared to be pain free. Although intracranial AVMs are very rare in companion animals, successful treatment using liquid embolization is possible and should be considered.

Systematic and standardized evaluation of superficial venous disease, guided by knowledge of the various clinical presentations, venous anatomy, and pathophysiology of reflux, is essential for appropriate diagnosis and optimal treatment. Duplex ultrasonography is the standard for delineating venous anatomy, detecting anatomic variants, and identifying the origin of venous insufficiency. This article reviews tools and techniques essential for physical examination and ultrasound assessment of patients with superficial venous disease.

Hygromas are malformations of the lymphatic system that appear since birth. It is developed by an abnormal origin of the lymphatic sacs. The most frequent location is the cervico-facial region. It may present complications such as infection, bleeding, or related to their size and location. We present the case of a 1-month-old infant with airway compromise in relation to a lesion in the oral cavity that was diagnosed as cystic hygroma., Los higromas son malformaciones del sistema linfático presentes desde el nacimiento. Su origen está en un desarrollo anómalo de los sacos linfáticos, siendo la ubicación más frecuente la región cérvicofacial. En su evolución pueden presentar complicaciones como infección, sangrado, o relacionadas con su tamaño y localización. Presentamos el caso de una lactante de 1 mes de vida que presenta compromiso de vía aérea en relación a una lesión en cavidad oral que fue diagnosticada como higroma quístico.

Rationale and Objectives: The aim of our retrospective study was to assess the safety and feasibility of cryoablation in high-risk patients with complex chest neoplastic lesions. Materials and Methods: Twenty patients with complex chest malignancies, both primary and secondary, located in the mediastinum, lung, and chest wall, underwent percutaneous CT-guided cryoablation treatments. Procedural success as well as complications were evaluated. Results: A total of 24 neoplastic lesions were treated (mean diameter: 27 mm; range: 7-54 mm). Technical success was obtained in all patients, without major complications or intraprocedural death. A pneumothorax not requiring a drainage tube placement was registered in 50% of patients, while 3/24 patients had a grade 3 pneumothorax requiring a chest tube placement. Conclusion: Percutaneous CT-guided cryoablation seems a safe and feasible treatment for complex thoracic lesions.

Background and purposeFlow diverters are increasingly used to treat intracranial aneurysms. We report the safety and efficacy of the p64 flow diverter, a resheathable and detachable device for intracranial aneurysms.Materials and methodsWe retrospectively reviewed 108 patients with 109 aneurysms treated with the p64 between March 2014 and July 2019. There were 87 women and 21 men, mean age 57 years. Of 109 aneurysms, 74 were discovered incidentally, 12 were symptomatic, 18 were previously treated, and five were ruptured dissection aneurysms. A total of 10 aneurysms were located in the posterior circulation. The mean aneurysm or remnant size was 8.1 mm.ResultsHemorrhage by perforation with the distal guidewire occurred in two patients with permanent neurological deficits in one. In one patient, acute in-stent occlusion caused infarction with a permanent deficit. Permanent morbidity was 1.9% (2 of 108, 95%CI 0.1-6.9%); there was no mortality. During follow-up, three in-stent occlusions occurred, all asymptomatic. There were no delayed hemorrhagic complications. At six months, 77 of 96 aneurysms (80.2%) were completely occluded, and at last follow-up, this increased to 93 of 96 aneurysms (96.9%). In-stent stenosis at any degree occurred in 11 patients, progressing to asymptomatic complete occlusion in one. In the other patients, stenosis resolved or improved at further follow-up.ConclusionThe p64 offers an effective and safe treatment option. Aneurysm occlusion rate was 97% at last follow-up, mostly achieved with a single device. There were no delayed hemorrhagic complications. Delayed in-stent stenosis infrequently progresses to occlusion but remains a matter of concern.

