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Under-awareness of Interventional Radiology (IR) care by the public has been reported. The aim of this study is to evaluate the impact of educational videos to facilitate better patient understanding during the informed consent process. Educational videos for six common IR procedures including chemoembolization, radioembolization, ablation, tunneled central venous catheter placement, port placement, and port removal were developed for educating patients in the pre-procedural setting. One hundred and eighty patients referred to a tertiary academic institution were randomly selected to participate, including 30 patients per procedure type. Anonymous seven question, five-point Likert-scale assessments were administered to the participants before and after engaging with the videos. The survey evaluated patients' perceived understanding of IR procedures and satisfaction with the videos as educational tools. One hundred and eighty patients completed the survey. Comparing post-video to pre-video ratings, there was an increase in patients' understanding of the involved anatomy (4.5 vs 3.3; p < 0.01), understanding of procedure benefits (4.6 vs 3.7; p < 0.01), understanding of procedural risks (4.5 vs 3.3; p < 0.01), understanding of procedural alternatives (3.4 vs 2.7; p < 0.01), and overall procedural understanding (4.7 vs 3.4; p < 0.01). Additionally, patients had a positive impression of the videos with a mean overall satisfaction rating of the video-assisted explanation of 4.80. A patient-centric video-assisted informed consent for IR procedures enhances patients' understanding and results in high patient satisfaction. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the online presence of interventional radiology (IR), and its popularity over time and location, given the reported under-awareness of the specialty. The study analyzed search volumes, searcher demographics, and query type related to IR and its four most searched procedures using Google Trends, Demographics.io, and Also Asked. Search strategies were stratified by volume and region ("Worldwide" and "United States"), and the quality of current patient materials in the first 10 Google search results was analyzed using the DISCERN instrument and Flesch Kincaid levels. The analyzed search trends demonstrated a slow uptrend in search volume over the past 15 years since 2013, with a CAGR rate of 0.6%. Demographics revealed that 80.9% of searchers were female and over half (51.8%) fell into the age range of 35–54 years old. Geographically, the US had the highest search volume (100) for the term "interventional radiology" and website search results mainly related to patient education about the specialty. The quality of online resources was poor with overall college-level readability, and "What is Interventional Radiology?" was the most popular query. There is a growing interest in IR procedures in recent years, particularly in the US, with middle-aged females being the most active demographic online. However, online resources containing information on specific IR procedures remain of poor quality. Actions should be taken to improve the quality, accessibility, and awareness of IR-related webpages to increase public knowledge of IR care in the US and abroad. • There is a growing interest in interventional radiology (IR) procedures in recent years. • Online resources containing information on IR procedures remain of poor quality. • Efforts should be taken to improve the quality and awareness of IR-related web pages. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common benign tumor in women of reproductive age and can present with symptoms including bleeding, bulk related symptoms, and infertility. Several treatment options are available for the management of uterine fibroids, including medical management, minimally invasive therapies such as uterine artery embolization and MR-guided focused ultrasound ablation, and surgical interventions ranging from laparoscopic myomectomy to open hysterectomy. Given this wide range of therapeutic interventions, it is important to understand the data supporting these interventions and to be able to apply it in different clinical settings. This document provides a summary of recent trials supporting various therapies for uterine fibroids, including recent evidence for MR-guided focused ultrasound ablation and a detailed discussion of fertility outcomes in myomectomy and uterine fibroid embolization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

To examine the clinical outcomes of yttrium-90 (Y90) transarterial radioembolization (TARE) for primary hepatocellular carcinoma (HCC) through the evaluation of a 5-year institutional experience. This retrospective study evaluated 88 consecutive patients with primary HCC receiving Y90 TARE treatment at an academic medical center from 2017 to 2021. Disease distribution was bilobar in 60.2% of patients with an average lesion diameter of 5.0 ± 3.4 cm and Barcelona Clinic Liver Cancer stage B or C in 77% of the participants. Clinical outcomes were elucidated by examination of complications, liver function tests, biochemical response, and radiographic response. Objective response ratio (ORR) and progression-free survival (PFS) were also calculated. The mean administered Y90 radiation dose was 127.8 ± 20.2 Gy. No significant complications or LFT elevations occurred post-therapy. Of the 73.9% of patients with α-fetoprotein-producing tumors, 67.8% experienced a complete or partial biochemical response 1 month post-treatment. The ORR was 83.3% on 6-month imaging and PFS was 9.6 ± 8.5 months. Functional outcomes (Eastern Cooperative Oncology Group) were maintained or improved in 79.6% and 76.1% of patients by 6 months and 1 year post-treatment, respectively. The mean survival was 14.7 ± 12.1 months. At 6 months post-treatment, 77.3% of patients were downstaged to or maintained Milan criteria, which was sustained for 74.4% and 70.0% of patients 1 year and 2 years after treatment, respectively. Y90-TARE is a safe and effective therapy for primary HCC. Enduring outcomes further act as a realistic bridge to liver transplantation, with a majority of patients maintaining Milan criteria and preserving their functional status long term. [ABSTRACT FROM AUTHOR]

