123 results on '"Raul N. Uppot"'
Search Results
2. Microwave Ablation as Bridging Therapy for Patients with Hepatocellular Carcinoma Awaiting Liver Transplant: A Single Center Experience
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John DiCapua, Eric Wehrenberg-Klee, Ronald S. Arellano, Raul N. Uppot, Omar Zurkiya, Thomas J. An, Nicholas J. Reid, Avik Som, Rory L. Cochran, and Sanjeeva P. Kalva
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Microwave ablation ,Liver transplantation ,Milan criteria ,medicine.disease ,Single Center ,Ablation ,Surgery ,Transplantation ,Hepatocellular carcinoma ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
To determine the pathologic response of computed tomography-guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant, and its subsequent effect on survival. A single-center retrospective analysis was conducted on 62 patients (M:F = 50:12) with mean age of 59.6 years ± 7.2 months (SD). Sixty-four total MWA procedures were performed for hepatocellular carcinomas within Milan criteria as bridging therapy to subsequent orthotopic liver transplant between August 2014 and September 2018. The pathology reports of the explanted livers were reviewed to assess for residual disease. Residual disease was categorized as complete or incomplete necrosis. Patient demographics, tumor/procedural characteristics, and laboratory values were evaluated. Survival from time of ablation and time of transplantation were recorded and compared between cohorts using log rank tests. The mean tumor size was 2.4 cm ± 0.7 cm (SD), (range = 1–4.6 cm). 32 (50%) cases required hydrodissection. Histopathologic necrosis was seen in 66% of cases at time of liver transplantation. Median time to liver transplant post-MWA was 12.6 months. [IQR = 8.6–14.8 months]. The median survival from ablation was 60.8 months [IQR = 45.5–73.7 months], and the median survival from transplant was 49.3 months [IQR = 33.7–60.1 months]. There was no significant difference in survival for patients with complete versus incomplete necrosis from ablation or liver transplant (p = 0.49, p = 0.46, respectively). Computed tomography-guided percutaneous microwave ablation is an effective bridge to orthotopic liver transplantation for patients with hepatocellular carcinoma. Level 3, non-randomized controlled cohort study/follow-up study.
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- 2021
3. Thermal Ablation of Renal Cell Carcinoma in Patients With Morbid Obesity: Assessment of Technique, Safety, and Oncologic Outcomes
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Ronald S. Arellano, Wenhui Zhou, Raul N. Uppot, and S. Herwald
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Ablation Techniques ,Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Disease ,Body Mass Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Renal cell carcinoma ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,business.industry ,General Medicine ,medicine.disease ,Obesity ,Kidney Neoplasms ,Nephrectomy ,Obesity, Morbid ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Sedative ,Anesthetic ,Female ,business ,Body mass index ,medicine.drug - Abstract
BACKGROUND. Obesity is a worldwide problem that impacts patient health as well as the morbidity associated with surgical procedures. Thus, patients with morbid obesity may not be suitable candidates for curative surgery. For this patient population, thermal ablation may be an effective alternative to nephrectomy. OBJECTIVE. The purpose of this study was to determine the feasibility, oncologic outcomes, and survival of patients with morbid obesity and renal cell carcinoma treated with thermal ablation. MATERIALS AND METHODS. A retrospective analysis was performed of 107 patients treated with CT-guided renal ablation for clinical T1 renal cell carcinoma between February 2005 and December 2017. Patients were stratified into two cohorts on body mass index of ≥ 40 kg/m2 (morbidly obese) and body mass index (weight in kilograms divided by the square of height in meters) of ≥ 40 (morbidly obese) and 18.5-24.9 (normal weight). Anesthetic and radiation dosages, procedure time, residual disease, and local recurrence, and adverse events were analyzed between the two groups. Kaplan-Meier statistics were used to evaluate cancer-related outcomes for each group. RESULTS. Thirty-four patients were morbidly obese, and 73 patients had normal weight. Morbid obesity was associated with longer procedural duration (p = .001), sedative doses (p = .002) and radiation exposure (p = .001) than normal weight. Hematomas were more prevalent in patients with morbid obesity than in those of normal weight (p = .01), but treatment efficacy and local recurrences were comparable with those for normal-weight individuals (p = .81 and p = .12, respectively). Cancer-related outcomes were equivalent between the two groups based on 5 years of imaging observation data. CONCLUSION. CT-guided thermal ablation remains technically feasible, well-tolerated, and effective in patients with morbid obesity and renal cell carcinoma, with the caveat of increased risk of perinephric hematoma, anesthesia dose, and radiation exposure. CLINICAL IMPACT. CT-guided thermal ablation can be considered a safe and effective treatment for renal cell carcinoma in patients with morbid obesity.
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- 2021
4. Thermal Ablation, Embolization, and Selective Internal Radiation Therapy Combined with Checkpoint Inhibitor Cancer Immunotherapy: Safety Analysis
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Konstantin S Leppelmann, Eric Wehrenberg-Klee, Florian J. Fintelmann, Kerry L. Reynolds, Zubin Irani, Joshua A Hirsch, Ronald S. Arellano, Meghan J. Mooradian, Kei Yamada, Leyre Zubiri, Suvranu Ganguli, Raul N. Uppot, and Ryan J. Sullivan
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Ablation Techniques ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Brachytherapy ,Programmed Cell Death 1 Receptor ,Ipilimumab ,Pembrolizumab ,Risk Assessment ,Gastroenterology ,B7-H1 Antigen ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Atezolizumab ,Interquartile range ,Neoplasms ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Immune Checkpoint Inhibitors ,Aged ,Retrospective Studies ,business.industry ,Selective internal radiation therapy ,Common Terminology Criteria for Adverse Events ,Cryoablation ,Middle Aged ,Combined Modality Therapy ,Embolization, Therapeutic ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Patient Safety ,Nivolumab ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
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.
