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Background Purpose Methods Results Conclusions The use of endovascular procedures is becoming increasingly popular across multiple clinical domains. These procedures are generally performed under image guidance using an interventional c‐arm x‐ray system. Radiation exposure to both patients and interventional staff due to use of fluoroscopy is a health and occupational concern, but modifications to the interventional workflow to address radiation may come at the cost of procedure time or quality.Interventional x‐ray collimation is a crucial task for improving image quality as well as reducing radiation exposure to both patients and operators who work in the x‐ray domain. However, collimation is heavily underutilized due to its cumbersome nature and the difficulty of manually manipulating multiple parameters during fast‐paced interventional procedures. Additionally, the widely varying collimation preferences of interventionalists across different procedure types, procedure phases, and anatomies makes the standardizing of collimation challenging for radiation technologist support staff.Automating collimation has the potential to bridge this gap, freeing up mental bandwidth for interventionalists and technologists and improving outcomes for patients. Here, we propose a tunable algorithm for automatic collimation based on a region‐of‐interest optimizer driven by a combination of image, system, device, and radiation based features and we illustrate its efficacy across varying personal preferences. Critically, we devise a method with a simple and easily understandable mapping between algorithm parameters and practical outcomes.We show a real‐time implementation of this algorithm using deep feature extraction by a convolutional neural network and evaluate its performance in a custom dataset of simulated fluoroscopy and recorded fluoroscopy from clinical radial access procedures. We evaluate the effects of a practically implemented mixed supervision training strategy on model performance and show potential for radiation reduction in simulation. An uncertainty analysis indicates that the algorithm is robust to noise and anatomical variation across our clinical dataset. Clinical acceptability and quality is evaluated through a reader study with expert neuro‐interventional radiologists, with participants indicating 100% clinical acceptability, high quality ratings, and improved radiation protection over their typical practice.The algorithm's modular design ensured that users' collimation requirements were met without disruption to the interventional workflow or procedure time, while exhibiting strong potential to reduce radiation risk to patients and operators. Evaluation in more varied clinical settings could support translation of this technology into the clinic. [ABSTRACT FROM AUTHOR]

Purpose: Some patients with spinal muscular atrophy and scoliosis require CT guidance during injections of nusinersen. The radiation applied to the operator in such procedures becomes an important issue in terms of staff health and safety. The aim of the study was to assess the operator's radiation exposure during CT-guided nusinersen injections in patients with spinal muscular atrophy and scoliosis. Methods: Consecutive 40 CT-guided nusinersen injections were analyzed in terms of operator's radiation exposure measured in real time. Results: The median radiation dose measured under the physician's lead apron and patient dose in terms of DLP was 0.20 µSv and 31.90 mGy*cm respectively. The radiation doses were significantly higher (p = 0.047) in patients with spinal instrumentation. Conclusion: The results show that CT-guided nusinersen injection is a relatively safe procedure in terms of operator's radiation exposure. This can allow for interventional radiologists to perform more procedures without exceeding their annual dose limit. [ABSTRACT FROM AUTHOR]

Background: As spontaneous renal artery dissection (SRAD) is a rare cause of abdominal pain, bilateral dissection is an extremely rare event. Only approximately two hundred cases of SRAD have been reported in the literature. The diagnosis is often delayed due to the rarity of the disease and non-specific clinical presentations such as flank pain, hypertension, fever, nausea, vomiting, and hematuria, which can be often misdiagnosed as a genito-urinary infection or gastrointestinal or bowel disease. Before 1980, the diagnosis of SRAD was mostly confirmed via autopsy or, rarely, via angiography. At present, the diagnosis is made using advanced imaging approaches, including computed tomography angiography (CTA) and magnetic resonance angiography (MRA), with a higher number of incidentally diagnosed SRADs. Methods: we performed laboratory tests and radiological examinations (computed abdominal tomography and multiplanar reconstruction) that revealed multiple infarctions and ischemic areas with hypoperfusion in the upper middle third of the left kidney and in a large part of middle and lower areas of the right kidney; the left renal artery exhibited increased intimal thickening and arteritis. Results: The multiplanar reconstruction revealed bilateral renal artery dissection and multiple arterial infarctions disseminated throughout both kidneys. After a clinical follow-up and hypertension retargeting, the patient was discharged with dual antiplatelet therapy and ACE inhibitor drugs. No lipid-lowering therapy was needed. Conclusions: Spontaneous renal artery dissection (SRAD) is a rare clinical event that typically presents with acute low-back or flank pain, hypertension, fever, hematuria, and acute renal failure. The condition could be misdiagnosed or receive a delayed diagnosis due to its relative rarity and non-specific presentation. The gold standard is enhanced computed tomography (CT) scans, and if the diagnosis is positive, vascular multiplanar reconstruction is generally suggested, as it can display lesions more clearly. Over 300 cases have been reported since the first characterization of SRAD; however, to date, a consensus has not been reached on the most appropriate treatment. Conservative therapy, open surgery, and intravascular intervention have been reported as treatments for SRAD. [ABSTRACT FROM AUTHOR]

Lymphatic complications are becoming increasingly identified in cancer patients. Chylous ascites, chylothorax, lymphoceles, and lymphorrhea are common in cancer patients and can occur due to traumatic injury during surgeries or infiltrative effects of the tumors themselves. Recently, some anti-neoplastic medications are also thought to result in lymphatic complications. Management options range from conservative options to minimally invasive interventions, to surgical interventions with no standardized management strategy. Imaging techniques such as dynamic contrast-enhanced magnetic resonance lymphangiography and intranodal computed tomography or fluoroscopic lymphangiography are becoming more valuable in diagnosis and treatment planning. Minimally invasive interventions are rapidly evolving and have become the first-line intervention in most cases. Current research, however, faces limitations due to study design and variability. Standardized reporting and prospective studies are needed to advance the field. This review summarizes some of the latest literature on lymphatic interventions in cancer patients and provides reporting recommendations for future studies on lymphatic interventions. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to evaluate the safety and efficacy of the combination of Lipiodol and N-butyl cyanoacrylate (N-BCA) for vascular embolization. Methods Patients with various vascular pathologies, eligible for embolization using a combination of Lipiodol and N-BCA, were included in this ethical committee–approved prospective multicenter study. Adverse events (AEs) during the procedure and up to 30 days were recorded and categorized into minor or major (AE classification by the Society of Interventional Radiology). Depending on the targeted volume of vascular occlusion of the lesion, lesions were classified into four groups (group 1: <50% target volume; group 2: 50–75%; group 3: 75–99%, and group 4: 100%). Consistency between the targeted and actual vascular occlusion achieved after embolization was assessed. Results One hundred and twenty-four patients were enrolled. All underwent at least one procedure, and 12 required a second procedure. No AEs were noted during the procedure, while 42 AEs occurred in 23 patients (18.5%) after and during the follow-up period. Two minor AEs in one patient (0.8%) were related to the mixture, and 26 AEs in 16 patients (12.9%) were related to the procedure (mostly minor A, 30.8% or B, 42.3%). The most frequent procedure-related AE was postembolization syndrome (4.8%). Nonfatal serious AEs related to the procedure occurred in two patients. The actual vascular occlusion was equal to or greater than the targeted volume in 119/135 lesions (88.1%) following the first procedure and in 11/13 lesions (84.6%) following the second procedure. Conclusion Lipiodol and N-BCA combination is safe and highly effective for vascular embolization. [ABSTRACT FROM AUTHOR]

