Search

Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.

To examine the prevalence of burnout in faculty radiologists in the United States and to explore the relationship between burnout and professional fulfillment (PF), intention to leave (ITL), and sleep-related impairment by gender.This cross-sectional study was conducted through a voluntary anonymous, electronic survey of radiologists at 11 academic medical institutions participating in the Physician Wellness Academic Consortium between January 2017 and September 2018. Faculty radiologists who completed the survey were included in the study. The survey contained the validated professional fulfillment index and National Institute of Health Patient Reported Outcomes Measurement Information System sleep-related impairment scale. Demographics of participants only included gender to protect anonymity. Sample t tests and χIn all, 456 faculty radiologists (171 women) answered the survey. The overall prevalence of burnout was 37.4%, PF was 35.6%, ITL was 33.3%, and sleep-related impairment was 45.3%. Burnout was higher in female versus male respondents (44% versus 31%, P.05), and PF and ITL were lower (30% versus 42%, P.05, 26% versus 38%, P.05, respectively). When faculty were stratified into burned out versus not burned out, PF was significantly lower in those with burnout (12% versus 52%, P.05), and ITL and sleep-related impairment was higher (51% versus 24%, P.05 and 75% versus 30%, P.05, respectively).Higher burnout was associated with reports of greater ITL and sleep-related impairment and lower PF. Female radiologists experience more burnout but less ITL than their male counterparts.

OBJECTIVE. The purpose of our study was to review key social justice and competitive advantage arguments for diversity in interventional radiology (IR) to substantiate the need for a more inclusive...

Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient for most patients, followed by elective diagnostic tests. However, if acute lower GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Colonoscopy can identify the site and cause of bleeding and provide effective treatment. CTA is a noninvasive diagnostic tool that is better tolerated by patients, can identify actively bleeding site or a potential bleeding lesion in vast majority of patients. RBC scan can identify intermittent bleeding, and with single-photon emission computed tomography, can more accurately localize it to a small segment of bowel. If patients are hemodynamically unstable, CTA and transcatheter arteriography/embolization can be performed. Colonoscopy can also be considered in these patients if rapid bowel preparation is feasible. Transcatheter arteriography has a low rate of major complications; however, targeted transcatheter embolization is only feasible if extravasation is seen, which is more likely in hemodynamically unstable patients. If bleeding site has been previously localized but the intervention by colonoscopy and transcatheter embolization have failed to achieve hemostasis, surgery may be required. Among patients with obscure (nonlocalized) recurrent bleeding, capsule endoscopy and CT enterography can be considered to identify culprit mucosal lesion(s). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Iliofemoral venous thrombosis carries a high risk for pulmonary embolism, recurrent deep vein thrombosis, and post-thrombotic syndrome complicating 30% to 71% of those affected. The clinical scenarios in which iliofemoral venous thrombosis is managed may be diverse, presenting a challenge to identify optimum therapy tailored to each situation. Goals for management include preventing morbidity from venous occlusive disease, and morbidity and mortality from pulmonary embolism. Anticoagulation remains the standard of care for iliofemoral venous thrombosis, although a role for more aggressive therapies with catheter-based interventions or surgery exists in select circumstances. Results from recent prospective trials have improved patient selection guidelines for more aggressive therapies, and have also demonstrated a lack of efficacy for certain conservative therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

To examine the prevalence of burnout among radiology trainees in the United States, and to study the relationships between burnout and professional fulfillment (PF), intent-to-leave (ITL), sleep-related impairment and self-compassion by gender.This cross-sectional study was conducted via an anonymous electronic survey sent to 11 large academic medical centers (Physician Wellness Academic Consortium) between January 2017 and September 2018. The survey included the Professional Fulfillment Index (PFI) and an abbreviated form of the PROMIS Sleep-related impairment (SRI) scale. Two-sample t-tests and chi-square exact tests were used for analysis (p0.05).Two hundred forty-seven radiology residents responded to the survey. Out of these, 36.2% reported burnout, 37.4% endorsed PF, 64.8% reported sleep-related impairment, 7.6% expressed ITL. There were no significant differences between genders. Burnout was associated with reduced PF, increased sleep-impairment (p0.001 for both) and increased ITL (p = 0.02). Lower PF, peer support, perceived appreciation for and meaningfulness in work, alignment of organizational and personal values, self-compassion, and higher sleep impairment were associated with burnout (p0.001 for all). Burnout was associated with perceptions of less support from department leaders (p = 0.003), control over schedules (p = 0.001) and helpfulness of electronic health record systems (p = 0.01). ITL was associated with reduced PF, perceived work appreciation, and leadership support (p = 0.03, p = 0.04, and p = 0.007, respectively).Burnout is prevalent among radiology residents. Many demonstrate sleep-impairment and reduced professional fulfillment, with a lesser fraction desiring to leave their institution. Key factors to burnout included peer and organizational support, electronic health record systems helpfulness, and personal factors like self-compassion and work appreciation.

