174 results on '"Nishita Kothary"'
Search Results
2. Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Artificial Intelligence in Interventional Radiology: From Code to Bedside
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Julius Chapiro, Bibb Allen, Aaron Abajian, Bradford Wood, Nishita Kothary, Dania Daye, Harrison Bai, Art Sedrakyan, Matthew Diamond, Vahan Simonyan, Gordon McLennan, Nadine Abi-Jaoudeh, and Bradley Pua
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Consensus ,Artificial Intelligence ,Research ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology, Interventional ,Cardiology and Cardiovascular Medicine ,Societies, Medical - Abstract
Artificial intelligence (AI)-based technologies are the most rapidly growing field of innovation in healthcare with the promise to achieve substantial improvements in delivery of patient care across all disciplines of medicine. Recent advances in imaging technology along with marked expansion of readily available advanced health information, data offer a unique opportunity for interventional radiology (IR) to reinvent itself as a data-driven specialty. Additionally, the growth of AI-based applications in diagnostic imaging is expected to have downstream effects on all image-guidance modalities. Therefore, the Society of Interventional Radiology Foundation has called upon 13 key opinion leaders in the field of IR to develop research priorities for clinical applications of AI in IR. The objectives of the assembled research consensus panel were to assess the availability and understand the applicability of AI for IR, estimate current needs and clinical use cases, and assemble a list of research priorities for the development of AI in IR. Individual panel members proposed and all participants voted upon consensus statements to rank them according to their overall impact for IR. The results identified the top priorities for the IR research community and provide organizing principles for innovative academic-industrial research collaborations that will leverage both clinical expertise and cutting-edge technology to benefit patient care in IR.
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- 2022
3. Use and Types of Advance Care Planning Prior to Image-Guided Procedures
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Shanmukha Srinivas, Shama Jaswal, Nishita Kothary, Isabel Newton, and Eric Keller
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Advanced and Specialized Nursing ,Radiological and Ultrasound Technology - Published
- 2022
4. Integration of single-shot quantitative x-ray imaging on a C-arm system for static and dynamic phantom studies
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Linxi Shi, Robert Bennett, Alexander Vezeridis, Nishita Kothary, and Adam Wang
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- 2023
5. Supplementary Data from Quantitative Ultrasound Spectroscopy for Differentiation of Hepatocellular Carcinoma from At-Risk and Normal Liver Parenchyma
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Ahmed El Kaffas, Jürgen K. Willmann, Jarrett Rosenberg, Nishita Kothary, Rosa M.S. Sigrist, and Isabelle Durot
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Supplementary Figures
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- 2023
6. Data from Quantitative Ultrasound Spectroscopy for Differentiation of Hepatocellular Carcinoma from At-Risk and Normal Liver Parenchyma
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Ahmed El Kaffas, Jürgen K. Willmann, Jarrett Rosenberg, Nishita Kothary, Rosa M.S. Sigrist, and Isabelle Durot
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Purpose:Quantitative ultrasound approaches can capture tissue morphologic properties to augment clinical diagnostics. This study aims to clinically assess whether quantitative ultrasound spectroscopy (QUS) parameters measured in hepatocellular carcinoma (HCC) tissues can be differentiated from those measured in at-risk or healthy liver parenchyma.Experimental Design:This prospective Health Insurance Portability and Accountability Act (HIPAA)–compliant study was approved by the Institutional Review Board. Fifteen patients with HCC, 15 non-HCC patients with chronic liver disease, and 15 healthy volunteers were included (31.1% women; 68.9% men). Ultrasound radiofrequency data were acquired in each patient in both liver lobes at two focal depths (3/9 cm). Region of interests (ROIs) were drawn on HCC and liver parenchyma. The average normalized power spectrum for each ROI was extracted, and a linear regression was fit within the −6 dB bandwidth, from which the midband fit (MBF), spectral intercept (SI), and spectral slope (SS) were extracted. Differences in QUS parameters between the ROIs were tested by a mixed-effects regression.Results:There was a significant intraindividual difference in MBF, SS, and SI between HCC and adjacent liver parenchyma (P < 0.001), and a significant interindividual difference between HCC and at-risk and healthy non-HCC parenchyma (P < 0.001). In patients with HCC, cirrhosis (n = 13) did not significantly change any of the three parameters (P > 0.8) in differentiating HCC from non-HCC parenchyma. MBF (P = 0.12), SI (P = 0.33), and SS (P = 0.57) were not significantly different in non-HCC tissue among the groups.Conclusions:The QUS parameters are significantly different in HCC versus non-HCC liver parenchyma, independent of underlying cirrhosis. This could be leveraged for improved HCC detection with ultrasound in the future.
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- 2023
7. Tunneled Peritoneal Catheter vs Repeated Paracenteses for Recurrent Ascites: A Cost-Effectiveness Analysis
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Xiao Wu, Rana Rabei, Eric J. Keller, Bradley King, Nishita Kothary, Maureen Kohi, Andrew Taylor, and Michael Heller
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Catheters, Indwelling ,Cost-Benefit Analysis ,Ascites ,Humans ,Paracentesis ,Radiology, Nuclear Medicine and imaging ,Medicare ,Cardiology and Cardiovascular Medicine ,United States ,Aged ,Retrospective Studies - Abstract
To compare the cost-effectiveness of tunneled peritoneal catheter (TPC) versus serial large-volume paracenteses (LVP) for patients with recurrent ascites.Retrospective, single-institution analysis of 100 consecutive patients undergoing LVP and eventual TPC placement (2015-2018) was performed with extraction of procedural complications and hospital admissions. LVPs were associated with 17 adverse events (AEs) while only 9 AEs occurred after TPC placement. While undergoing routine LVP, the patients had 30 hospitalizations monthly (177 days in total) and 10 hospitalizations monthly (51 days) after TPC placement. A cost-effectiveness analysis with Markov modeling was performed comparing TPC and LVP. Costs were based on Medicare reimbursement rates. Statistical analyses include base case calculation, Monte Carlo simulations, and deterministic sensitivity analyses.TPC placement was the dominant strategy with a comparable health benefit of 0.08060 quality-adjusted life-years (QALY) (LVP: 0.08057 QALY) at a lower cost of $4151 (LVP: $8401). Probabilistic sensitivity analysis showed TPC was superior in 97.49% of simulations. Deterministic sensitivity analysis demonstrated the superiority of TPC compared to LVP if the TPC complication rate was 9.47% per week and the complication rate for LVP was 1.32% per procedure. TPC was more cost-effective when its procedural cost was $5427 (base case: 1174.5), and remained as such when the cost of LVP was varied as much as $10,000 (base case: $316.48).In this study, TPC was more cost-effective than LVP in patients with recurrent ascites due to the reduced risk of infection, emergency department visits, and length of hospitalization stays.
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- 2022
8. Reimagining the IR Workflow for a Better Work–Life Balance
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John Krumm, Nishita Kothary, Lawrence V. Hofmann, Eric T. Foo, Lisa J. Cianfichi, Paul M. Kerr, and Edward Guzman
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Inpatients ,medicine.diagnostic_test ,business.industry ,Work-Life Balance ,Control (management) ,Work–life balance ,Volume (computing) ,Interventional radiology ,Radiology, Interventional ,Workflow ,law.invention ,law ,Radiologists ,CLARITY ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Operations management ,Adaptive learning ,Cardiology and Cardiovascular Medicine ,business ,Block (data storage) - Abstract
Several workflow changes were implemented in a large academic interventional radiology practice, including separation of inpatient and outpatient services, early start times, and using an adaptive learning system to predict case length tailored to individual physicians. Metrics including procedural volume, on-time start, accuracy at predicting case length, and room shutdown time were assessed before and after the intervention. Considerable improvements were seen in accuracy of first case start times, predicting block times, and last case encounter ending times. It is proposed that with improved role clarity, interventional radiologists can regain control over their schedules, utilize work hours more efficiently, and improve work–life balance.
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- 2021
9. Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade
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Aditya Karandikar, Agnieszka Solberg, Alice Fung, Amie Y. Lee, Amina Farooq, Amy C. Taylor, Amy Oliveira, Anand Narayan, Andi Senter, Aneesa Majid, Angela Tong, Anika L. McGrath, Anjali Malik, Ann Leylek Brown, Anne Roberts, Arthur Fleischer, Beth Vettiyil, Beth Zigmund, Brian Park, Bruce Curran, Cameron Henry, Camilo Jaimes, Cara Connolly, Caroline Robson, Carolyn C. Meltzer, Catherine H. Phillips, Christine Dove, Christine Glastonbury, Christy Pomeranz, Claudia F.E. Kirsch, Constantine M. Burgan, Courtney Scher, Courtney Tomblinson, Cristina Fuss, Cynthia Santillan, Dania Daye, Daniel B. Brown, Daniel J. Young, Daniel Kopans, Daniel Vargas, Dann Martin, David Thompson, David W. Jordan, Deborah Shatzkes, Derek Sun, Domenico Mastrodicasa, Elainea Smith, Elena Korngold, Elizabeth H. Dibble, Elizabeth K. Arleo, Elizabeth M. Hecht, Elizabeth Morris, Elizabeth P. Maltin, Erin A. Cooke, Erin Simon Schwartz, Evan Lehrman, Faezeh Sodagari, Faisal Shah, Florence X. Doo, Francesca Rigiroli, George K. Vilanilam, Gina Landinez, Grace Gwe-Ya Kim, Habib Rahbar, Hailey Choi, Harmanpreet Bandesha, Haydee Ojeda-Fournier, Ichiro Ikuta, Irena Dragojevic, Jamie Lee Twist Schroeder, Jana Ivanidze, Janine T. Katzen, Jason Chiang, Jeffers Nguyen, Jeffrey D. Robinson, Jennifer C. Broder, Jennifer Kemp, Jennifer S. Weaver, Jesse M. Conyers, Jessica B. Robbins, Jessica R. Leschied, Jessica Wen, Jocelyn Park, John Mongan, Jordan Perchik, José Pablo Martínez Barbero, Jubin Jacob, Karyn Ledbetter, Katarzyna J. Macura, Katherine E. Maturen, Katherine Frederick-Dyer, Katia Dodelzon, Kayla Cort, Kelly Kisling, Kemi Babagbemi, Kevin C. McGill, Kevin J. Chang, Kimberly Feigin, Kimberly S. Winsor, Kimberly Seifert, Kirang Patel, Kristin K. Porter, Kristin M. Foley, Krupa Patel-Lippmann, Lacey J. McIntosh, Laura Padilla, Lauren Groner, Lauren M. Harry, Lauren M. Ladd, Lisa Wang, Lucy B. Spalluto, M. Mahesh, M. Victoria Marx, Mark D. Sugi, Marla B.K. Sammer, Maryellen Sun, Matthew J. Barkovich, Matthew J. Miller, Maya Vella, Melissa A. Davis, Meridith J. Englander, Michael Durst, Michael Oumano, Monica J. Wood, Morgan P. McBee, Nancy J. Fischbein, Nataliya Kovalchuk, Neil Lall, Neville Eclov, Nikhil Madhuripan, Nikki S. Ariaratnam, Nina S. Vincoff, Nishita Kothary, Noushin Yahyavi-Firouz-Abadi, Olga R. Brook, Orit A. Glenn, Pamela K. Woodard, Parisa Mazaheri, Patricia Rhyner, Peter R. Eby, Preethi Raghu, Rachel F. Gerson, Rina Patel, Robert L. Gutierrez, Robyn Gebhard, Rochelle F. Andreotti, Rukya Masum, Ryan Woods, Sabala Mandava, Samantha G. Harrington, Samir Parikh, Sammy Chu, Sandeep S. Arora, Sandra M. Meyers, Sanjay Prabhu, Sara Shams, Sarah Pittman, Sejal N. Patel, Shelby Payne, Steven W. Hetts, Tarek A. Hijaz, Teresa Chapman, Thomas W. Loehfelm, Titania Juang, Toshimasa J. Clark, Valeria Potigailo, Vinil Shah, Virginia Planz, Vivek Kalia, Wendy DeMartini, William P. Dillon, Yasha Gupta, Yilun Koethe, Zachary Hartley-Blossom, Zhen Jane Wang, Geraldine McGinty, Adina Haramati, Laveil M. Allen, and Pauline Germaine
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Radiologists ,Humans ,Radiology, Nuclear Medicine and imaging ,Patient Safety ,Dissent and Disputes ,United States - Published
- 2022
10. Genomic Analysis of Vascular Invasion in HCC Reveals Molecular Drivers and Predictive Biomarkers