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- 2021
5. P024 KEYNOTE-937 trial in progress: adjuvant pembrolizumab for hepatocellular carcinoma and complete radiologic response after surgical resection or local ablation
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U. Malhotra, Eunhee Kim, Ann-Lii Cheng, Arndt Vogel, Raul N. Uppot, Andrew X. Zhu, Abby B. Siegel, Lipika Goyal, Jian Zhou, Masatoshi Kudo, and Thomas Yau
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Surgical resection ,Radiologic Response ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hepatocellular carcinoma ,Local ablation ,medicine ,Radiology ,Pembrolizumab ,medicine.disease ,business ,Adjuvant - Published
- 2021
6. CT Texture Analysis and Machine Learning Improve Post-ablation Prognostication in Patients with Adrenal Metastases: A Proof of Concept
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Dania Daye, Paul B. Shyn, Raul N. Uppot, Nathan E. Frenk, Michael S. Gee, Azadeh Tabari, Vanessa Fiorini Furtado, Kemal Tuncali, Stuart G. Silverman, Ronald S. Arellano, Pedro V. Staziaki, and Florian J. Fintelmann
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Ablation Techniques ,Male ,Support Vector Machine ,medicine.medical_treatment ,Adrenal Gland Neoplasms ,Pilot Projects ,Texture (music) ,Machine learning ,computer.software_genre ,030218 nuclear medicine & medical imaging ,Machine Learning ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Proportional hazards model ,Area under the curve ,Univariate ,Retrospective cohort study ,Middle Aged ,Prognosis ,Ablation ,Survival Analysis ,Support vector machine ,Treatment Outcome ,ROC Curve ,Tumor progression ,Disease Progression ,Female ,Artificial intelligence ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
To assess the performance of pre-ablation computed tomography texture features of adrenal metastases to predict post-treatment local progression and survival in patients who underwent ablation using machine learning as a prediction tool. This is a pilot retrospective study of patients with adrenal metastases undergoing ablation. Clinical variables were collected. Thirty-two texture features were extracted from manually segmented adrenal tumors. A univariate cox proportional hazard model was used for prediction of local progression and survival. A linear support vector machine (SVM) learning technique was applied to the texture features and clinical variables, with leave-one-out cross-validation. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess performance between using clinical variables only versus clinical variables and texture features. Twenty-one patients (61% male, age 64.1 ± 10.3 years) were included. Mean time to local progression was 29.8 months. Five texture features exhibited association with progression (p
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- 2019
7. Radiofrequency Ablation, Cryoablation, and Microwave Ablation for T1a Renal Cell Carcinoma: A Comparative Evaluation of Therapeutic and Renal Function Outcomes
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Raul N. Uppot, Colin J. McCarthy, Ronald S. Arellano, Sanna E. Herwald, and Wenhui Zhou
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Percutaneous ,Radiofrequency ablation ,medicine.medical_treatment ,Renal function ,Cryosurgery ,Disease-Free Survival ,030218 nuclear medicine & medical imaging ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,law ,Renal cell carcinoma ,medicine.artery ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Renal artery ,Microwaves ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,Aged, 80 and over ,Radiofrequency Ablation ,business.industry ,Microwave ablation ,Cryoablation ,Middle Aged ,Ablation ,medicine.disease ,Kidney Neoplasms ,Tumor Burden ,030220 oncology & carcinogenesis ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
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.
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- 2019
8. How We Do It: Adrenal Biopsy and Ablation
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Ronald S. Arellano, Ashraf Thabet, Khalid W. Shaqdan, Raul N. Uppot, and Rita Maria Lahoud
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medicine.medical_specialty ,Percutaneous ,microwave ,medicine.medical_treatment ,R895-920 ,Thermal ablation ,ablation ,Lesion ,Medical physics. Medical radiology. Nuclear medicine ,radiofrequency ,hypertensive crisis ,Biopsy ,medicine ,biopsy ,medicine.diagnostic_test ,Adrenal gland ,business.industry ,Adrenalectomy ,Cryoablation ,Ablation ,medicine.anatomical_structure ,adrenal ,cryoablation ,Radiology ,medicine.symptom ,business - Abstract
Adrenal lesions represent a heterogeneous group of neoplasms that may be benign or malignant. If imaging fails to exclude a lesion as definitely benign or if molecular profiling is required, percutaneous image-guided biopsy may be indicated. When an adrenal lesion requires surgical resection, some patients are found to be too high at surgical risk or some patients may refuse adrenalectomy. Image-guided percutaneous thermal ablation can be an effective alternative – radiofrequency, microwave, and cryoablation have all been described in literature for the successful treatment of adrenal tumors. In this article, technical and clinical factors that reduce the risk of complications, some unique to the adrenal gland, are discussed.
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- 2019
9. Implementing Virtual and Augmented Reality Tools for Radiology Education and Training, Communication, and Clinical Care
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Gianluca De Novi, Colin J. McCarthy, Raul N. Uppot, Eliot L. Siegel, Andrew Phelps, Benjamin Laguna, and Jesse Courtier
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medicine.medical_specialty ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,Information Dissemination ,MEDLINE ,Virtual reality ,030218 nuclear medicine & medical imaging ,Entertainment ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Medical imaging ,Humans ,Radiology, Nuclear Medicine and imaging ,Clinical care ,Augmented Reality ,business.industry ,Communication ,Virtual Reality ,Radiography ,030220 oncology & carcinogenesis ,Augmented reality ,Smartphone ,Radiology ,business - Abstract
Advances in virtual immersive and augmented reality technology, commercially available for the entertainment and gaming industry, hold potential for education and clinical use in medicine and the field of medical imaging. Radiology departments have begun exploring the use of these technologies to help with radiology education and clinical care. The purpose of this review article is to summarize how three institutions have explored using virtual and augmented reality for radiology.
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- 2019
10. Dual-Source Dual-Energy CT in Detection and Characterization of Urinary Stones in Patients With Large Body Habitus: Observations in a Large Cohort
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Vinit Baliyan, Avinash Kambadakone, Raul N. Uppot, Dushyant V. Sahani, Hamed Kordbacheh, and Brian H. Eisner
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Adult ,Male ,medicine.medical_specialty ,Image quality ,Urinary system ,030218 nuclear medicine & medical imaging ,Radiography, Dual-Energy Scanned Projection ,03 medical and health sciences ,0302 clinical medicine ,Urolithiasis ,medicine ,Humans ,Habitus ,Dual source ,Radiology, Nuclear Medicine and imaging ,In patient ,Obesity ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General Medicine ,Middle Aged ,Large cohort ,030220 oncology & carcinogenesis ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Urinary Calculi ,Radiology ,Dual energy ct ,Tomography, X-Ray Computed ,business - Abstract
The objective of our study was to investigate the impact of large body habitus on dual-energy CT (DECT) image quality and stone characterization.We retrospectively included 105 consecutive patients with large body habitus (90 kg) who underwent stone protocol DECT between 2015 and 2017. The evaluation of DECT datasets was performed for image quality assessment based on European Guidelines on Quality Criteria for Computed Tomography and for determination of stone composition (i.e., uric acid vs non-uric acid). Correlation between DECT characterization and crystallography results was performed when available. The cohort was divided into two groups on the basis of body weight (≤ 104 kg and104 kg), and comparisons were made for image quality and stone characterization.One hundred ninety-seven urinary tract calculi (size: mean ± SD, 5.7 ± 5.3 mm; range, 1.4-56 mm) were detected in 73% (79/108) of examinations in 105 patients (weight: mean ± SD, 104.0 ± 12.7 kg; range, 91-163 kg). The overall mean image quality score of blended images and color maps was 3.7 and 3.9, respectively, and the effective dual-energy FOV limitation did not hamper stone characterization. The diagnostic acceptability scores of blended images and color maps were slightly lower in patients weighing104 kg than in patients ≤ 104 kg (mean scores [highest score, 4 points]: blended images, 3.62 vs 3.82 [p = 0.0314]; color maps, 3.75 vs 3.98 [p = 0.0034]), but the scores were within acceptable range. Stone characterization as uric acid versus non-uric acid was achieved in 80% (158/197) of calculi (size: mean ± SD, 6.4 ± 5.7 mm; range, 1.6-56 mm), and DECT stone characterization was (95.6%) accurate with reference to crystallography. Twenty percent (39/197) of calculi could not be characterized on DECT, and these calculi were significantly smaller in size (size: mean ± SD, 2.8 ± 1.4 mm; range, 1.4-8.2 mm; p0.001) than those that could be characterized. The mean size of uncharacterized calculi was slightly larger in patients weighing104 kg (3.3 ± 1.6 mm) than in those weighing ≤ 104 kg (2.2 ± 0.6 mm).In patients with large body habitus, dual-source DECT provides acceptable image quality and allows characterization of almost all clinically significant calculi.