Background Little is known about the level of burnout among program administrators (PAs) working in graduate medical education. Objective We created a national database with baseline burnout data for PAs from residency and fellowship programs, including intention to leave their current positions. Methods A cross-sectional study was conducted in July 2017 to assess levels of burnout in a national cohort of PAs, who were largely members of online specialty forums. The Copenhagen Burnout Inventory (CBI) was used to measure burnout. Univariate analysis produced descriptive statistics for CBI. We performed a 2-sample t test to measure differences in average burnout scores for those who had thoughts of resigning from their positions and those who had not. Results Of the approximately 10 205 national PAs, we sampled 1126 (11%). Of the 1126 individuals who received the study information, 931 (83%) completed the baseline survey. Total mean scores for all subscales were elevated (personal: 53.7, SD 21.4; work-related: 52.0, SD 22; and client-related: 30.6, SD 20.8; each scale ranged from 0, low, to 100, high). Burnout scores differed between those contemplating leaving their jobs and those who were not, across all subscales of CBI, including personal (64.2 versus 42.4, –24.18 to –19.44 confidence interval [CI]), work-related (63.5 versus 39.7, –26.12 to –21.35 CI), and client-related (36.6 versus 24.2, –14.95 to –9.84 CI; P < .0001 for all). Conclusions In this national survey of PAs, burnout scores measured by the CBI were higher among those who had considered leaving their positions.

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

BACKGROUND: Little is known about the level of burnout among program administrators (PAs) in medical education and its impact on the trainee environment. OBJECTIVE: To investigate variations in burnout levels over a 1-year period among a national cohort of PAs and examine any associations between perceived support and isolation. DESIGN: A 1-year longitudinal study conducted to assess burnout levels among PAs across the USA. The Copenhagen Burnout Inventory (score range, 0–100) was used to measure burnout over one academic year (July 2017–June 2018). The generalized estimating equations model was used to measure changes in burnout levels from the start of the academic year. To explore the differences in burnout scores across question response levels, a one-way ANOVA test was utilized and reported as least squares means ± SD. PARTICIPANTS: Individuals who self-identified as PAs in a graduate medical education training program. Among the 1084 persons nationwide who expressed interest, 904 (83%) completed the baseline survey; 29 of the 42 (69%) local administrators completed the survey. “Clients” defined as interns, residents/fellows, and medical students. MAIN MEASURES: Change in burnout score using the validated tool. Hypothesis formulated prior to data collection. KEY RESULTS: Among the 931 participants, the 3rd quarter (March 2018) marked the lowest average personal burnout score (change from the start of academic year, − 3.67; p

OBJECTIVE. The purpose of this study is to review the various techniques and clinical management paradigms using tissue plasminogen activator (tPA) to treat severe frostbite injuries, which are relevant to the interventional radiologist. MATERIALS AND METHODS. A literature search yielded 157 citations, which were manually screened for inclusion criteria of case reports, case series, cohort studies, and randomized prospective studies that reported the use of tPA to treat severe frostbite injuries, of which 16 qualified for review. Data extracted from the studies included authors, journal, year of publication, initial assessment and management of severe frostbite injuries, inclusion and exclusion criteria for tPA therapy, treatment and control group size, different imaging modalities used in evaluation of severe frostbite injuries, tPA treatment protocols, outcomes, and side effects or complications. RESULTS. The analyzed series included 209 patients with 1109 digits at risk of amputation who were treated with intraarterial (IA) or IV tPA (116 and 77 patients, respectively). A total of 926 digits at risk were treated with IA tPA and resulted in amputation of 222 digits, for a salvage rate of 76%. Twenty-four of 63 patients underwent amputation after IV tPA, resulting in a salvage rate of 62%. Both digital subtraction angiography and triple-phase bone scan were used for initial imaging evaluation. Additional concurrent treatment included therapeutic heparin, warfarin, nonsteroidal antiinflammatory drugs, pain management, and light dressings with topical antimicrobial agents. CONCLUSION. Severe frostbite injuries can lead to devastating outcomes with loss of limbs and digits, yet clinical management continues to consist primarily of tissue rewarming, prolonged watchful waiting, and often delayed amputation. Recent studies have shown promising results using both IA and IV tPA to reduce amputation after severe frostbite injuries. Through a meta-analysis of thrombolytic therapy in the management of severe frostbite, this article provides a useful guideline for interventional radiologists including a suggested protocol, inclusion and exclusion criteria, and potential complications.