Simple Summary: Locally advanced rectal cancer presents significant treatment challenges, often requiring aggressive multimodal therapy. Transarterial chemoembolization (TACE) is an innovative approach that allows for the targeted delivery of chemotherapy directly to the tumor, minimizing systemic exposure and potentially reducing adverse effects. This systematic review aims to evaluate the current evidence on TACE in rectal cancer, focusing on its efficacy in tumor reduction, survival outcomes, and safety profile. By summarizing data from various studies, this review highlights TACE's potential role as an adjunctive therapy in managing this difficult-to-treat cancer. While initial results are promising, further research is needed to establish its optimal use in clinical practice and to better define its benefits in combination with other standard therapies. Background: Locally advanced rectal cancer (LARC) presents a significant treatment challenge. Transarterial chemoembolization (TACE) has emerged as a potential adjunctive treatment, offering targeted delivery of chemotherapeutic agents to the tumor site, minimizing systemic exposure. This systematic review aims to assess the current literature on this novel technique and evaluate the safety and efficacy profile of TACE in treating this complex cohort of patients. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, EMBASE, and Cochrane Library, to identify studies evaluating TACE in LARC. Inclusion criteria encompassed clinical trials, cohort studies, and case series reporting on outcomes such as tumor response rate, overall survival (OS), progression-free survival (PFS), and treatment-related adverse events. Results: A total of eight studies involving 543 patients met the inclusion criteria. The studies varied in design, with five prospective and three retrospective studies. A higher prevalence of male participants (68.7%) was noted, with a median age of 60.3 years. The studies primarily evaluated the efficacy and safety of TACE in LARC treatment. Pathological response rates, tumor reduction, and survival outcomes varied across studies, with TACE showing promise in reducing tumor size, improving survival, and controlling metastasis. Major complications were rare, reported in 6.0% of cases. Conclusions: TACE is a promising therapeutic option for patients with LARC, demonstrating favorable tumor response rates and manageable toxicity profiles. Further large-scale, randomized controlled trials are warranted to confirm these findings and better define the role of TACE in the multimodal treatment of LARC. [ABSTRACT FROM AUTHOR]

The National Palliative Care and Interventional Radiotherapy Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) carried out a survey whose aim was to obtain a "snapshot" of the real-world practice of nonmelanoma skin cancer (NMSC) treatments in Italy. The survey was conducted on SurveyMonkey's online interface and was sent via e-mail to our society Radiation Oncologists. Fifty-eight Italian radiation oncologists (ROs), representing 54 centers, answered the survey. Thirteen percent of the ROs declared they treat fewer than 10 NMSC lesions annually, 36% treat between 11 and 20, and 51% treat more than 20 lesions annually. Interventional radiotherapy (IRT) was offered by 25% of the ROs, and every case was reportedly discussed by a multidisciplinary team (71%). Electrons (74%), volumetric modulated arc therapy (V-MAT) (57%), three-dimensional conformal radiotherapy (3D-CRT) (43%), and IRT (26%) were the main treatment options. With external beam radiotherapy (EBRT), 46 and 53 different RT schedules were treated for curative and palliative intent, respectively; whereas for IRT, there were 21 and 7 for curative and palliative intent, respectively. The most popular EBRT curative options were 50–70.95/22–35 fractions (fx) and 50–70 Gy/16-20fx and for EBRT palliative settings, 30Gy/10fx, and 20–35Gy/5fx. For IRT, the most popular curative options were 32–50Gy/8-10fx and 30–54Gy/3-5fx, whereas 30Gy/6fz was the palliative option. Less than 10 re-RT cases were reported in one year in 42.5%, 11–20 cases in 42.5%, and >20 cases annually in 15%. Electrons (61%), VMAT (49%), and BRT (25%) were the most widely used approaches: 20–40Gy in 10fx and 20–25Gy in 5fx were the recommended fractionations. The survey shows a variegated reality. A national registry with more detailed data could help in undercover its causes. • The Italian Association of Radiotherapy and Clinical Oncology (AIRO) proposed a survey to verify the national radiotherapy practices for nonmelanoma skin cancer (NMSC). • The preferred treatment techniques were: electrons (74%) and volumetric modulated arc therapy (V-MAT) (57%). • Interventional radiotherapy (IRT) can only be offered as a therapeutic option in only 25% of Italian RT centers. • Differing RT schedules but mainly adhering to international recommendations. • Data show that the single center experience was likely to play a prevalent role. [ABSTRACT FROM AUTHOR]

Acute upper gastrointestinal bleeding (UGIB) secondary to gastric cancer presents a significant clinical challenge due to its high morbidity and mortality rates. Transcatheter arterial embolisation (TAE) has emerged as a potential therapeutic option for managing this condition, especially in the context of failed endoscopic management. This systematic review aims to evaluate the efficacy and safety of TAE in treating acute upper gastrointestinal (GI) bleeding caused by gastric cancer. A systematic search of medical databases, including PubMed, MEDLINE, and EMBASE, was conducted for studies published between 2000 and 2023. Included studies reported on the use of TAE for acute upper GI bleeding specifically due to gastric cancer, including retrospective analyses, case reports, and cohort studies. Demographics and clinical outcomes were reported. A total of 7 studies met the inclusion criteria, all being retrospective in nature. The overall technical success rate of TAE was 94.9 %. Overall clinical success rates were 72 % with a 95 % confidence interval (CI) of 66–79 %. Overall rebleeding rates were 11 % with a 95 % CI of 3–18 %. Major complications were reported in 2.4 % of patients, including ischemic complications and organ perforation. The overall 30-day mortality rate was 26.4 %, primarily due to underlying disease progression rather than procedural complications. TAE is an effective and safe intervention for managing acute upper GI bleeding secondary to gastric cancer, with high success rates. TAE should be considered a viable treatment modality for this challenging condition, particularly for patients who are being considered for neoadjuvant therapy or indeed those not suitable candidates for curative surgical intervention. • TAE achieved a technical success rate of 94.9 % in treating gastric cancer bleeding. • Clinical success rate of TAE was 72 % with a rebleeding rate of 11 %. • Major complications occurred in 2.4 % of patients, including ischemia and perforation. • 30-day mortality rate was 26.4 %, primarily due to underlying disease progression. • TAE is a viable option for patients unfit for curative surgery or neoadjuvant therapy. [ABSTRACT FROM AUTHOR]

Background: The common femoral artery is a chief source of blood supply to the lower limb. Variations in its anatomy, like its absence, high level commencement of the deep femoral artery (DFA) with a superficial course, are unusual. The knowledge of such variations may have substantial clinical applications, specifically in vascular surgical procedures, catheterizations, and diagnostic or interventional radiology. Case report: During femoral triangle dissection of a 78-years female cadaver, absence of common femoral artery, commencement of DFA at the inguinal ligament level, following a superficial path contrary to its name was observed bilaterally. The exterior diameter of superficial and DFA were 5 mm, 4 mm and 6 mm, 4 mm respectively on the right and left side. Conclusions: Awareness of such variations is essential for interventional radiologists, vascular, orthopaedic, plastic & reconstructive surgeons to plan and execute interventional and surgical procedures effectively and for Anatomist for successful embalming. [ABSTRACT FROM AUTHOR]

