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Prostate carcinoma is one of the most common cancers worldwide in men, with over 3 million men currently living with prostate carcinoma. In men, routine screening and successful treatment schemes, including radiation, prostatectomy, or hormone therapy, have allowed for high survivability. Dogs are recognized as one of the only mammals to spontaneously develop prostate neoplasia and are an important translational model. Within veterinary medicine, treatment options have historically been limited in efficacy or paired with high morbidity. Recently, less invasive treatment modalities have been investigated in dogs and people and demonstrated promise. Below, current treatment options available in dogs and people are reviewed, as well as a discussion of current and future trends within interventional treatment for canine PC.

Purpose: To evaluate access site adverse events following ClotTriever-mediated large-bore mechanical thrombectomy via small upper extremity deep veins (< 6-mm). Materials and methods: Twenty patients, including 24 upper extremity venous access sites, underwent ClotTriever-mediated large-bore thrombectomy of the upper extremity and thoracic central veins for symptomatic deep vein obstruction unresponsive to anticoagulation. Patients without follow-up venous duplex examinations (n = 3) were excluded. Patients who had > 6-mm diameter veins accessed (n = 3) were excluded. Temporary purse-string sutures and manual pressure were used for access site hemostasis in all patients. Vein access site and diameter, technical success (defined as placement of the 13.5-French ClotTriever sheath followed by thrombectomy), and early (< 30-days) and late (> 30-days) access site-related adverse events (according to the Adverse Event Classification by the Society of Interventional Radiology criteria) were recorded. Results: Fourteen patients (8 males, 6 females; mean age 51.7 ± 13.6 years) comprising 16 upper extremity venous access sites were included in this study. Access sites included: right brachial (n = 7), left brachial (n = 5), and bilateral brachial (n = 2) veins. The mean access site diameter was 4.3-mm ± 0.67-mm. Technical success was achieved via all access sites. Six (42.9%) patients underwent stent reconstruction following thrombectomy through the same accesses. After the procedure, all purse-string sutures were removed within 24 h. Three (21.4%) patients experienced small access site hematomas that did not require transfusion, intervention, or prolonged hospitalization. Initial follow-up venous duplex ultrasounds were performed at 29.3 ± 21.7 days following intervention. The mean follow-up interval to the second and third venous duplex ultrasounds were 124.3 ± 64-days and 225.1 ± 80.1 days, respectively. One (7.1%) patient developed right arm swelling six days after the procedure and was found to have thrombosis of the previously accessed right brachial vein. No other clinically or sonographically significant access site adverse events were observed. Conclusion: ClotTriever-mediated large-bore thrombectomy via small upper extremity veins is safe with minimal access site adverse events. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Headaches can be categorized as tension-type headaches, migraine, trigeminal autonomic cephalgia, and other primary headache disorders according to the Third International Classification of Headache Disorders. Headaches are one of the most common disorders within the nervous system and have a prevalence of >48% within the general population. Nerve blocks are a type of nerve stimulation that is believed to help reduce the frequency and severity of headaches. The physiological effect of the greater occipital nerve block on headaches is thought to be due to the central nervous system connections of the greater occipital nerve and trigeminal and cervical afferent fibers, which is believed to be the prime origin of migraine headaches. Nerve blocks can contain a variety of drug regimens including steroids, local anesthetics, or a mixture of both. Trigger point injections (TPIs) are an invasive therapy where a needle is guided directly into a trigger point that has been previously identified upon examination. Botulinum toxin A is an alternative treatment modality that can be injected with TPIs. Botulinum toxin A is a potent naturally occurring toxin that causes dose-dependent muscular relaxation by inhibiting the release of acetylcholine at the neuromuscular junction. Summary of Key Findings: (1) Both greater occipital nerve blocks and TPIs have been shown to reduce headache frequency and severity in the short term; however, it appears to be due to the needle injected into the soft tissue structures and not due to the type of solution injected. (2) Ultrasound guidance allows for a more accurate and effective technique than a blind injection as it allows for accurate injection into the targeted muscles, thereby minimizing complications and increasing the chance of success. (3) Once symptoms have been alleviated, clinicians should evaluate the patient's mechanics in the upper trunk to determine whether there are any mechanical abnormalities leading to the formation of myofascial pain and/or trigger points causing the headache symptoms. If identified and treated appropriately, this can allow for a long-term solution in correcting the cause rather than the symptoms alone. (4) Participants receiving a greater occipital nerve block or TPI, despite the drug regimen or dosage, experienced similar benefits with no statistical significance. In deciding which treatment approach to take, the clinician should speak with the patient to educate them on the available options and allow the patient to be part of the decision-making process to best meet their needs and include a rehabilitation plan with all the treatment approaches. Clinical Question: In patients who experience chronic headaches, was there a greater decrease in headache frequency and severity with a greater occipital nerve block or TPI? Clinical Bottom Line: Needles into the supraclavicular region for headaches lead to decreased severity and frequency of headaches in the short term but will not lead to headache resolution. Strength of Recommendation: B. [ABSTRACT FROM AUTHOR]