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- 2019
11. The Tipping Point: Key Oncologic Imaging Findings Resulting in Critical Changes in the Management of Malignant Tumors of the Gastrointestinal Tract
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Jennifer Y. Wo, Ryan D. Nipp, Raul N. Uppot, Lipika Goyal, Jonathan Wu, and Motaz Qadan
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medicine.medical_specialty ,Gastrointestinal tumors ,Anal Carcinoma ,Decision Making ,Small bowel adenocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Neoplasm Invasiveness ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Neoplasm Metastasis ,Gastrointestinal Neoplasms ,Neoplasm Staging ,Gastrointestinal tract ,business.industry ,Prognosis ,medicine.disease ,Tipping point (climatology) ,digestive system diseases ,Patient management ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Adenocarcinoma ,Radiology ,business - Abstract
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.
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- 2019
12. Adapting a Computerized Medical Dictation System to Prepare Academic Papers in Radiology
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Yadiel Sánchez, Raul N. Uppot, and Anand M. Prabhakar
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medicine.medical_specialty ,Dictation ,business.industry ,MEDLINE ,Manuscripts, Medical as Topic ,Work Simplification ,030218 nuclear medicine & medical imaging ,Speech Recognition Software ,User-Computer Interface ,03 medical and health sciences ,0302 clinical medicine ,Software ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Composition (language) ,030217 neurology & neurosurgery - Abstract
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.
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- 2018
13. Role of Machine Learning and Artificial Intelligence in Interventional Oncology
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Brian D'Amore, Dania Daye, Raul N. Uppot, and Sara Smolinski-Zhao
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0301 basic medicine ,Routine screening ,medicine.diagnostic_test ,business.industry ,Automatic identification and data capture ,Interventional oncology ,Interventional radiology ,Machine learning ,computer.software_genre ,Field (computer science) ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Software ,Workflow ,Oncology ,030220 oncology & carcinogenesis ,Medicine ,Effective treatment ,Artificial intelligence ,business ,computer - Abstract
The purpose of this review is to highlight the current role of machine learning and artificial intelligence and in the field of interventional oncology. With advancements in technology, there is a significant amount of research regarding the application of artificial intelligence and machine learning in medicine. Interventional oncology is a field that can benefit greatly from this research through enhanced image analysis and intraprocedural guidance. These software developments can increase detection of cancers through routine screening and improve diagnostic accuracy in classifying tumors. They may also aid in selecting the most effective treatment for the patient by predicting outcomes based on a combination of both clinical and radiologic factors. Furthermore, machine learning and artificial intelligence can advance intraprocedural guidance for the interventional oncologist through more accurate needle tracking and image fusion technology. This minimizes damage to nearby healthy tissue and maximizes treatment of the tumor. While there are several exciting developments, this review also discusses limitations before incorporating machine learning and artificial intelligence in the field of interventional oncology. These include data capture and processing, lack of transparency among developers, validating models, integrating workflow, and ethical challenged. In summary, machine learning and artificial intelligence have the potential to positively impact interventional oncologists and how they provide cancer care treatments.
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- 2021
14. Infection Control in Interventional Radiology During the COVID-19 Era
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Robert M. Sheridan, Raul N. Uppot, Rory L. Cochran, Avik Som, Anthony Tucker-Bartley, Sanjeeva P. Kalva, Dania Daye, Sara Smolinski-Zhao, and Gabrielle S. Ndakwah
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Telehealth ,Radiology, Interventional ,Article ,030218 nuclear medicine & medical imaging ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Health care ,Medicine ,Infection control ,Humans ,Radiology, Nuclear Medicine and imaging ,Personal protective equipment ,Pandemics ,Personal Protective Equipment ,Infection Control ,medicine.diagnostic_test ,Radiology Department, Hospital ,business.industry ,SARS-CoV-2 ,COVID-19 ,Interventional radiology ,medicine.disease ,Triage ,United States ,Infectious disease (medical specialty) ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Medical emergency ,business - Abstract
The COVID-19 pandemic has challenged the capacity of interventional radiology departments worldwide to effectively treat COVID-19 and non-COVID-19 patients while preventing disease transmission among patients and healthcare workers. In this review, we describe the various data driven infection control measures implemented by the interventional radiology department of a large tertiary care center in the United States including the use and novel re-use of personal protective equipment, COVID-19 testing strategies, modifications in procedural workflows and the leveraging of telehealth visits. Herein, we provide effective triage, procedural, and management algorithms that may guide other interventional radiology departments during the ongoing COVID-19 pandemic and in future infectious disease outbreaks.
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- 2021
15. Abstract No. 157 Computed tomography–guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant: a single-center experience
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Eric Wehrenberg-Klee, Rory L. Cochran, Nicholas J. Reid, Ronald S. Arellano, Omar Zurkiya, Avik Som, Raul N. Uppot, and Thomas J. An
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medicine.medical_specialty ,Bridging (networking) ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Microwave ablation ,Computed tomography ,Single Center ,medicine.disease ,Awaiting liver transplant ,Hepatocellular carcinoma ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
16. Let the EHR Talk Loudly: An EHR-Connected Verbal Surgical Safety Checklist for Medical Procedures in the Intensive Care Unit
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Alvin Y.C. Yu, Richard M. Pino, Raul N. Uppot, Jarone Lee, and Katayoun Samadi
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Leadership and Management ,business.industry ,Concordance ,Public Health, Environmental and Occupational Health ,MEDLINE ,medicine.disease ,Intensive care unit ,Checklist ,law.invention ,Test (assessment) ,Workflow ,Patient safety ,Intensive Care Units ,Software ,law ,Surveys and Questionnaires ,Medicine ,Electronic Health Records ,Humans ,Medical emergency ,business - Abstract
Objectives The purpose of this study was to test the accuracy and user acceptance of an electronic health records (EHR)-connected verbal surgical safety checklist in the intensive care unit (ICU). Methods An EHR-connected verbal checklist software was deployed in our ICU between January 2019 and June 2019. The software, loaded on a mobile tablet, loudly verbalized clinical information from the EHR in the form of a time-out checklist. The accuracy of the information delivered was compared with up-to-date clinical data in the EHR in 300 patients. User acceptance was assessed using survey instruments. Results The software accurately verbalized patient demographics in 100% (300/300) of tested cases. Concordance rates with real-time values in the EHR for the following variables were calculated: allergies 98.6% (296/300), international normalized ratio 97.6% (293/300), and platelets 91.6% (275/300). Surveys showed that 41.2% (7/17) of users preferred current standard EHR time-outs, 17.6% (3/17) preferred verbalization software, 35.3% (6/17) preferred neither, and 5.9% (1/17) wanted both. When asked if EHR-connected verbalization software should officially replace the current standard EHR checklists, 76.5% (13/17) supported the idea. Conclusions An EHR-connected verbal surgical safety checklist software can leverage information in the EHR to help with workflow and patient safety. This study shows that the software can verbally deliver clinical information with great accuracy and that most ICU staff would support replacing current time-out processes.