Musculoskeletal image-guided interventional radiology plays a key role in diagnosing and treating a range of conditions. Recent advances have yielded a wide variety of procedures that can be applied selectively and enable the personalisation of patient care. This review aims to outline the indications, applications, and techniques of subspecialist musculoskeletal oncology interventional procedures that were used at our tertiary referral centre with a focus on how these may be used to personalise patient management. The applications of a range of diagnostic and therapeutic image-guided interventional procedures including different methods of bone and soft tissue sampling, ablation, and augmentation procedures across different types of patients and pathologies are reviewed. To supplement the reviewed literature, we included our own experience and radiology images retrospectively collected from our Picture Archiving and Communication System (PACS). We demonstrate how the range of musculoskeletal image-guided interventions provide flexibility in the diagnosis and management of different tumours across different patient populations. This study provides the musculoskeletal interventional radiologist with insight into how to appropriately utlilise different techniques to optimise the diagnosis, treatment and palliation of tumours. [ABSTRACT FROM AUTHOR]

To re-audit compliance with an amended sedation protocol following the latest national guidelines. To confirm the improved safety achieved through EEG guidance for drug administration during procedural sedation. Following the revision of the departmental protocol, 14 standards were set. Sedation data and outcomes in 150 consecutive patients undergoing fluoroscopic and combined endoscopic procedures were evaluated against these. Combination sedo-analgesia was titrated by the interventional radiology nurses guided by bispectral index sensor (BIS) measurements to achieve readings between 80 and 85. Doses were stratified by patient age and ASA status. Nasal oxygen was given and standard monitoring including pulse oximetry and capnography were used alongside to assess for complications, notably hypoxaemia of ≤ 94%. 85% were non-vascular procedures, the bulk made up of oesophageal stent insertion, gastrostomy, oesophageal dilatation of radiation strictures and biliary procedures. Mean procedure time was 32.9 minutes (10–170). Mean doses of midazolam and fentanyl were 3.99mg (±1.9) and 92.3μg (±35.4), respectively. 84% of patients were classified as having received light or moderate sedation (BIS 70–89). Three standards for patient sedation were missed, but no patient required sedation reversal or airway management, and none developed hypoxaemia. BIS guidance of sedation administration allows real-time assessment of the patient's response to sedo-analgesia administered and allows prediction about the safety of further drug administration. It identifies patients waking up, allowing this to be anticipated and reduces interruptions of the procedure. It offers clear clinical advantages to interval assessment of patients' response to clinical stimuli and reduces under-as well as oversedation. • BIS is a standardised and continuous assessment of the depth of sedation. • In contrast to clinical assessment, EEG monitoring does not disturb the patient. • BIS improves the accuracy of sedation and reduces airway complications. • The safety of further drug administration can be predicted by EEG monitoring. • The continuous display of BIS increases nurses' confidence in drug administration. [ABSTRACT FROM AUTHOR]

There is no comprehensive data collection outlining the numbers and types of interventional radiology (IR) procedures in the United Kingdom. Similarly, limited data are available on the IR facilities and workforce within the National Health Services (NHS) trusts. The purpose of this study is to evaluate the number/type of IR procedures, facilities, and workforces across England and Wales. This retrospective study used the 2000 Freedom of Information Act to obtain information regarding the IR procedures performed in NHS trusts in England and Wales from 2017 to 2021. We collected additional information on IR workforce and facilities, including the number of IR consultants, nurses, trainees, and angiographic suites and day case units; analysed procedures by complexity; and performed data analysis by region. A total of 1,340,352 IR procedures were analysed. An increasing trend was observed in the number of IR procedures from 2017 to 2021 (p =0.07, R=0.93). There were more intermediate and complex procedures than simple ones (p =0.0001). Notable geographical variation was observed in terms of IR facilities including angiographic suites and day case units, and the number of IR consultants, nurses, and trainees. The IR field continues to grow as evidenced by increasing trends in the number and complexity of the procedures over the years. There is an uneven IR workforce, services, and facilities distribution across England and Wales. Therefore, there is a crucial need for centralised data collection to evaluate and monitor interventions besides comprehensive revision of UK IR service provision. • Approximately 280,000 IR procedures are performed annually in England and Wales. • Two-thirds of the procedures were intermediate and complex with 1/3 were vascular IR cases. • Significant inequality in services, workforce and facilities across the country. • A significant shortage in IR consultants and nurses and low number of IR trainees. • There are no central records of procedure outcomes, safety and/or cost. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Setting Design Population Methods Results Main Outcome Measures Conclusion We aim to clarify potential risk factors of complications after uterine artery embolisation (UAE).Complications after uterine artery embolisation (UAE) for symptomatic fibroids are rare, but failure of treatment occurs for approximately 13%–24% of patients at 10 years.We conducted a case–control study including all complications post UAE over 15 years in our specialised unit.All Grade 2 complications (or worse) for the Society of Interventional Radiology Standards of Practice Committee complications post UAE were considered. One thousand one hundred seventy‐two UAE were performed.Complications were divided into two groups: early (< 1 month) or late (≥ 1 month) to differentiate complications from failure of procedure. Multinomial analysis was conducted to assess links between complications and potential risk factors.Sixty‐nine (0.06%) complications were found: 24.6% hospitalisation for pain (n = 17/69), 30.4% for infection (n = 21/69) and 2.9% expulsion of fibroid (n = 2/69). Overall, 31 patients underwent a second procedure (45%).Intra‐uterine device and multiple fibroids were strongly related to early complications (ORearly = 4.44, IC 95%: 1.5–13.3 and ORearly = 3.7, IC 95%: 1.2–11.3, respectively). The only factor that appeared to be associated with risk of early and late complications was the major fibroid's diameter (for an increased size of 25 mm, ORearly = 1.7, IC 95%: 1.1–2.6; ORlate = 1.5, IC 95%: 1.04–2.2).Our study enlightens about the potential risk factors of UAE's complications and differentiate their impact between early and late complications. [ABSTRACT FROM AUTHOR]

The impact of intersectionality on academic radiology physician compensation is not well known. The aim of this study was to assess impact of intersectionality on academic radiology financial compensation, based on rank, gender and race/ethnicity in US medical schools. Data were collected from the AAMC Faculty Salary Survey, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for radiology faculty with MD or equivalent degree in diagnostic radiology (DR) as well as interventional radiology (IR) was collected for 2023, stratified by rank, gender, and race/ethnicity. The AAMC Faculty Salary Survey data for 2023 included responses for 683 IR (138 women, 545 men) and 2431 DR (862 women, 1569 men) faculty. Men had a higher median compensation than women at all ranks, for both IR and DR, except DR instructors. The gender pay gap was greater in IR faculty compared to DR faculty of the same rank. All intersectional groups among IR faculty reported a lower median compensation compared to White men of the same rank. All intersectional groups among DR faculty, except Asian Men, had a lower median compensation than White men of the same rank. Among IR faculty, Asian women assistant professors faced the greatest disparity in median compensation, down to $75 K (15%) lower than White men. Among DR faculty, Black/African American women assistant professors faced the greatest disparity on median compensation, down to $48 K (10.5%) lower than White men. The study results raise important concerns about impact of intersectionality on faculty compensation in radiology which needs further study and should be addressed as part of broader drive to increase diversity, equity, and inclusion in academic radiology. • All intersectional groups among IR faculty reported a lower median compensation compared to White men of the same rank. • Among IR faculty, Asian women Assistant Professors received 15% lower compensation than White men. • Among DR faculty, Black women received 10.5% lower compensation than White men. [ABSTRACT FROM AUTHOR]