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Renumathy Dhanasekaran, Nishita Kothary, Maya Krishnan, Jun Yin, Sharon J. Pitteri, Vinodhini Arjunan, Dean W. Felsher, Jangho Park, Anand Rajan Kd, Mindie H. Nguyen, Abel Bermudez, Nam S. Hoang, Fernando Jose Garcia Marques, and Olivia A. Girvan
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Adult ,Male ,0301 basic medicine ,Carcinoma, Hepatocellular ,Genes, myc ,Mice, Transgenic ,Biology ,Article ,Transcriptome ,Mice ,03 medical and health sciences ,0302 clinical medicine ,microRNA ,Biomarkers, Tumor ,medicine ,Animals ,Humans ,Neoplasm Invasiveness ,Epigenetics ,Aged ,Aged, 80 and over ,Tissue microarray ,Proteomic Profile ,Hepatology ,Oncogene ,Liver Neoplasms ,Genomics ,Middle Aged ,medicine.disease ,digestive system diseases ,Fibronectins ,MicroRNAs ,030104 developmental biology ,Hepatocellular carcinoma ,Cancer cell ,Cancer research ,Female ,030211 gastroenterology & hepatology - Abstract
BACKGROUND AND AIMS Vascular invasion (VI) is a critical risk factor for HCC recurrence and poor survival. The molecular drivers of vascular invasion in HCC are open for investigation. Deciphering the molecular landscape of invasive HCC will help identify therapeutic targets and noninvasive biomarkers. APPROACH AND RESULTS To this end, we undertook this study to evaluate the genomic, transcriptomic, and proteomic profile of tumors with VI using the multiplatform cancer genome atlas (The Cancer Genome Atlas; TCGA) data (n = 373). In the TCGA Liver Hepatocellular Carcinoma cohort, macrovascular invasion was present in 5% (n = 17) of tumors and microvascular invasion in 25% (n = 94) of tumors. Functional pathway analysis revealed that the MYC oncogene was a common upstream regulator of the mRNA, miRNA, and proteomic changes in VI. We performed comparative proteomic analyses of invasive human HCC and MYC-driven murine HCC and identified fibronectin to be a proteomic biomarker of invasive HCC (mouse fibronectin 1 [Fn1], P = 1.7 × 10-11 ; human FN1, P = 1.5 × 10-4 ) conserved across the two species. Mechanistically, we show that FN1 promotes the migratory and invasive phenotype of HCC cancer cells. We demonstrate tissue overexpression of fibronectin in human HCC using a large independent cohort of human HCC tissue microarray (n = 153; P
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- 2021
11. Limitations of Fluorine 18 Fluoromisonidazole in Assessing Treatment-induced Tissue Hypoxia after Transcatheter Arterial Embolization of Hepatocellular Carcinoma: A Prospective Pilot Study
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Rajesh P. Shah, Paul F. Laeseke, Lewis K. Shin, Frederick T. Chin, Nishita Kothary, and George M. Segall
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Male ,Carcinoma, Hepatocellular ,Technical Development ,Liver Neoplasms ,Pilot Projects ,Fluorine ,General Medicine ,Middle Aged ,Embolization, Therapeutic ,Positron Emission Tomography Computed Tomography ,Positron-Emission Tomography ,Humans ,Prospective Studies ,Misonidazole ,Radiopharmaceuticals ,Hypoxia ,Aged - Abstract
PURPOSE: To determine the variance and correlation with tumor viability of fluorine 18 ((18)F) fluoromisonidazole (FMISO) uptake in hepatocellular carcinoma (HCC) prior to and after embolization treatment. MATERIALS AND METHODS: In this single-arm, single-center, prospective pilot study between September 2016 and March 2017, participants with at least one tumor measuring 1.5 cm or larger with imaging or histologic findings diagnostic for HCC were enrolled (five men; mean age, 68 years; age range, 61–76 years). Participants underwent (18)F-FMISO PET/CT before and after bland embolization of HCC. A tumor-to-liver ratio (TLR) was calculated by using standardized uptake values of tumor and liver. The difference in mean TLR before and after treatment was compared by using a Wilcoxon rank sum test, and correlation between TLR and tumor viability was assessed by using the Spearman rank correlation coefficient. RESULTS: Four participants with five tumors were included in the final analysis. The median tumor diameter was 3.2 cm (IQR, 3.0–3.9 cm). The median TLR before treatment was 0.97 (IQR, 0.88–0.98), with a variance of 0.02, and the median TLR after treatment was 0.85 (IQR, 0.79–1), with a variance of 0.01; both findings indicate a narrow range of (18)F-FMISO uptake in HCC. The Spearman rank correlation coefficient was 0.87, indicating a high correlation between change in TLR and nonviable tumor. CONCLUSION: Although there was a correlation between change in TLR and response to treatment, the low signal-to-noise ratio of (18)F-FMISO in the liver limited its use in HCC. Keywords: Molecular Imaging-Clinical Translation, Embolization, Abdomen/Gastrointestinal, Liver Clinical trial registration no. NCT02695628 © RSNA, 2022
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- 2022
12. Perceptions of Futility in Interventional Radiology: A Multipractice Systematic Qualitative Analysis
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Nishita Kothary, Eric J. Keller, Michael Heller, and Rana Rabei
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Male ,medicine.medical_specialty ,Palliative care ,Quality management ,Psychological intervention ,Radiology, Interventional ,Grounded theory ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Radiologists ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Referral and Consultation ,Data collection ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Focus group ,Content analysis ,Family medicine ,Female ,Perception ,Cardiology and Cardiovascular Medicine ,business ,Medical Futility - Abstract
To characterize perceptions of palliative versus futile care in interventional radiology (IR) as a roadmap for quality improvement. Interventional radiologists (IRs) and referring physicians were recruited for anonymous interviews and/or focus groups to discuss their perceptions and experiences related to palliative verse futile care in IR. Sessions were recorded, transcribed, and systematically analyzed using dedicated software, content analysis, and grounded theory. Data collection and analysis continued simultaneously until additional interviews stopped revealing new themes: 24 IRs (21 males, 3 females, 1–39 years of experience) and 7 referring physicians (3 males, 4 females, 6–14 years of experience) were analyzed. Many IRs (75%) perceived futility as an important issue. Years of experience (r = 0.60, p = 0.03) and being in academics (r = 0.62, p = 0.04) correlated with greater perceived importance. Perceptions of futility and whether a potentially inappropriate procedure was performed involved a balance between four sets of factors (patient, clinician, procedural, and cultural). These assessments tended to be qualitative in nature and are challenged by a lack of data, education, and consistent workflows. Referring clinicians were unaware of this issue and assumed IR had guidelines for differentiating between palliation and futility. This study characterized the complexity and qualitative nature of assessments of palliative verses futile care in IR while highlighting potential means of improving current practices. This is important given the number of critically ill patients referred to IR and costs of potentially inappropriate interventions.
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- 2020
13. Comparison of Opioid Medication Use after Conventional Chemoembolization versus Drug-Eluting Embolic Chemoembolization
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Mohamed Khalaf, Victoria Green, Tie Liang, Rajesh Shah, Nishita Kothary, and Alexander Vezeridis
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Adult ,Male ,Antiemetic Agent ,Carcinoma, Hepatocellular ,Time Factors ,Vomiting ,Nausea ,medicine.drug_class ,Analgesic ,Pain ,Risk Assessment ,Risk Factors ,medicine ,Humans ,Antiemetic ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Odds ratio ,Middle Aged ,medicine.disease ,Analgesics, Opioid ,Regimen ,Treatment Outcome ,Opioid ,Hepatocellular carcinoma ,Anesthesia ,Antiemetics ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
PURPOSE To assess the use of opioid analgesics and/or antiemetic drugs for pain and nausea following selective chemoembolization with doxorubicin-based conventional (c)-transarterial chemoembolization versus drug-eluting embolic (DEE)-transarterial chemoembolization for hepatocellular carcinoma (HCC). MATERIALS AND METHODS From October 2014 to 2016, 283 patients underwent 393 selective chemoembolization procedures including 188 patients (48%) who underwent c-transarterial chemoembolization and 205 (52%) who underwent DEE-transarterial chemoembolization. Medical records for all patients were retrospectively reviewed. Administration of postprocedural opioid and/or antiemetic agents were collated. Time of administration was stratified as phase 1 recovery (0-6 hours) and observation (6-24 hours). Logistic regression model was used to investigate the relationship of transarterial chemoembolization type and use of intravenous and/or oral analgesic and antiemetic medications while controlling for other clinical variables. RESULTS More patients treated with DEE-transarterial chemoembolization required intravenous analgesia in the observation (6-24 hours) phase (18.5%) than those treated with c-transarterial chemoembolization (10.6%; P = .033). Similar results were noted for oral analgesic agents (50.2% vs. 31.4%, respectively; P < .001) and antiemetics (17.1% vs. 7.5%, respectively; P = .006) during the observation period. Multivariate regression models identified DEE-transarterial chemoembolization as an independent predictor for oral analgesia (odds ratio [OR], 1.84; P = .011), for intravenous and oral analgesia in opioid-naive patients (OR, 2.46; P = .029) and for antiemetics (OR, 2.56; P = .011). CONCLUSIONS Compared to c-transarterial chemoembolization, DEE-transarterial chemoembolization required greater amounts of opioid analgesic and antiemetic agents 6-24 hours after the procedure. Surgical data indicate that a persistent opioid habit can develop even after minor surgeries, therefore, caution should be exercised, and a regimen of nonopiate pain medications should be considered to reduce postprocedural pain after transarterial chemoembolization.
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- 2020
14. Achieving Speaker Gender Equity at the SIR Annual Scientific Meeting: The Effect of Female Session Coordinators
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Yvonne Maldonado, Christine E. Ghatan, Daniel Y. Sze, Shellie Josephs, Marcelina G. Perez, Magali Fassiotto, Jonathan Altamirano, and Nishita Kothary
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Male ,Gender equity ,Time Factors ,Gender diversity ,Sexism ,Session (web analytics) ,030218 nuclear medicine & medical imaging ,Physicians, Women ,03 medical and health sciences ,0302 clinical medicine ,Radiologists ,Humans ,Speech ,Medicine ,Radiology, Nuclear Medicine and imaging ,Societies, Medical ,Medical education ,business.industry ,Congresses as Topic ,Gender balance ,030220 oncology & carcinogenesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Inclusion (education) ,Women, Working - Abstract
To examine the impact of targeted efforts to increase the number of female speakers at the Society of Interventional Radiology (SIR) Annual Scientific Meeting (ASM) by reporting gender trends for invited faculty in 2017/2018 vs 2016.Faculty rosters for the 2016, 2017, and 2018 SIR ASMs were stratified by gender to quantify female representation at plenary sessions, categorical courses, symposia, self-assessment modules, and "meet-the-expert" sessions. Keynote events, scientific abstract presentations, and award ceremonies were excluded. In 2017, the SIR Annual Meeting Committee issued requirements for coordinators to invite selected women as speakers. Session coordinators are responsible for issuing speaker invitations, and invited speakers have the option to decline.Years 2017 and 2018 showed increases in female speaker representation, with women delivering 13% (89 of 687) and 14% (85 of 605) of all assigned presentations, compared with 9% in 2016 (46 of 514; P = .03 and P = .01, respectively). Gender diversity correlated with the gender of the session coordinator(s). When averaged over a 3-year period, female speakers constituted 7% of the speaker roster (112 of 1,504 presentations) for sessions led by an all-male coordinator team, compared with 36% (108 of 302) for sessions led by at least 1 female coordinator (P.0001). Results of the linear regression model confirmed the effect of coordinator team gender composition (P.0001).Having a woman as a session coordinator increased female speaker participation, which suggests that the inclusion of more women as coordinators is one mechanism for achieving gender balance at scientific meetings.