• This study included 2099 cases of gestational trophoblastic tumours. • Of 38 uterine haemorrhagic complications, 17 patients presented with potentially life-threatening uterine rupture. • This is a rare yet serious event; specific mortality remains low at approximately 3%. • Fertility-sparing techniques are feasible, with five cases of pregnancy reported. • Deep myometrial or serosal invasion: a predictive factor for haemorrhagic complication? Gestational trophoblastic neoplasia are highly vascularized infiltrating lesions that can lead to severe haemorrhagic complications. The aim of this study was to describe the characteristics of patients with gestational trophoblastic neoplasia who experienced uterine haemorrhagic complications, and their management. This retrospective study analysed the histories of 2099 patients with gestational trophoblastic neoplasia registered at the French Reference Centre for Trophoblastic Disease between 1999 and 2023. Among 2099 patients with a confirmed diagnosis of gestational trophoblastic neoplasia, 38 patients who experienced uterine haemorrhagic complications requiring interventional treatment were identified. Among them, 23 (61%) had a low-risk tumour and 15 (39%) had a high-risk tumour according to their International Federation of Gynecology and Obstetrics score. Twenty (53%) patients experienced haemoperitoneum and 18 (47%) patients experienced massive vaginal bleeding. Seventeen (45%) patients experienced uterine rupture. Haemorrhagic treatment consisted of surgery for 26 (70%) patients, exclusive uterine embolization for six (16%) patients, embolization followed by surgery for four (11%) patients, and embolization after failure to control bleeding by aspiration for one (3%) patient. Of the five deaths (13%), one (3%) was related to the uterine haemorrhagic complication. Three of 15 (20%) patients treated conservatively reported subsequent pregnancies. There are no established guidelines for managing severe uterine haemorrhagic complications. The availability of interventional radiology resources could allow for increased use of fertility-preserving procedures, with encouraging results regarding subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Tabletop simulation can be used to support and test system processes for clinical workflows. This paper will describe an innovative approach to testing change in clinical workflows for direct admissions to the operating room and interventional radiology departments in a 700-bed urban hospital in the Pacific Northwest and will highlight the specific benefits to nurse leaders. The simulation exercise involved key stakeholders and subject matter experts from various departments and aimed to evaluate the process workflow, provoke discussion on gaps, uncover improvement opportunities, and formulate recommendations. The simulation experience was broadly acknowledged by those involved as novel, engaging, suitable for complex process changes in health care settings and promoting valuable collaboration. [ABSTRACT FROM AUTHOR]

To evaluate the representation of women as speakers at U.S. radiology annual scientific meetings (ASM). This retrospective study analyzed speaker demographic data from the Society of Interventional Radiology (SIR) and American Roentgen Ray Society (ARRS) ASM between 2019 and 2022. Speaker gender was identified through publicly available profiles, and the percentage of female speakers was calculated for each year. Statistical significance of trends was determined using chi-squared tests, and linear regression analysis was employed to assess trends and to predict future representation. At the SIR ASM, female representation increased from 20.0 % (67 of 334 speakers) in 2019 to 26.5 % (90 of 340 speakers) in 2022. Chi-squared tests showed a statistically significant increase when adjusted for the percentage of female membership. At the ARRS ASM, female representation fluctuated, dropping from 36.6 % (104 of 284 speakers) in 2019 to 17.7 % (43 of 243 speakers) in 2020, then rising to 48.5 % (190 of 392 speakers) in 2022. A chi-squared test revealed significant variation in female representation across the years (p < 0.0001). While both ASM showed an overall positive trend in female speaker representation, SIR demonstrated consistent increases, whereas ARRS exhibited significant fluctuations. Continued efforts in advocacy and targeted interventions are needed to sustain progress and address the gender gap in radiology. [ABSTRACT FROM AUTHOR]

