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Purpose To describe interventional oncology therapies combined with immune checkpoint inhibitor (ICI) therapy targeting the programmed death 1 pathway in patients with different neoplasms. Materials and Methods This was a retrospective cohort study of patients who underwent tumor-directed thermal ablation, embolization, or selective internal radiation therapy (SIRT) between January 1, 2011, and May 1, 2019, and received anti–programmed death 1/PD-L1 agents ≤ 90 days before or ≤ 30 days after the interventional procedure. Immune-related adverse events (irAEs) and procedural complications ≤ 90 days after the procedure were graded according to the Common Terminology Criteria for Adverse Events version 5.0. The study included 65 eligible patients (49% female; age 63 years ± 11.1). The most common tumors were metastatic melanoma (n = 28) and non–small cell lung cancer (NSCLC) (n = 12). Patients underwent 78 procedures (12 patients underwent > 1 procedure), most frequently SIRT (35.9%) and cryoablation (28.2%). The most common target organs were liver (46.2%), bone (24.4%), and lung (9.0%). Most patients received ICI monotherapy with pembrolizumab (n = 30), nivolumab (n = 22), and atezolizumab (n = 6); 7 patients received ipilimumab and nivolumab. Results Seven (10.8%) patients experienced an irAE (71.4% grade 1–2), mostly affecting the skin. Median time to irAE was 33 days (interquartile range, 19–38 days). Five irAEs occurred in patients with melanoma, and no irAEs occurred in patients with NSCLC. Management required corticosteroids (n = 3) and immunotherapy discontinuation (n = 1); all irAEs resolved to grade ≤ 1. There were 4 intraprocedural and 32 postprocedural complications (77.8% grade Conclusions No unmanageable or unanticipated toxicities occurred within 90 days after interventional oncology therapies combined with ICIs.

Purpose To compare the therapeutic and renal function outcomes of radiofrequency (RF) ablation, cryoablation, and microwave (MW) ablation for treatment of T1a renal cell carcinoma (RCC). Materials and Methods A retrospective assessment of 297 patients (mean age 72 years range 24–90 years) with biopsy-proven RCC treated with image-guided percutaneous thermal ablation was performed between October 2006 and December 2016. Mean tumor size was 2.4 cm; mean radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, hilar tumor touching the main renal artery or vein, and location relative to polar lines; Preoperative Aspects and Dimensions Used for an Anatomical; and c-centrality scores were 6.0, 7.0, and 2.8, respectively. Assessments of adverse events, treatment efficacy, and therapeutic outcomes were performed among RF ablation, cryoablation, and MW ablation. The 2-year disease-free, metastatic-free, and cancer-specific survival rates were tabulated. Estimated glomerular filtration rate was used to assess for treatment related changes in renal function. Results A total of 297 T1aN0M0 biopsy-proven RCCs measuring 1.2–3.9 cm were treated with computed tomography–guided RF ablation (n = 244, 82%), cryoablation (n = 26, 9%), and MW ablation (n = 27, 9%). There were no significant differences in patient demographics among the 3 groups (P = .09). Technical success rates were similar among the 3 treatments (P = .33). Primary efficacy at 1 month postablation was more likely to be achieved with RF ablation and MW ablation than with cryoablation. At 2 years’ follow-up, there was no local recurrence, metastatic progression, or RCC-related death observed in the 3 groups. There was no significant change in estimated glomerular filtration rate among the 3 ablation groups compared with baseline at 2-year follow-up (P = .71). Conclusion RF ablation, cryoablation, and MW ablation are equivalent at 2 years for treatment of T1a RCC for therapeutic outcome, stability of renal function, and low adverse event rate.

Objective: The purpose of this article is to review tumor staging systems for gastrointestinal tumors including pancreatic adenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, gastric adenocarcinoma, small bowel adenocarcinoma, rectal carcinoma, and anal carcinoma and identify the key imaging findings (“tipping points”), which change patient management based on changes in tumor staging. Conclusion For all malignant gastrointestinal tumors, there are key imaging findings (“tipping points”) including tumor size, tumor extension, lymphadenopathy, vascular invasion, and distant metastasis that dictate patient management and prognosis, based on changes in tumor stage. In interpreting these imaging studies, radiologists should be cognizant of these “tipping points” to guide patient management.

Everyday radiologists use dictation software to compose clinical reports of imaging findings. The dictation software is tailored for medical use and to the speech pattern of each radiologist. Over the past 10 years we have used dictation software to compose academic manuscripts, correspondence letters, and texts of educational exhibits. The advantages of using voice dictation is faster composition of manuscripts. However, use of such software requires preparation. The purpose of this article is to review the steps of adapting a clinical dictation software for dictating academic manuscripts and detail the advantages and limitations of this technique.