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- 2019
15. Cost-effectiveness of tunneled peritoneal catheters versus repeat paracenteses for recurrent ascites in gynecologic malignancies
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Xiao Wu, Eric J. Keller, Rana Rabei, Helena Rockwell, Summer Beeson, Michael Heller, and Nishita Kothary
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Catheters, Indwelling ,Oncology ,Genital Neoplasms, Female ,Cost-Benefit Analysis ,Obstetrics and Gynecology ,Ascites ,Humans ,Paracentesis ,Female ,Retrospective Studies - Abstract
To compare the cost-effectiveness of tunneled peritoneal catheter (TPC) versus repeated large-volume paracentesis (LVP) for patients with recurrent ascites secondary to gynecological malignancy.A retrospective cohort study was performed at a single institution from 2016 through 2019 of patients with recurrent ascites from gynecologic malignancies that underwent either TPC or LVP. Data on procedural complications and hospital admissions were extracted. A cost-effectiveness analysis with Markov modeling was performed comparing TPC and LVP. Statistical analyses include base case calculation, Monte Carlo simulations and deterministic sensitivity analyses.There were no significant differences between the cohorts in the average number of hospital days (p = 0.21) or emergency department visits (p = 0.69) related to ascites. Palliative care was more often involved in the care of patients who had a TPC. The base case calculation showed TPC to be the more cost-effective strategy with a slightly lower health benefit (0.22980 versus 0.22982 QALY) and lower cost ($3043 versus $3868) relative to LVP (ICER of LVP compared to TPC: $44,863,103/QALY). Probabilistic sensitivity analysis showed TPC was the more cost-effective strategy in 8028/10,000 simulations. Deterministic sensitivity analysis showed TPC to be more cost-effective if its complication risk was0.81% per 22 days or its procedural cost of TPC insertion was$1997. When varying the cost of complications, TPC was more cost-effective if the cost of its complication was less than $49,202.TPC is the more cost-effective strategy when compared to LVP in patients with recurrent ascites from gynecological malignancy.
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- 2021
16. The Need to Mitigate Unconscious Bias to Improve Sponsorship Opportunities for Underrepresented Faculty in Academic Radiology
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Barbara Jerome, Nishita Kothary, and Magali Fassiotto
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Faculty, Medical ,media_common.quotation_subject ,Interprofessional Relations ,Ethnic group ,Face (sociological concept) ,Women Physicians ,Physicians, Women ,Ethnicity ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Personnel Selection ,Academic medicine ,Minority Groups ,media_common ,Medical education ,Academic Medical Centers ,Unconscious, Psychology ,Career Choice ,business.industry ,Racial Groups ,General Medicine ,Unconscious bias ,Cultural Diversity ,Bias, Implicit ,Career Mobility ,business ,Radiology ,human activities ,Diversity (politics) - Abstract
Women physicians and those from racial and ethnic groups underrepresented in medicine face unique barriers to career advancement in academic medicine, especially in specialties that lack diversity such as radiology. One such barrier is the effect of unconscious bias on the ability of faculty from these groups to find effective sponsors. Given the central role of sponsorship in career advancement, departments are called on to implement formal sponsorship programs to address inequities stemming from bias.
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- 2021
17. Perceptions of Ethics in Interventional Radiology
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Nishita Kothary, Eric J. Keller, Summer A. Beeson, Helena Rockwell, and K. Dickey
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Medical education ,Demographics ,Ethical issues ,medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,education ,Interventional radiology ,Target population ,Radiology, Interventional ,Content analysis ,Perception ,Surveys and Questionnaires ,Radiologists ,Text messaging ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cognitive interview ,business ,media_common - Abstract
To characterize perceptions of ethics among interventional radiologists to guide the development of an applied, specialty-specific approach to ethics.A 17-question survey on perceptions of ethics and use of ethics resources was developed and vetted via cognitive interviewing of 15 diverse, representative members of the target population. The survey was distributed via the Society of Interventional Radiology, receiving 685 responses (48% participation and 90% completion rates). Responses were compared between different demographics, and common themes from free text responses were identified via content analysis.Most respondents indicated ethics is important for IR (93%) and more focus on practical approaches to ethical issues is needed (73%). Various ethical issues were perceived to be important for IR, but differentiating palliative from futile care was ranked as the top ethical issue. Trainees had more ethics training (P=0.05) but less confidence in navigating ethical issues (P0.01). Regardless of career stage, those with ethics training (44%) were more confident in navigating ethical issues (P0.01). Use of resources such as information sheets for patients and resources for coping with complications were variable and limited by lack of availability or knowledge of such resources in IR.Interventional radiologists believe ethics is important and face diverse ethical issues, but they are challenged by variable experiences and access to practical tools to navigate these challenges.
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- 2021
18. A Predictive Model for Postembolization Syndrome after Transarterial Hepatic Chemoembolization of Hepatocellular Carcinoma
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Rajesh Shah, Nishita Kothary, Ankaj Khosla, Vandana Sundaram, Katherine Jackson, Mohammed Ahmed Abdelrazek Mohammed, Mohamed H. Khalaf, and Manisha Desai
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Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Tumor burden ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Aged ,Retrospective Studies ,Aged, 80 and over ,Models, Statistical ,business.industry ,Liver Neoplasms ,Syndrome ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Female ,Radiology ,business - Abstract
Purpose To develop and validate a predictive model for postembolization syndrome (PES) following transarterial hepatic chemoembolization (TACE) for hepatocellular carcinoma. Materials and Methods In this single-center, retrospective study, 370 patients underwent 513 TACE procedures between October 2014 and September 2016. Seventy percent of the patients were randomly assigned to a training data set and the remaining 30% were assigned to a testing data set. Variables included demographic, laboratory, clinical, and procedural details. PES was defined as pain and/or nausea beyond 6 hours after TACE that required intravenous medication for symptom control. The predictive model was developed by using conditional inference trees and Lasso regression. Results Demographics, laboratory data, performance, tumor characteristics, and procedural details were statistically similar for the training and testing data sets. Overall, 83 of 370 patients (22.4%) after 107 of 513 TACE procedures (20.8%) met the predefined criteria. Factors identified at univariable analysis included large tumor burden (P = .004), drug-eluting embolic TACE (P = .03), doxorubicin dose (P = .003), history of PES (P.001) and chronic pain (P.001), of which history of PES, tumor burden, and drug-eluting embolic TACE were identified as the strongest predictors by the multivariable analysis and were used to develop the predictive model. When applied to the testing data set, the model demonstrated an area under the curve of 0.62, sensitivity of 79% (22 of 28), specificity of 44.2% (53 of 120), and a negative predictive value of 90% (53 of 59). Conclusion The model identified history of postembolization syndrome, tumor burden, and drug-eluting embolic chemoembolization as predictors of protracted recovery because of postembolization syndrome. © RSNA, 2018.
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- 2019
19. The Role of Physician-Driven Device Preference in the Cost Variation of Common Interventional Radiology Procedures
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Nishita Kothary, Alexander Vezeridis, M. Kate Bundorf, and Vinita Shivakumar
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medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Attitude of Health Personnel ,medicine.medical_treatment ,Clinical Decision-Making ,Radiography, Interventional ,Tertiary care ,Choice Behavior ,Standard deviation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Interventional Radiology Procedure ,Linear regression ,Radiologists ,medicine ,Transjugular liver biopsy ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Healthcare Disparities ,Practice Patterns, Physicians' ,Disposable Equipment ,Physician's Role ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Health Care Costs ,Preference ,030220 oncology & carcinogenesis ,Nephrostomy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To analyze the impact of physician-specific equipment preference on cost variation for procedures typically performed by interventional radiologists at a tertiary care academic hospital. Materials and Methods From October 2017 to October 2019, data on all expendable items used by 9 interventional radiologists for 11 common interventional radiology procedure categories were compiled from the hospital analytics system. This search yielded a final dataset of 44,654 items used in 2,121 procedures of 11 different categories. The mean cost per case for each physician as well as the mean, standard deviation, and coefficient of variation (CV) of the mean cost per case across physicians were calculated. The proportion of spending by item type was compared across physicians for 2 high-variation, high-volume procedures. The relationship between the mean cost per case and case volume was examined using linear regression. Results There was a high variability within each procedure, with the highest and the lowest CV for radioembolization administration (56.6%) and transjugular liver biopsy (4.9%), respectively. Variation in transarterial chemoembolization cost was mainly driven by microcatheters/microwires, while for nephrostomy, the main drivers were catheters/wires and access sets. Mean spending by physician was not significantly correlated with case volume (P =.584). Conclusions Physicians vary in their item selection even for standard procedures. While the financial impact of these differences vary across procedures, these findings suggest that standardization may offer an opportunity for cost savings.
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- 2020
20. Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations
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Magali Fassiotto, Dan Jurafsky, Jure Leskovec, Heidi Chen, Jonathan Altamirano, Emma Pierson, Sonja Schmer-Galunder, and Nishita Kothary
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Male ,020205 medical informatics ,media_common.quotation_subject ,Quality care ,Empathy ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,Perception ,Physicians ,Surveys and Questionnaires ,0202 electrical engineering, electronic engineering, information engineering ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,media_common ,Hierarchy ,Physician-Patient Relations ,Sex Characteristics ,business.industry ,General Medicine ,Patient Satisfaction ,Female ,business ,Social psychology - Abstract
Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First...
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- 2020
21. The Economic Footprint of Interventional Radiology in the United States: Implications for Systems Development
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Edward O’Beirne, Kristan Staudenmayer, Lakshika Tennakoon, Nishita Kothary, and Soleil Shah
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Adult ,medicine.medical_specialty ,Hospitalized patients ,Sample (statistics) ,Radiology, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Diagnosis-Related Groups ,System development ,Inpatients ,Inpatient care ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Patient data ,Health Care Costs ,Length of Stay ,United States ,Hospitalization ,030220 oncology & carcinogenesis ,Emergency medicine ,business - Abstract
Despite the growing presence of interventional radiology (IR) in inpatient care, its global impact on the health care system remains uncharacterized. The aim of this study was to quantitate the use of IR services rendered to hospitalized patients in the United States and the impact on cost.The National Inpatient Sample 2016 was queried. Using the International Classification of Diseases, 10th revision, Clinical Modification/Procedure Classification System, adult inpatients who underwent routine IR procedures were identified. Unadjusted and adjusted analyses were performed. Weighted patient data are presented to provide national estimates.Of the 29.7 million inpatient admissions in 2016, 2.3 million (7.8%) had at least one IR procedure. Patients who needed IR were older (62.8 versus 57.1 years, P.001), were sicker on the basis of the All Patient Refined Diagnosis Related Groups (27% major or extreme versus 14% for non-IR, P.001), and had higher inpatient mortality (8.2% versus 1.7%, P.001). While representing 7.8% of all admissions, this cohort accounted for 18.4% ($68.4 billion) of adult inpatient health care costs and about 3 times higher mean hospitalization cost compared with other inpatients ($29,402 versus $11,062, P.001), which remained significant even after controlling for age and All Patient Refined Diagnosis Related Group.Approximately 1 in 10 US inpatients are treated by IR during their hospitalizations. These patients are sicker, with about 4 times higher mortality and 2.5 times greater length of stay, accounting for almost one-fifth of all health care costs. These findings suggest that IR should have a voice in discussions of means to save costs and improve patient outcomes in the United States.