This chapter is about a talented Latina house staff who became unknowingly embroiled in a microaggression deceptively leveled against her by a duplicitous senior faculty member.

Thoracic duct embolization is a percutaneous, image-guided intervention used in the management of chylothorax. Chylothorax, or chylous leak in the chest, is a rare condition that represents a spectrum of disorders that have in common leakage of intestinal lymph (chyle) into the thorax. Although conservative and surgical management are the standard of care, we present an overview of lymphangiography and percutaneous thoracic duct embolization.

The main imaging modality of the urinary tract in children is ultrasound. When further cross-sectional morphologic examination and/or functional evaluation is required, magnetic resonance (MR) imaging is the logical and optimal second step, particularly in pediatric patients. There are two main exceptions to this. The first one is when after an ultrasound, additional diagnostic imaging for urolithiasis is needed. The second one involves severe polytrauma, including blunt abdominal trauma. In this review, an overview of the MR imaging and computed tomography examinations important for current and future daily pediatric uroradiologic practice is presented.

In an effort to promote more durable local control of larger lesions, thermal ablation has been combined with chemical ablative techniques and with vaso-occlusive procedures such as chemoembolization and bland embolization in an effort to mitigate the limitations inherent in the use of any single treatment for hepatocellular carcinoma (HCC) >3 cm. The heat-sink effect is the underlying principle for combining vaso-occlusive therapies with ablative techniques. Combination therapies do present viable options for abrogating tumor progression and potentially downsizing tumors to facilitate transplant. We discuss the two most commonly used combination locoregional therapies by the interventionalist and the evidence defining the best techniques in practice.

To assess the United States interventional radiology (IR) academic physician workforce diversity and comparative specialties.Public registries were used to assess demographic differences among 2012 IR faculty and fellows, diagnostic radiology (DR) faculty and residents, DR subspecialty fellows (pediatric, abdominal, neuroradiology, and musculoskeletal), vascular surgery and interventional cardiology trainees, and 2010 US medical school graduates and US Census using binomial tests with .001 significance level (Bonferroni adjustment for multiple comparisons). Significant trends in IR physician representation were evaluated from 1992 to 2012.Women (15.4%), blacks (2.0%), and Hispanics (6.2%) were significantly underrepresented as IR fellows compared with the US population. Women were underrepresented as IR (7.3%) versus DR (27.8%) faculty and IR fellows (15.4%) versus medical school graduates (48.3%), DR residents (27.8%), pediatric radiology fellows (49.4%), and vascular surgery trainees (27.7%) (all P.001). IR ranked last in female representation among radiologic subspecialty fellows. Blacks (1.8%, 2.1%, respectively, for IR faculty and fellows); Hispanics (1.8%, 6.2%); and combined American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders (1.8%, 0) showed no significant differences in representation as IR fellows compared with IR faculty, DR residents, other DR fellows, or interventional cardiology or vascular surgery trainees. Over 20 years, there was no significant increase in female or black representation as IR fellows or faculty.Women, blacks, and Hispanics are underrepresented in the IR academic physician workforce relative to the US population. Given prevalent health care disparities and an increasingly diverse society, research and training efforts should address IR physician workforce diversity.

Hepatic malignancies are one of the most challenging areas in oncologic care. Cure is not usually possible due to the high frequency of intrahepatic recurrence in spite of complete resection or ablation of the initial tumor. Despite this, of liver-directed therapies can afford durable local control through vigilant monitoring and aggressive multimodality treatment regimens structured by a team of specialists in medical, surgical and interventional oncology. Ablative therapies are highly efficient in causing cell death within the effective range of the probe, but are less efficacious for larger tumors. Conversely, arterially-directed therapies can treat the entire liver, but are less efficient at killing an entire tumor. Combining regional with local therapies offers increased efficacy in tumor cell kill and in promoting local control. The impact on overall disease recurrence and survival is less well understood at present.