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- 2020
17. Transjugular Intrahepatic Portosystemic Shunt Placement for Portal Hypertension: Meta-Analysis of Safety and Efficacy of 8 mm vs. 10 mm Stents
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Suvranu Ganguli, Kei Yamada, Jiangtao Liu, Raul N. Uppot, Emily D. Bethea, and Eric Wehrenberg-Klee
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medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Gastroenterology ,Stent ,Subgroup analysis ,Review Article ,RC799-869 ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Lower risk ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Paracentesis ,Portal hypertension ,030211 gastroenterology & hepatology ,business ,Transjugular intrahepatic portosystemic shunt ,Hepatic encephalopathy - Abstract
Introduction. Hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement remains a leading adverse event. Controversy remains regarding the optimal stent diameter given that smaller stents may decrease the amount of shunted blood and decrease the risk of HE, but stent patency and/or clinical adequacy of portal decompression may also be affected. We aim to provide meta-analysis-based evidence regarding the safety and efficacy of 8 mm vs. 10 mm stents during TIPS placement. Methods. PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing 8 mm and 10 mm stents during TIPS placement for portal hypertension decompression in cirrhotic patients. Randomized controlled trials and cohort studies were prioritized for inclusion. Overall evaluation of quality and bias for each study was performed. The outcomes assessed were the prevalence of HE, rebleeding or failure to control refractory ascites, and overall survival. Subgroup analysis based on TIPS indication was conducted. Results. Five studies with a total number of 489 cirrhotic patients were identified. The pooled hazard ratio (HR) of post-TIPS HE was significantly lower in patients in the 8 mm stent group than in the 10 mm stent group (HR: 0.68, 95% CI: 0.51~0.92, p value < 0.0001). The combined HR of post-TIPS rebleeding/the need for paracentesis was significantly higher in patients in the 8 mm stent group than in the 10 mm stent group (HR: 1.76, 95% CI: 1.22~2.55, p value < 0.0001). There was no statistically significant difference in the overall survival between the 8 mm and 10 mm stent groups. The combined risk of HE in the variceal bleeding subgroup was statistically lower (HR: 0.52, CI: 0.34-0.80) with an 8 mm stent compared with a 10 mm stent. The combined risk of both rebleeding/paracentesis and survival was not statistically significant between 8 mm and 10 mm stent use in subgroup analysis. Conclusion. 8 mm stents during TIPS placement are associated with a significant lower risk of HE compared to 10 mm stents (32% decreased risk), as well as a 76% increased risk of rebleeding/paracentesis. Meta-analysis results suggest that there is not one superior stent choice for all clinical scenarios and that the TIPS indication of variceal bleeding or refractory ascites might have different appropriate selection of the shunt diameter.
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- 2020
18. Image-Guided Thermal Ablation for Non-resectable Recurrence of Renal Cell Cancer Following Nephrectomy: Clinical Experience with Eleven Patients
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Ronald S. Arellano, Raul N. Uppot, Sanna E. Herwald, and Wenhui Zhou
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Salvage therapy ,Renal function ,Kidney Function Tests ,Nephrectomy ,Asymptomatic ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Renal cell carcinoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,Aged, 80 and over ,Salvage Therapy ,Creatinine ,business.industry ,Middle Aged ,medicine.disease ,Survival Analysis ,Kidney Neoplasms ,Surgery ,Treatment Outcome ,Surgery, Computer-Assisted ,chemistry ,030220 oncology & carcinogenesis ,Catheter Ablation ,Feasibility Studies ,Female ,Neoplasm Recurrence, Local ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
To assess the feasibility, safety and clinical outcomes of image-guided percutaneous thermal ablation as salvage therapy for local recurrence of renal cell carcinoma (RCC) in patients initially treated surgically with curative intent. A retrospective review of 11 consecutive patients (M/F = 8:3, mean age = 76 years) who underwent computed tomography (CT)-guided thermal ablation for locally recurrent RCC after partial (72%, 8/11) or radical nephrectomy (28%, 3/11) with a mean time to recurrence of 48 months (range 2–156). Assessment of technical success, complication (peri- and post-procedural), oncological outcome and survival analysis were performed. Patient baseline and follow-up renal function surrogates including creatinine level (Cr) and estimated glomerular filtration rate (eGFR) were statistically compared. Eleven biopsy-proven recurrent RCC measuring 1.4–3.9 cm (mean = 2.8 cm) were treated with CT-guided thermal ablation. Technical success was achieved in 100% (11/11) of the cases. There were no major complications except for one (9%) asymptomatic hemorrhage (Clavien–Dindo grade I complication). Complete response, local progression-free and overall survival rate were 91, 91 and 82% during the mean follow-up time of 2.5 years (range 0.1–7.1). Renal function was overall stable without significant change at 1 month and last follow-up (p = 0.21; GFR, p = 0.10; creatinine). Image-guided percutaneous thermal ablation is a feasible, safe and effective for local recurrence after nephrectomy, representing a non-surgical alternative for unresectable disease.
- Published
- 2018
19. Interventional Radiology Training Using a Dynamic Medical Immersive Training Environment (DynaMITE)
- Author
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Steven L. Dawson, Synho Do, Colin J. McCarthy, Alvin Y.C. Yu, and Raul N. Uppot
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Dynamite ,Computer science ,Virtual Reality ,MEDLINE ,Interventional radiology ,Equipment Design ,Radiology, Interventional ,Virtual reality ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Task Performance and Analysis ,medicine ,Humans ,Education, Medical, Continuing ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Clinical Competence ,Clinical competence ,030217 neurology & neurosurgery - Published
- 2018
20. Multicenter phase 2 trial of sirolimus for tuberous sclerosis: kidney angiomyolipomas and other tumors regress and VEGF- D levels decrease.
- Author
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Sandra L Dabora, David Neal Franz, Stephen Ashwal, Arthur Sagalowsky, Francis J DiMario, Daniel Miles, Drew Cutler, Darcy Krueger, Raul N Uppot, Rahmin Rabenou, Susana Camposano, Jan Paolini, Fiona Fennessy, Nancy Lee, Chelsey Woodrum, Judith Manola, Judy Garber, and Elizabeth A Thiele
- Subjects
Medicine ,Science - Abstract
Tuberous sclerosis (TSC) related tumors are characterized by constitutively activated mTOR signaling due to mutations in TSC1 or TSC2.We completed a phase 2 multicenter trial to evaluate the efficacy and tolerability of the mTOR inhibitor, sirolimus, for the treatment of kidney angiomyolipomas.36 adults with TSC or TSC/LAM were enrolled and started on daily sirolimus. The overall response rate was 44.4% (95% confidence intervals [CI] 28 to 61); 16/36 had a partial response. The remainder had stable disease (47.2%, 17/36), or were unevaluable (8.3%, 3/36). The mean decrease in kidney tumor size (sum of the longest diameters [sum LD]) was 29.9% (95% CI, 22 to 37; n = 28 at week 52). Drug related grade 1-2 toxicities that occurred with a frequency of >20% included: stomatitis, hypertriglyceridemia, hypercholesterolemia, bone marrow suppression (anemia, mild neutropenia, leucopenia), proteinuria, and joint pain. There were three drug related grade 3 events: lymphopenia, headache, weight gain. Kidney angiomyolipomas regrew when sirolimus was discontinued but responses tended to persist if treatment was continued after week 52. We observed regression of brain tumors (SEGAs) in 7/11 cases (26% mean decrease in diameter), regression of liver angiomyolipomas in 4/5 cases (32.1% mean decrease in longest diameter), subjective improvement in facial angiofibromas in 57%, and stable lung function in women with TSC/LAM (n = 15). A correlative biomarker study showed that serum VEGF-D levels are elevated at baseline, decrease with sirolimus treatment, and correlate with kidney angiomyolipoma size (Spearman correlation coefficient 0.54, p = 0.001, at baseline).Sirolimus treatment for 52 weeks induced regression of kidney angiomyolipomas, SEGAs, and liver angiomyolipomas. Serum VEGF-D may be a useful biomarker for monitoring kidney angiomyolipoma size. Future studies are needed to determine benefits and risks of longer duration treatment in adults and children with TSC.Clinicaltrials.gov NCT00126672.