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- 2020
22. Interreader Variability in Semantic Annotation of Microvascular Invasion in Hepatocellular Carcinoma on Contrast-enhanced Triphasic CT Images
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Rajesh Shah, Nishita Kothary, Bhavik N. Patel, Olivier Gevaert, Shaimaa Bakr, Andrew Kesselman, and Sandy Napel
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Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,media_common.quotation_subject ,medicine ,Contrast (vision) ,Humans ,Neoplasm Invasiveness ,media_common ,Original Research ,Aged ,Aged, 80 and over ,Observer Variation ,Semantic annotation ,business.industry ,Liver Neoplasms ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,Semantics ,Hepatocellular carcinoma ,Female ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
PURPOSE: To evaluate interreader agreement in annotating semantic features on preoperative CT images to predict microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Preoperative, contrast material–enhanced triphasic CT studies from 89 patients (median age, 64 years; age range, 36–85 years; 70 men) who underwent hepatic resection between 2008 and 2017 for a solitary HCC were reviewed. Three radiologists annotated CT images obtained during the arterial and portal venous phases, independently and in consensus, with features associated with MVI reported by other investigators. The assessed factors were the presence or absence of discrete internal arteries, hypoattenuating halo, tumor-liver difference, peritumoral enhancement, and tumor margin. Testing also included previously proposed MVI signatures: radiogenomic venous invasion (RVI) and two-trait predictor of venous invasion (TTPVI), using single-reader and consensus annotations. Cohen (two-reader) and Fleiss (three-reader) κ and the bootstrap method were used to analyze interreader agreement and differences in model performance, respectively. RESULTS: Of HCCs assessed, 32.6% (29 of 89) had MVI at histopathologic findings. Two-reader agreement, as assessed by pairwise Cohen κ statistics, varied as a function of feature and imaging phase, ranging from 0.02 to 0.6; three-reader Fleiss κ varied from −0.17 to 0.56. For RVI and TTPVI, the best single-reader performance had sensitivity and specificity of 52% and 77% and 67% and 74%, respectively. In consensus, the sensitivity and specificity for the RVI and TTPVI signatures were 59% and 67% and 70% and 62%, respectively. CONCLUSION: Interreader variability in semantic feature annotation remains a challenge and affects the reproducibility of predictive models for preoperative detection of MVI in HCC. Supplemental material is available for this article. © RSNA, 2020
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- 2020
23. Comparison of Drug-Eluting Embolics versus Conventional Transarterial Chemoembolization for the Treatment of Patients with Unresectable Hepatocellular Carcinoma: A Cost-Effectiveness Analysis
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Ajay Malhotra, Xiao Wu, Julius Chapiro, and Nishita Kothary
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Adult ,Male ,medicine.medical_specialty ,Palliative care ,Carcinoma, Hepatocellular ,Time Factors ,Adolescent ,Cost-Benefit Analysis ,Clinical Decision-Making ,Health benefits ,Drug Costs ,030218 nuclear medicine & medical imaging ,Decision Support Techniques ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Cost Savings ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Sensitivity analyses ,Aged ,Aged, 80 and over ,Drug Carriers ,Antibiotics, Antineoplastic ,business.industry ,Disease progression ,Decision Trees ,Liver Neoplasms ,Clinical course ,Cost-effectiveness analysis ,Middle Aged ,medicine.disease ,Models, Economic ,Treatment Outcome ,Doxorubicin ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Disease Progression ,Quality of Life ,Lower cost ,Female ,Radiology ,Quality-Adjusted Life Years ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To compare the cost-effectiveness of using doxorubicin-loaded drug-eluting embolic (DEE) transarterial chemoembolization versus that of using conventional transarterial chemoembolization for patients with unresectable hepatocellular carcinoma (HCC). Materials and Methods A decision-analysis model was constructed over the lifespan of a payer’s perspective. The model simulated the clinical course, including periprocedural complications, additional transarterial chemoembolization or other treatments (ablation, radioembolization, or systemic treatment), palliative care, and death, of patients with unresectable HCC. All clinical parameters were derived from the literature. Base case calculations, probabilistic sensitivity analyses, and multiple two-way sensitivity analyses were performed. Results In the base case calculations for patients with a median age of 67 years (range for conventional transarterial chemoembolization: 28–88 years, range for DEE-transarterial chemoembolization: 16–93 years), conventional transarterial chemoembolization yielded a health benefit of 2.11 quality-adjusted life years (QALY) at a cost of $125,324, whereas DEE-transarterial chemoembolization yielded 1.71 QALY for $144,816. In 10,000 Monte Carlo simulations, conventional transarterial chemoembolization continued to be a more cost-effective strategy. conventional transarterial chemoembolization was cost-effective when the complication risks for both the procedures were simultaneously varied from 0% to 30%. DEE-transarterial chemoembolization became cost-effective if the conventional transarterial chemoembolization mortality exceeded that of DEE-transarterial chemoembolization by 17% in absolute values. The two-way sensitivity analyses demonstrated that conventional transarterial chemoembolization was cost-effective until the risk of disease progression was >0.4% of that for DEE-transarterial chemoembolization in absolute values. Our analysis showed that DEE-transarterial chemoembolization would be more cost-effective if it offered >2.5% higher overall survival benefit than conventional transarterial chemoembolization in absolute values. Conclusions Compared with DEE-transarterial chemoembolization, conventional transarterial chemoembolization yielded a higher number of QALY at a lower cost, making it the more cost-effective of the 2 modalities.
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- 2020
24. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep vein thrombosis
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Susan R. Kahn, Jim A. Julian, Clive Kearon, Chu-Shu Gu, David J. Cohen, Elizabeth A. Magnuson, Anthony J. Comerota, Samuel Z. Goldhaber, Michael R. Jaff, Mahmood K. Razavi, Andrei L. Kindzelski, Joseph R. Schneider, Paul Kim, Rabih Chaer, Akhilesh K. Sista, Robert B. McLafferty, John A. Kaufman, Brandt C. Wible, Morey Blinder, Suresh Vedantham, Michael Sichlau, Athanasios Vlahos, Steven Smith, Quinn Thalheimer, Nisha Singh, Rekha Harting, John Gocke, Scott Guth, Neel Shah, Paul Brady, Marvin Schatz, Mindy Horrow, Peyman Markazi, Leli Forouzan, Terence A.S. Matalon, David Hertzog, Swapna Goday, Margaret Kennedy, Robert Kaplan, Thomas Campbell, Jamie Hartman, Elmer Nahum, Arvind Venkat, Venkataramu Krishnamurthy, John Rectenwald, Peter Henke, Jonathan Eliason, Jonathon Willatt, Guillermo Escobar, Shaun Samuels, Barry Katzen, James Benenati, Alex Powell, Constantino Pena, Howard Wallach, Ripal Gandhi, Joseph Schneider, Stanley Kim, Farrah Hashemi, Joseph Boyle, Nilesh Patel, Michael Verta, Daniel Leung, Marc Garcia, Phillip Blatt, Jamil Khatri, Dave Epstein, Randall Ryan, Tom Sweeny, Michael Stillabower, George Kimbiris, Tuhina Raman, Paul Sierzenski, Lelia Getto, Michael Dignazio, Mark Horvath, Heather Gornik, John Bartholomew, Mehdi Shishehbor, Frank Peacock, Douglas Joseph, Soo Hyum Kim, Natalia Fendrikova Mahlay, Daniel Clair, Sean Lyden, Baljendra Kapoor, Gordon McLennon, Gregory Pierce, James Newman, James Spain, Amanjiit Gill, Aaron Hamilton, Anthony Rizzo, Woosup Park, Alan Dietzek, Ira Galin, Dahlia Plummer, Richard Hsu, Patrick Broderick, Andrew Keller, Sameer Sayeed, Dennis Slater, Herb Lustberg, Jan Akus, Robert Sidman, Mandeep Dhami, Phillip Kohanski, Anca Bulgaru, Renuka Dulala, James Burch, Dinesh Kapur, Jie Yang, Mark Ranson, Alan Wladis, David Varnagy, Tarek Mekhail, Robert Winter, Manuel Perez-Izquierdo, Stephen Motew, Robin Royd-Kranis, Raymond Workman, Scott Kribbs, Gerald Hogsette, Phillip Moore, Bradley Thomason, William Means, Richard Bonsall, John Stewart, Daniel Golwya, Ezana Azene, Wayne Bottner, William Bishop, Dave Clayton, Lincoln Gundersen, Jody Riherd, Irina Shakhnovich, Kurt Ziegelbein, Thomas Chang, Karun Sharma, Sandra Allison, Fil Banovac, Emil Cohen, Brendan Furlong, Craig Kessler, Mike McCullough, Jim Spies, Judith Lin, Scott Kaatz, Todd Getzen, Joseph Miller, Scott Schwartz, Loay Kabbani, David McVinnie, John Rundback, Joseph Manno, Richard Schwab, Randolph Cole, Kevin Herman, David Singh, Ravit Barkama, Amish Patel, Anthony Comerota, John Pigott, Andrew Seiwert, Ralph Whalen, Todd Russell, Zakaria Assi, Sahira Kazanjian, Jonathan Yobbagy, Brian Kaminski, Allan Kaufman, Garett Begeman, Robert DiSalle, Subash Thakur, Marc Jacquet, Thomas Dykes, Joseph Gerding, Christopher Baker, Mark Debiasto, Derek Mittleider, George Higgins, Steven Amberson, Roger Pezzuti, Thomas Gallagher, Robert Schainfeld, Stephan Wicky, Sanjeeva Kalva, Gregory Walker, Gloria Salazar, Benjamin Pomerantz, Virenda Patel, Christopher Kabrhel, Shams Iqbal, Suvranu Gangull, Rahmi Oklu, Scott Brannan, Sanjay Misra, Haraldur Bjarnason, Aneel Ashrani, Michael Caccavale, Chad Fleming, Jeremy Friese, John Heit, Manju Kalra, Thanila Macedo, Robert McBane, Michael McKusick, Andrew Stockland, David Woodrum, Waldemar Wysokinski, Adarsh Verma, Andrew Davis, Jerry Chung, David Nicker, Brian Anderson, Robert Stein, Michael Weiss, Parag Patel, William Rilling, Sean Tutton, Robert Hieb, Eric Hohenwalter, M. Riccardo Colella, James Gosset, Sarah White, Brian Lewis, Kellie Brown, Peter Rossi, Gary Seabrook, Marcelo Guimaraes, J. Bayne Selby, William McGary, Christopher Hannegan, Jacob Robison, Thomas Brothers, Bruce Elliott, Nitin Garg, M. Bret Anderson, Renan Uflacker, Claudio Schonholz, Laurence Raney, Charles Greenberg, John Kaufman, Frederick Keller, Kenneth Kolbeck, Gregory Landry, Erica Mitchell, Robert Barton, Thomas DeLoughery, Norman Kalbfleisch, Renee Minjarez, Paul Lakin, Timothy Liem, Gregory Moneta, Khashayar Farsad, Ross Fleischman, Loren French, Vasco Marques, Yasir Al−Hassani, Asad Sawar, Frank Taylor, Rajul Patel, Rahul Malhotra, Farah Hashemi, Marvin Padnick, Melissa Gurley, Fred Cucher, Ronald Sterrenberg, G. Reshmaal Deepthi, Gomes Cumaranatunge, Sumit Bhatla, Darick Jacobs, Eric Dolen, Pablo Gamboa, L. Mark Dean, Thomas Davis, John Lippert, Sanjeev Khanna, Brian Schirf, Jeffrey Silber, Donald Wood, J. Kevin McGraw, Lucy LaPerna, Paul Willette, Timothy Murphy, Joselyn Cerezo, Rajoo Dhangana, Sun Ho Ahn, Gregory Dubel, Richard Haas, Bryan Jay, Ethan Prince, Gregory Soares, James Klinger, Robert Lambiase, Gregory Jay, Robert Tubbs, Michael Beland, Chris Hampson, Ryan O'Hara, Chad Thompson, Aaron Frodsham, Fenwick Gardiner, Abdel Jaffan, Lawrence Keating, Abdul Zafar, Radica Alicic, Rodney Raabe, Jayson Brower, David McClellan, Thomas Pellow, Christopher Zylak, Joseph Davis, M. Kathleen Reilly, Kenneth Symington, Camerson Seibold, Ryan Nachreiner, Daniel Murray, Stephen Murray, Sandeep Saha, Gregory Luna, Kim Hodgson, Robert McLafferty, Douglas Hood, Colleen Moore, David Griffen, Darren Hurst, David Lubbers, Daniel Kim, Brent