Purpose: Our goal was to review the incidence and outcomes of cholecystostomy tube placement during the COVID pandemic as compared to matched controls. Materials and Methods: Monthly interventional radiology (IR) case volume was evaluated during the COVID pandemic through July 30, 2020, and was compared to monthly IR case volume during the same time period in 2019. A retrospective review of 40 patients who received percutaneous cholecystostomy tubes between March 2020 and July 2020 (first COVID pandemic peak in Boston, MA) was compared in a propensity matched controlled study. 14 COVID-positive patients were matched to 26 control patients who received a cholecystostomy tube. Outcomes such as positive cholecystostomy tube microbiology, pre-procedural ICU status, and death were evaluated. Results: During March to July 30, 2020, cholecystostomy tube placement constituted 0.43%, average 6 (range 2-10) cases/month of 1389 (range 672-1777) cases/month, whereas in the year prior for the same period it constituted 0.28%, 5.8 (range 4-8) cases/month of 2103 (range 1998-2146) cases/month. We find the average age was 66.5 ± 17.7 (SD) for COVID-negative and 66.0 ± 17.7 (SD) years for COVID-positive patients. Pre-procedure 19% (5/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients were intubated at the time of placement, P = 0.04. Post-procedure, 54% (14/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients had positive cholecystostomy tube fluid microbiology cultures, P = 0.82. 38% (10/26) of COVID-negative patients and 57% (8/14) of COVID-positive patients were in the ICU at the time of placement, P = 0.26. 23% (6/26) of the COVID-negative patients and 36% (5/14) of COVID-positive patients died post-procedure, P = 0.41. 15.4% (4/26) COVID-negative and 14.3% (2/14) of COVID-positive patients had any complications reported, P = 0.93. Conclusions: During the COVID-19 pandemic, we observed a relative increase in the number of cholecystostomy tube referrals despite a drop in total IR case volume. There were no significant differences in post-procedure long-term outcomes and the microbial culture results in our matched control review. Our study suggests that this perceived increase in cholecystostomy tube placements is not secondary to unique COVID pathophysiology, but rather a persistent incidence of acalculous cholecystitis in the setting of chronic ICU stays seen during the COVID pandemic. With the continuation of the pandemic, cholecystostomy tube placement incidence may increase with continued COVID patient care and chronic ICU stays for these patients.

Image-guided biopsy and ablation relies on successful identification and targeting of lesions. Currently, image-guided procedures are routinely performed under ultrasound, fluoroscopy, magnetic resonance imaging, or computed tomography (CT) guidance. However, these modalities have their limitations including inadequate visibility of the lesion, lesion or organ or patient motion, compatibility of instruments in an magnetic resonance imaging field, and, for CT and fluoroscopy cases, radiation exposure. Recent advances in technology have resulted in the development of a new generation of navigational guidance tools that can aid in targeting lesions for biopsy or ablations. These navigational guidance tools have evolved from simple hand-held trajectory guidance tools, to electronic needle visualization, to image fusion, to the development of a body global positioning system, to growth in cone-beam CT, and to ablation volume planning. These navigational systems are promising technologies that not only have the potential to improve lesion targeting (thereby increasing diagnostic yield of a biopsy or increasing success of tumor ablation) but also have the potential to decrease radiation exposure to the patient and staff, decrease procedure time, decrease the sedation requirements, and improve patient safety. The purpose of this article is to describe the challenges in current standard image-guided techniques, provide a definition and overview for these next-generation navigational devices, and describe the current limitations of these, still evolving, next-generation navigational guidance tools.

Purpose To evaluate the technique, efficacy, safety, and clinical outcomes of CT–guided microwave ablation of tumors in the hepatic dome. Materials and Methods Retrospective review was conducted of 46 consecutive patients (31 men and 15 women; mean age, 64 y) treated with CT-guided microwave ablation for hepatic-dome tumors between June 2011 and December 2014. Baseline demographics of sex, tumor diagnosis, tumor location, tumor size, and technical details were recorded. Technical success was evaluated. Treatment response was assessed per European Association for the Study of the Liver criteria. Overall success and overall survival were calculated, and complications were recorded. Results Forty-eight tumors were treated. Tumor locations included segments VIII (n = 32), VII (n = 10), and VIa (n = 6). Mean tumor size was 2.4 cm (range, 0.9–5.2 cm). Thirty-four tumors (70%) were treated following creation of artificial ascites with 0.9% normal saline solution (mean volume, 1,237 mL; range, 300–3,000 mL). The technical success rate was 100%, and the complete response rate was 94%. Overall survival rate was 73.9% over 24.7 months of follow-up. There were no major complications. Two patients experienced small, asymptomatic pneumothoraces that were aspirated at the time of the procedure and required no further treatment. Conclusions CT-guided microwave ablation of tumors in the hepatic dome is associated with a high technical success rate, high complete response rate, and low complication rate.