- Published
- 2011
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21. Retrospective evaluation of image-guided cholecystostomy tube utilization and outcomes during the first wave of the COVID-19 pandemic
- Author
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Dania Daye, Nicholas J. Reid, Raul N. Uppot, Silvia Salamone, Tristan Yeung, Avik Som, Austin Snyder, and John Di Capua
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General surgery ,Incidence (epidemiology) ,Vital signs ,Interventional radiology ,General Medicine ,medicine.disease ,Tertiary care ,Cholecystostomy ,Pandemic ,medicine ,Cholecystitis ,business - Abstract
Objectives: During the COVID-19 pandemic, there was a perceived increase in the number of cholecystostomy tube placements. We have retrospectively analyzed the incidence and outcomes of cholecystostomy tube placement during the COVID-19 pandemic surge. Material and Methods: Cholecystostomy tube placement and overall interventional radiology (IR) case volume were analyzed at our tertiary care center during the pandemic (March 15, 2020–July 30, 2020) and compared to the same time period in 2019. In addition, an age- and gender-matched control study of outcomes for 40 patients (25 from our home institution and 15 from our affiliated hospitals) grouped by COVID-19 status who received percutaneous cholecystostomy tubes between March 15, 2020, and July 30, 2020, was performed. Results: We observed a significant increase in relative cholecystostomy tube volume during the pandemic, despite a decrease in total IR case volume. There was no significant difference in pre- or post-procedural laboratory data, vital signs, imaging, or mortality between COVID-positive and COVID-negative patients who received cholecystostomy tubes. Conclusion: Percutaneous cholecystostomy tube placement is likely a safe treatment for acalculous cholecystitis in patients with COVID-19 with equivalent outcomes to patients without COVID-19.
- Published
- 2021
22. Abstract No. 23 Thermal ablation for anatomically complex renal tumors: assessment of periprocedural and treatment outcomes of microwave ablation, radiofrequency ablation, and cryoablation
- Author
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Wenhui Zhou, Raul N. Uppot, Ronald S. Arellano, and S. Herwald
- Subjects
medicine.medical_specialty ,business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,Treatment outcome ,Microwave ablation ,Thermal ablation ,Cryoablation ,law.invention ,law ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
23. Abstract No. 83 Using Gelfoam to sculpt cryoablation growth: a phantom study
- Author
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B. McCafferty, A. Gunn, Kei Yamada, J. Huang, Raul N. Uppot, E. Sanchez, T. Bochnakova, and Ronald S. Arellano
- Subjects
business.industry ,medicine.medical_treatment ,medicine ,Radiology, Nuclear Medicine and imaging ,Cryoablation ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Imaging phantom - Published
- 2021
24. Abstract No. 557 Natural history and course of splenic artery aneurysms: experience from 200 patients over 2 decades
- Author
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Sanjeeva P. Kalva, Zubin Irani, Eric Wehrenberg-Klee, Ronald S. Arellano, Ashraf Thabet, Raymond W. Liu, Patrick D. Sutphin, Raul N. Uppot, X. Chen, and S. Iqbal
- Subjects
Natural history ,medicine.medical_specialty ,business.industry ,General surgery ,medicine.artery ,medicine ,Radiology, Nuclear Medicine and imaging ,Splenic artery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
25. Abstract No. 20 Assessment of pre-emptive multimodal analgesia to reduce post-procedural opioid requirements in patients undergoing liver microwave ablation
- Author
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P. Stefanovich, Rafael Vazquez, C. Pau, S. Low, B. Kamdar, N. Joseph, J. Di Capua, Raul N. Uppot, Junjian Huang, Ronald S. Arellano, N. Davis, Avik Som, and M. Omodon
- Subjects
Opioid ,business.industry ,Anesthesia ,Microwave ablation ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2021
26. Abstract No. 156 Incidence and outcomes of cholecystostomy tubes in COVID-19 patients
- Author
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Gloria Salazar, Raul N. Uppot, Avik Som, Tristan Yeung, Silvia Salamone, Dania Daye, Nicholas J. Reid, Marc D. Succi, and Austin Snyder
- Subjects
medicine.medical_specialty ,Microbiological culture ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Acalculous cholecystitis ,Interventional radiology ,Article ,Surgery ,Cholecystostomy ,medicine ,Tube placement ,Percutaneous cholecystostomy ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
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.
- Published
- 2021
27. Abstract No. 467 Analysis of healthcare cost and resource utilization associated with thermal ablation of renal cell carcinoma
- Author
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Wenhui Zhou, Raul N. Uppot, Ronald S. Arellano, and S. Herwald
- Subjects
medicine.medical_specialty ,Renal cell carcinoma ,business.industry ,medicine ,Thermal ablation ,Healthcare cost ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,medicine.disease ,business ,Resource utilization - Published
- 2021
28. Abstract No. 123 Development of an electronic health record–integrated chatbot algorithm for interventional radiology abscess management consults
- Author
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S.M. Jang, J. Huang, J. Panagides, Dania Daye, and Raul N. Uppot
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,medicine.disease ,computer.software_genre ,Chatbot ,Electronic health record ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Cardiology and Cardiovascular Medicine ,Abscess ,business ,computer - Published
- 2021
29. Percutaneous Image-Guided Thermal Ablation for Multifocal Renal Cell Carcinoma: 10-Year Experience at a Single Center
- Author
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Wenhui Zhou, Adam S. Feldman, Raul N. Uppot, and Ronald S. Arellano
- Subjects
Ablation Techniques ,Adult ,Male ,medicine.medical_specialty ,Time Factors ,Percutaneous ,genetic structures ,Radiofrequency ablation ,medicine.medical_treatment ,Technical success ,030232 urology & nephrology ,Thermal ablation ,Single Center ,030218 nuclear medicine & medical imaging ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,law ,Renal cell carcinoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Microwave ablation ,Cryoablation ,General Medicine ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Surgery ,Treatment Outcome ,Surgery, Computer-Assisted ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
The objective of our study was to assess the technical success, safety, and oncologic and renal function outcomes of CT-guided percutaneous thermal ablation for synchronous multiple renal masses in a single session.A retrospective analysis of 23 patients (16 men and 7 women; median age, 70 years) with biopsy-proven multifocal renal cell carcinoma (RCC) masses treated with radiofrequency ablation (RFA), cryoablation, or microwave ablation (MWA) was performed. Preablation, postablation, and follow-up serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate (GFR) levels were recorded to evaluate the stability of renal function. Technical success, complications, treatment response, oncologic outcome, and overall survival were assessed.Biopsy-proven RCCs were treated in 23 patients. Median tumor size was 2.3 cm (range, 1.0-4.0 cm). The mean RENAL (radius, exophytic vs endophytic properties, nearness of tumor to the collecting system or sinus, anterior vs posterior, location relative to polar lines) nephrometry score was 6.3 (range, 4.0-10.0); mean PADUA (preoperative aspects and dimensions used for anatomical) score, 7.8 (range, 6.0-11.0); and mean centrality index (C-index), 3.1 (range, 0.7-6.8). The mean ablation time was 23 minutes (range, 3-24 minutes). Technical success was achieved for 100% of tumors. Of the 49 complications, nine (18%) were classified as Clavien-Dindo grade I complications. Complete response was achieved in 41 of the 49 (84%) tumors. Local progression-free, RCC-specific disease-free, and overall survival rates during the imaging follow-up time (mean, 3.1 years; range, 0.1-9.6 years) were 96% (22/23), 100% (23/23), and 91% (21/23), respectively.CT-guided percutaneous thermal ablation is a safe, effective, and durable treatment intervention for multifocal renal masses.