To evaluate wellness among interventional radiologists using a multidimensional survey. An anonymous 53-item survey, including 36 Perceived Wellness Survey (PWS) prompts, was created in Qualtrics (an online survey tool) to assess wellness among interventional radiology attendings and residents. The survey was open from June to September, 2022, 2 years into the COVID-19 Pandemic. The survey was distributed via Society of Interventional Radiology Forums, social media (Twitter, LinkedIn, and Facebook), and personal correspondence. PWS scores were categorized into Wellness Composite and subscores (physical, emotional, intellectual, psychological, social, and spiritual). 367 surveys were completed. 300 (81.7%) respondents were male and 67 (18.3%) were female. Respondents included attending physicians (297; 81.0%) and residents (70; 19.0%). Practice settings included academic (174; 47.4%), private (114; 31.0%), private-academic hybrid (62; 16.9%), and others (17; 4.7%). Mean Wellness Composite at academic centers (14.74 ± 3.16; range: 5.42–23.50) was significantly lower than at private (15.22 ± 3.37; range: 6.13–23.51) and hybrid (16.14 ± 2.47; range: 10.20–23.50) practices (p = 0.01). Respondents < 40 years old had significantly lower emotional wellness subscores compared to those ≥ 40 years old (4.34 ± 0.86 vs. 4.60 ± 0.87; p = 0.006). There were no significant differences between geographic regions in the United States, however, International respondents had significantly lower social and intellectual wellness (INT) subscores. Physical wellness subscore (4.00 ± 0.9) was significantly lower than the other subscores (4.59 ± 0.81) (p <.001). Overall mean Wellness Composite was 15.11 ± 3.13 (range: 5.42–23.51). Overall self-reported wellness was lower among interventional radiologists practicing at academic centers. Interventional Radiologists < 40 years old and residents had lower emotional wellness, while international respondents had lower social and INT. Overall wellness scores were lower than prior PWS studies. [ABSTRACT FROM AUTHOR]

To evaluate moral injury (MI) among interventional radiologists using validated assessment tools. An anonymous 29-question online survey was distributed to interventional radiologists using the Society of Interventional Radiology Connect Open Forum website, Twitter, Facebook, LinkedIn, and electronic mail. The survey consisted of demographic and practice environment questions, a global quality of life (QoL) scale (scored 1–100), the MI Symptom Scale‑Healthcare Professional (MISS-HP) (scored 1–100), and two open-ended questions. A MISS-HP score ≥ 36 was indicative of experiencing MI. P <.05 was considered statistically significant for all two-sided tests. Beginning on March 30, 2023, 365 surveys were completed over 5 days. Of the respondents, 299 (81.9%) were male, 65 (17.8%) were female, and one preferred not to disclose gender. The respondents included practicing interventional radiologists (299; 81.9%) and interventional radiologists-in-training (66; 18.1%). Practice settings included academic (146; 40.0%), community (121; 33.2%), hybrid (84; 23.0%), or other (14; 3.8%) centers. Mean QoL was 71.1 ± 17.0 (range: 0–100) suggestive of "good" QoL. Mean QoL in the MI subgroup was significantly different from that for the rest of the group (67.6 ± 17.0 vs. 76.6 ± 16.0; P < 0.05). 223 (61.1%) respondents scored ≥ 36 on the MISS-HP, and thus were categorized as having profession-related MI. Mean MISS-HP was 39.9 ± 12.6 (range: 10–83). Mean MISS-HP in the MI subgroup was significantly different from that for the rest of the group (47.4 ± 9.6 vs. 28.0 ± 5.7; P < 0.05). There was a negative correlation between MI and QoL (r = −0.4; P < 0.001). Most common themes for greatest contribution to MI were ineffective leadership, barriers to patient care, corporatization of medicine, non-physician administration, performing futile procedures, turf battles, and reduced resources. Most common themes for ways to reduce MI were more autonomy, less bureaucracy, more administrative support, physician-directed leadership, adequate staffing, changes to the medical system, physician unionization, transparency with insurance companies, more time off, and leaving medicine/retirement. MI is prevalent among interventional radiologists, and it negatively correlates with QoL. Future work should investigate causative factors and mitigating solutions. [ABSTRACT FROM AUTHOR]

Medicolegal challenges in radiology are broad and impact both radiologists and patients. Radiologists may be affected directly by malpractice litigation or indirectly due to defensive imaging ordering practices. Patients also could be harmed physically, emotionally, or financially by unnecessary tests or procedures. As technology advances, the incorporation of artificial intelligence into medicine will bring with it new medicolegal challenges and opportunities. This article reviews the current and emerging direct and indirect effects of medical malpractice on radiologists and summarizes evidence-based solutions. [ABSTRACT FROM AUTHOR]

Quality improvement (QI) initiatives have benefited patients as well as the broader practice of medicine. Large-scale QI has been facilitated by multi-institutional data registries, many of which were formed out of national or international medical society initiatives. With broad participation, QI registries have provided benefits that include but are not limited to establishing treatment guidelines, facilitating research related to uncommon procedures and conditions, and demonstrating the fiscal and clinical value of procedures for both medical providers and health systems. Because of the benefits offered by these databases, Society of Interventional Radiology (SIR) and SIR Foundation have committed to the development of an interventional radiology (IR) clinical data registry known as VIRTEX. A large IR database with participation from a multitude of practice environments has the potential to have a significant positive impact on the specialty through data-driven advances in patient safety and outcomes, clinical research, and reimbursement. This article reviews the current landscape of societal QI programs, presents a vision for a large-scale IR clinical data registry supported by SIR, and discusses the anticipated results that such a framework can produce. [Display omitted] [ABSTRACT FROM AUTHOR]