BackgroundThe novel low-profile p48 flow diverter has been designed to treat aneurysms on small vessels of 1.75-3mm. We report our first clinical experiences.MethodsBetween March 2018-January 2020, 22 patients with 25 aneurysms were treated with the p48 in 3 centers. One patient had 3 aneurysms covered by one p48 and one patient had 2 aneurysms. There were 5 men, 17 women, with a mean age of 55 years (median 59, range 29-73 years).ResultsIn 25 aneurysms, 24 p48 flow diverters were placed. In 1 patient additional coils were placed in the aneurysm. Procedural vessel rupture by the micro guidewire occurred in 2 patients and vessel rupture during p48 balloon dilatation occurred in 1 patient. Overall, the permanent morbidity rate was 13.6% (3 of 22, 95%CI 3.9-34.2%) and mortality was 4.5% (1 of 22, 95%CI <0.01-23.5%). Most complications were procedure-related and not device-specific. Of 22 patients with 25 aneurysms treated with p48, 18 patients with 20 aneurysms had angiographic follow-up after 5-18 months. Of 19 aneurysms, 10 were occluded and 7 showed a remnant. Two aneurysms were open after 6 months. Three aneurysms were still not occluded after 12, 14, and 18 months and these 3 were retreated. Retreatment rate was 16% (3 of 19) and the adequate occlusion rate was 90% (17 of 19).ConclusionsTreatment of aneurysms in small-caliber vessels with the p48 is feasible and effective but is not without complications. More data is needed to establish indications, safety, and efficacy more accurately.

Biliary tract complications (BTCs) still burden liver transplantation (LT). The wide reporting variability highlights the absence of systematic screening. From 2000 to 2009, simultaneous liver biopsy and direct biliary visualization were prospectively performed in 242 recipients at 3 and 6 months (n = 212, 87.6%) or earlier when indicated (n = 30, 12.4%). Median follow-up was 148 (107–182) months. Seven patients (2.9%) experienced postprocedural morbidity. BTCs were initially diagnosed in 76 (31.4%) patients; 32 (42.1%) had neither clinical nor biological abnormalities. Acute cellular rejection (ACR) was present in 27 (11.2%) patients and in 6 (22.2%) BTC patients. Nine (3.7%) patients with normal initial cholangiography developed BTCs after 60 (30–135) months post-LT. BTCs directly lead to 7 (2.9%) re-transplantations and 14 (5.8%) deaths resulting in 18 (7.4%) allograft losses. Bile duct proliferation at 12-month biopsy proved an independent risk factor for graft loss (P = 0.005). Systematic biliary tract and allograft evaluation allows the incidence and extent of biliary lesions to be documented more precisely and to avoid erroneous treatment of ACR. The combination ‘abnormal biliary tract-canalicular proliferation’ is an indicator of worse graft outcome. BTCs are responsible for important delayed allograft and patient losses. These results underline the importance of life-long follow-up and appropriate timing for re-transplantation., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction Postembolisation syndrome (PES) is the most common side effect of vascular embolisation of solid organs. Although prophylactic corticosteroids are known to reduce the incidence and severity of PES, no trials investigating their efficacy have been conducted in men undergoing prostatic artery embolisation (PAE). We postulate that steroids can have a similar effect in reducing PES after PAE. This paper describes the rationale and detailed protocol for a randomised controlled trial evaluating the efficacy of dexamethasone (DEXA) in reducing PES after PAE. Methods and analysis In this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 60 individuals undergoing PAE for benign prostatic hyperplasia. Participants will be randomised to receive IV DEXA (24 mg) or placebo (saline). The primary outcomes will be postprocedural fever, pain and quality of life. The secondary outcomes will include postprocedural nausea, postprocedural medicine usage, laboratory parameters (C reactive protein, prostate-specific antigen) and early PAE results. Ethics and dissemination Ethics approval was obtained from the Danish Committee on Health Research Ethics in the Capital Region (H-20025910). The results from this trial will be disseminated through publication in peer-reviewed journals and national and international presentations.