Warren, Jeremy Engel, D.P. Suresh, Eric VanderWoude, Rahul Razdan, Mark Hutchins, Terry Rounsborg, Madhu Midathada, Daniel Moravec, Joni Tilford, Joni Beckman, Mahmood Razavi, Kurt Openshaw, D. Preston Flanigan, Christopher Loh, Howard Dorne, Michael Chan, Jamie Thomas, Justin Psaila, Michael Ringold, Jay Fisher, Any Lipcomb, Timothy Oskin, Brandt Wible, Brendan Coleman, David Elliott, Gary Gaddis, C. Doug Cochran, Kannan Natarajan, Stewart Bick, Jeffrey Cooke, Ann Hedderman, Anne Greist, Lorrie Miller, Brandon Martinez, Vincent Flanders, Mark Underhill, Lawrence Hofmann, Daniel Sze, William Kuo, John Louie, Gloria Hwang, David Hovsepian, Nishita Kothary, Caroline Berube, Donald Schreiber, Brooke Jeffrey, Jonathan Schor, Jonathan Deitch, Kuldeep Singh, Barry Hahn, Brahim Ardolic, Shilip Gupta, Riyaz Bashir, Angara Koneti Rao, Manish Garg, Pravin Patil, Chad Zack, Gary Cohen, Frank Schmieder, Valdimir Lakhter, David Sacks, Robert Guay, Mark Scott, Karekin Cunningham, Adam Sigal, Terrence Cescon, Nick Leasure, Thiruvenkatasamy Dhurairaj, Patrick Muck, Kurt Knochel, Joann Lohr, Jose Barreau, Matthew Recht, Jayapandia Bhaskaran, Ranga Brahmamdam, David Draper, Apurva Mehta, James Maher, Melhem Sharafuddin, Steven Lentz, Andrew Nugent, William Sharp, Timothy Kresowik, Rachel Nicholson, Shiliang Sun, Fadi Youness, Luigi Pascarella, Charles Ray, Martha-Gracia Knuttinen, James Bui, Ron Gaba, Valerie Dobiesz, Ejaz Shamim, Sangeetha Nimmagadda, David Peace, Aarti Zain, Alison Palumto, Ziv Haskal, Jon Mark Hirshon, Howard Richard, Avelino Verceles, Jade Wong-You-Chong, Bertrand Othee, Rahul Patel, Bogdan Iliescu, David Williams, Joseph Gemmete, Wojciech Cwikiel, Kyung Cho, James Schields, Ranjith Vellody, Paula Novelli, Narasimham Dasika, Thomas Wakefield, Jeffrey Desmond, James Froehlich, Minhajuddin Khaja, David Hunter, Jafar Golzarian, Erik Cressman, Yvonne Dotta, Nate Schmiechen, John Marek, David Garcia, Isaac Tawil, Mark Langsfeld, Stephan Moll, Matthew Mauro, Joseph Stavas, Charles Burke, Robert Dixon, Hyeon Yu, Blair Keagy, Kyuny Kim, Raj Kasthuri, Nigel Key, Michael Makaroun, Robert Rhee, Jae−Sung Cho, Donald Baril, Luke Marone, Margaret Hseih, Kristian Feterik, Roy Smith, Geetha Jeyabalan, Jennifer Rogers, Russel Vinik, Dan Kinikini, Larry Kraiss, Michelle Mueller, Robert Pendleton, Matthew Rondina, Mark Sarfati, Nathan Wanner, Stacy Johnson, Christy Hopkins, Daniel Ihnat, John Angle, Alan Matsumoto, Nancy Harthun, Ulku Turba, Wael Saad, Brian Uthlaut, Srikant Nannapaneni, David Ling, Saher Sabri, John Kern, B. Gail Macik, George Hoke, Auh Wahn Park, James Stone, Benjamin Sneed, Scott Syverud, Kelly Davidson, Aditya Sharma, Luke Wilkins, Carl Black, Mark Asay, Daniel Hatch, Robert Smilanich, Craig Patten, S. Douglas Brown, Ryan Nielsen, William Alward, John Collins, Matthew Nokes, Randolph Geary, Matthew Edwards, Christopher Godshall, Pavel Levy, Ronald Winokur, Akhilesh Sista, David Madoff, Kyungmouk Lee, Bradley Pua, Maria DeSancho, Raffaele Milizia, Jing Gao, Gordon McLean, Sanualah Khalid, Larry Lewis, Nael Saad, Mark Thoelke, Robert Pallow, Seth Klein, Gregorio Sicard, Heather L. Gornik, Jim Julian, Stephen Kee, Lawrence Lewis, Elizabeth Magnuson, and Timothy P. Murphy
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Mechanical Thrombolysis ,medicine.medical_treatment ,Catheter directed thrombolysis ,030204 cardiovascular system & hematology ,Iliac Vein ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Quality of life ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Internal medicine ,Epidemiology ,Medicine ,Humans ,In patient ,Thrombolytic Therapy ,030212 general & internal medicine ,cardiovascular diseases ,Thrombus ,Venous Thrombosis ,business.industry ,Thrombolysis ,Femoral Vein ,Middle Aged ,medicine.disease ,United States ,humanities ,3. Good health ,Venous thrombosis ,Treatment Outcome ,Quality of Life ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
After deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT.The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1 month, 6 months, 12 months, 18 months, and 24 months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups.Of 692 ATTRACT patients, 691 were analyzed (mean age, 53 years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1 month (difference, 5.7; P = .0006) and from baseline to 6 months (5.1; P = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 2.4; P = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1 month (difference, 10.0; P .0001) and 6 months (8.8; P .0001) and in the per-protocol analysis at 18 months (difference, 5.8; P = .0086) and 24 months (difference, 6.6; P = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 3.2; P = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups.Among patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1 month and 6 months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24 months.
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- 2020
25. Abstract No. 151 Perceptions of ethics in interventional radiology
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C. Couture, Nishita Kothary, S. Beeson, H. Rockwell, Eric J. Keller, and K. Dickey
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Interventional radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
26. Abstract No. 500 Tunneled peritoneal catheter versus repeated paracenteses for recurrent malignant ascites: a cost-effectiveness analysis
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Brian King, X. Wu, Rana Rabei, Andrew Taylor, Eric J. Keller, Nishita Kothary, Michael Heller, and Maureen P. Kohi
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medicine.medical_specialty ,business.industry ,Ascites ,medicine ,Radiology, Nuclear Medicine and imaging ,Cost-effectiveness analysis ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Peritoneal catheter ,business ,Surgery - Published
- 2021
27. Abstract No. 438 Palliative or heroic interventional radiology: a retrospective analysis of procedures performed at the end of life
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H. Rockwell, S. Srinivas, Eric J. Keller, Nishita Kothary, and S. Beeson
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General surgery ,Retrospective analysis ,Medicine ,Radiology, Nuclear Medicine and imaging ,Interventional radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
28. Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review
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Advait Patil, Joseph D. Forrester, Nishita Kothary, Jeff Choi, Jung Gi Min, and Peter I Cha
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medicine.medical_specialty ,Percutaneous ,RD1-811 ,medicine.medical_treatment ,Analgesic ,thoracotomy ,Cochrane Library ,Critical Care and Intensive Care Medicine ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pectus excavatum ,Medicine ,Thoracotomy ,Prospective cohort study ,Cryoneurolysis ,RC86-88.9 ,business.industry ,Medical emergencies. Critical care. Intensive care. First aid ,analgesia ,030208 emergency & critical care medicine ,medicine.disease ,rib fractures ,Chest Wall Pain ,Surgery ,epidural ,Systematic Review ,business - Abstract
BackgroundThere is a critical need for non-narcotic analgesic adjuncts in the treatment of thoracic pain. We evaluated the efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain, specifically addressing the applicability of intercostal cryoneurolysis for pain control after chest wall trauma.MethodsA systematic review was performed through searches of PubMed, EMBASE, and the Cochrane Library. We included studies involving patients of all ages that evaluated the efficacy of intercostal cryoneurolysis as a pain adjunct for chest wall pathology. Quantitative and qualitative synthesis was performed.ResultsTwenty-three studies including 570 patients undergoing cryoneurolysis met eligibility criteria for quantitative analysis. Five subgroups of patients treated with intercostal cryoneurolysis were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (three studies); malignant chest wall pain (two studies); and traumatic rib fractures (one study). There is overall low-quality evidence supporting intercostal cryoneurolysis as an analgesic adjunct for chest wall pain. A majority of studies demonstrated decreased inpatient narcotic use with intercostal cryoneurolysis compared with conventional pain modalities. Intercostal cryoneurolysis may also lead to decreased hospital length of stay. The procedure did not definitively increase operative time, and risk of complications was low.ConclusionsGiven the favorable risk-to-benefit profile, both percutaneous and thoracoscopic intercostal cryoneurolysis may serve as a worthwhile analgesic adjunct in trauma patients with rib fractures who have failed conventional medical management. However, further prospective studies are needed to improve quality of evidence.Level of evidenceLevel IV systematic reviews and meta-analyses.
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- 2021
29. Dynamic Measurement of Arterial Liver Perfusion With an Interventional C-Arm System
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Yamil Saenz, Rebecca Fahrig, Michael Manhart, Nishita Kothary, Terilyn Moore, Kerstin Müller, Yu Deuerling-Zheng, Jarrett Rosenberg, Sonja Gehrisch, Lior Molvin, and Sanjit Datta
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Liver perfusion ,medicine.medical_specialty ,Computed tomography perfusion ,Swine ,Liver procedures ,medicine.medical_treatment ,Contrast Media ,Pilot Projects ,Perfusion scanning ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Hepatic Artery ,0302 clinical medicine ,Text mining ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Embolization ,Reproducibility ,business.industry ,Reproducibility of Results ,General Medicine ,Blood flow ,Cone-Beam Computed Tomography ,Embolization, Therapeutic ,Liver ,030220 oncology & carcinogenesis ,Models, Animal ,Feasibility Studies ,Female ,Radiology ,business - Abstract
Objective intraprocedural measurement of hepatic blood flow could provide a quantitative treatment end point for locoregional liver procedures. This study aims to validate the accuracy and reproducibility of cone-beam computed tomography perfusion (CBCTp) measurements of arterial liver perfusion (ALP) against clinically available computed tomography perfusion (CTp) measurements in a swine embolization model.Triplicate CBCTp measurements using a selective arterial contrast injection were performed before and after complete embolization of the left lobe of the liver in 5 swine. Two CBCTp protocols were evaluated that differed in sweep duration (3.3 vs 4.5 seconds) and the number of acquired projection images (166 vs 248). The mean ALP was measured within identical volumes of interest selected in the embolized and nonembolized regions of the perfusion map generated from each scan. Postembolization CBCTp values were also compared with CTp measurements.The 2 CBCTp protocols demonstrated high concordance correlation (0.90, P0.001). Both CBCTp protocols showed higher reproducibility than CTp in the nontarget lobe, with an intraclass correlation of 0.90 or greater for CBCTp and 0.83 for CTp (P0.001 for all correlations). The ALP in the embolized lobe was nearly zero and hence excluded for reproducibility. High concordance correlation was observed between the CTp and each CBCTp protocol, with the shorter CBCTp protocol reaching a concordance correlation of 0.75 and the longer achieving 0.87 (P0.001 for both correlations).Dynamic blood flow measurement using an angiographic C-arm system is feasible and produces quantitative results comparable to CTp.
