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This article presents the results of a nationwide survey addressing the status quo of gender equality and family friendliness within German interventional radiology (IR) with a focus on clinical entry and career development.All members of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) were invited to participate in an online survey between November 2021 and February 2022. The survey consisted of 39 questions on demographic information, marital and parental status, experiences with entry and promotion in IR, family friendliness, and equality. A descriptive analysis of the responses was conducted.197 surveys from female (n=76; 39%) and male (n=121; 61%) interventional radiologists at various stages of training and career were analyzed. Fewer female attending physicians (58%) and chiefs of departments (23%) lived with children compared to male attending physicians (76%) and chiefs of departments (55%). Fewer men (4%) than women (41%) were primarily responsible for childcare. More female (55%) than male (6%) attending physicians worked part-time. Women rated entry into IR as more difficult than men. 55% of women felt disadvantaged by their gender (men: 6%); this was due to assumptions that women "perform less than men" (46%), "drop out due to family commitments" (35%) and that "men are promoted preferentially" (19%). 54% believed that it is more difficult for women to combine work and family. The reasons for this are "family commitments" and "lack of flexible work schedules and childcare". Parents with primary responsibility spent less than 50% of their working time on clinical interventions. Fathers from a younger generation were more likely to take parental leave than fathers of a previous generation (52% vs. 17%). Similar numbers of men (51%) and women (55%) planned to work part-time in the future.There are gender-specific differences in the German IR. To ensure sustainable recruitment of young talent, measures such as the normalization of flexible work schedules should be introduced to create equal conditions for women and men, as well as mothers and fathers, and thus take changing (family) structures adequately into account. · There are gender-specific differences in career entry/career development in German interventional radiology.. · Working conditions must be adapted to ensure the next generation.. · Changing family structures must be adequately taken into account.. · Dewald CL, Blum SF, Becker LS etal. Exploring gender roles in German interventional radiology - how progressive are we? Fortschr Röntgenstr 2024; DOI 10.1055/a-2427-0303., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Pelvic venous disorders (PeVD) are an underdiagnosed cause of chronic pelvic pain in women. They are caused by venous insufficiency of the pelvic or ovarian veins, leading to the development of mainly periuterine and periovarian varices. It is a progressive disease if left untreated and can cause swelling, dyspareunia, dysmenorrhea, and other symptoms, some non-specific, that affect the patient's quality of life. Interventional therapies are a central component of the treatment of PeVD, with a variety of techniques available for both diagnosis and treatment., Method: This review provides an overview of the pathophysiologic background, diagnosis, and, most importantly, interventional treatment options for PeVD., Results: There is a lack of standardized nomenclature and internationally accepted diagnostic criteria for PeVD as well as randomized controlled trials demonstrating clinical success. However, in clinical trials, endovascular therapy for PeVD has been shown to be safe and effective. This review presents the various interventional techniques for the treatment of PeVD, including embolization, stenting, and sclerotherapy., Conclusion: The importance of PeVD is receiving growing recognition. Recent advances, such as the development of the Symptoms-Varices-Pathophysiology (SVP) classification, provide an impetus to standardize nomenclature and are the first step toward systematizing disease management. Interventional therapies provide a safe and tailored minimally invasive treatment option for patients with PeVD., Key Points: · Pelvic venous disorders are an underdiagnosed condition with frequently delayed diagnosis and debilitating symptoms.. · Until now, the PeVD nomenclature has been imprecise, with terms like May-Thurner syndrome/Nutcracker syndrome.. · Interventional approaches are effective and play a central role in PeVD treatment.., Citation Format: · Dewald CL, Becker LS, Meyer BC. Interventional Therapy of Pelvic Venous Disorders (PeVD). Fortschr Röntgenstr 2024; 196: 921 - 927., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Retroperitoneal and rectus sheath hemorrhage (RRSH) has been described as a potentially fatal condition with mortality rates of up to 30 % due to the risk of exsanguination in combination with often nonspecific clinical symptoms. Patients at risk are > 65 years of age as well as those receiving anticoagulation/antiplatelet medicine. Classifications based on etiology consist of trauma, surgery, and/or underlying vascular pathologies, though spontaneous occurrences without precipitating factors have been reported and are expected to increase with the high number of patients undergoing anticoagulant therapy., Method: Analysis, summary, and discussion of published review articles and expert recommendations., Results: The most commonly described symptom during clinical examination is abdominal pain. However, depending on the volume loss, clinical symptoms may include signs of abdominal compartment and hemorrhagic shock. Computed tomography angiography (CTA) with high sensitivity and specificity for the presence of active bleeding plays an important role in the detection of RH and RSH. Therapy management is based on different pillars, which include surgical and interventional measures in addition to conservative measures (volume replacement, optimization of coagulation parameters). Due to its lower invasiveness with simultaneously high technical and clinical success rates, interventional therapy in particular has gained increasing importance., Conclusion: Diagnostic and therapeutic workup of the patients by an interdisciplinary team is essential for optimal patient care. In case of transcatheter arterial embolization, a standardized approach to the detection of bleeding sites within the vascular territory of the core hematoma appears to favorably influence success and patient outcome., Key Points: · The clinical presentation of retroperitoneal and rectus sheath hematomas can be very heterogeneous and nonspecific. Quick diagnosis is essential due to the relatively high mortality rate (approx. 