- Published
- 2017
30. Navigational Guidance and Ablation Planning Tools for Interventional Radiology
- Author
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Arash Anvari, Raul N. Uppot, Ronald S. Arellano, Yadiel Sánchez, Anthony E. Samir, and Anand M. Prabhakar
- Subjects
Ablation Techniques ,Image-Guided Biopsy ,medicine.medical_specialty ,Seven Management and Planning Tools ,medicine.medical_treatment ,Radiology, Interventional ,Patient Care Planning ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,medicine ,Humans ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Image fusion ,Modalities ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Interventional radiology ,Ablation ,Surgery, Computer-Assisted ,030220 oncology & carcinogenesis ,Radiology ,business - Abstract
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.
- Published
- 2017
31. 3:36 PM Abstract No. 36 Machine learning-based radiomic features on pre-ablation magnetic resonance imaging as predictors of pathologic response in patients with hepatocellular carcinoma listed for hepatic transplant
- Author
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Jayashree Kalpathy-Cramer, S. Brito Orama, Dania Daye, Raul N. Uppot, Azadeh Tabari, H. Kim, Ken Chang, Sanjeeva P. Kalva, Harrison X. Bai, Michael S. Gee, and Eric Wehrenberg-Klee
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,medicine.disease ,Ablation ,Hepatocellular carcinoma ,Pathologic Response ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
32. TAS-120 Overcomes Resistance to ATP-Competitive FGFR Inhibitors in Patients with FGFR2 Fusion-Positive Intrahepatic Cholangiocarcinoma
- Author
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Islam Baiev, Raul N. Uppot, Leah Y. Liu, Giulia Siravegna, Isobel J Fetter, Stephanie Reyes, Dejan Juric, Cristina R. Ferrone, Emily E. Van Seventer, David T. Ting, Sachie Otsuki, Ipsita Dey-Guha, Jochen K. Lennerz, William C. Hahn, Lei Shi, Krushna C. Patra, Ignaty Leschiner, Gad Getz, Heather A. Shahzade, Cyril H. Benes, Phuong Vu, Robin Kate Kelley, Liudmila Elagina, Vikram Deshpande, Hiroshi Hirai, James J. Harding, Alberto Bardelli, Ferran Fece de la Cruz, Andrew X. Zhu, A. John Iafrate, Raymond W.S. Ng, Nabeel Bardeesy, Takeshi Sagara, Kenneth K. Tanabe, Rona Yaeger, Supriya K. Saha, Srivatsan Raghavan, Brandon Nadres, Janet E. Murphy, Ryan B. Corcoran, Ronald S. Arellano, and Lipika Goyal
- Subjects
0301 basic medicine ,Male ,Fibroblast Growth Factor ,Oncogene Proteins, Fusion ,Cell ,Drug Resistance ,Drug resistance ,medicine.disease_cause ,Circulating Tumor DNA ,Cholangiocarcinoma ,0302 clinical medicine ,Adenosine Triphosphate ,Erdafitinib ,Medicine ,Tomography ,Cancer ,Oncogene Proteins ,Mutation ,Tumor ,Kinase ,Middle Aged ,X-Ray Computed ,medicine.anatomical_structure ,Oncology ,Fibroblast growth factor receptor ,030220 oncology & carcinogenesis ,embryonic structures ,Female ,Type 2 ,Receptor ,Signal Transduction ,musculoskeletal diseases ,Adult ,animal structures ,FGFR Inhibition ,Oncology and Carcinogenesis ,Article ,Cell Line ,03 medical and health sciences ,Structure-Activity Relationship ,Cell Line, Tumor ,Genetics ,Humans ,Receptor, Fibroblast Growth Factor, Type 2 ,Fusion ,Protein Kinase Inhibitors ,Aged ,business.industry ,Phenylurea Compounds ,030104 developmental biology ,Pyrimidines ,Tumor progression ,Drug Resistance, Neoplasm ,Cancer research ,Neoplasm ,business ,Tomography, X-Ray Computed - Abstract
ATP-competitive fibroblast growth factor receptor (FGFR) kinase inhibitors, including BGJ398 and Debio 1347, show antitumor activity in patients with intrahepatic cholangiocarcinoma (ICC) harboring activating FGFR2 gene fusions. Unfortunately, acquired resistance develops and is often associated with the emergence of secondary FGFR2 kinase domain mutations. Here, we report that the irreversible pan-FGFR inhibitor TAS-120 demonstrated efficacy in 4 patients with FGFR2 fusion–positive ICC who developed resistance to BGJ398 or Debio 1347. Examination of serial biopsies, circulating tumor DNA (ctDNA), and patient-derived ICC cells revealed that TAS-120 was active against multiple FGFR2 mutations conferring resistance to BGJ398 or Debio 1347. Functional assessment and modeling the clonal outgrowth of individual resistance mutations from polyclonal cell pools mirrored the resistance profiles observed clinically for each inhibitor. Our findings suggest that strategic sequencing of FGFR inhibitors, guided by serial biopsy and ctDNA analysis, may prolong the duration of benefit from FGFR inhibition in patients with FGFR2 fusion–positive ICC.Significance:ATP-competitive FGFR inhibitors (BGJ398, Debio 1347) show efficacy in FGFR2-altered ICC; however, acquired FGFR2 kinase domain mutations cause drug resistance and tumor progression. We demonstrate that the irreversible FGFR inhibitor TAS-120 provides clinical benefit in patients with resistance to BGJ398 or Debio 1347 and overcomes several FGFR2 mutations in ICC models.This article is highlighted in the In This Issue feature, p. 983
- Published
- 2019
33. SURGICAL RESECTION VERSUS ABLATION FOR EARLY-STAGE HEPATOCELLULAR CARCINOMA: A RETROSPECTIVE COHORT ANALYSIS
- Author
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Kenneth K. Tanabe, Grace C. Lee, Keith D. Lillemoe, Cristina R. Ferrone, Raul N. Uppot, Motaz Qadan, Parsia A. Vagefi, and Lawrence S. Blaszkowsky
- Subjects
Surgical resection ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Gastroenterology ,Article ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Fibrosis ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Stage (cooking) ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Liver Neoplasms ,Cancer ,Retrospective cohort study ,General Medicine ,Middle Aged ,Ablation ,medicine.disease ,digestive system diseases ,Survival Rate ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Catheter Ablation ,030211 gastroenterology & hepatology ,Surgery ,Female ,business - Abstract
The most appropriate treatment for early-stage hepatocellular carcinoma (HCC) remains unclear. This study compared the association of resection versus ablation with overall survival (OS) in patients with early-stage HCC.Using the National Cancer Database (NCDB), patients diagnosed with stage I/II HCC between 2004 and 2014 were identified. Cox analysis was used to determine predictors of OS.We identified 53,161 patients, of whom 15.9% underwent ablation and 14.5% underwent resection. Patients with fewer comorbidities, larger tumors, and private insurance were more likely to undergo resection. Resection was associated with significantly improved OS compared to ablation (HR 0.58, 95% CI 0.54-0.61, p 0.001), at all tumor sizes (p 0.05) and any degree of liver fibrosis (p 0.05).Resection of HCC tumors of all sizes and any degree of underlying fibrosis was associated with significantly improved OS compared with ablation. There was pronounced variability in the use of ablation versus resection for early-stage HCC.This study found that patients with early-stage hepatocellular carcinoma (HCC) have improved overall survival (OS) after surgical resection, compared to ablation, at all tumor sizes and any extent of liver disease. There were also marked variations in treatment patterns for early-stage HCC.