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- 2017
30. The Role of Cone-Beam CT in Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis
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Gloria L. Hwang, Kerstin Mueller, Moiz Ahmad, Jarrett Rosenberg, Nishita Kothary, Christopher D Stave, Leland Pung, and Rajesh Shah
- Subjects
medicine.medical_specialty ,Cone beam computed tomography ,Carcinoma, Hepatocellular ,Computed Tomography Angiography ,Radiography, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Transcatheter arterial chemoembolization ,Computed tomography angiography ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Angiography, Digital Subtraction ,Reproducibility of Results ,Digital subtraction angiography ,Cone-Beam Computed Tomography ,medicine.disease ,Newcastle–Ottawa scale ,Treatment Outcome ,Meta-analysis ,Predictive value of tests ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Radiology ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Purpose To review available evidence for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries. Materials and Methods Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included "cone beam," "CBCT," "C-arm," "CACT," "cone-beam CT," "volumetric CT," "volume computed tomography," "volume CT," AND "liver," "hepatic*," "hepatoc*." Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included. Results Inclusion criteria were met by 18 studies. Pooled sensitivity of cone-beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%–95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for tumor detection was 67% (95% CI, 51%–80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%–95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%–74%). Conclusions Cone-beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization. Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC.
- Published
- 2017
31. The Role of Dual-Phase Cone-Beam CT in Predicting Short-Term Response after Transarterial Chemoembolization for Hepatocellular Carcinoma
- Author
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Sonja Gehrisch, Mohammed Ahmed Abdelrazek Mohammed, Sanjit Datta, Gloria L. Hwang, Moiz Ahmad, Daniel Y. Sze, Jarrett Rosenberg, Kerstin Müller, John D. Louie, and Nishita Kothary
- Subjects
Male ,Carcinoma, Hepatocellular ,Time Factors ,Multivariate analysis ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Hounsfield scale ,Odds Ratio ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Univariate ,Washout ,Odds ratio ,Cone-Beam Computed Tomography ,Middle Aged ,medicine.disease ,Tumor Burden ,Treatment Outcome ,Response Evaluation Criteria in Solid Tumors ,Hepatocellular carcinoma ,Multivariate Analysis ,Linear Models ,Radiographic Image Interpretation, Computer-Assisted ,Female ,030211 gastroenterology & hepatology ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Progressive disease - Abstract
Purpose To identify computational and qualitative features derived from dual-phase cone-beam CT that predict short-term response in patients undergoing transarterial chemoembolization for hepatocellular carcinoma (HCC). Materials and Methods This retrospective study included 43 patients with 59 HCCs. Six features were extracted, including intensity of tumor enhancement on both phases and characteristics of the corona on the washout phase. Short-term response was evaluated by modified Response Evaluation Criteria in Solid Tumors on follow-up imaging, and extracted features were correlated to response using univariate and multivariate analyses. Results Univariate and multivariate analyses did not reveal a correlation between absolute and relative tumor enhancement characteristics on either phase with response (arterial P = .21; washout P = .40; ∆ P = .90). On multivariate analysis of qualitative characteristics, the presence of a diffuse corona was an independent predictor of incomplete response ( P = .038) and decreased the odds ratio of objective response by half regardless of tumor size. Conclusions Computational features extracted from contrast-enhanced dual-phase cone-beam CT are not prognostic of response to transarterial chemoembolization in patients with HCC. HCCs that demonstrate a diffuse, patchy corona have reduced odds of achieving complete response after transarterial chemoembolization and should be considered for additional treatment with an alternative modality.
- Published
- 2017
32. Endovascular Management of May–Thurner Syndrome in Adolescents: A Single-Center Experience
- Author
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Daniel Y. Sze, Nishita Kothary, William T. Kuo, Roger E. Goldman, Matthew P. Lungren, V. Arendt, and Lawrence V. Hofmann
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Population ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Prosthesis Design ,Single Center ,California ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Risk Factors ,May-Thurner Syndrome ,Humans ,Medicine ,Thrombolytic Therapy ,Radiology, Nuclear Medicine and imaging ,Child ,education ,Vascular Patency ,Retrospective Studies ,education.field_of_study ,business.industry ,Endovascular Procedures ,Age Factors ,Thrombolysis ,May–Thurner syndrome ,medicine.disease ,Venous Obstruction ,Thrombosis ,Surgery ,Treatment Outcome ,Mild symptoms ,Cohort ,Feasibility Studies ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To report a single-center experience in regard to the technique, safety, and clinical outcomes of endovascular therapy for treatment of May–Thurner syndrome (MTS) in adolescent patients. Materials and Methods A retrospective review identified 10 patients (6 female; mean age, 16 y; range, 12–18 y; mean weight, 73 kg; range, 50–116 kg) treated by endovascular therapy for MTS from 1998 to 2015. Clinical presentations consisted of acute thrombotic MTS (n = 6) and nonthrombotic MTS (n = 4). Catheter‐directed thrombolysis was performed in all cases of thrombosis. Venoplasty and stent placement were performed in all cases. Self-expanding stents 12–16 mm in diameter and 4–9 cm in length were deployed. Results No major periprocedural complications were observed. Median follow-up was 32 months (range, 6–109 mo). Primary and secondary patency rates were 79% and 100% at 12 months and 79% and 89% at 36 months, respectively. In a single patient with permanent loss of flow in the treated segment, multiple risk factors for thrombosis were identified. Rates of posttreatment symptoms were 0% by Villalta score and 60% (n = 6; mild symptoms) by modified Villalta score at the last clinical follow-up. Conclusions Endovascular therapy for the treatment of MTS in our adolescent cohort was safe and effective in relieving venous obstruction. Stent placement in patients with underlying thrombophilic disorders is associated with loss of secondary patency, suggesting the need for further consideration in this population.
- Published
- 2017
33. Ultrasound-Guided Liver Biopsy With Gelatin Sponge Pledget Tract Embolization in Infants Weighing Less Than 10 kg
- Author
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Nishita Kothary, Frank Glen Seidel, Eric J. Monroe, Giri Shivaram, Anne E. Gill, Matthew P. Lungren, Matthew C. Hawkins, and Will S. Lindquester
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Biliary atresia ,Biopsy ,medicine ,Humans ,Medical history ,Embolization ,Adverse effect ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Retrospective Studies ,Chi-Square Distribution ,medicine.diagnostic_test ,business.industry ,Liver Diseases ,Infant, Newborn ,Gastroenterology ,Infant ,Retrospective cohort study ,medicine.disease ,Surgery ,Liver ,Infant, Extremely Low Birth Weight ,Child, Preschool ,Liver biopsy ,Pediatrics, Perinatology and Child Health ,Female ,030211 gastroenterology & hepatology ,Radiology ,Complication ,business - Abstract
OBJECTIVES The aim of the study was to describe and assess the technical success and safety of ultrasound-guided liver biopsy with gelatin sponge pledget tract embolization technique in infants
- Published
- 2016
34. Embolotherapy for Neuroendocrine Tumor Liver Metastases: Prognostic Factors for Hepatic Progression-Free Survival and Overall Survival
- Author
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Ghassan El-Haddad, Hooman Yarmohammadi, Kristen Stashek, Nishita Kothary, Riad Salem, Steven C. Rose, Nicholas Fidelman, David C. Metz, Daniel Y. Sze, James X. Chen, E. Paul Wileyto, Sarah B. White, Michael C. Soulen, and W Hwang
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Tare weight ,medicine.medical_treatment ,Gastroenterology ,Disease-Free Survival ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Embolization ,Progression-free survival ,Chemoembolization, Therapeutic ,Propensity Score ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Proportional hazards model ,Liver Neoplasms ,Hazard ratio ,Retrospective cohort study ,Middle Aged ,Prognosis ,Neuroendocrine Tumors ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Propensity score matching ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pancreas - Abstract
The purpose of the study was to evaluate prognostic factors for survival outcomes following embolotherapy for neuroendocrine tumor (NET) liver metastases.This was a multicenter retrospective study of 155 patients (60 years mean age, 57 % male) with NET liver metastases from pancreas (n = 71), gut (n = 68), lung (n = 8), or other/unknown (n = 8) primary sites treated with conventional transarterial chemoembolization (TACE, n = 50), transarterial radioembolization (TARE, n = 64), or transarterial embolization (TAE, n = 41) between 2004 and 2015. Patient-, tumor-, and treatment-related factors were evaluated for prognostic effect on hepatic progression-free survival (HPFS) and overall survival (OS) using unadjusted and propensity score-weighted univariate and multivariate Cox proportional hazards models.Median HPFS and OS were 18.5 and 125.1 months for G1 (n = 75), 12.2 and 33.9 months for G2 (n = 60), and 4.9 and 9.3 months for G3 tumors (n = 20), respectively (p 0.05). Tumor burden 50 % hepatic volume demonstrated 5.5- and 26.8-month shorter median HPFS and OS, respectively, versus burden ≤50 % (p 0.05). There were no significant differences in HPFS or OS between gut or pancreas primaries. In multivariate HPFS analysis, there were no significant differences among embolotherapy modalities. In multivariate OS analysis, TARE had a higher hazard ratio than TACE (unadjusted Cox model: HR 2.1, p = 0.02; propensity score adjusted model: HR 1.8, p = 0.11), while TAE did not differ significantly from TACE.Higher tumor grade and tumor burden prognosticated shorter HPFS and OS. TARE had a higher hazard ratio for OS than TACE. There were no significant differences in HPFS among embolotherapy modalities.