12-30 %).. · The main risk factors are age > 65 years and the intake of anticoagulants, the use of which has increased 2.5 times in the last 10 years. Coagulopathies, retroperitoneal masses, and hemodialysis are less common causes.. · Computed tomography angiography (CTA) has a high sensitivity and specificity for the presence of active bleeding and has replaced diagnostic subtraction angiography (DSA).. · Treatment should be performed in a multidisciplinary setting with the inclusion of internal medicine, radiology, and surgery. The main indications for embolization are the detection of active contrast extravasation on CTA and the presence of abdominal pain. In cases without active bleeding and with stable vital parameters, conservative treatment measures can be sufficient. Surgical treatment is often reserved for treatment-refractory bleeding with symptoms of abdominal compartment.. · A systematic standardized approach to the detection of bleeding on DSA seems to have advantages regarding technical and clinical success rates.., Citation Format: · Becker LS, Dewald CLA et al. Spontaneous retroperitoneal and rectus sheath hematomas and their interventional therapy: a review. Fortschr Röntgenstr 2024; 196: 163 - 175., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose:  To evaluate the feasibility and image quality of a motion correction algorithm for supra-selective C-arm computed tomography (CACT) of the pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA)., Materials & Methods:  CACT raw data acquired during 30 consecutive BPAs were used for image reconstruction using either standard (CACTorg) or a motion correction algorithm (CACTmc), using 400 iterations. Two readers independently evaluated 188 segmental and 564 sub-segmental contrast-enhanced pulmonary arteries in each reconstruction. The following categories were assessed: Sharpness of the vessel, motion artifacts, delineation of bronchial structures, vessel geometry, and visibility of treatable lesions. The mentioned criteria were rated from grade 1 to grade 3: grade 1: excellent quality; grade 2: good quality; grade 3: poor/seriously impaired quality. Inter-observer agreement was calculated using Cohen's Kappa. Due to an excellent agreement, the ratings of both readers were merged. Differences in the assessed image quality criteria were evaluated using pairwise Wilcoxon signed-rank test., Results:  Inter-observer agreement was excellent for all evaluated image quality criteria (κ > 0.81). For all assessed image quality criteria, the ratings on CACTorg were good but improved significantly for CACTmc to excellent for the whole vascular tree (p < 0.01). When considering segmental and sub-segmental levels individually, all image quality criteria improved significantly for CACTmc on both levels (p < 0.01). While ratings of CACTmc were constant for both levels (segmental and sub-segmental) for all criteria, the ratings of CACTorg were slightly impaired for the sub-segmental arteries., Conclusion:  Motion correction for supra-selective contrast-enhanced CACT of the pulmonary arteries is feasible and improves the overall image quality., Key Points:   · Motion artifacts can severely impair the diagnostic accuracy of CACT.. · A motion correction algorithm can significantly improve image quality in CACT of the pulmonary arteries.. · Especially the overall image quality of sub-segmental branches is significantly improved.., Citation Format: · Maschke S, Werncke T, Becker LS et al. Motion Reduction for C-Arm Computed Tomography of the Pulmonary Arteries: Image Quality of a Motion Correction Algorithm in Patients with Chronic Thromboembolic Hypertension During Balloon Pulmonary Angioplasty. Fortschr Röntgenstr 2021; 193: 1074 - 1080., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose:  Chemosaturation percutaneous hepatic perfusion (CS-PHP) allows selective intrahepatic delivery of high dose cytotoxic melphalan in patients with curatively untreatable liver tumors while limiting systemic toxicity through hemofiltration of the hepatic venous blood. Aim of this study was to investigate the response to therapy, survival and safety of the CS-PHP procedure in patients with liver-dominant metastatic uveal melanoma (UM)., Materials and Methods:  Overall response rate (ORR) and disease control rate (DCR) were assessed according to Response Evaluation Criteria In Solid Tumors (RECIST1.1). Median overall survival (mOS), median progression-free survival (mPFS) and hepatic progression-free survival (mhPFS) were analyzed using Kaplan-Meier estimation. Adverse events were evaluated with Common Terminology Criteria for Adverse Events (CTCAE) v5., Results:  Overall, 30 patients were treated with 70 CS-PHP in a salvage setting from October 2014 to January 2019. In total, ORR and DCR were 42.3 % and 80.8 %, respectively. Overall, mOS was 12 (95 % confidence interval (CI) 7-15) months, and both, mPFS and mhPFS were 6 months, respectively (95 % CI 4-10; 95 % CI 4-13). Adverse events (AE) most frequently included significant but transient hematologic toxicities (87 % of grade 3/4 thrombocytopenia), less frequent AEs were hepatic injury extending to liver failure (3 %), cardiovascular events including one case of ischemic stroke (3 %)., Conclusion:  Salvage treatment with CS-PHP is effective in selected patients with UM. The interventional procedure is safe. Serious hepatic and cardiovascular events, although rare, require careful patient selection and should be closely monitored., Key Points:   · CS-PHP is safe for selected patients with liver-dominant metastatic uveal melanoma.. · CS-PHP resulted in hepatic disease control in 80 % of patients.. · Hematologic events following CS-PHP are common but manageable.., Citation Format: · Dewald CL, Hinrichs JB, Becker LS et al. Chemosaturation with Percutaneous Hepatic Perfusion: Outcome and Safety in Patients with Metastasized Uveal Melanoma. Fortschr Röntgenstr 2021; 193: 928 - 936., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)