Introduction Postembolisation syndrome (PES) is the most common side effect of vascular embolisation of solid organs. Although prophylactic corticosteroids are known to reduce the incidence and severity of PES, no trials investigating their efficacy have been conducted in men undergoing prostatic artery embolisation (PAE). We postulate that steroids can have a similar effect in reducing PES after PAE. This paper describes the rationale and detailed protocol for a randomised controlled trial evaluating the efficacy of dexamethasone (DEXA) in reducing PES after PAE. Methods and analysis In this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 60 individuals undergoing PAE for benign prostatic hyperplasia. Participants will be randomised to receive IV DEXA (24 mg) or placebo (saline). The primary outcomes will be postprocedural fever, pain and quality of life. The secondary outcomes will include postprocedural nausea, postprocedural medicine usage, laboratory parameters (C reactive protein, prostate-specific antigen) and early PAE results. Ethics and dissemination Ethics approval was obtained from the Danish Committee on Health Research Ethics in the Capital Region (H-20025910). The results from this trial will be disseminated through publication in peer-reviewed journals and national and international presentations.

Objective: To summarize the literature on trans-arterial embolization in inflammatory musculoskeletal conditions, focusing on efficacy and safety. Materials and Methods: PRISMA guidelines were followed. A systematic literature search revealed 19 studies, with a total of 394 participants, eligible for inclusion. Results: The included studies consisted of case reports/series and non-randomized interventional studies, with knee osteoarthritis and adhesive capsulitis of the shoulder as the most frequent conditions. In all studies except one, pain was reduced up to four years after treatment. All adverse events were transient. Due to high heterogeneity, meta-analysis was not possible. Conclusion: The included early studies showed encouraging results regarding efficacy and safety. However, randomized, placebo-controlled trials are warranted.

Interventional radiology techniques cause radiation exposure both to patient and personnel. The radiation dose to the operator is usually measured with dosimeters located at specific points above or below the lead aprons. The aim of this study is to develop and validate two fast Monte Carlo (MC) codes for radiation transport in order to improve the assessment of individual doses in interventional radiology. The proposed methodology reduces the number of required dosemeters and provides immediate dose results., Peer Reviewed, Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Postprint (published version)