To evaluate single-institution outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) in the treatment of locally advanced neuroendocrine tumor (NET) hepatic metastases with a focus on safety and efficacy of treatment. A single-center retrospective cohort study of the outcomes of consecutive patients with NELM who underwent DEB-TACE between 2014 and 2019 was performed. Clinicopathologic characteristics, radiologic response (modified Response Evaluation Criteria in Solid Tumors) at 1-month follow-up, adverse events, progression-free survival (PFS), and overall survival were calculated. Among 287 patients (mean age of 62 years; 39% male: 61% female), disease burden was bilobar (90.2%) with mean largest tumor diameter measuring 4.9 ± 2.8 cm. Of these patients, 14.6% had no evidence of tumor in other organs or lymph nodes. Complete response occurred in 60 (20.9%) patients while 133 (46.3%) had partial responses. Major complication occurred in 2.4%. Liver function tests including total bilirubin and AST were overall stable at the 1-month follow-up, with only a small increase in the ALT at +8.9% (p < 0.01). Overall survival was 80.1% at 1 year, 49.1% at 3 years, and 12.3% at 5 years with a mean PFS of 14.4 ± 12.5 months. Based on this institutional experience, DEB-TACE is an acceptable locoregional therapy choice for hepatic metastases of NET due to its tolerable safety profile and relative efficacy. [ABSTRACT FROM AUTHOR]

Protein lysine methyltransferases (PKMTs) play essential roles in gene expression regulation and cancer development. Somatic mutations in PKMTs are frequently observed in cancer cells. In biochemical experiments, we show here that the NSD1 mutations Y1971C, R2017Q, and R2017L observed mostly in solid cancers are catalytically inactive suggesting that NSD1 acts as a tumor suppressor gene in these tumors. In contrast, the frequently observed T1150A in NSD2 and its T2029A counterpart in NSD1, both observed in leukemia, are hyperactive and introduce up to three methyl groups in H3K36 in biochemical and cellular assays, while wildtype NSD2 and NSD1 only introduce up to two methyl groups. In Molecular Dynamics simulations, we determined key mechanistic and structural features controlling the product specificity of this class of enzymes. Simulations with NSD2 revealed that H3K36me3 formation is possible due to an enlarged active site pocket of T1150A and loss of direct contacts of T1150 to critical residues which regulate the product specificity of NSD2. Bioinformatic analyses of published data suggested that the generation of H3K36me3 by NSD2 T1150A could alter gene regulation by antagonizing H3K27me3 finally leading to the upregulation of oncogenes. [ABSTRACT FROM AUTHOR]

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Rationale and Objectives: Evaluate trends and demographic predictors of imaging utilization at a university-affiliated health system.Materials and Methods: In this single-institution retrospective study, per capita estimates of imaging utilization among patients active in the health system were computed by cross-referencing all clinical encounters (2004-2016) for 1,628,980 unique patients with a listing of 6,157,303 diagnostic radiology encounters. Time trends in imaging utilization and effects of gender, race/ethnicity, and age were assessed, with subgroup analyses performed by imaging modality. Utilization was analyzed as both a continuous and binary outcome variable.Results: Over 13 years, total diagnostic exams rose 6.8% a year (285,947-622,196 exams per annum), while the active population size grew 7.0% a year (244,238-543,290 active patients per annum). Per capita utilization peaked in 2007 at 1.33 studies/patient/year before dropping to 1.06 from 2011 to 2015. Latest per capita utilization was 0.22 for computed tomography, 0.10 for MR, 0.20 for US, 0.03 for NM, 0.51 for radiography, and 0.07 for mammography. Over the study period, ultrasound utilization doubled, whereas NM and radiography utilization decreased. computed tomography, MR, and mammography showed no significant net change. Univariate analysis of utilization as a continuous variable showed statistically significant effects of gender, race/ethnicity, and age (P < 0.0001), with utilization higher in males and Blacks and lower in Asian/Pacific Islanders and Hispanics. Utilization increased with age, except for a decline after age 75. Many of the effects of age, gender, and race/ethnicity were also found when analyzing the binarized utilization variable.Conclusions: Although absolute counts of imaging studies more than doubled, the net change in per capita utilization over the study period was minimal. Variations in utilization across age, gender, and race/ethnicity may reflect differential health needs and/or access disparities, warranting future studies. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: There is a gap in current medical student education pertaining to procedural skills' exposure and acquisition. The aim of this study is to evaluate the institutional experience of a novel medical student procedural course and its impact on procedural confidence.Materials and Methods: This is a single-center prospective study performed at a public medical school and its associated tertiary care medical center between June 2020 and January 2021. This study was deemed exempt by our Institutional Review Board and was performed with participant consent. The multimodal course developed by the radiology department consisted of four didactic lectures, four simulation sessions, and a minimum of 16 clinical rotation hours with the department's vascular access team. Primary outcomes were assessed by comparing participant pre and post course surveys including twenty-five 5-point Likert scaled questions.Results: Twenty-five self-selected students completed the course in its entirety. The curriculum and the corresponding survey analysis were stratified into sections by procedure modality. An increase in participant confidence to a moderate or greater level was observed when comparing pre and post course survey data for each procedure: vascular access (4% vs 52%, p < 0.01), thoracentesis (8% vs 48%, p < 0.01), paracentesis (8% vs 72%, p < 0.01), lumbar puncture (4% vs 44%, p < 0.01), and bone marrow biopsy (0% vs 48%, p < 0.01).Conclusions: The creation of a medical-student-centric procedural course is feasible and fills a potential gap in undergraduate medical education. This study demonstrated that a comprehensive multimodal course, designed to include didactic, simulation and clinical experiences, increases participant exposure to, participation with, and confidence in bedside procedural performance abilities. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of a lecture series in increasing awareness and knowledge about common interventional radiology (IR) procedures amongst emergency medicine and internal medicine residents at a tertiary care academic medical center.A series of two 60-minute lectures was presented at both the Emergency and Internal Medicine weekly didactic conferences for the respective residency programs. The lectures covered the indications, contraindications, imaging, pre-procedure preparation, complications, and follow-up of common IR procedures, including both didactics as well as interactive question and answer segments. The first lecture included central venous access, IVC filters, and image-guided biopsies, and the second lecture covered biliary interventions, genitourinary interventions, and vascular embolization. Pre/post lecture assessments were given evaluating participant knowledge, and paired one-tailed t-tests were elucidated for evaluating differences in the mean scores.A total of 77 emergency and internal medicine resident physicians participated in assessments of the lecture series. There were significantly increased scores (P<0.001) after both of the lectures (36% to 82% on the first lecture and 44% to 65% on the second lecture), suggesting increased knowledge of the common IR procedures discussed in the lecture.This work demonstrated that educational initiatives such as lecture series implementation are effective methods to increase knowledge of common IR procedures and raise awareness of the specialty among referring providers. [ABSTRACT FROM AUTHOR]