This article describes minimally invasive treatments for managing chronic low back pain (LBP) related to lumbar spinal stenosis, facetogenic LBP, vertebrogenic LBP, or discogenic LBP. We also propose a clinical decision-making tool to guide clinicians in appropriate patient selection for various treatments. [ABSTRACT FROM AUTHOR]

The article discusses the importance of quality assurance (QA) and quality improvement (QI) in interventional radiology (IR) to ensure effective, safe, and patient-centered care. It highlights the guidance provided by the Society of Interventional Radiology (SIR) and the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) on adverse event rates in IR procedures. The document also presents a comparison of reported adverse event rates and thresholds over the last 30 years for specific procedures like percutaneous biliary drainage and transarterial chemoembolization (TACE). Despite advancements in IR, there is no evidence that the use of adverse event thresholds has led to a reduction in adverse event rates. [Extracted from the article]

Purpose: Engaging in clinical service development is a prerequisite for Interventional Radiology (IR) to prosper as a full clinical discipline. The CIRSE Clinical Services in IR Task Force conducted a survey of CIRSE members worldwide to assess the current status of their clinical practice and to identify areas of practice requiring further support. Materials and Methods: An online questionnaire with 63 structured items was sent to 7,501 CIRSE members in November 2023. The survey was closed in January 2024 and a statistical data analysis was performed. Results: A total of 520 complete responses were collected. 49.6% of respondents have an IR outpatient clinic, 34.5% have a dedicated IR day-case ward and 19.8% have dedicated inpatient beds. While 62% of respondents treat patients as the primary consultant responsible for their patients' care, 40.3% of respondents currently without their own beds have admitting rights to the hospital. Clinical practice activities are itemised in the work schedule of 41.3% of respondents and 45% routinely perform ward rounds. A total of 40% feel very positive with their personal clinical practice competency. Conclusion: With half of responding IRs having primary patient access and clinical services in place, the results are encouraging; however further engagement by those who are not yet involved is required. The authors advocate a step-wise approach towards clinical services starting with ward rounds, and subsequently taking increasing responsibility for each step in the IR patient pathway. [ABSTRACT FROM AUTHOR]

Ilio-femoral venous reconstruction has progressed from being only performed by a limited number of pioneers (often using equipment repurposed from other areas of interventional radiology) to a discrete subspecialty of endovascular practice with a dedicated range of tools and increasingly evolved techniques to secure optimal results. This review is intended to reflect the modern practice of ilio-femoral stenting in the acute and chronic settings, from initial patient assessment to completion of procedure and follow-up care. [ABSTRACT FROM AUTHOR]

Purpose: The development of new endovascular technologies for transarterial embolization has relied on animal studies to validate efficacy before clinical trials are undertaken. Because embolizations in animals and patients are primarily conducted with fluoroscopy alone, local hemodynamic changes are not assessed during testing. However, such hemodynamic metrics could be important indicators of procedure efficacy that could support improved patient outcomes, such as via the determination of procedural endpoints. The purpose of this study is to create a high-fidelity benchtop system for multiparametric (i.e., hemodynamic and imaging) assessment of transarterial embolization procedures. Methods: The benchtop system consists of a 3D printed, anatomically accurate vascular phantom; a flow loop with a cardiac output simulator; a high-speed video camera; and pressure transducers and flow meters. This system enabled us to vary the heart rate and blood pressure and to simulate clinically relevant hemodynamic states, such as healthy adult, aortic regurgitation, and hypovolemic shock. Results: With our radiation-free angiography-mimetic imaging system, we could simultaneously assess gauge pressure and flow values during transarterial embolization. We demonstrated the feasibility of recapitulating the digital subtraction angiography workflow. Finally, we highlighted the utility of this system by characterizing the relationship between an imaging-based metric of procedural endpoint and intravascular flow. We also characterized hemodynamic changes associated with particle embolization within a branch of the hepatic artery and found them to be within reported patient data. Conclusion: Our benchtop vascular system was low-cost and reproduced transarterial embolization-related hemodynamic phenomena with high fidelity. We believe that this novel platform enables the characterization of patient physiology, novel catheterization devices, and techniques. [ABSTRACT FROM AUTHOR]

Purpose: Transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma; however, it awaits approval in Japan. This study aimed to simulate the cost-effectiveness of TARE over chemoembolization when TARE is approved in Japan and identify the requirements for cost-effectiveness. Materials and methods: A Markov model was constructed to analyze the costs and effectiveness associated with TARE and transarterial chemoembolization with drug-eluting beads (DEB-TACE) for 2-month cycles over 5 years. In the primary analysis, the intention-to-treat survival data were used to calculate transition probabilities, whereas the ancillary analysis assessed the per-protocol survival data. DEB-TACE costs were calculated using the Japanese nationwide claims Diagnosis Procedure Combination database between April 2018 and March 2022, whereas TARE costs were estimated using database and international sources. The incremental cost-effectiveness ratio (ICER) was determined based on the payer's perspective and compared with the Japanese willingness-to-pay threshold of 5 million Japanese yen (JPY) (31,250 USD) per quality-adjusted life years (QALY). Results: From the claims database, 6,986 patients with hepatocellular carcinoma who received DEB-TACE were identified. In the primary analysis, the ICER was 5,173,591 JPY (32,334 USD)/QALY, surpassing the Japanese willingness-to-pay threshold. However, the ancillary analysis showed a lower ICER of 4,156,533 JPY (25,978 USD)/QALY, falling below the threshold. The one-way deterministic sensitivity analysis identified progression-free survival associated with TARE and DEB-TACE, DEB-TACE costs, and radioactive microsphere reimbursement price as key ICER influencers. The primary analysis suggested that setting the reimbursement price of radioactive microspheres below 1.399 million JPY (8,744 USD), approximately 2.8% lower than the price in the United Kingdom, would place the ICER below the Japanese willingness-to-pay threshold. Conclusions: Under specific conditions, TARE can be a more cost-effective treatment than DEB-TACE. If the reimbursement price of radioactive microspheres is set approximately 2.8% lower than that in the United Kingdom, TARE could be cost-effective compared with DEB-TACE. [ABSTRACT FROM AUTHOR]