Els procediments de radiologia intervencionista (IR) són cada vegada més utilitzats a mesura que avança la tecnologia i, per tant, el nombre d’aplicacions ha augmentat constantment. Aquests procediments mínimament invasius poden donar lloc a una elevada exposició radiològica per el pacient i per l’operador. Encara que l’ús adequat dels equips de protecció personal (davantals plomats i pantalles de protecció) redueix substancialment la dosi rebuda pels treballadors, sovint és difícil conèixer quina és la dosi rebuda per les parts no cobertes així com que la dosi mesurada pels detectors que s’utilitzen per monitoritzar la dosi dels operadors és prou representativa, ja que la distribució espacial del camp de radiació és molt inhomogènia. En el projecte europeu PODIUM (Personal Online Dosimetry Using Computational Methods), en el que està emmarcat aquest estudi, es va desenvolupar el codi de simulació Monte Carlo PENELOPE/PenEasy_IR.. L’anàlisi de les dades extretes permet comprovar quins paràmetres influeixen a la dosi que arriba al personal sanitari i comparar-los en diferents condicions i. A més, aquest estudi pretén determinar no només l’impacte en la radiació rebuda pels treballades dels paràmetres de funcionament dels equips de RX per a radiologia intervencionista sinó que pretén especialment investigar l’efecte que hi té les dades antropomètriques del propi pacient. El voltatge és el paràmetre que més influeix en la dosi que rep el personal mèdic, seguit de la filtració afegida i les angulacions de la estructura d’arc en C. L’amplada i el gruix del tórax o maluc del pacient, en les dues intervencions estudiades, són bons predictors per determinar l’exposició dels treballadors. Encara que aquest estudi es va realitzar considerant pacients femenins, els resultats també poden ser aplicats per pacients masculins., Los procedimientos de radiología intervencionista (IR) están cada vez más extendidos a medida que avanza la tecnología, y el número de aplicaciones ha aumentado constantemente. Estos procedimientos mínimamente invasivos pueden dar lugar a una elevada dosis de radiación para el paciente y el operador. Aunque el uso adecuado de equipos de protección personal reduce sustancialmente la dosis recibida por los trabajadores, es difícil conocer la dosis recibida en las partes no protegidas del cuerpo así como que las dosis medidas experimentalmente con los dosímetros utilizados habitualmente para monitorizar la dosis de los operadores es lo suficientemente representativa, ya que la distribución espacial del campo de radiación es muy inhomogénea. En el proyecto europeo PODIUM (Personal Online Dosimetry Using Computational Methods), en el que está enmarcado este estudio, se desarrolló el código de simulación Monte Carlo PENELOPE / PenEasy_IR. El análisis de los datos extraídos permite comprobar qué parámetros influyen en la dosis que alcanza el personal sanitario y compararlos en diferentes condiciones Este estudio pretende determinar no sólo la influencia en la dosis recibida por los trabajadores de los parámetros de funcionamiento de los equipos de RX de radiología intervencionista sino especialmente el impacto de los datos antropométricos de los pacientes. El voltaje es el parámetro más influyente en la dosis que reciben los operadores, seguido de la filtración añadida y las angulaciones de la estructura de arco en C. La anchura y el grosor del paciente (tórax-cadera) tanto de la intervención cardíaca como abdominal son buenos predictores para determinar la dosis que recibe el personal médico. Aunque este estudio se realizó considerando a mujeres como pacientes, los resultados pueden ser aplicados a pacientes masculinos., Interventional radiology (IR) procedures are becoming more widely available as technology advances, and the number of applications has steadily increased. These minimally invasive procedures can potentially result in high patient and operator radiation does. Although the appropriate use of personal protective equipment substantially reduces the dose received by workers, it is often difficult to know the dose received by unprotected areas of the operator’s body, and to ensure the representativeness of the usual dose measurements since the spatial distribution of the radiation is very inhomogeneous. In the PODIUM (Personal Online Dosimetry Using Computational Methods) project, in which this study is immersed, was developed the Monte Carlo code PENELOPE / PenEasy_ . The analysis of the extracted data allows to check which parameters influence the dose that reaches the medical staff and compare them in different conditions. Moreover, this study intends to determine not only the influence of the basic parameters of the X-ray systems used for interventional radiology but specially the impact of the anthropometric data of patients. Tube voltage is the most influencing parameter followed by the added filtration and angulations of the C-arm. Thoracic and abdominal thickness and width of the patient are both good predictors to determine operator’s dose. Although this study has been made for female phantoms, results can be applied for male patients.

Introduction: Interventional procedures are associated with potentially high radiation doses to the skin. The 2013/59/EURATOM Directive establishes that the equipment used for interventional radiology must have a device or a feature informing the practitioner of relevant parameters for assessing patient dose at the end of the procedure. Monte Carlo codes of radiation transport are considered to be one of the most reliable tools available to assess doses. However, they are usually too time consuming for use in clinical practice. This work presents the validation of the fast Monte Carlo code MC-GPU for application in interventional radiology. Methodologies: MC-GPU calculations were compared against the well-validated Monte Carlo simulation code PENELOPE/penEasy by simulating the organ dose distribution in a voxelized anthropomorphic phantom. In a second phase, the code was compared against thermoluminescent measurements performed on slab phantoms, both in a calibration laboratory and at a hospital. Results: The results obtained from the two simulation codes show very good agreement, differences in the output were within 1%, whereas the calculation time on the MC-GPU was 2500 times shorter. Comparison with measurements is of the order of 10%, within the associated uncertainty. Conclusions: It has been verified that MC-GPU provides good estimates of the dose when compared to PENELOPE program. It is also shown that it presents very good performance when assessing organ doses in very short times, less than one minute, in real clinical set-ups. Future steps would be to simulate complex procedures with several projections., Peer Reviewed, Objectius de Desenvolupament Sostenible::3 - Salut i Benestar, Postprint (published version)