- Published
- 2019
34. Abstract No. 158 Changes in interventional radiology case volumes during the COVID-19 pandemic
- Author
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Avik Som, Sanjeeva P. Kalva, Tristan Yeung, M. Lang, B. Little, Raul N. Uppot, Marc D. Succi, and Dania Daye
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Interventional radiology ,medicine.disease ,Article ,Pandemic ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
35. CT-Guided Percutaneous Microwave Ablation of Tumors in the Hepatic Dome: Assessment of Efficacy and Safety
- Author
-
Ronald S. Arellano, Arash Anvari, Raul N. Uppot, Ashraf Thabet, Nazanin H. Asvadi, and Andrew X. Zhu
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Time Factors ,Percutaneous ,Asymptomatic ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Microwaves ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Microwave ablation ,Retrospective cohort study ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Predictive value of tests ,Hepatocellular carcinoma ,Catheter Ablation ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
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.
- Published
- 2016
36. Percutaneous Image-Guided Cryotherapy for Local Control of Recurrent Plexiform Schwannoma in a 3-Year-Old Male
- Author
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Michael S. Gee, Anand M. Prabhakar, Florian J. Fintelmann, Anuradha S. Shenoy-Bhangle, Raul N. Uppot, and Yadiel Sánchez
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,Cryotherapy ,030218 nuclear medicine & medical imaging ,Plexiform Schwannoma ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Neoplasm Recurrence ,X ray computed ,Thoracic vertebrae ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Published
- 2017
37. Abstract No. 603 Comparison of thermal ablative modalities for anatomically complex renal tumors: periprocedural complications and treatment outcomes
- Author
-
Wenhui Zhou, Raul N. Uppot, Ronald S. Arellano, and S. Herwald
- Subjects
medicine.medical_specialty ,Modalities ,business.industry ,Treatment outcome ,Ablative case ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
38. Abstract No. 701 Assessment of the thermal properties of absorbable gelatin powder for potential use as a tissue separator during microwave ablation procedures
- Author
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A. Kashefi, T. Bochnakova, Kei Yamada, Avik Som, Suvranu Ganguli, Raul N. Uppot, and Ronald S. Arellano
- Subjects
business.industry ,Thermal ,Microwave ablation ,Medicine ,Radiology, Nuclear Medicine and imaging ,Absorbable gelatin powder ,Composite material ,Cardiology and Cardiovascular Medicine ,business ,Separator (electricity) - Published
- 2020
39. Abstract No. 495 Comparative analysis of non-hydrodissection techniques for percutaneous computed tomography–guided thermal ablation of liver neoplasms
- Author
-
Raul N. Uppot, Rory L. Cochran, Kei Yamada, Ronald S. Arellano, and Avik Som
- Subjects
Percutaneous ,medicine.diagnostic_test ,business.industry ,Thermal ablation ,Medicine ,Radiology, Nuclear Medicine and imaging ,Computed tomography ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Published
- 2020
40. Abstract No. 605 Outcome of renal ablation in morbidly obese patients: technical results, procedural complications, and oncological survival
- Author
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S. Herwald, Ronald S. Arellano, Wenhui Zhou, and Raul N. Uppot
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Morbidly obese ,Cardiology and Cardiovascular Medicine ,Renal ablation ,business ,Outcome (game theory) ,Surgery - Published
- 2020
41. 4:03 PM Abstract No. 271 Risk stratification of periprocedural complications and treatment failure for T1b renal cell carcinoma
- Author
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S. Herwald, Raul N. Uppot, Ronald S. Arellano, and Wenhui Zhou
- Subjects
medicine.medical_specialty ,business.industry ,Renal cell carcinoma ,Risk stratification ,Urology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Treatment failure - Published
- 2020
42. 3:27 PM Abstract No. 211 Results of a novel integrated technology incubator and innovation curriculum in interventional and diagnostic radiology training programs: the MESH incubator
- Author
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Katherine P. Andriole, Raul N. Uppot, M. Ottensmeyer, Marc D. Succi, James A. Brink, B. Zamarron, Florian J. Fintelmann, Michael S. Gee, and T. McLoud
- Subjects
medicine.medical_specialty ,Integrated technology ,business.industry ,Medicine ,Incubator ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Cardiology and Cardiovascular Medicine ,business ,Curriculum - Published
- 2020
43. Abstract No. 541 Association of therapeutic efficacy and the heat-sink effect for central renal tumors: is microwave ablation superior to radiofrequency ablation?
- Author
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Wenhui Zhou, S. Herwald, Ronald S. Arellano, and Raul N. Uppot
- Subjects
medicine.medical_specialty ,business.industry ,Radiofrequency ablation ,law ,Microwave ablation ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Heat sink ,Cardiology and Cardiovascular Medicine ,business ,law.invention - Published
- 2020
44. Abstract No. 496 Comparison of periprocedural outcome and health care costs associated with microwave ablation, radiofrequency ablation, and cryoablation ablative modalities for T1 renal cell carcinoma
- Author
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S. Herwald, Raul N. Uppot, Wenhui Zhou, and Ronald S. Arellano
- Subjects
medicine.medical_specialty ,Modalities ,Radiofrequency ablation ,business.industry ,medicine.medical_treatment ,Microwave ablation ,Cryoablation ,medicine.disease ,law.invention ,law ,Renal cell carcinoma ,Ablative case ,Health care ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
45. Infrastructure Design: A Critical Element in the Care of the Patient With Obesity
- Author
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Mary W Matz, Vilma E. Ortiz, Bob Winters, Rick J Ottolino, and Raul N. Uppot
- Subjects
Leadership and Management ,business.industry ,Health Personnel ,Palliative Care ,Public Health, Environmental and Occupational Health ,MEDLINE ,030208 emergency & critical care medicine ,medicine.disease ,Infrastructure design ,Obesity ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Medical emergency ,Health Facilities ,Element (criminal law) ,business ,Delivery of Health Care ,Healthcare system - Abstract
The worldwide rate of obesity continues to rise, causing healthcare systems to morph to meet the demands posed by the concomitant increase in comorbidities associated with this condition. Increasing patient weight imposes its own constraints on the safety of patients and providers; therefore, a sound healthcare facility infrastructure is required to properly address the medical needs of patients with obesity. Currently, most healthcare systems-in their attitudes, equipment, and facility design-are ill equipped to meet the needs of this epidemic. In this article, we discuss the facilities and equipment design considerations in providing medical care to patients with obesity. Extending beyond the physical plant, we also touch on organizational elements that enable the healthcare provider to safely care for this challenging patient population. The rising prevalence and disease burden of excess adiposity highlight the obligation to recognize that the design needs common to all of our patients must include the particular needs of the patient with obesity.