The purpose of this study is to understand the factors influencing a medical trainee's decision to pursue a career in Interventional Radiology (IR), and thereby to inform strategies to support the recruitment and retention of women in IR. Between April and August 2018, a 20-item survey was sent to all members of the Society of Interventional Radiology's Resident, Fellow, and Student section (SIR-RFS). Survey-weighted logistic regression models were constructed to quantify the association between key survey items and gender. Odds ratios and their 95% confidence intervals were computed to summarize each association. False-discovery rate adjusted p-values were computed to account for multiple comparisons. The survey had 567 respondents, corresponding to a 21% response rate. 51% of respondents were medical students, and 49% were radiology residents and fellows. Women comprised 26% of respondents. Women respondents were less likely to be interested in pursuing careers in IR (OR 1.73; 95% confidence interval (CI): 1.09-2.75; p=0.021, p FDR =0.104). Factors that women cited as deterrents to pursuing a career in IR included a desire to become pregnant (OR 4.80; 95%CI: 3.27-7.05; p/p FDR <0.001), a concern for gender-related bias (OR 12.13; 95%CI: 8.01-18.38; p/p FDR <0.001), a concern for ethnicity-related bias (OR 2.07; 95%CI: 1.38-3.09; p<0.001, p FDR =0.004), a concern for sexual-orientation related bias (OR 1.75; 95%CI: 1.04-2.93, p=0.035, p FDR =0.123), and lack of opportunity for professional advancement (OR 0.56; 95%CI: 0.38-0.84); p=0.006; p FDR =0.039). Women trainees are less interested in pursuing careers in IR, citing a desire to have kids and gender-related bias as leading deterrents. Implementing interventions that target these disincentives will help support the recruitment and retention of women in IR. [ABSTRACT FROM AUTHOR]

This article analyzes the external occupational radiation exposure distribution and trends among radiation workers in Jiangsu Province. The results show that the total annual collective effective dose for radiation workers in Jiangsu Province from 2019 to 2022 was 24.82 person·Sv, with an average annual effective dose of 0.34 mSv over the 4-y period. The average annual effective dose exhibited an initial increase followed by a subsequent decrease, with statistically significant differences (P  < .001) between different years. In the medical uses, nuclear medicine and interventional radiology had higher average annual effective doses compared to other categories, at 0.42 and 0.38 mSv, respectively (P  < .05). In industrial applications, accelerator operation and industrial testing workers had higher average annual effective doses compared to others, at 0.32 and 0.31 mSv, respectively (P  < .001). Among different levels of medical institutions, secondary hospitals had the highest average annual effective dose (0.38 mSv, P  < .001). Overall, the average annual effective dose for radiation workers in Jiangsu Province remained relatively low from 2019 to 2022, meeting national standards. However, special attention should still be given to radiation workers in nuclear medicine, interventional radiology, industrial testing, and accelerator operation. [ABSTRACT FROM AUTHOR]

The article published in the CardioVascular & Interventional Radiology journal details the journey of Francisco Cesar Carnevale in developing Prostatic Artery Embolization (PAE) as a successful treatment for lower urinary tract symptoms related to benign prostatic hyperplasia (BPH). Carnevale's work began with preclinical studies in dogs, leading to clinical studies and training courses on PAE at the University of Sao Paulo Medical School. The article highlights Carnevale's efforts in gaining approval for PAE by the Brazilian Federal Council of Medicine and recognition from various urological associations, culminating in his receipt of the CIRSE Gold Medal in 2024 for his outstanding contributions to interventional radiology. [Extracted from the article]

Patients with end-stage renal disease undergoing hemodialysis encounter significant challenges in care coordination and experience higher complication rates. Peritoneal dialysis (PD) is an evidence-based alternative that significantly improves patients' quality of life. Peritoneal dialysis catheter insertion methods include open surgical, laparoscopic, peritoneoscopic, and percutaneous image-guided approaches. Despite comparable success rates and cost-effectiveness, the US healthcare system underutilizes the percutaneous method. This article aims to provide an overview of the essential components of the technique of percutaneous peritoneal dialysis catheter insertion, as well as address patient selection nuances and considerations for urgent-start dialysis. Additionally, it reviews the outcomes and complications associated with image-guided percutaneous PD catheter placement, advocating for its wider adoption. [ABSTRACT FROM AUTHOR]

Objective: To describe and study retrospectively the combination of elastic nails and cementoplasty to stabilize pathological fractures in the upper limb and present the results on pain and mobility. Materials and Methods: Between January 2022 and April 2024, six patients with a median age of 65 were treated with elastic nailing and cement injection. Pathological fractures were located in the clavicle (n = 3), humerus (n = 1) and radius (n = 2). Displacement at the fracture site was noted in two cases. Results: All nails were inserted successfully. Two nails were used for the humerus (n = 1) and the radius (n = 2), and a single nail was used for the clavicle (n = 3). A median volume of 6.5 cc of PMMA was injected. Median duration of the procedure was 155 min. Median pain score dropped from 8/10 the day before intervention to 3.5/10 at 10 days of follow-up and 3/10 at one-month follow-up. Three patients could move their upper limb without limitation. For the five patients for whom imaging was available, no fracture displacement was recorded at a median last follow-up of 3 months. There was no delayed complication. Conclusion: The combination of elastic nail and cementoplasty is feasible and allows to reduce pain and restore limb function. It may offer an alternative to patients suffering from pathological fractures in the upper limb and who are not candidates for surgery. [ABSTRACT FROM AUTHOR]