The combination of immunotherapy and radiotherapy/chemoradiation has demonstrated promising results in some disease sites for cancer patients. However, translation to real-world practice is complicated by limited representation in clinical trials of older adults with comorbidities who comprise a significant percentage of patients treated in the clinic. The purpose of this review is to outline the current evidence for multimodality treatment in the older adult population including extrapolation from single modality therapies and the rationale for combinatorial treatment. Although few in number, ongoing trials specifically targeting older cancer patients are highlighted. Looking toward the future, current gaps in the field are identified with recommendations to consider both in the preclinical setting and when designing clinical trials in order to better inform the use of multimodality therapy in the clinic as this data evolves. [ABSTRACT FROM AUTHOR]

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Purpose: To assess the prevalence of positive conflicts of interest (COI) disclosures in United States-based interventional radiology (IR) research as well as the level of agreement between disclosed financial relationships and Open Payment Data for top-cited image-guided procedure research.Materials and Methods: All publications in volume 30 (2019) of the Journal of Vascular and Interventional Radiology (JVIR) were reviewed to estimate the prevalence of COI disclosures in IR research. Publications were categorized as primary research, systematic review, or other. The prevalence was subsequently compared across JVIR publication subtypes and categories and on the basis of whether they were device-focused publications using χ2 tests. Additionally, the Web of Science database was searched for the top 10 most cited studies of 10 common image-guided procedures with available U.S. physician payment data. The payments were categorized as historical (>1 year prior to publication) or active (<1 year prior to publication) and compared with the disclosed financial COIs using 1-way analysis of variance.Results: Positive COI disclosures were present in 114 (29%) of the 397 publications in JVIR volume 30. Positive COI disclosures were most prevalent in standards of practice (50%, P = .01) and more prevalent in device-focused publications (54% vs 23%, P < .01). Among the 396 authors of 100 United States-based top-cited image-guided procedure publications, 383 (97%) failed to disclose at least 1 active financial relationship, with an average of $57,937 in undisclosed payments per publication.Conclusions: COI are prevalent in IR, similar to other areas of healthcare research, and COI in top-cited image-guided procedure research are often underreported. [ABSTRACT FROM AUTHOR]

Purpose: To report the impact of the coronavirus disease 2019 (COVID-19) pandemic on interventional radiology (IR).Materials and Methods: A 78-question survey was distributed to practicing interventional radiologists and IR trainees. The survey consisted of demographic and practice environment queries. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) screener, and coping strategies were assessed using the Brief-Coping Orientation to Problems Experienced (Brief-COPE) questionnaire.Results: There were 422 respondents including 333 (78.9%) attending interventional radiologists and 89 (21.1%) interventional radiologists-in-training from 15 counties. Most respondents were from academic medical centers (n = 218; 51.7%). A large majority (n = 391; 92.7%) performed a procedure on a patient with confirmed COVID-19 infection. An N95 mask was the most common (n = 366; 93.6%) safety measure employed. Cancellation or limitation of elective procedures were reported by 276 (65.4%) respondents. Many respondents (n = 177; 41.9%) had self-reported anxiety (GAD-7 score >5) with an overall mean GAD-7 score of 4.64 ± 4.63 (range: 0-21). Factors associated with reporting anxiety included female gender (p = 0.045), increased call coverage (p = 0.048), lack of adequate departmental adjustments (p <0.0001), and lack of adjustments in a timely manner (p <0.0001). The most utilized coping strategy was acceptance (mean of 5.49 ± 1.88), while the most employed dysfunctional coping strategy was self-distraction (mean of 4.16 ± 1.67). The odds of reporting anxiety increased by >125% with adoption of dysfunctional strategies.Conclusion: The COVID-19 pandemic induced practice alterations and high rates of self-reported anxiety in IR. Female gender, increased call coverage, and lack of adequate or timely departmental adjustments were associated with increased anxiety levels. [ABSTRACT FROM AUTHOR]