Purpose: The performance of vision-language models (VLMs) with image interpretation capabilities, such as GPT-4 omni (GPT-4o), GPT-4 vision (GPT-4V), and Claude-3, has not been compared and remains unexplored in specialized radiological fields, including nuclear medicine and interventional radiology. This study aimed to evaluate and compare the diagnostic accuracy of various VLMs, including GPT-4 + GPT-4V, GPT-4o, Claude-3 Sonnet, and Claude-3 Opus, using Japanese diagnostic radiology, nuclear medicine, and interventional radiology (JDR, JNM, and JIR, respectively) board certification tests. Materials and methods: In total, 383 questions from the JDR test (358 images), 300 from the JNM test (92 images), and 322 from the JIR test (96 images) from 2019 to 2023 were consecutively collected. The accuracy rates of the GPT-4 + GPT-4V, GPT-4o, Claude-3 Sonnet, and Claude-3 Opus were calculated for all questions or questions with images. The accuracy rates of the VLMs were compared using McNemar's test. Results: GPT-4o demonstrated the highest accuracy rates across all evaluations with the JDR (all questions, 49%; questions with images, 48%), JNM (all questions, 64%; questions with images, 59%), and JIR tests (all questions, 43%; questions with images, 34%), followed by Claude-3 Opus with the JDR (all questions, 40%; questions with images, 38%), JNM (all questions, 42%; questions with images, 43%), and JIR tests (all questions, 40%; questions with images, 30%). For all questions, McNemar's test showed that GPT-4o significantly outperformed the other VLMs (all P < 0.007), except for Claude-3 Opus in the JIR test. For questions with images, GPT-4o outperformed the other VLMs in the JDR and JNM tests (all P < 0.001), except Claude-3 Opus in the JNM test. Conclusion: The GPT-4o had the highest success rates for questions with images and all questions from the JDR, JNM, and JIR board certification tests. [ABSTRACT FROM AUTHOR]

Purpose: Numerous navigation devices for percutaneous, CT-guided interventions exist and are, due to their advantages, increasingly integrated into the clinical workflow. However, effective training methods to ensure safe usage are still lacking. This study compares the potential of an augmented reality (AR) training application with conventional instructions for the Cube Navigation System (CNS), hypothesizing enhanced training with AR, leading to safer clinical usage. Methods: An AR-tablet app was developed to train users puncturing with CNS. In a study, 34 medical students were divided into two groups: One trained with the AR-app, while the other used conventional instructions. After training, each participant executed 6 punctures on a phantom (204 in total) following a standardized protocol to identify and measure two potential CNS procedural user errors: (1) missing the coordinates specified and (2) altering the needle trajectory during puncture. Training performance based on train time and occurrence of procedural errors, as well as scores of User Experience Questionnaire (UEQ) for both groups, was compared. Results: Training duration was similar between the groups. However, the AR-trained participants showed a 55.1% reduced frequency of the first procedural error (p > 0.05) and a 35.1% reduced extent of the second procedural error (p < 0.01) compared to the conventionally trained participants. UEQ scores favored the AR-training in five of six categories (p < 0.05). Conclusion: The AR-app enhanced training performance and user experience over traditional methods. This suggests the potential of AR-training for navigation devices like the CNS, potentially increasing their safety, ultimately improving outcomes in percutaneous needle placements. [ABSTRACT FROM AUTHOR]

The aim of this study was to optimise the vessel angle as well as the stack number from the profiles of carbon dioxide digital subtraction angiography (CO2-DSA) images of a water phantom containing an artificial vessel tilted at different angles which imitate arteries in the body. The artificial vessel was tilted at 0°, 15°, and 30° relative to the horizontal axis with its centre as the pivot point, and CO2-DSA images were acquired at each vessel tilt angle. The maximum opacity method was used to stack up to four images of the next frame one by one. The signal-to-noise ratio (SNR) was determined from the profile curves. The Wilcoxon rank sum test was used to evaluate whether the profile curve and SNR differed depending on the vessel tilt angle or stack number, and a p-value of less than 0.05 was considered statistically significant. Images acquired at 0° had a significantly lower SNR than images acquired at 15° (p = 0.10). When the vessel angle was 30°, the profile curves were significantly improved (p < 0.05) when two or more images were stacked over the original image. Images with a good SNR were acquired at the vessel tilt angle of 15°, and the shape of the profile curve was improved when two or more images were stacked on the original image. This study demonstrates that the quality of images acquired using CO2-DSA can be significantly improved through parameter optimisation for image acquisition and post-processing. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has the potential to support time-critical stroke treatment. In a previous study we demonstrated the feasibility of deep learning based automatic classification for thrombus detection during thrombectomies, a catheter-guided procedure to remove occlusions of cerebral vessels. However, this method has yet to be tested during a live intervention. In this work, we present a setup to integrate AI based support in an angiography suite. A classification PC was connected to the angiography by means of a real-time video connection as well as a research interface for control signals. We found that video conversion in real-time does not affect the classification result in comparison to offline classification of DICOM data. Analyzing 50 video streams of previous cases, the system could classify digital-subtraction angiography (DSA) sequences within 13.3 seconds on average. This processing time can further be reduced to an average of 7.9 seconds with GPU acceleration. Additionally, the system successfully classified two DSA sequences acquired during live thrombectomy, identifying the presence of thrombi in less than 5 seconds. So far, the classification result has only been displayed in the control room of the angiography suite to demonstrate feasibility. In the outlook, however, we also discuss how the result can be displayed directly on the angiography screen. [ABSTRACT FROM AUTHOR]

Thermal ablation is used to treat liver metastasis including those from breast cancer. The ablation is associated with pain, hemorrhage, and biliary structure damage leading to bilomas. Biloma is a collection of bile that can occur inside or outside the biliary system, which could happen as a rare complication of surgery (from procedures like abdominal surgery or diagnostic procedures), trauma, or spontaneously. We report a case of biloma development after microwave ablation (MWA) of a metastatic lesion in the liver. We present a 66-year-old female diagnosed with stage 4 intraductal carcinoma of the right breast with metastasis to the liver. She developed biloma and infarction of the left lobe of the liver following MWA, which was treated with percutaneous internal/external biliary drain placement. Her symptoms and liver function tests were completely resolved after 3 months, and her left hepatic lobe completely atrophied in the same period. Biloma is a rare but concerning complication of MWA, therefore high suspicion should be maintained in patients presenting with cholestatic symptoms and fever postprocedure. When identified, drainage with antibiotic therapy can effectively treat biloma and resolve the symptoms.

Patients with upper extremity deep vein thrombosis (UEDVT) generally present with similar symptoms including arm swelling, erythema, heaviness, or pain. However, this condition is caused by different factors which can influence management decisions. As a result, UEDVT is categorized by primary or secondary etiology. Primary UEDVT is most commonly a result of anatomical subclavian vein compression, whereas secondary UEDVT is most frequently associated with indwelling catheters. Regardless of etiology, anticoagulation therapy is recommended, and interventional treatment is reserved for more severe cases. This series includes outcome data for 8 heterogenous patients treated for UEDVT with mechanical thrombectomy using the ClotTriever System by an interventional radiologist in a single healthcare system. Herein we present procedural imaging for select cases and discuss treatment characteristics and outcomes based on etiology.