Background: Splenic artery embolization (SAE) is increasingly favored for adult blunt splenic injury management. We compared SAE to other splenic injury management strategies using robust statistical techniques. Materials and methods: Univariate analyses of demographics and outcomes were performed for four patient groups: observation, SAE, splenic surgery, splenic surgery + SAE in the American College of Surgeons Trauma Quality Program (TQIP) database. To address nonlinear associations of ED vital signs with mortality, multivariable spline-based logistic regression models with interaction terms between hemodynamic status and management strategy and either splenic Abbreviated Injury Score (AIS) or Injury Severity Score (ISS), were generated. Results: In 44,187 splenic injury patients meeting study inclusion criteria, the most common management strategy was observation alone (77.9%). The observation group had median spleen AIS of 2, ISS 20, with 6.3% mortality; SAE (2.6%) had median spleen AIS3, ISS 24, with 6.6% mortality; splenic surgery (22.4%) AIS4, ISS 29, with 15.4% mortality; and splenic surgery + SAE (0.04%) AIS4, ISS 29, with 15.2% mortality. In multivariable models, SAE had lower predicted probability of mortality than surgery over most initial ED systolic blood pressures (SBPs). At all spleen AIS, SAE had lower predicted mortality than surgery. SAE had lower mortality than surgery except at very high ISS, where it was comparable. SAE had lower predicted mortality than observation management at spleen AIS≥3. In subgroup analysis of patients without severe multi-system injuries, predicted mortality did not differ by management strategy. Conclusions: SAE is associated with decreased mortality at spleen AIS 3–5. The benefits of SAE appear to be largely for spleen AIS 3–5 in the setting of severe (AIS≥3) multi-system injuries. [ABSTRACT FROM AUTHOR]

Background: Bronchial artery pseudoaneurysm is a rare vascular disorder, and cases of bronchial pseudoaneurysms reported after lung surgery are even rarer. The number of reported cases is very limited due to the unclear pathogenesis, lack of diagnostic criteria and treatment guidelines, and nonspecific clinical manifestations. Case presentation: The paper reports a case of a patient with primary lung adenocarcinoma who developed hemoptysis, chest and back pain, and right hemothorax after lobectomy. Due to the lack of experience in treatment, we suspected that the above symptoms were caused by postoperative broncho-vascular fistula. The second thoracotomy and bronchoscopy examination did not reveal any obvious hemorrhage or fistula, and a subsequent bronchial arteriography confirmed the presence of a pseudoaneurysm in the right main bronchial artery. Later, the patient underwent transcatheter bronchial artery embolization and was followed up for half of a year after the operation without experiencing any of the previously mentioned symptoms. Conclusions: The case reports the successful cure of bronchial artery pseudoaneurysm after pulmonary lobectomy through bronchial artery embolization. [ABSTRACT FROM AUTHOR]

Background: Hemoptysis is a potentially life-threatening condition often requiring prompt and effective management to control bleeding and stabilize patients. Endovascular embolization has emerged as a minimally invasive and highly effective therapeutic option for managing hemoptysis, particularly in cases of bronchial artery or non-bronchial systemic artery involvement. This study presents a series of cases highlighting the clinical application, procedural techniques, and outcomes of endovascular embolization in managing moderate to severe hemoptysis. Objectives: 1. To evaluate the role of endovascular embolization in managing hemoptysis. 2. To illustrate the procedural techniques and challenges associated with embolization through a case-based approach. 3. To assess clinical outcomes, including short-term and long-term bleeding control. METHODS: The study includes a retrospective review of seven cases of hemoptysis managed with endovascular embolization. Each case describes the clinical presentation, imaging findings, procedural details, embolic agents used, and post-procedural outcomes. Results: All seven patients underwent successful embolization procedures with immediate control of bleeding in 100% of cases. Follow-up data indicated sustained hemostasis in six cases, while one patient experienced minor rebleeding requiring additional management. Common etiologies included bronchiectasis, tuberculosis sequelae, and aspergilloma. The most frequently embolized vessels were the bronchial arteries, followed by intercostal and subclavian branches. Complications were minimal, with no major adverse events observed. Conclusions: Endovascular embolization is a safe, effective, and life-saving technique for managing hemoptysis. This case series underscores its critical role in controlling acute bleeding and highlights its utility in a range of underlying etiologies. Enhancing procedural expertise and timely referral are key to optimizing outcomes. [ABSTRACT FROM AUTHOR]