Objectives: To analyze current interventional radiology residency program websites based on validated criteria and highlight areas for improvement during the COVID-19 pandemic.Materials and Methods: ACGME-accredited interventional radiology residency programs were identified from the Society of Interventional Radiology (SIR) public database, including 91 independent and 89 integrated programs. Program Webpages were then evaluated during September and October 2020 based on the presence of 48 criteria, organized into seven main categories including visibility & communication, program information, curriculum information, faculty description, research, recruitment, and salary and benefits. Programs were also evaluated based on region and research ranking. Additionally, 166 programs with accreditation for Early Specialization in Interventional Radiology (ESIR) were assessed for the presence or absence of ESIR pathway acknowledgement on program webpages.Results: The online search yielded information on all integrated programs (89/89, 100%) and 74 independent programs (74/91, 80.3%). For the ESIR programs, the online search for accreditation acknowledgement yielded 108 programs (108/166, 65%) approved for this pathway. Only seven of the 89 integrated programs met at least 75% of the criteria. Of the 91 independent programs, only one met at least 75% of the criteria. On average, integrated programs met more criteria (25, 52%) than independent programs (17, 36%). When comparing programs based on national rank, the visibility & communication category met more criteria on average than the lower ranked programs (integrated =73% vs. 64%, p = 0.01), (independent = 73% vs. 45%, p = 0.01). When comparing programs regionally, statistical significance was found only in the research category (p = 0.01). When comparing the integrated programs with the independent programs for averages in the 7 categories and the total criteria, statistical significance was found in all categories except facility description: visibility & communication (67.5% vs. 53. 7%, p = 0.01), program information (75.7% vs. 58%, p = 0.01), curriculum information (54.8% vs. 31.4, p = 0.01), research (42.5% vs. 27.5%, p = 0.01), recruitment (42.6% vs. 26.8%, p = 0.01), salary & benefits (47.8% vs. 26.8%, p = 0.01), and total criteria (52% vs. 35.8%, p = 0.01.Conclusion: IR residency programs across the country are proficient in providing curricular, and logistical information online. However, improvement is needed in providing nonacademic highlights unique to programs that can aid in maximizing applicant match and compatibility. The information provided by online resources has the potential to influence residency applicant's program ranking and chosen pathway, particularly during the COVID19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate national trends in tube-related genitourinary interventions, with specific attention to primary operator specialty.Methods: Using a 5% national sample of Medicare claims data from 2005 to 2015, all claims associated with nephrostomy tube, nephro-ureteral tube, and ureteral stent placement and exchange were identified. The annual volume of the nine billable procedures were analyzed to evaluate trends in the number of procedures performed and primary operator specialty over time. The Charleston Comorbidity Index (CCI) was used to evaluate patient comorbidities and to determine differences in patient populations treated by interventional radiologists and urologists.Results: The total volume of tube-related genitourinary interventions has increased over the course of the study period, representing 455.0 services per 100,000 Medicare Fee-for-Service beneficiaries in 2005 to 607.2 services in 2015, an increase of 33.4%. Interventional radiologists performed the majority of all procedures in all procedure types and for each year (>90%) with the exception of nephro-ureteral catheter placement or ureteral stent placement, for which urologists performed the overwhelming majority of procedures each year (>85%). Interventional radiologists performed 63% of their total number of procedures on patients with a CCI = 3 or higher, and urologists performed 42% of their total number of procedures on patients with a CCI = 3 or higher (P < .01).Conclusion: Tube-related genitourinary interventions have demonstrated persistent growth over the 2005 to 2015 decade. Interventional radiologists are the dominant providers for the majority of these interventions compared with urologists while delivering care to a patient population with a higher number of comorbidities. [ABSTRACT FROM AUTHOR]

Palbociclib is a widely used treatment for advanced breast cancer in older adults. However, the existing evidence regarding its safety and tolerability in this age group is inconsistent and limited to retrospective subgroup or pooled analyses. We conducted a prospective single-arm multicenter phase 2 study to evaluate the safety and tolerability of palbociclib in participants aged 70 years or older with advanced hormone receptor-positive breast cancer. Participants were given palbociclib in combination with their physician's choice of endocrine therapy (letrozole or fulvestrant). The primary endpoint was the incidence of grade 3+ adverse events (AEs) by six months. Secondary endpoints included AE-related dose delays, dose reductions, early discontinuations, and hospitalizations. Additionally, we compared these endpoints by age groups (70–74 and ≥ 75 years). Of the 90 participants (median age 74 years [70–87]) enrolled, 75.6% (95% confidence interval [CI], 65.4–84.0) had grade 3+ AEs by six months. The most frequent grade 3+ AEs were neutropenia (61%), fatigue (4%), and nausea (3%). Febrile neutropenia was uncommon (1.1%). Due to AEs, 36% had dose delays, 34% had dose reductions, 10% had early discontinuations, and 10% had hospitalizations. Compared to those aged 70–74 years, participants aged ≥75 years had higher rates of early discontinuations (5.9% vs 15.9%, a difference of 9.5% [95% CI 3.5%–22.5%]). Palbociclib has an overall favorable safety profile in adults aged ≥70 with advanced breast cancer. However, adults ≥75 years had a trend toward higher rates of AE-related early discontinuations compared to those 70–74 years. Further research is needed to evaluate tolerability and improve the delivery of palbociclib in older adults. ClinicalTrials.gov : NCT03633331 [ABSTRACT FROM AUTHOR]