Normal hepatic arterial anatomy consists of the right hepatic artery and left hepatic artery branching from the common hepatic artery. Despite this being the most common configuration, many variations have been described. Here, we present a rare variant of hepatic arterial anatomy- a replaced right hepatic artery with direct aortic origin. Additionally, the patient was found to have a dorsal pancreatic artery originating from the replaced right hepatic artery This was angiographically identified during mapping for transarterial radioembolization for hepatocellular carcinoma. The unique anatomy in this case and the effect it had on transarterial radioembolization planning described herein demonstrates the necessity of understanding variant hepatic arterial anatomy in endovascular hepatic interventions.

In medical practice, the retrieval of intravascular foreign bodies (IFBs) represents a challenge and often requires a multidisciplinary approach. We report a case of a 65-year-old male patient with a metallic guide wire extended from the right subclavian artery to the left ventricle. An interventional radiology team employed the “trap technique”, with a combination of a retrieval device and angiographic catheters, which results crucial in this case. Proper device management and imaging assessment are essentil to the successful retrieval of IFBs. Further research is warranted to refine IFB retrieval techniques and evaluate long-term outcomes.

Uterine leiomyomas are one of the most common smooth muscle tumors in women. Cervical leiomyomas, in contrast, are a relatively rare entity with limited available information, presenting a challenge for determining optimal treatment. Uterine artery embolization of cervical leiomyomas has been previously explored and met with some success. However, it has been associated with complications such as expulsion or incomplete embolization. This case, however, describes a patient who presented with a large cervical fibroid and was successfully treated with bilateral ovarian artery embolization, resulting in decreased fibroid burden and resolution of the patient's symptoms. Previous reports have demonstrated successful ovarian artery embolization for uterine leiomyomas, but this approach has yet to be shown for a cervical leiomyoma. Given the challenge presented by cervical leiomyomas, this case emphasizes a unique anatomical variant and the embolization method, providing an alternative, less-invasive option for reducing patient disease burden.

Dual antiplatelet therapy is commonly used to treat or prevent thromboembolic events in patients with deep vein thrombosis, pulmonary embolism, atrial fibrillation, in patients after coronary artery stenting, cerebral artery stenting or artificial heart valves, etc. Although they significantly reduce the morbidity and mortality from thromboembolic events, dual antiplatelet therapy is associated with the risk of bleeding, which can be life-threatening. Gastrointestinal bleeding is one of the most common and dangerous events when using dual antiplatelet therapy for a long time. According to studies, nearly half of the major bleeding cases related to dual antiplatelet therapy arise from the gastrointestinal (GI) tract. We report the case of a 74-year-old female patient with lower gastrointestinal bleeding after using dual antiplatelet therapy that was successfully treated endovascularly with a coil.

In dental imaging, Cone Beam Computed Tomography (CBCT) is a widely used imaging modality for diagnosis and treatment planning. Small dental scanning units are the most popular due to their cost-effectiveness. However, these small systems have the limitation of a small field of view (FOV) as the source and detector move at a limited angle in a circular path. This often limits the FOV size. In this study, we addressed this issue by modifying the source-detector trajectory of the small dental device. The main goal of this study was to extend the FOV algorithmically by acquiring projection data with optimal projection angulation and isocenter location rather than upgrading any physical parts of the device. A novel algorithm to implement a Volume of Interest (VOI) guided trajectory is developed in this study based on the small dental imaging device's geometry. In addition, this algorithm is fused with a previously developed off-axis scanning method which uses an elliptical trajectory, to compensate for the existing constraints and to further extend the FOV. A comparison with standard circular trajectory is performed. The FOV of such a standard trajectory is a circle of 11 cm diameter in the axial plane. The proposed novel trajectory extends the FOV significantly and a maximum FOV of 19.5 cm is achieved with the Structural Similarity Index Measure (SSIM) score ranging between (≈98-99%) in different VOIs. The study results indicate that the proposed source-detector trajectory can extend dental imaging FOV and increase imaging performance, which ultimately results in more precise diagnosis and enhanced patient outcomes.

Background: To evaluate p-Cry in 10 years as a feasible and radical approach in patients with small renal masses (

Abstract Radiotherapy sensitivity is associated with the prognosis of patients with tongue squamous cell carcinoma (TSCC). In the present study, we proposed to explore the specific mechanism of interventional radiology (IR) therapy for TSCC in vitro and in vivo. TSCC cells were treated with 6 Gy IR and tumor bearing mice were treated with 20 Gy × 1 IR. DIA quantitative proteomics along with bioinformatics analysis were conducted in TSCC cells to investigate differential proteins related to IR and relation of which involved in TMEM147 and SPHK1 was confirmed by immunoprecipitation. Cell proliferation, apoptosis, autophagy& autophagy flux along with calcium signaling pathway detection were performed in vitro and in vivo. Our results showed that IR induced increasing calcium levels accompanied by up-regulated TMEM147 and down-regulated SPHK1 along with enhancing autophagy together with apoptosis. The effect of calcium overloading induced by IR on autophagy and apoptosis was dependent on increasing TMEM147 and decreasing SPHK1. However, IR-induced autophagy and apoptosis tended to be independent of only increasing calcium levels when down-regulating TMEM147 or up-regulating SPHK1 expression in vitro and in vivo. Our study suggested that calcium-mediated TMEM147/SPHK1 may promote autophagy and apoptosis to improve radiotherapy sensitivity in TSCC.

Total gastrectomy with Roux-en-Y esophagojejunostomy is a common surgical treatment for early gastric cancer; however, postoperative complications such as anastomotic leaks remain a serious risk. This report details a 59-year-old female who underwent total gastrectomy with Roux-en-Y esophagojejunostomy for early gastric cancer, followed by percutaneous embolization for esophagojejunal (EJ) anastomotic leakage. Despite initial percutaneous drainage for fluid accumulation at the EJ site, subsequent CT revealed significant anastomotic dehiscence. Endoscopic treatment was ineffective and surgical intervention posed a high risk of mortality; therefore, percutaneous embolization was requested. This involved four sessions using cut gel foam, N-butyl-2-cyanoacrylate, and lipiodol. The procedure was successful without complications and led to complete resolution of the leakage and dehiscence. Follow-up CT scans at 6- and 32-months post-procedure confirmed the absence of recurrence. This case highlights the potential of percutaneous embolization as a treatment option for anastomotic leakage after Roux-en-Y esophagojejunostomy.