- Published
- 2016
35. Quantitative Ultrasound Spectroscopy for Differentiation of Hepatocellular Carcinoma from At-Risk and Normal Liver Parenchyma
- Author
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Isabelle Durot, Nishita Kothary, Jarrett Rosenberg, Jürgen K. Willmann, Rosa Sigrist, and Ahmed El Kaffas
- Subjects
Liver Cirrhosis ,Male ,Cancer Research ,Cirrhosis ,Carcinoma, Hepatocellular ,Chronic liver disease ,Risk Assessment ,Workflow ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Parenchyma ,medicine ,Carcinoma ,Image Processing, Computer-Assisted ,Humans ,Quantitative Ultrasound Spectroscopy ,Aged ,Ultrasonography ,Aged, 80 and over ,business.industry ,Spectrum Analysis ,Ultrasound ,Liver Neoplasms ,Disease Management ,Middle Aged ,medicine.disease ,digestive system diseases ,Oncology ,Liver Lobe ,Liver ,ROC Curve ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Female ,business ,Nuclear medicine - Abstract
Purpose: Quantitative ultrasound approaches can capture tissue morphologic properties to augment clinical diagnostics. This study aims to clinically assess whether quantitative ultrasound spectroscopy (QUS) parameters measured in hepatocellular carcinoma (HCC) tissues can be differentiated from those measured in at-risk or healthy liver parenchyma. Experimental Design: This prospective Health Insurance Portability and Accountability Act (HIPAA)–compliant study was approved by the Institutional Review Board. Fifteen patients with HCC, 15 non-HCC patients with chronic liver disease, and 15 healthy volunteers were included (31.1% women; 68.9% men). Ultrasound radiofrequency data were acquired in each patient in both liver lobes at two focal depths (3/9 cm). Region of interests (ROIs) were drawn on HCC and liver parenchyma. The average normalized power spectrum for each ROI was extracted, and a linear regression was fit within the −6 dB bandwidth, from which the midband fit (MBF), spectral intercept (SI), and spectral slope (SS) were extracted. Differences in QUS parameters between the ROIs were tested by a mixed-effects regression. Results: There was a significant intraindividual difference in MBF, SS, and SI between HCC and adjacent liver parenchyma (P < 0.001), and a significant interindividual difference between HCC and at-risk and healthy non-HCC parenchyma (P < 0.001). In patients with HCC, cirrhosis (n = 13) did not significantly change any of the three parameters (P > 0.8) in differentiating HCC from non-HCC parenchyma. MBF (P = 0.12), SI (P = 0.33), and SS (P = 0.57) were not significantly different in non-HCC tissue among the groups. Conclusions: The QUS parameters are significantly different in HCC versus non-HCC liver parenchyma, independent of underlying cirrhosis. This could be leveraged for improved HCC detection with ultrasound in the future.
- Published
- 2019
36. Emergency General Surgery Quality Improvement Efforts for the Elderly: Are Needs Different from the Young?
- Author
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Lakshika Tennakoon, Kristan Staudenmayer, Raul Coimbra, Clay Cothren Burlew, and Nishita Kothary
- Subjects
Quality management ,business.industry ,Medicine ,Surgery ,Medical emergency ,business ,medicine.disease - Published
- 2020
37. Assessing the Risk of Hemorrhagic Complication following Transjugular Liver Biopsy in Bone Marrow Transplantation Recipients
- Author
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Nishita Kothary, Lawrence V. Hofmann, Mohammed Ahmed Abdelrazek Mohammed, Daniel Y. Sze, Matthew P. Lungren, Thomas J. Ward, and Osman Ahmed
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Blood transfusion ,medicine.medical_treatment ,Hemorrhage ,Hepatic Veins ,030204 cardiovascular system & hematology ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Hemoglobins ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Biopsy ,medicine ,Humans ,Transjugular liver biopsy ,Blood Transfusion ,Radiology, Nuclear Medicine and imaging ,Aged ,Bone Marrow Transplantation ,Retrospective Studies ,medicine.diagnostic_test ,Platelet Count ,business.industry ,Liver Diseases ,Retrospective cohort study ,Phlebography ,Odds ratio ,Middle Aged ,Transplant Recipients ,Confidence interval ,Surgery ,surgical procedures, operative ,Liver ,Hemorrhagic complication ,Predictive value of tests ,Female ,Biopsy, Large-Core Needle ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Purpose To determine if recipients of bone marrow transplants (BMTs) are at increased risk of hemorrhagic complications following transjugular liver biopsy (TJLB). Materials and Methods TJLBs in BMT and non-BMT patients between January 2007 and July 2014 were reviewed. Patient demographic and pre- and postprocedural laboratory data were reviewed. Mean platelet count and International Normalized Ratio were 174,300 × 10 3 /µL ± 107.3 (standard deviation) and 1.2 ± 0.4, respectively, for BMT recipients, compared with 88,100 × 10 3 /µL ± 70.9 and 1.2 ± 0.5, respectively, for non-BMT. Patients in whom hemoglobin level decreased by > 1 g/dL and/or required transfusion within 15 days of TJLB were reviewed to determine the presence of a biopsy-related hemorrhagic complication. Results A total of 1,600 TJLBs in 1,120 patients were analyzed. Of these, 183 TJLBs in 159 BMT recipients and 1,417 TJLBs in 961 patients non-BMT patients were performed. Thirteen TJLBs were complicated by hemorrhage: five in BMT (2.9%) and eight in the non-BMT cohorts (0.6%; P 3 /µL) in all but one patient (8 × 10 3 /µL). BMT recipients had an odds ratio of 4.9 (95% confidence interval, 1.25–17.3) for post-TJLB bleeding/hemorrhage compared with those without BMTs ( P Conclusions TJLB continues to be a safe procedure in the vast majority of patients. However, hemorrhagic complications occurred at a rate of 2.9% in BMT recipients, compared with 0.6% in patients without BMTs, and therefore caution should be exercised when performing TJLB in this group.
- Published
- 2016
38. Superselective Chemoembolization of HCC: Comparison of Short-term Safety and Efficacy between Drug-eluting LC Beads, QuadraSpheres, and Conventional Ethiodized Oil Emulsion
- Author
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John D. Louie, Gloria L. Hwang, Nishita Kothary, Marnix G.E.H. Lam, Ellen Q Wang, William T. Kuo, M. Abdelmaksoud, Daniel Y. Sze, Lawrence V. Hofmann, and Feng Duan
- Subjects
Male ,Contrast Media ,Radiography, Interventional ,030218 nuclear medicine & medical imaging ,Ethiodized Oil ,0302 clinical medicine ,80 and over ,media_common ,Aged, 80 and over ,Drug Carriers ,Interventional ,Liver Neoplasms ,Angiography ,Cone-Beam Computed Tomography ,Middle Aged ,Microspheres ,Treatment Outcome ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Emulsion ,Chemoembolization ,Emulsions ,Female ,Radiology ,Therapeutic ,Drug carrier ,Adult ,Drug ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Iohexol ,media_common.quotation_subject ,03 medical and health sciences ,Journal Article ,medicine ,Humans ,Comparative Study ,Radiology, Nuclear Medicine and imaging ,In patient ,Chemoembolization, Therapeutic ,Transcatheter arterial chemoembolization ,Aged ,business.industry ,Carcinoma ,Angiography, Digital Subtraction ,Ct guidance ,Hepatocellular ,medicine.disease ,Radiography ,Doxorubicin ,Gelatin ,business ,Digital Subtraction - Abstract
PURPOSE: To study the comparative short-term safety and efficacy of transcatheter arterial chemoembolization (TACE) with drug-eluting LC Beads loaded with doxorubicin (DEBDOX), doxorubicin-eluting QuadraSpheres (hqTACE), and conventional TACE using ethiodized oil for superselective C-arm computed tomography (CT)-guided treatment of hepatocellular carcinoma (HCC) after the onset of drug shortages. MATERIALS AND METHODS: From March 2010 to March 2011, 166 patients with HCC were treated with 232 superselective TACE procedures using C-arm cone-beam CT at one institution. Patients underwent treatment depending on the availability of materials after the onset of drug shortages. Conventional TACE with doxorubicin, cisplatin, and Ethiodol was performed for 159 procedures, DEBDOX TACE was performed for 47, and hqTACE was performed for 26. Toxicity and objective response were compared at 3 months after treatment. Data were stratified for the high-risk population (Child-Pugh class B, performance status 1, bilobar disease, and/or post-resection recurrence) and initial versus repeat treatment. Kruskal-Wallis H test, Mann-Whitney U test, and Fisher exact test were used to compare the groups, with Bonferroni correction where needed. RESULTS: Whole liver response rates trended higher for conventional TACE (conventional TACE, 65.4%; DEBDOX, 63.8%; hqTACE, 53.8%) (P = .085). Only minor trends for differences in toxicity were observed between the three groups. Low-risk patients had higher whole liver (P = .001) and treated lesion (P = .007) response rates when treated with conventional TACE, but no significant differences were seen for DEBDOX and hqTACE. Treatment-naive patients also had higher whole liver (P = .012) and treated lesion (P = .056) response rates. No advantages for drug-eluting microspheres were found. CONCLUSION: Within statistical power limitations, overall toxicity and efficacy were equivalent in patients treated with LC Beads, QuadraSpheres, or ethiodized oil emulsions, including in high-risk patients, when performed superselectively with cone-beam C-arm CT guidance.
- Published
- 2016
39. 4:03 PM Abstract No. 163 The role of interventional radiology in managing biliary complications following liver transplantation in the pediatric population
- Author
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V. Green, Mohamed Khalaf, S. Josephs, and Nishita Kothary
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General surgery ,Medicine ,Radiology, Nuclear Medicine and imaging ,Interventional radiology ,Liver transplantation ,Cardiology and Cardiovascular Medicine ,business ,Pediatric population - Published
- 2020
40. 3:09 PM Abstract No. 73 Evaluating the impact of communal traits and gender-based perceptions on Press-Ganey scores
- Author
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Sonja Schmer-Galunder, Jure Leskovec, Emma Pierson, Jonathan Altamirano, Dan Jurafsky, H. Chen, Nishita Kothary, and Magali Fassiotto
- Subjects
business.industry ,Perception ,media_common.quotation_subject ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,media_common ,Clinical psychology - Published
- 2020
41. Abstract No. 533 Comparison of drug-eluting beads versus conventional transarterial chemoembolization: a cost-effectiveness analysis
- Author
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Nishita Kothary, Xiao Wu, Ajay Malhotra, and Julius Chapiro
- Subjects
Drug eluting beads ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cost-effectiveness analysis ,Cardiology and Cardiovascular Medicine ,business ,Biomedical engineering - Published
- 2020
42. Untapped Resources: Attaining Equitable Representation for Women in IR
- Author
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Jonathan Altamirano, Shellie Josephs, Nishita Kothary, Yvonne Maldonado, Magali Fassiotto, Daniel Y. Sze, Marcelina G. Perez, and Gloria L. Hwang
- Subjects
Male ,Gender diversity ,Sexism ,Radiology, Interventional ,030218 nuclear medicine & medical imaging ,Representation (politics) ,03 medical and health sciences ,Physicians, Women ,0302 clinical medicine ,Radiologists ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Productivity ,Societies, Medical ,Medical education ,medicine.diagnostic_test ,Career Choice ,business.industry ,Interventional radiology ,Congresses as Topic ,Quartile ,Education, Medical, Graduate ,030220 oncology & carcinogenesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Specialization ,Women, Working - Abstract
Purpose To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators. Materials and Methods Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012–2017) were statistically compared to that of recurring male faculty. Results From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P = .722; total publications P = .689; and authorship P = .662). Conclusions This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record.