The tolerability and efficacy of targeted therapy in older adults with cancer has not been adequately studied. Neratinib is a novel HER1, HER2, HER4 tyrosine kinase inhibitor that has recently been granted FDA approval for treatment of breast cancer. The major toxicity of neratinib is diarrhea, which affects up to 90% of patients. This phase II trial evaluates the safety and tolerability of neratinib in adults ≥60. Patients aged 60 or older with histologically proven metastatic breast cancer and HER2 amplification (defined by ASCO/CAP guideline) or HER2/HER3 activating mutation were enrolled to receive neratinib at 240 mg daily in 28-day cycles. The association between tolerability, defined as dose reduction and number of completed courses, and log 2 Cancer and Aging Research Group (CARG) toxicity risk score was assessed using a Student's t -test and linear regression, respectively. Response rate, progression free survival, and overall survival were also evaluated. 25 patients were enrolled with median age of 66 (range 60–79). Seventy-six percent of patients were white, 16% Asian, and 8% African-American. Seventy-six percent were patients with hormone receptor (HR) positive metastatic breast cancer (MBC) and 24% were patients with HR negative MBC. Median number of prior lines of metastatic therapy were 3 (range 0–11). 20/25 (80%) had worst grade toxicities ≥2. A total of 9/25 (36%) had grade 3 toxicities including 5/20 (20%) diarrhea, 2/20 (8%) vomiting, and 2/20 (8%) abdominal pain. There were no grade 4 or 5 toxicities. A total of 9/25 (36%) had dose reduction, and 2/25 (8%) discontinued therapy due to toxicity. The association between dose reductions and CARG toxicity score reached borderline statistical significance suggesting a trend with participants with higher CARG toxicity risk scores being more likely to require a dose modification (p = 0.054). 1/25 (4%) had a partial response, 11/25 (44%) had stable disease, 12/25 (48%) had progression of disease, and 1/25 (4%) was not assessed. Median progression free survival (PFS) was 2.6 months (95% CI [2.56–5.26]), and median overall survival (OS) was 17.4 months (95% CI [10.3, NA]). Neratinib was safe in this population of older adults with HER2 amplified or HER2/3 mutated metastatic breast cancer (BC). Higher CARG toxicity risk score may be associated with greater need for dose adjustments. Future studies are needed to confirm this finding. [ABSTRACT FROM AUTHOR]

Twitter is an increasingly popular social media platform within the health care community. The objective of this analysis is to characterize the profile of radiation oncology–related tweets and Twitter users over the past 6 years. Using the web-based social media analytics platform Symplur Signals, we filtered tweets containing at least 1 of the following hashtags or key words: #radonc, #radiationoncology, "rad onc," or "radiation oncology." We evaluated radiation oncology–related Twitter activity between October 2014 and March 2020 for tweet frequency, tweet content, and individuals or groups posting tweets. We identified the most influential Twitter users contributing to radiation oncology–related tweets. From 2014 to 2020, the quarterly volume of radiation oncology–related tweets increased from 5027 to 29,763. Physicians contributed the largest growth in tweet volume. Academic radiation oncologists comprise 60% of the most influential Twitter accounts responsible for radiation oncology–related content. The number of radiation-oncology resident physicians on Twitter increased from 25 to 328 over the past 6 years, and 20% of radiation-oncology residency programs have a Twitter account. Seventy-one percent of radiation oncology–related tweets generated direct communication via mentions, and 59% of tweets contain links to external sources, including scientific articles. The number of physicians contributing radiation oncology–related Twitter content has increased significantly in recent years. Academic radiation oncologists are the primary influencers of radiation oncology–related Twitter activity. Twitter is used by radiation oncologists to both professionally network and discuss findings related to the field. There remains the opportunity for radiation oncologists to broaden their audience on Twitter to encompass a more diverse community, including patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the #Radiology conversation on Twitter social media platform during the COVID-19 pandemic.Materials and Methods: From February 1 to December 31, 2020, all tweets with a #Radiology hashtag were identified using the healthcare social media analytics tool, Symplur Signals. Data collected included number of tweets, retweets, impressions, links, and user characteristics. Data were stratified by the presence of a COVID-19-related keyword, and a social media network analysis was further performed.Results: Of the 68,172 tweets, 10,093 contained COVID-19 content from 2809 users generating 65,513,669 impressions. More tweets with COVID-19 content contained links than without (P < 0.01). Network analysis demonstrated most users were physicians (48.10%), authoring the most tweets (40.38%), using the most mentions (32.15%), and retweeting the most (51.45%). The most impressions, however, were by healthcare organizations not providing clinical care (20,235,547 impressions, 30.89%). Users came from 80 countries, most from the United States (29.3%) and the United Kingdom (8.69%). During early March, COVID-19 dominated the #Radiology conversation, making up 54.67% of tweets the week of March 14 and 64.74% of impressions the week of March 21 compared to 13.97% of tweets and 16.76% of impressions in the remainder of the study period (P < 0.01).There was an influx of new users to the #Radiology conversation during this time period with more users tweeting about COVID-19 than not (P < 0.01).Conclusion: Discussion of COVID-19 in the #Radiology community increased significantly during the early weeks of the pandemic. Real time sharing and collaboration proved a useful tool when rapid information dissemination was needed to manage an emerging pathogen. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The purpose of our study was to improve awareness and knowledge of the American College of Radiology Appropriateness Criteria (ACR-AC) among Emergency Medicine (EM) residents and to assess the long-term effectiveness of this ACR-AC lecture-based series.Materials and Methods: Ten lectures-based on the ACR-AC were given to EM residents at an academic medical center. Four of these lectures were subsequently repeated in the subsequent academic year. A prelecture quiz was given to all participants prior to each lecture and the same quiz was given after each lecture. Participants were instructed to select the most appropriate imaging study for each question. Results were analyzed with a 2-tailed paired sample t-test for the means.Results: A total of 28 residents from three EM resident classes participated in the lecture-based series over the course of this 2-year study. In phase I of the study, there was statistically significant improvement in mean postlecture quiz scores compared to prelecture quiz scores (55.7% vs 80.5%, P < 0.01) for each topic, as well as within each training level, (P < 0.05). In phase II, the resident class of 2018 had the only statistically significant difference between prelecture and postlecture quiz scores (59% vs 94%, P < 0.05). EM residents further demonstrated an enduring effect at 1 year with statistically significant improvement in prelecture quiz scores during phase II compared with phase I (88% vs 50%, P < 0.05).Conclusions: This work revealed that lecture-based education on the ACR-AC, relevant to EM residents, significantly increased the participant knowledge for ordering appropriate imaging. In addition, it was evident participants retained the knowledge they acquired from these lectures during phase II 1 year later. [ABSTRACT FROM AUTHOR]