Abstract Purpose To investigate over 10 years the safety and efficacy of percutaneous cryoablation for the treatment of abdominal wall endometriosis (AWE). Methods A systematic review was conducted of literature published between March 2014 and March 2024. Inclusion criteria focused on treatment efficacy studies, while exclusion criteria targeted case reports and studies lacking pertinent outcome data. Methodological quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Results A total of eight studies were included. Local pain scores decreased from a median of 8/10 (interquartile range (IQR) 7–9) on the visual analog scale to 1/10 (IQR 0–2) at the last follow-up (p

Abstract Background Pneumothorax is a potential complication following computed tomography-guided lung biopsy (CT-LB). However, the relationship between the lung needle path CT attenuation values and risk of post-procedural immediate pneumothorax remains unclear. The study aims to investigate this relationship. Methods The present single-center retrospective cohort study analyzed the data obtained from 453 patients who underwent CT-LB from 2019 to 2022. The relationship between the lung needle path CT attenuation values and post-procedural immediate pneumothorax was assessed using restricted cubic splines, which were adjusted for potential confounders, and validated using linear and nonlinear binomial logistic models. Results A total of 453 patients (mean age: 60.2 ± 12.0 years old, 217 male patients) were evaluated. The incidence of post-procedural immediate pneumothorax was 41.06% (186/453). The median needle path CT attenuation was − 831 Hounsfield units (Hu). The linear models indicated an unstable association between lung needle path CT attenuation and post-procedural immediate pneumothorax (odds ratio: 0.99, 95% confidence interval: 0.99-1.00). The nonlinear analysis identified an inflection point at a CT attenuation value of -805 Hu. A stronger negative link was identified for needle path CT attenuation values below − 805 Hu (odds ratio: 0.99, 95% confidence interval: 0.98–0.99) between the needle path CT attenuation value and pneumothorax, while no statistically significant association was identified between these when the CT attenuation value was above − 805 Hu. Conclusion There is a nonlinear association between the lung needle path CT attenuation values and risk of post-procedural immediate pneumothorax. For CT attenuation values below − 805 Hu, increasing the needle path CT attenuation values might reduce the risk of pneumothorax.

Osteoid osteomas are benign bone tumors characterized by severe localized pain, often challenging the daily lives of young patients. While these tumors are typically solitary, rare cases of multiple osteoid osteomas have been reported. This research paper presents a case series of 2 young patients with multiple osteoid osteomas, highlighting their clinical presentation, diagnostic workup, treatment with cryoablation, and follow-up. The paper emphasizes the effectiveness of cryoablation as a minimally invasive treatment option for these challenging cases.

Advances in breast cancer treatment have markedly reduced the incidence of massive bleeding, yet severe hemorrhage remains a critical issue in locally advanced or metastatic cases. Traditional management strategies often prove inadequate for significant bleeding, highlighting the need for alternative interventions. We detail the management of a 64-year-old patient with a neglected locally advanced breast tumor, leading to life-threatening hemorrhage. Conventional bleeding control measures failed, necessitating microsphere embolization. Effective hemostasis was achieved without adverse events or recurrence of bleeding, allowing for the initiation of chemotherapy. This case underscores the rarity yet potential severity of hemorrhage in breast cancer, challenging conventional management. Embolization, typically reserved for other hemorrhagic conditions, is appearing as a viable alternative for breast cancer-related hemorrhage, particularly in large tumors where surgery is impractical. Further research is necessary to establish its role in managing minor bleeding.

A 48-year-old female with a background history of alcoholic liver cirrhosis and noninsulin-dependent diabetes presented to our institution with emphysematous pyelonephritis of the right kidney diagnosed on CT. Both urine and blood culture grew multidrug-resistant Escherichia coli. The patient developed severe thrombocytopenia, hyponatremia, confusion as well as septic shock. Preoperative right renal arterial embolization was performed, followed by immediate primary nephrectomy. This article reports the first documented case of preoperative angioembolization to prevent severe intraoperative hemorrhage and vascular complications in severe emphysematous pyelonephritis.

Generalized lymphangiomatosis (GLA) is a very rare condition in adults, characterized by diffused proliferation of lymphatic vessels that requires differential diagnosis from other vascular disorders such as cavernous or capillary hemangioma. This is because of overlapping characteristics on histopathological examination. Therefore, imaging features such as CT and MRI are useful to evaluate morphological characteristics, location, and the extent of the spread as well as differential diagnosis with other pathologies. We report a case of a 22-year-old female patient with left hemothorax after thoracoscopic sympathectomy for the treatment of hand sweating. The patient underwent drainage and cleaning of the left pleura. Chest computed tomography and lumbar spine magnetic resonance imaging showed multiple fat infiltration foci of the lumbar spine and pelvis. A wing bone biopsy of the pelvis was initially performed for the diagnosis of chronic osteomyelitis. Afterwards, the patient continued to have pleural drainage and developed hemothorax and chylothorax, amounting to 3000 mL. The chest tube was blocked with a mixture of biological glue and lipiodol (2 mL of glue, ratio of glue to lipiodol: 1:4) and a 3 i-ED coil complex. After the intervention, the pleural fluid decreased; the left pleural fluid was still 15 mm thick, and the amount of fluid drained after 1 week was 100 mL. Aspiration of the chest wall lesion showed fluid rich in fat droplets. Combined with the results of lumbar spine magnetic resonance imaging and the old biopsy, this was consistent with generalized lymphangiomatosis.

Sarcomas present challenges in management due to their aggressive nature. Interventional radiology, utilizing ablation and embolization, offer promising alternatives for recurrent cases. In recent years, combined techniques (ablation + embolization) and the use of balloon-microcatheter have been introduced to enhance the necrotic effect in HCC treatment. This paper presents the case of a 47-year-old female with recurrent abdominal sarcoma treated with balloon-occluded microwave ablation (b-MWA) and balloon-occluded transarterial embolization (b-TAE). Post-treatment imaging revealed a significant reduction in lesion size and absence of pathological contrast enhancement. This study highlights the potential of balloon-catheter-assisted combined therapies (b-MWA + b-TAE) in managing sarcomas, expanding the applicability of interventional radiology for inoperable cases that are too large for ablative therapy alone or requiring multiple antennas. Further research is warranted to refine protocols and enhance patient outcomes in sarcoma management.

A 68-year-old male with liver cirrhosis presented with dizziness and dyspnea two days after endoscopic Histoacryl occlusion of gastric varicses. Imaging revealed a large endovascular embolization of Histoacryl glue, spanning from porto-caval collaterals via the inferior vena cava to the right atrium, partially occluding right atrial inflow. This case report describes the successful removal of this large net-like mass of Histoacryl glue using thrombectomy devices from the inferior vena cava and the right atrium. Postprocedure imaging showed near-complete clearance with residual fragments in the superior mesenteric vein and small emboli in the pulmonary arteries. The patient was discharged in stable condition. Histoacryl glue can cause severe complications if embolized. This case highlights the potential of advanced thrombectomy devices for managing embolic complications from endovascular treatments.