- Published
- 2018
46. Radiation Dose and Risk Estimates of CT-Guided Percutaneous Liver Ablations and Factors Associated with Dose Reduction
- Author
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Colin J. McCarthy, Aoife Kilcoyne, Bob Liu, Michael S. Gee, Raul N. Uppot, Ronald S. Arellano, Xinhua Li, and Alexis M. Cahalane
- Subjects
Ablation Techniques ,Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Logistic regression ,Radiation Dosage ,Radiography, Interventional ,Effective dose (radiation) ,Risk Assessment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,business.industry ,Liver Neoplasms ,Absolute risk reduction ,Irreversible electroporation ,Stepwise regression ,Middle Aged ,Radiation Exposure ,Ablation ,030220 oncology & carcinogenesis ,Relative risk ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
To determine the radiation dose associated with CT-guided percutaneous liver ablations and identify potential risk factors that result in higher radiation doses. Between June 2011 and June 2015, 245 consecutive patients underwent 304 CT-guided liver ablation treatments. Patient demographics, tumor characteristics and procedural parameters were identified and analyzed. The peak skin dose and effective dose were assessed for each procedure. Excess relative risk related to radiation effects was calculated. A logistic regression model was prepared by means of stepwise logistic regression to identify variables predictive of increased radiation exposure. Tumor ablations were performed with microwave (n = 220), radiofrequency (n = 74) or irreversible electroporation (IRE) (n = 10). The mean peak skin dose for ablations was 239.2 ± 136.4 mGy, and the mean effective dose was 36.6 ± 22.3 mSv. Of the patient and procedural parameters that were analyzed, increasing weight, use of intravenous contrast and/or hydrodissection during the procedure, together with treatment of multiple lesions in the same sitting were all associated with higher radiation exposure. The mean increase in the absolute risk of fatal malignancy from a single procedure was 0.18% (range 0.02–0.9%). No deterministic skin changes were identified in the patient cohort. The overall risk of stochastic and deterministic effects from radiation associated with CT-guided ablations is low compared with other inherent procedural complications. This study identifies several factors that are associated with higher radiation dose in percutaneous liver ablation procedures.
- Published
- 2018
47. Technical challenges of imagingimage-guided interventions in obese patients
- Author
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Raul N. Uppot
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,business.industry ,Psychological intervention ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,General Medicine ,The role of imaging in obesity special feature: Review article ,Imaging equipment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Diagnostic quality ,medicine ,Image guided interventions ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,030212 general & internal medicine ,Obesity ,business - Abstract
Obese patients challenge imaging departments in their ability to obtain diagnostic quality images and to perform image-guided interventions. These technical challenges include properly accommodating large patients on imaging equipment, adjusting equipment settings to address imaging limitations, and pre-planning and preparation for image-guided interventions to insure safe and successful outcomes. Knowing and addressing these challenges can result in successfully addressing the imaging and image-guided interventions needs of obese patients.
- Published
- 2018
48. Risk Assessment of Chronic Kidney Disease following Microwave Ablation for Stage T1 Renal Cell Carcinoma
- Author
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Raul N. Uppot, Wenhui Zhou, Ronald S. Arellano, and Sanna E. Herwald
- Subjects
Ablation Techniques ,Male ,medicine.medical_specialty ,Time Factors ,030232 urology & nephrology ,Urology ,Renal function ,urologic and male genital diseases ,Radiography, Interventional ,Risk Assessment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Renal cell carcinoma ,Risk Factors ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Renal Insufficiency, Chronic ,Microwaves ,Carcinoma, Renal Cell ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,Creatinine ,medicine.diagnostic_test ,business.industry ,Microwave ablation ,Postoperative complication ,Interventional radiology ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Progression-Free Survival ,chemistry ,Female ,Cardiology and Cardiovascular Medicine ,business ,Stage 4 chronic kidney disease ,Tomography, X-Ray Computed ,Biomarkers ,Kidney disease ,Glomerular Filtration Rate - Abstract
PURPOSE To assess safety and renal-function outcomes after microwave (MW) ablation of localized stage T1 renal cell carcinoma (RCC). MATERIALS AND METHODS A retrospective review was conducted of 38 patients (28 men; mean age, 69 y; range, 51-88 y) who underwent computed tomography (CT)-guided MW ablation for stage T1N0M0 RCC. Baseline and follow-up renal function surrogates including creatinine level and estimated glomerular filtration rate (eGFR) were statistically compared. Peri- and postoperative complication rates, technical success, and treatment response were also assessed. RESULTS A total of 44 biopsy-proven stage T1N0M0 RCCs measuring 1.2-6.9 cm (mean, 2.5 cm) were treated, and renal function was measured 1 mo after treatment. Mean eGFRs were 60 mL/min/1.73 m2 at baseline and 59 mL/min/1.73 m2 at 1 month after ablation. At 1-year and last follow-ups, the means of difference were 3.3% (95% confidence interval, -4.4 to 4.3; P = .99) and 3.3% (95% confidence interval, -4.3 to 4.8; P = .91), respectively. The 2-years freedom from eGFR decrease to < 60 mL/min/1.73 m2 was 2% (P = .91). Among the 5 patients (13%) with preexisting stage 4 chronic kidney disease (CKD; eGFR < 30 mL/min/1.73 m2) before ablation, there was no significant postablative onset of decline or CKD upstaging (P = .001). There were no major complications, and 5 patients (13%) had small asymptomatic perinephric hematomas (Society of Interventional Radiology minor complication, class A/B) that were managed conservatively. CONCLUSIONS At 2-year follow-up, CT-guided percutaneous MW ablation is safe and well-tolerated and achieves nephron preservation similar to existing ablative modalities.
- Published
- 2018
49. 03:36 PM Abstract No. 183 Utility of jet ventilation in percutaneous ablation of hepatocellular carcinoma
- Author
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A. Gupta, Raul N. Uppot, Ronald S. Arellano, and R. Vazquez
- Subjects
medicine.medical_specialty ,Jet ventilation ,Percutaneous ,business.industry ,medicine.medical_treatment ,Hepatocellular carcinoma ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Ablation ,medicine.disease - Published
- 2019
50. 03:45 PM Abstract No. 88 A comparative evaluation of procedural and therapeutic outcomes of thermal ablation for T1b versus T1a renal cell carcinoma
- Author
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Raul N. Uppot, S. Herwald, Wenhui Zhou, and Ronald S. Arellano
- Subjects
medicine.medical_specialty ,Renal cell carcinoma ,business.industry ,medicine ,Thermal ablation ,Urology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Comparative evaluation - Published
- 2019
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