Age disparities among cancer clinical trial participants are pervasive and worsening over time. Identification of factors associated with age disparities is critical to improve enrollment of older patients on trials. The incidence and impact of trial eligibility criteria that exclude patients on the basis of age remains opaque. ClinicalTrials.gov was queried for completed oncologic randomized controlled trials (RCTs). Phase 3 RCTs assessing a therapeutic intervention among adult cancer patients were included. Trial eligibility criteria were assessed using the ClinicalTrials.gov website as well as trial publications and protocol documentation. Seven hundred and forty-two trials met inclusion criteria, with a total combined enrollment of 449,720 patients. Upper age restriction enrollment criteria were identified for 10.1% of RCTs; the median age cutoff for restricted trials was 72 years (interquartile range 70–80 years). Linear regression modeling revealed decreasing incidence of age restriction criteria over time, at a rate of −1.1% annually (p =.03); trials initiating enrollment in 2002–2005, for example, had a 16.1% rate of age-restrictive eligibility criteria, compared with 7.6% for trials initiating enrollment in 2010–2014. Use of eligibility criteria that explicitly exclude patients on the basis of age appears to be decreasing with time. Future efforts should aim to better characterize the relationship between eligibility criteria (such as those that exclude patients on the basis of specific organ function) and their association with age disparities among enrolled patients. [ABSTRACT FROM AUTHOR]

Oncologists can be one of the major barriers to older adult's participation in research. Multiple studies have described academic clinicians' concerns for not enrolling older adults onto trials. Although the majority of older adults receive their cancer care in the community, few studies have examined the unique challenges that community oncologists face and how they differ from oncologist-related barriers in academia. Semi-structured interviews were conducted by telephone or face-to-face with 44 medical oncologists (24 academic-based and 20 community-based) at City of Hope from March to June 2018. Interviews explored oncologists' perceptions of barriers to clinical trial enrollment of older adults with cancer. Data were analyzed using qualitative content analysis. Of the 44 participants, 36% were women and 68% were in practice for >10 years. Among the entire sample, stringent eligibility criteria (n = 20) and oncologist concerns for treatment toxicities (n = 15) were the most commonly cited barriers. Compared to academic oncologists, community oncologists more often cited patient attitudes, beliefs, and understanding (n = 9 vs. n = 2) and caregiver burden (n = 6 vs. n = 0). In contrast, compared to community oncologists, academic oncologists more often cited oncologist bias (n = 10 vs. n = 3) and insufficient time/support (n = 4 vs. n = 1). Differences in perceptions among academic and community oncologists about trials suggest that barriers are multifaceted, complex, and vary by practice setting. Interventions to increase trial accrual among older adults with cancer may benefit from being tailored to address the unique barriers of different practice settings. [ABSTRACT FROM AUTHOR]

With the aging of the US population, the number of individuals age 65 or older who will be diagnosed with breast cancer is expected to rise. Despite this, older adults with breast cancer remain severely under-represented in cancer clinical trials. Numerous studies have highlighted disparites in care experienced by older patients with breast cancer. Dr. Arti Hurria was one of the most influential leaders in oncology to shed light on this vunerable and growing population. By uniting the fields of geriatrics and oncology, she brought together a powerful community of like-minded individuals and, through collaborative research, pioneered the current day approach and care of older patients with cancer. In this review, we highlight Dr. Hurria's contribution in breast oncology. Specifically, we describe her work on functional and cognitive effects of breast cancer therapy, shared-decision making, toxicity risk prediction, and breast cancer therapeutics. [ABSTRACT FROM AUTHOR]

Until recently, the progress in the diagnosis and management of cancer has not been matched by similar progress in the assessment of the increasing numbers of older and more complex patients with cancer. Dr. Arti Hurria identified this gap at the outset of her career, which she dedicated toward studying the geriatric assessment (GA) as an improvement over traditional methods used in oncology to assess vulnerability in older patients with cancer. This review documents the progress of the GA and its integration into oncology. First, we detail the GA's origins in the field of geriatrics. Next, we chronicle the early rise of geriatric oncology, highlighting the calls of early thought-leaders to meet the demands of the rapidly aging cancer population. We describe Dr. Hurria's early efforts toward meeting these calls though the implementation of the GA in oncology research. We then summarize some of the seminal studies constituting the evidence base supporting GA's implementation. Finally, we lay out the evolution of cancer-focused guidelines recommending the GA, concluding with future needs to advance the next steps toward more widespread implementation in routine cancer care. Throughout, we describe Dr. Hurria's vision and its execution in driving progress of the GA in oncology, from her fellowship training to her co-authored guidelines recommending GA for all older adults with cancer—published in the year of her untimely death. [ABSTRACT FROM AUTHOR]