Abstract Percutaneous image-guided ablation techniques are a consolidated therapeutic alternative for patients with high preoperative surgical risk for the management of oncological diseases in multiple body districts. Each technique has both pros and cons according to the type of energy delivered, mechanism of action, and site of application. The present article reviews the most recent literature results on ablation techniques applied in the field of genitourinary diseases (kidney, adrenal glands, prostate, and uterus), describing the advantages of the use of each technique and their technical limitations and summarizing the major recommendations from an international consensus meeting. Critical relevant statement The article critically evaluates the efficacy and safety of ablation therapies for various genitourinary tract diseases, demonstrating their potential to improve patient outcomes and advance clinical radiology by offering minimally invasive, effective alternatives to traditional surgical treatments. Key Points Ablation therapies are effective alternatives to surgery for renal cell carcinoma. Ablation techniques offer effective treatment for intermediate-risk prostate cancer. Ablation is a promising tool for adrenal tumor management. Ablation reduces fibroid symptoms and volume, offering an alternative to surgery. Graphical Abstract

Abstract Purpose To present the radiological and clinical outcomes of super-selective transcatheter renal artery embolization in patients with renal injury hemorrhage, and share our experience. Methods 43 patients with renal injury hemorrhage who underwent 46 SRAEs were enrolled in this retrospective review study. Records, images, and outcomes were reviewed. The individual embolic method and its observed effects were investigated. Results Angiography showed free extravasation in 25 angiograms, pseudoaneurysm in 15 angiograms, and arteriovenous fistulas in 1 angiogram. Most patients achieved initial clinical success (38/43, 88.4%), and 41 patients achieved final clinical success (41/43, 95.3%). 9/11 patients who adopted empirical embolization achieved initial clinical success (81.8%). In our study, the combination of PVA particles and micro-coils has emerged as the most commonly utilized material combination (24/46, 52.2%). Significant differences in hemoglobin levels were observed before and after the embolization procedure (p = 0.026, 95%CI: 1.03–15.54). Post-embolization clinical follow-up showed no evidence of recurrent hematuria, progression of hematoma, hypertension, and no reflux of the embolic agent. Conclusion Though SRAE showed satisfactory results across a broad range of renal injury hemorrhage, there are still some aspects that need attention: (1) Surgical procedure should be understood, including the surgical site, access routes, and placement of implants, such as double-J stents. (2) In cases where identifying the bleeding point proves challenging, consider the possibility of an accessory renal artery. Trial registration Chinese Clinical Trial Registry ChiCTR2400085050, Registration Date: 30 May 2024, retrospectively, non-randomized.

Abstract Background Inferior vena cava filter (IVC) retrieval is most often routine but can be challenging with high morbidity in complex cases, especially those with an extended dwelling time. While risk of morbidity in complex retrievals is decreased with advanced filter retrieval techniques, deciding when and which to use these requires detailed pre-procedural planning. The purpose of our study was to evaluate patient-specific 3D printed anatomic IVC filter models for aiding complex IVC filter retrievals. Methods All IVC filter retrieval patients between June 2021 and September 2022 at one academic medical hospital were prospectively screened. Nine met criteria for complex retrieval, and their CT images were used to 3D print patient-specific IVC and filter models. Models were used in pre-procedural planning and clinical utility was assessed using the Anatomic Model Utility Likert Questionnaire and estimations of the procedural and fluoroscopy time saved. Results The usage of 3D printed models in pre-procedural planning had high clinical utility based on the Likert questionnaire (Anatomic Model Utility Points 366.7 ± 103.1). Using a model significantly increased confidence in planning (p = 0.03) and modified the treatment plan in seven cases. It also led to cost-efficient use of resources in the procedure suite with estimated reduction in procedure and fluoroscopy time of 29.0 [20.3] (p = 0.003) and 10.2 [6.7] (p = 0.002) minutes, respectively. Conclusion 3D printed anatomic models for patients who require complex IVC filter retrieval demonstrated Likert-based high clinical utility and led to estimated reductions of procedural and fluoroscopy time.

Abstract Traumatic injuries continue to be on the rise globally and with it, the role interventional radiology (IR) has also expanded in managing this patient cohort. The role of damage control surgery (DCS) has been well established in the trauma management pathway, however it is only recently that Damage Control IR (DCIR) has become increasingly utilized in managing the extremis trauma and emergency patient. Visceral artery embolizations (both temporary and permanent), temporary balloon occlusions including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in iliac arteries and aorta respectively are amongst the treatment options now available for the trauma (and non-traumatic bleeding) patient. We review the literature for the role of DCS and utilization of IR in trauma, outcomes and the paradigm shift towards minimally invasive techniques. The focus of this paper is to highlight the importance of multi-disciplinary working and having established pathways to ensure timely treatment of trauma patients as well as careful patient selection. We show that outcomes are best when both surgical and IR are involved in patient care from the outset and that DCIR should not be defined as Non-Operative Management (NOM) as it currently is categorized as.

Abstract Objective Knowing factors that impact catheter stay duration is important since removing drainage catheters too early or late can have significant consequences. We present a single center retrospective study that analyzes multiple variables, including abscess size, white blood cell count, and patient age, to see if a correlation between them and duration of catheter stay exists. The inclusion criteria were patients that had abdominal abscesses treated with percutaneous abscess drainage using a pigtail catheter, ≥ 18 years of age, and had available medical images and records. 44 patients were included. Results Among white blood cell count, patient age, and abscess volume, the only significant relationship with duration of catheter stay was abscess size (R = 0.42, p-value = 0.0049).

Abstract To verify the treatment effect of the combination of transpulmonary chemoembolization (TPCE) and microwave ablation (MWA), targeting the treatment of recurrent or advanced non-small cell lung cancer (NSCLC). A total of 53 patients were studied and grouped according to the diameter of the largest pulmonary nodule, defined as index tumor size (ITS). Patients with an ITS > 3 cm (n = 20) were treated with TPCE and MWA. Patients with an ITS ≤ 3 cm were treated either with a combination therapy (n = 24) or MWA alone (n = 9). The treatment response, including complications and survival outcome, was then analyzed. After TPCE, there was an average ITS reduction of 0.91 cm, and 25% of patients in ITS > 3 cm were downgraded to ITS ≤ 3 cm. After TPCE, there were 12 patients (27%) with PR status and 32 (73%) with SD status. No PD patient in our case series was noted before MWA.The complication rate of MWA was significantly higher in ITS ≤ 3 cm than in ITS > 3 cm (p = 0.013). The median survival time (MST) was 26.7 months, and the time to progression was 13.2 months. The patients in the ITS ≤ 3 cm had longer MST than the others (31.6 vs. 15.8 months, p = 0.003). The significant prognostic factor was ITS > 3 cm (HR: 1.18, p = 0.02). A combination of TPCE and MWA might be feasible to control non-operable, recurrent, or advanced NSCLC.

Although coil embolization is commonly perceived as a minimally invasive procedure, the associated radiation exposure cannot be disregarded. To date, no specific study has investigated radiation exposure during coil embolization. This study aimed to investigate the potential of lowering the pulse rate to decrease radiation exposure during coil embolization while maintaining patient safety. Radiation data and clinical features of 70 patients who underwent coil embolization between 2015 and 2020 were retrospectively analyzed. Since July 2017, the pulse rate was regulated from 7.5 to 4 frames per second (f/s). Statistical analyses were performed to examine the correlation between pulse rate and radiation exposure. Out of the 70 procedures, 30 were performed at the standard pulse rate (7.5 f/s), and 40 were performed at the lower pulse rate (4 f/s). In the lower-pulse-rate group, the absorbed dose to the patient (AK) was 2580.7 (±217) mGy, whereas in the standard-pulse-rate group, it was 4760 (±411.1). Both the dose-area product (DAP) and AK were substantially reduced in the low pulse rate group (p = 0.000002). There was a significant correlation between DAP and AK and pulse rate (p = 0.004, p = 0.0017, respectively). Moreover, there was no significant correlation between pulse rate and perioperative complications. Our findings suggest that using a lower pulse rate (4 f/s) can effectively reduce radiation exposure during coil embolization for cerebral aneurysms while ensuring patient safety.