Background: Lumen-apposing metal stents (LAMS) are utilized in a wide range of therapeutic gastrointestinal applications. We present our experience with LAMS-assisted drainage of complex pelvic abscesses at a large safety-net hospital. Methods: EUS-guided LAMS placements for pelvic abscesses from July 2020 to June 2024 were analyzed. Data were collected on patient demographics, procedure indications, fluid collection size, stent characteristics, stent dwell time, and complications. All cases underwent multidisciplinary review with Surgery and Interventional Radiology (IR) prior to LAMS-assisted drainage; all were deemed not amenable to drainage by IR. Results: Eleven patients underwent EUS-guided drainage of complex pelvic abscesses with cautery-enhanced LAMS. Diverticulitis was the most common cause of abscesses (n = 6; 55%). The average time from presentation to drainage was 7 days (1–18). The average abscess size was 7.2 cm (3.9–12.0 cm). The most common LAMS size was 15 mm × 10 mm; each was placed through the left colon and rectum with both technical and clinical success. All abscesses completely resolved with a mean stent dwell time of 28 days (17–42 days). After stent removal, the fistula was not routinely closed. No complications such as stent migration, bleeding, or perforation occurred. There were no recurrences and no patients required additional surgical or IR procedures with a mean follow-up of 25 weeks (SD 35.6). Conclusions: Adequate drainage is the cornerstone of pelvic abscess management, but IR or surgical access can be challenging, with inadequate drainage and prolonged hospitalization leading to significant morbidity. In our experience, EUS-guided, LAMS-assisted drainage provides a safe and effective alternative for managing pelvic abscesses. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Percutaneous image‐guided cementoplasty is a medical procedure for strengthening bones structurally altered by disease, such as osteolytic metastasis. This procedure involves injecting biocompatible liquid bone cement, through one or more trocars into the damaged bone. Within a few minutes the bone cement hardens and restores the rigidity of the bony structure. The introduction of this technique in the case of large cancellous bones, such as the pelvis, raises some practical issues such as: how to manage the flow of cement with variable viscosity over time and how to inject a large amount of cement under fluoroscopy to effectively restore the patient's ability to bear weight?As a means of training for young practitioners to ensure maximal filling of a metastatic bone area, we have designed and manufactured a pelvic phantom capable of replicating cement diffusion in healthy and metastatic bone under fluoroscopic and computed tomography guidance.The preliminary stage of the study consisted of an analysis of various lattice structures, with the objective of reproducing the haptic feedback experienced during the needle insertion and diffusion of cement within the trabecular bone. Cementoplasty tests were conducted by an experienced radiologist under fluoroscopy and CT guidance to evaluate the performance of the lattice structure. The initial analysis provided the groundwork for the design of the phantom pelvis, which was then evaluated against a patient case. The phantom was divided into two distinct components: a disposable section with lattice structure, intended for the injection of cement, and a reusable part representing the pelvic bones. Two additive manufacturing methods were selected for the production of the phantom: Stereolithography (SLA) for the lattice structure and Fused Deposition Modeling (FDM) for the pelvic bones. The disposable component was composed of different lattice structures, selected to best match the anatomic conditions of both healthy and diseased areas visible on the patient images. Subsequently, the performance of the phantom was validated against patient images through a cementoplasty test.A total of 12 distinct lattice structures were subjected to three tests of cementoplasty. Stochastic lattices with 500 microns beam thickness and densities varying from 15% to 5% demonstrated the most effective replication of the needle haptic feedback, as well as the diffusion of the cement into healthy and osteolytic cancellous bone. These structures were then implanted in the phantom and validated against one patient case.A methodology to design and manufacture a phantom dedicated to cementoplasty from patient images is proposed. Initially, a series of lattice structures, exhibiting diverse structure types, thicknesses, and densities, were evaluated to assess their capacity to accurately reproduce the haptic feedback of the needle and the diffusion of cement in the trabecular bone. Subsequent to the outcomes of these investigations, several structures were selected for the development of a phantom capable of accurately replicating a cementoplasty procedure under fluoroscopy and CT guidance. This phantom will enable the training of future practitioners on the procedure of cementoplasty in the pelvis. [ABSTRACT FROM AUTHOR]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]