Our goal was to identify pathogenic variants (PV) associated with germline cancer predisposition in an unselected cohort of older breast cancer survivors. Older patients with cancer may also be at higher risk for clonal hematopoiesis (CH) due to their age and chemotherapy exposure. Therefore, we also explored the prevalence of PVs suggestive of CH. We evaluated 44 older adults (65 years or older) diagnosed with breast cancer who survived at least two years after diagnosis from a prospective study, compared to healthy controls over the age of 65 (n = 36). DNA extracted from blood samples and a multi-gene panel test was used to evaluate for common hereditary cancer predisposition and CH PVs. Fisher's exact test was used to compare PV rates between groups. Eight PVs in ATM , BRCA2 (x2), PALB2 , RAD51D , BRIP1 , and MUTYH (x2) were identified in 7 of 44 individuals with breast cancer (15.9%, 95% CI: 7–30%), whereas none were identified in healthy controls (p =.01). Results remained statistically significant after removal of MUTYH carriers (p =.045). PVs indicative of CH (ATM , NBN , and PPM1D [x2]) were identified in three of 27 individuals with breast cancer who received chemotherapy and in one healthy control. Moderate-risk and later disease onset high-risk hereditary cancer predisposition PVs were statistically significantly enriched in our survivorship cohort compared to controls. Because age- and chemotherapy-related CH are more frequent in this population, care must be taken to differentiate potential CH PVs from germline cancer predisposition PVs. [ABSTRACT FROM AUTHOR]

We aimed to use diffusion tensor imaging (DTI) to detect alterations in white matter microstructure in older patients with breast cancer receiving chemotherapy. We recruited women age ≥60 years with stage I–III breast cancer (chemotherapy [CT] group; n = 19) to undergo two study assessments: at baseline and within one month after chemotherapy. Each assessment consisted of a brain magnetic resonance imaging scan with DTI and neuropsychological (NP) testing using the National Institutes of Health (NIH) Toolbox Cognition Battery. An age- and sex-matched group of healthy controls (HC, n = 14) underwent the same assessments at matched intervals. Four DTI parameters (fractional anisotropy [FA], mean diffusivity [MD], axial diffusivity [AD], and radial diffusivity [RD]) were calculated and correlated with NP testing scores. For CT group but not HCs, we detected statistically significant increases in MD and RD in the genu of the corpus callosum from time point 1 to time point 2 at p < 0.01, effect size:0.3655 and 0.3173, and 95% confidence interval: from 0.1490 to 0.5821, and from 0.1554 to 0.4792, for MD and RD respectively. AD values increased for the CT group and decreased for the HC group over time, resulting in significant between-group differences (p = 0.0056, effect size:1.0215, 95% confidence interval: from 0.2773 to 1.7657). There were no significant correlations between DTI parameters and NP scores (p > 0.05). We identified alterations in white matter microstructures in older women with breast cancer undergoing chemotherapy. These findings may potentially serve as neuroimaging biomarkers for identifying cognitive impairment in older adults with cancer. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate ultrasound-accelerated, catheter-directed thrombolysis (CDT) for treatment of acute submassive pulmonary embolism (PE).Materials and Methods: This single-center, retrospective study included patients who underwent CDT for acute submassive PE (N = 113, 52% men/48% women) from 2013 to 2017. Baseline characteristics included history of deep venous thrombosis (12%), history of PE (6%), and history of cancer (18%). Of cohort patients, 88% (n=99) had a simplified PE severity index score of ≥ 1 indicating a high risk of mortality.Results: A technical success rate of 100% was achieved with 84% of patients having bilateral catheter placements. Average tissue plasminogen activator (tPA) therapy duration was 20.7 hours ± 1.5, and median tPA dose was 21.5 mg. Three patients (2.6%) experienced minor hemorrhagic complications. Mean hospital length of stay was 6 days. Mean pulmonary arterial pressure decreased from 55 mm Hg on presentation to 37 mm Hg (P < .01) 1 day following initiation of thrombolytic therapy. All-cause mortality rate of 4% (n = 4) was noted on discharge, which increased to 6% (n = 7) at 6 months. At 6-month follow-up compared with initial presentation, symptom improvements (93%), physiologic improvements (heart rate 72 beats/min vs 106 beats/min, P < .01), oxygen requirement improvements (fraction of inspired oxygen 20% vs 28%, P < .01), and right ventricular systolic pressure improvements by echocardiography (30 mm Hg vs 47 mm Hg, P < .01) were observed.Conclusions: CDT for acute submassive PE was associated with low complications and mortality, decreased right ventricular systolic pressure, high rates of clinical improvement, and improved intermediate-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Intravascular ultrasound (IVUS) is a proven and rapidly developing imaging modality that can be used for a multitude of both diagnostic and interventional purposes. By allowing for superior intraluminal characterization, compared with angiography, IVUS has emerged as a technically valuable tool in interventional procedures such as transjugular intrahepatic portosystemic shunt/direct intrahepatic portosystemic shunt, venous interventions (May Thurner stenting, inferior vena cava filter placement, recanalization in the setting of chronic venous thrombosis/insufficiency), percutaneous fenestration in the setting of aortic dissection and angioplasty. Additional applications evaluating coronary arteries and plaque morphology have been described, but are outside the scope of this review. In addition to IVUS's merit as a pre- and intra-procedural guidance modality, there are also several advantages compared to the gold standard of angiography which include decreased need for iodinated contrast, decreased radiation exposure and decreased procedural times in certain cases. With current research, such as that aimed at supraharmonic imaging, further improvements in imaging depth, resolution and contrast to noise ratio are on the horizon. [ABSTRACT FROM AUTHOR]