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Purpose In order to monitor the quality and standardization of imaging reports and procedures, as well as fulfill JC and CMS requirements for peer review, our department has developed a web-based information-technology system that facilitates and tracks conferences for report review and evaluation. The purpose of this study was to analyze the data obtained by this system to describe the frequency and the type of disagreements encountered. Materials and Methods Grapevine is a web-based group peer review system integrated into the hospital Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) to allow for ease of use and monitoring of compliance. Approximately 12 reports, randomly selected by Grapevine, were reviewed in two system-facilitated conferences per week over a 1-year period. The frequency and the type of disagreements identified by group peer review using Grapevine was examined. Results A total of 539 diagnostic and interventional vascular studies underwent group peer review over the study time period. 16 (3%) disagreements requiring attention were identified through group review and logged using the Grapevine interface; 7 were ultrasound cases (44%), 6 were CT cases (37.5%), 2 were procedures (12.5%) and 1 was MR (6.25%). Of all the disagreements identified by the group, 4 reports were addended (25%) in response to the reviewers’ concerns. Conclusion Grapevine is an easy to use integrated web-based group peer review system that can improve peer review compliance and track report disagreements. The majority of the reports were deemed acceptable by the group, with disagreements mostly related to interpretation of vascular imaging.

eTACE procedure. Results: 128 patients underwent eTACE over the defined 3 year period. Of these, 39 patients did not have subsequent imaging. The remaining 89 patients included in the study received 1-3 eTACE treatments. 7 of the 89 patients (8%) had findings consistent with arteritis on subsequent angiography. From a practical standpoint the side effect of arteritis can markedly limit the ability of superselective access on subsequent TACE procedures. In this study 5 of the 7 positive cases (71%) involved lobar or segmental vasculature proximal to the previously treated tumor site, potentially limiting the options for repeat TACE to that location. Conclusion: Given the paucity of data available on arteritis complications from TACE using a particular chemotherapeutic agent, assessing statistical significance on this finding is difficult. A comparison with the limited available data suggests that an 8% incidence of arteritis is quite high, with other studies providing incidences as low as 2%(1). Further studies comparing the incidence of arteritis complications from eTACE vs TACE with other agents is warranted and currently underway at this institution.

Purpose To assess the clinical effectiveness of angiography and transcatheter intervention in patients with gastrointestinal (GI) bleeding Materials and Methods Clinical records of 76 patients who underwent angiography and embolization for gastrointestinal bleeding were reviewed after obtaining IRB approval. Patient demographics, history, angiographic findings, treatment and outcomes were recorded. The technical success, 24hr and 30day rebleeding and mortality rates were calculated. Multivariate analyses were performed to assess the factors associated with 24hr and 30day rebleeding. Results There were 53 men and 23 women with a mean age of 66 years. 22 patients (29%) underwent endoscopy prior to angiography. All endoscopies were positive: 15/22 (68%) patients with upper GI bleeding and 7/22 (32%) of patients with lower GI bleeding. Tc 99m labeled RBC scan, available in 7 (10%), was positive for bleeding in 6 (85%). Patients received blood transfusions (n=47, 62%) and vasoconstrictors (n=12, 16%) prior to angiography. Positive angiographic findings were seen in 58 (active contrast extravasation in 43 (56.5%), and pseudoaneurysm in 15 (20%). Angiography was negative for GI bleeding in 18. Embolization was performed in 75 (99%). This included empiric embolization in 17. The agents used were coils (n=35, 46%), gel foam (n=12, 16%), microparticles (n=14, 18%), glue (n=1, 1%) or a combination of these (n=13, 17%). Embolization was technically successful in 74 (98.6%). 24 hr and 30 day rebleeding rates were 11 (14.5%) and 14 (18.5%) respectively. Of the 11 who had 24 hr rebleeding, 7 required surgery and two had successful repeat embolization. Of the 14 who had rebleeding at 30 days, 5 required surgery, 5 underwent successful repeat embolization. 24 hr and 30 day mortality rates were 7 (9%) and 7 (9%) respectively. Ischemic complications following embolization were seen in 3 (4%) of which two required surgery. Prior GI bleeding was an independent variable associated with 30 day rebleeding. Conclusion Angiographic intervention has high technical success and acceptable clinical success with minimal complications for patients presenting with GI bleeding. Repeat intervention may increase overall clinical success.

Purpose The purpose of this study was to determine the feasibility and the impact of using QatchAll to identify the frequency and type of technical issues reported in the Division of Vascular Imaging and Intervention at our institution. Materials and Methods To assess, document and improve the technical quality of imaging studies and image guided interventions, our department has developed a novel information technology system called QatchAll embedded into our current workflow to report and track technical issues. The QatchAll database was reviewed August 2011 to September 2012 time period for technical issues reported by radiologists in the Division of Vascular Imaging and Intervention. The frequency and the types of quality issues reported were examined. As a measure of improvement in the quality of care achieved through the use of QatchAll, the frequency of quality issues over the time period of the study was also assessed. Results 130 quality events were reported using the QatchAll interface integrated into the hospital Picture Archiving and Communication System (PACS) by 13 Vascular and Interventional Radiologists. 16% of the reports involved CT, 49% US, 16% MR, and 19% Procedures. During the study period, the average number of quality issues raised by the radiologists per month decreased in the second half of the study period (7.6 events) as compared to the first half (13 events). As a result of such reporting, there was increased frequency of communication between technologists and the radiologists, immediate correction of errors and a significant decrease in the number of call-backs for repeat examinations. Conclusion Monitoring and improving quality in interventional radiology is greatly assisted by the QatchAll reporting tool embedded into the daily workflow. Utilizing QatchAll allows for better communication between technologists and radiologists with overall improvement in the quality of imaging studies.