Recent years have seen an increase in the use of virtual and augmented reality platforms for health-care education. These have been used for teaching anatomy, simulation of emergencies, and procedural training. We review the potential roles and ongoing challenges related to implementation of this technology.

Purpose To compare the effectiveness of percutaneous abscess drainage in patients with pyogenic liver abscesses of the following types: single, single multiloculated, multiple, and multiple multiloculated. Materials and Methods One hundred nine patients with 149 liver abscesses who underwent percutaneous drainage during an 11-year period were divided into a single abscess group and a multiple abscess group. Of the 109 patients, 54 had multiloculated abscesses and were divided into single and multiple multiloculated abscess groups. Technical success was defined as the ability to place the catheter within the abscess cavity and clinical success was defined as improvement in the patient's symptoms. Clinical findings, management strategy, complication rate, and success rate were analyzed. Results Technical success rates were 96% (82 of 85) for a single abscess and 96% (23 of 24) for multiple abscesses ( P = 1.0). Clinical success was achieved in 74 of 85 patients (87%) with a single abscess and 22 of 24 patients (92%) with multiple abscesses ( P = .729). Technical success rates were 94% (32 of 34) for a single multiloculated abscess and 95% (19 of 20) for multiple multiloculated abscesses ( P = 1.0). Clinical success was achieved in 30 of 34 patients (88%) with a single multiloculated abscess and 18 of 20 patients (90%) with multiple multiloculated abscesses ( P = 1). No significant difference in hospital stay was seen between single and multiple abscess groups ( P = .373) or between single multiloculated and multiple multiloculated abscess groups ( P = .180). There were no major complications or mortality related to the procedure. Conclusions Percutaneous drainage is a safe and effective procedure in the treatment of pyogenic liver abscess, regardless of abscess complexity and/or multiplicity.

Obstructive uropathy and urosepsis constitute a medical emergency and require emergent decompression of the urinary collecting system. Image-guided percutaneous nephrostomy tube placement using ultrasound and fluoroscopy allows for decompression of the obstructed renal collecting system with minimal complications.

Purpose To describe early experience with cooled dextrose 5% in water (D5W) solution retrograde pyeloperfusion during radiofrequency (RF) ablation of renal cell carcinoma (RCC) within 1.5 cm of the ureter with respect to feasibility, safety, and incidence of residual/recurrent tumor in proximity to the cooled collecting system. Materials and Methods Between November 2004 and April 2007, 17 patients underwent 19 RF ablation sessions of RCCs within 1.5 cm of the ureter during cooled D5W pyeloperfusion (nine men, eight women; mean tumor size, 3.5 cm; mean age, 73 y; mean distance to ureter, 7 mm). RF ablation was performed with pulsed impedance control current. The records and imaging studies of patients treated with this technique were reviewed for demographics, indication, technique, complications, and tumor recurrence. Results All 19 RF ablation and ureteral catheter placement procedures were technically successful. No patient developed a ureteral stricture or hydronephrosis during a mean of 14 months of follow-up (range, 4–32 months). Three patients had residual tumor on the first follow-up imaging study, but all three tumors were completely ablated after a second RF ablation session. No complications or deaths occurred. No recurrent tumor was seen anywhere in the treated tumors, and there was complete ablation of the tumor margin in proximity to the collecting system. Conclusions RF ablation of RCC within 1.5 cm of the ureter is feasible with cooled D5W retrograde pyeloperfusion and is not associated with reduced efficacy, ureteral injury, or early recurrence.

With advances in imaging capabilities and percutaneous instruments, many urologic diseases that were once managed surgically are now managed with minimally invasive image-guided techniques. Interventional uroradiology has evolved from simple renal biopsies for diagnostic confirmation, to percutaneous management of stones, to ablation of renal and adrenal tumors. Central to this evolution is the close cooperation with the urologist and nephrologist, each of whom provides specific skill sets and knowledge that can be used to successfully manage the patient. The purpose of this article is to detail the wide range of image-guided interventional techniques, including a discussion of indications, methods, success rates, and complications.