- Published
- 2018
43. Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty
- Author
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Jie Li, Magali Fassiotto, Nishita Kothary, and Yvonne Maldonado
- Subjects
Adult ,Male ,medicine.medical_specialty ,Faculty, Medical ,media_common.quotation_subject ,Interprofessional Relations ,Specialty ,Graduate medical education ,Stereotype ,Affect (psychology) ,California ,Job Satisfaction ,Education ,03 medical and health sciences ,Physicians, Women ,0302 clinical medicine ,Sex Factors ,Perception ,medicine ,Humans ,030212 general & internal medicine ,media_common ,Retrospective Studies ,Academic Medical Centers ,Stereotyping ,Career Choice ,05 social sciences ,050301 education ,Training Support ,Stereotype threat ,Education, Medical, Graduate ,Family medicine ,General Surgery ,Multivariate Analysis ,Medicine ,Regression Analysis ,Surgery ,Women in science ,Job satisfaction ,Female ,0503 education - Abstract
Objective Similar to women in Science, Technology, Engineering and Mathematics disciplines, women in medicine are subject to negative stereotyping when they do not adhere to their sex-role expectations. These biases may vary by specialty, largely dependent on the gender’s representation in that specialty. Thus, females in male-dominated surgical specialties are especially at risk of stereotype threat. Herein, we present the role of gender expectations using trainee evaluations of physician faculty at a single academic center, over a 5-year period (2010-2014). Design Using Graduate Medical Education evaluation data of physician faculty from MedHub, we examined the differences in evaluation scores for male and female physicians within specialties that have traditionally had low female representation (e.g., surgical fields) compared to those with average or high female representation (e.g., pediatrics). Setting Stanford Medicine residents and fellows’ MedHub ratings of their physician faculty from 2010 to 2014. Participants A total of 3648 evaluations across 1066 physician faculty. Results Overall, female physicians received lower median scores than their male counterparts across all specialties. When using regression analyses controlling for race, age, rank, and specialty-specific characteristics, the negative effect persists only for female physicians in specialties with low female representation. Conclusions This finding suggests that female physicians in traditionally male-dominated specialties may face different criteria based on sex-role expectations when being evaluated by trainees. As trainee evaluations play an important role in career advancement decisions, dictate perceptions of quality within academic medical centers and affect overall job satisfaction, we propose that these differences in evaluations based merely on gender stereotypes could account, in part, for the narrowing pipeline of women promoted to higher ranks in academic medicine.
- Published
- 2017
44. Watershed Hepatocellular Carcinomas: The Risk of Incomplete Response following Transhepatic Arterial Chemoembolization
- Author
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John D. Louie, Ali M. Tahvildari, Kerstin Mueller, Patrick G. Sullivan, Daniel Y. Sze, Chris Takehana, Vishal Sidhar, Jarrett Rosenberg, and Nishita Kothary
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Milan criteria ,Gastroenterology ,California ,Disease-Free Survival ,Liver disease ,Age Distribution ,Model for End-Stage Liver Disease ,Risk Factors ,Internal medicine ,medicine ,Humans ,Neoplasm Invasiveness ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Sex Distribution ,Survival rate ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Survival Rate ,Transplantation ,Treatment Outcome ,Response Evaluation Criteria in Solid Tumors ,Hepatocellular carcinoma ,Female ,Neoplasm Recurrence, Local ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Progressive disease - Abstract
Purpose Hepatocellular carcinomas (HCCs) bridging two or more Couinaud–Bismuth segments of the liver ("watershed tumors") can recruit multiple segmental arteries. The primary hypothesis of this study was that fewer watershed tumors show complete response (CR) after chemoembolization, with shorter time to local recurrence. Secondary analysis on the impact on transplantation eligibility in the presence of progressive disease was also performed. Materials and Methods A total of 155 transplantation-eligible patients whose HCC met Milan criteria (watershed, n=83; nonwatershed, n=72) and was treated with chemoembolization were included. Cone-beam computed tomography (CT) was used for guidance and for confirmation of circumferential uptake. Local response to chemoembolization per modified Response Evaluation Criteria In Solid Tumors and local disease-free survival (DFS) for the index tumor were calculated. Differences were assessed by univariate and multivariate analyses. Results CR after a single of chemoembolization was observed in 55.4% of watershed tumors and in 72.2% of nonwatershed tumors ( P = .045). Estimated DFS intervals were 151 days (95% confidence interval [CI], 93–245 d) and 336 days (95% CI, 231–747 d; P = .040) in the watershed and nonwatershed groups, respectively. Worse DFS was observed with a Model for End-Stage Liver Disease score > 20 ( P = .0001), higher Child–Pugh–Turcotte score ( P = .049), and watershed location ( P = .040). Waiting list drop-off rates were statistically similar between groups. Conclusions Hepatocellular carcinomas located in the watershed region of the liver have a poorer response to chemoembolization than those located elsewhere. These tumors are associated with worse DFS and require additional treatments to maintain transplantation eligibility per Milan criteria. Cone-beam CT can identify crossover supply and confirm complete geographic drug uptake, possibly reducing (but not eliminating) the risk of incomplete response.
- Published
- 2015
45. Optimal Imaging Surveillance Schedules after Liver-Directed Therapy for Hepatocellular Carcinoma
- Author
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Bao H. Do, Daniel Y. Sze, John D. Louie, David M. Hovsepian, Nishita Kothary, F. Edward Boas, Mark Kantrowitz, Gloria L. Hwang, and William T. Kuo
- Subjects
Male ,medicine.medical_specialty ,Schedule ,Carcinoma, Hepatocellular ,Time Factors ,Radiofrequency ablation ,medicine.medical_treatment ,law.invention ,law ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Chemoembolization, Therapeutic ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Magnetic resonance imaging ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Recurrent Hepatocellular Carcinoma ,Surgery ,Treatment Outcome ,Liver ,Hepatocellular carcinoma ,Catheter Ablation ,Female ,Radiology ,Neoplasm Recurrence, Local ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Purpose To optimize surveillance schedules for the detection of recurrent hepatocellular carcinoma (HCC) after liver-directed therapy. Materials and Methods New methods have emerged that allow quantitative analysis and optimization of surveillance schedules for diseases with substantial rates of recurrence such as HCC. These methods were applied to 1,766 consecutive chemoembolization, radioembolization, and radiofrequency ablation procedures performed on 910 patients between 2006 and 2011. Computed tomography or magnetic resonance imaging performed just before repeat therapy was set as the time of "recurrence," which included residual and locally recurrent tumor as well as new liver tumors. Time-to-recurrence distribution was estimated by Kaplan–Meier method. Average diagnostic delay (time between recurrence and detection) was calculated for each proposed surveillance schedule using the time-to-recurrence distribution. An optimized surveillance schedule could then be derived to minimize the average diagnostic delay. Results Recurrence is 6.5 times more likely in the first year after treatment than in the second. Therefore, screening should be much more frequent in the first year. For eight time points in the first 2 years of follow-up, the optimal schedule is 2, 4, 6, 8, 11, 14, 18, and 24 months. This schedule reduces diagnostic delay compared with published schedules and is cost-effective. Conclusions The calculated optimal surveillance schedules include shorter-interval follow-up when there is a higher probability of recurrence and longer-interval follow-up when there is a lower probability. Cost can be optimized for a specified acceptable diagnostic delay or diagnostic delay can be optimized within a specified acceptable cost.
- Published
- 2015
46. A Role for Virtual Reality in Planning Endovascular Procedures
- Author
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Andrew Kesselman, Mohamed H. Khalaf, Mohammed Ahmed Abdelrazek Mohammed, David S. Wang, and Nishita Kothary
- Subjects
Male ,Models, Anatomic ,Patient-Specific Modeling ,Computed Tomography Angiography ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,Virtual reality ,Radiographic image interpretation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,User-Computer Interface ,0302 clinical medicine ,Imaging, Three-Dimensional ,Human–computer interaction ,Predictive Value of Tests ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,business.industry ,Volumetric data ,Suite ,Liver Neoplasms ,Representation (systemics) ,Models, Cardiovascular ,Virtual Reality ,Middle Aged ,Aneurysm ,Embolization, Therapeutic ,Therapy, Computer-Assisted ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Cardiology and Cardiovascular Medicine ,business ,Splenic Artery ,030217 neurology & neurosurgery - Abstract
Current imaging technologies are capable of acquiring volumetric data, but they are limited by the flat 2-dimensional representation of complex 3-dimensional data. This pictorial report illustrates the potential role of interactive virtual reality (VR) that enables physicians to visualize and interact with image data as if they were real physical objects. Increasing availability of tools that make the VR environment a possibility could potentially be valuable in the interventional radiology suite.
- Published
- 2017
47. Notice of Removal: Quantitative ultrasound spectroscopy to differentiate between hepatocellular carcinoma and at-risk liver parenchyma
- Author
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Nishita Kothary, Rosa Sigrist, Jarrett Rosenberg, Ahmed El Kaffas, Isabelle Durot, and Juergen K. Willmann
- Subjects
medicine.medical_specialty ,Cirrhosis ,business.industry ,Ultrasound ,medicine.disease ,Lesion ,Increased risk ,Hepatocellular carcinoma ,Quantitative assessment ,Medicine ,Radiology ,medicine.symptom ,business ,Quantitative Ultrasound Spectroscopy ,Liver parenchyma - Abstract
Early detection of hepatocellular carcinoma (HCC) is critically needed to improve patient survival. Ultrasound is the first-line technology to screen patients at increased risk but has low sensitivity and specify in particular in hepatic cirrhosis. Quantitative ultrasound spectroscopy (QUS) is a promising tool that may increase diagnostic accuracy of ultrasound by enabling quantitative assessment and computerized screening. This study aimed to perform a clinical assessment of QUS parameters for differentiating HCC lesion tissue from liver parenchyma.
- Published
- 2017
48. Administering Blood Products Before Selected Interventional Radiology Procedures: Developing, Applying, and Monitoring a Standardized Protocol
- Author
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Jarrett Rosenberg, Nishita Kothary, Seema Singh Saharan, Nam S. Hoang, David M. Hovsepian, Andrew A. Tran, and Shaughnessy B. Brown
- Subjects
Male ,medicine.medical_specialty ,Platelet Transfusion ,030204 cardiovascular system & hematology ,Radiography, Interventional ,03 medical and health sciences ,Plasma ,0302 clinical medicine ,Blood product ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,International Normalized Ratio ,Single institution ,Protocol (science) ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Surgery ,030220 oncology & carcinogenesis ,Hemorrhagic complication ,Anesthesia ,Practice Guidelines as Topic ,Female ,Fresh frozen plasma ,Guideline Adherence ,business - Abstract
To apply and monitor a single institution's adherence to internally established guidelines for the preoperative administration of platelets and/or fresh frozen plasma (FFP) before a specified subset of minimally invasive interventional radiology (IR) procedures.Beginning in December 2008, we implemented a set of restrictive guidelines for preoperative platelet and/or FFP administration before IR procedures at a single academic hospital. Basing our program on the methodology of Lean Six Sigma, we compared the number and appropriateness of transfusions between the months of January and October in 2008 (prepolicy), again in 2010 (postpolicy), and finally in 2015 (follow-up). Patients with a platelet count less than or equal to 50,000 or an international normalized ratio greater than or equal to 1.7 met criteria for receiving platelets or FFP, respectively, before their IR procedure. For all three periods, we compared the rates of transfusion, hemorrhagic complications, and proportion of appropriate versus inappropriate blood product administration (BPA) per our guidelines.There was a significant increase in the number of appropriate BPAs between 2008 and 2010 from 58% to 76% (P = .021). Between 2010 and 2015, the rate trended up further, from 76% to 88% (P = .051). Overall, between 2008 and 2015, the improvement from 58% to 88% was significant (P.001). The rate of hemorrhagic complications was extremely low in all three groups.Restrictive guidelines for receiving platelets and FFP administrations before IR procedures can sustainably decrease the rate of overall BPA while increasing the proportion of appropriate BPA without impacting the rate of hemorrhagic complications.
- Published
- 2017
49. Abstract No. 509 Same-day discharge after chemoembolization: a predictive model to assist physicians in minimizing overnight admissions
- Author
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Rajesh Shah, K. Jackson, M. AbdelRazek, M. Desai, V. Sundaram, Nishita Kothary, and Mohamed Khalaf
- Subjects
medicine.medical_specialty ,business.industry ,Emergency medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Same day discharge - Published
- 2018
50. Reply to: 'Parity at the Podium'
- Author
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Nishita Kothary, Magali Fassiotto, and Jonathan Altamirano
- Subjects
medicine.medical_specialty ,Health personnel ,business.industry ,Family medicine ,medicine ,MEDLINE ,Radiology, Nuclear Medicine and imaging ,Parity (physics) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
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