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Introduction: Interventional radiology (IR) is a rapidly developing speciality where innovation-especially in teaching practices-is vital. With workforce and capacity shortages, synthesis of classical educational theories and novel strategies utilising virtual reality (VR) and artificial intelligence (AI) provide opportunities to make teaching as efficient and effective as possible. The aim of this review is to examine the literature on different approaches in IR teaching and learning in undergraduates and postgraduates., Methods: Literature was reviewed using a comprehensive search strategy with relevant keywords. Articles were limited to 2013-2023. Databases searched included MEDLINE, Embase, British Education Index and ERIC, in addition to a manual review of references., Results: Of the 2903 unique abstracts reviewed by the authors, 43 were relevant to the purpose of this study. The major pedagogical approaches identified were categorised into the following-traditional master-apprentice mentoring, virtual reality/simulation, physical models, and remote teaching. VR simulations enable practise free from the limits of time and risk to patients, as well as potential for standardised formal curricula. AI has the capability to enhance training simulations and assessment of trainees. With recent events necessitating innovation in online remote teaching, programs that are accessible whilst arguably imparting just as much clinical knowledge as in-person education have now been developed., Conclusion: Mentoring has conventionally been the standard for radiology teaching, however there are now several alternative pedagogical approaches available to the IR community. A combination of the most effective ideas within each is the optimal method by which IR should be taught., (© 2024. The Author(s).)

Radiological incidental findings (IFs) are previously undetected abnormalities which are unrelated to the original indication for imaging and are unexpectedly discovered. In brain magnetic resonance imaging (MRI), the prevalence of IFs is increasing. By reviewing the literature on IFs in brain MRI performed for research purposes and discussing ethical considerations of IFs, this paper provides an overview of brain IF research results and factors contributing to inconsistencies and considers how the consent process can be improved from an ethical perspective. We found that despite extensive literature regarding IFs in research MRI of the brain, there are major inconsistencies in the reported prevalence, ranging from 1.3% to 99%. Many factors appear to contribute to this broad range: lack of standardised definition, participant demographics variance, heterogenous MRI scanner strength and sequences, reporter variation and results classification. We also found significant discrepancies in the review, consent and clinical communication processes pertaining to the ethical nature of these studies. These findings have implications for future studies, particularly those involving artificial intelligence. Further research, particularly in relation to MRI brain IFs would be useful to explore the generalisability of study results., (© 2024 Royal Australian and New Zealand College of Radiologists.)

Aims: This study aims to assess the impact that delivering an introductory interventional radiology (IR) lecture series has on the knowledge and perception of the specialty among medical students in a resource-limited setting with, until recently, no IR presence., Materials and Methods: An introductory four-hour lecture series in IR was delivered to third-year medical students in Tanzania. Prior to and following the lecture series, participants completed a 27-item paper-based survey assessing their knowledge and perception of the specialty., Results: Out of a class of 213, the pre- and post-lecture survey was returned by 148 (69.5%) and 151 (70.9%) respondents, respectively. 94.5% of respondents indicated that they were aware of IR as a specialty. Among respondents, 97.3% expressed interest in having IR lectures integrated into their curriculum, compared to 29.0% that reported having any prior IR training. 27.3% believed their knowledge in IR compared to other specialties was either "good" or "excellent", which improved to 43.3% (p<0.001). Identification that IR physicians consult patients directly, have outpatient clinics, have inpatient beds, and do rounds improved from 55.4% to 81.1% (p<0.001), 49.7% to 60.3% (p=0.066), 48.3% to 66.7% (p=0.001), and 52.0% to 66.2% (p=0.013), respectively., Conclusion: By introducing short lectures on IR-relevant topics, knowledge and perception of IR improved among Tanzanian medical students. Early education and exposure to IR should be prioritized to promote the continued growth of the specialty in this setting., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Background: The Woven EndoBridge (WEB) is a device used for intrasaccular flow diversion, designed for the elimination of wide-necked bifurcation aneurysms from the circulation. In this study, we aim to assess the safety and efficacy of the WEB and its uses in treating aneurysms of different morphologies and locations., Methods: In a retrospective analysis, we compiled a comprehensive dataset from patients treated with the WEB device across three major Australian neurovascular centers from May 2017 to September 2023. The case series encompassed a spectrum of aneurysm types, including wide-necked bifurcation, sidewall, and irregularly shaped aneurysms, as well as cases previously managed with alternative therapeutic strategies. This study additionally encompasses cases where aneurysms were managed using the WEB device in combination with supplementary endovascular devices., Results: The study included 169 aneurysms in 161 patients. The rate of satisfactory aneurysm occlusion was 85.6%, with 86.7% of patients maintaining good functional status at their most recent follow-up. The procedure exhibited a low mortality rate of 0.6% and a thromboembolic complication rate of 7.1% (n = 12/161). There were no instances of postoperative re-rupture and the procedure-related hemorrhage rate was low (1.2%, n = 2/169), aligning with the literature regarding the safety and efficacy of the WEB device., Conclusions: Our multicenter trial reinforces the WEB device's role as an effective and safe modality for intracranial aneurysm management, supporting its expanded application beyond wide-necked bifurcation aneurysms. Further prospective studies are required to delineate its evolving role fully., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to the vast majority of women living in SSA due to limited access to interventional radiology (IR) in the region. One of the few countries in SSA now offering UAE in a public hospital setting is Tanzania. This study aims to assess the safety and effectiveness of UAE in this new environment., Methods: From June 2019 to July 2022, a single-center, retrospective cohort study was conducted at Tanzania's first IR service on all patients who underwent UAE for the management of symptomatic fibroids or adenomyosis. Patients were selected for the procedure based on symptom severity, imaging findings, and medical management failure. Procedural technical success and adverse events were recorded for all UAEs. Self-reported symptom severity and volumetric response on imaging were compared between baseline and six-months post-procedure using paired sample t-tests., Results: During the study period, 92.1% (n = 35/38) of patients underwent UAE for the management of symptomatic fibroids and 7.9% (n = 3/38) for adenomyosis. All (n = 38/38) were considered technically successful and one minor adverse event occurred (2.7%). Self-reported symptom-severity scores at six-months post-procedure decreased in all categories: abnormal uterine bleeding from 8.8 to 3.1 (-5.7), pain from 6.7 to 3.2 (-3.5), and bulk symptoms from 2.8 to 1 (-1.8) (p < 0.01). 100% of patients reported satisfaction with outcomes. Among the nine patients with follow-up imaging, there was a mean volumetric decrease of 35.5% (p = 0.109)., Conclusions: UAE for fibroids and adenomyosis can be performed with high technical success and low complication rates in a low-resource setting like Tanzania, resulting in significant symptom relief for patients. Building capacity for UAE has major public health implications not only for fibroids and adenomyosis, but can help address the region's leading cause of maternal mortality, postpartum hemorrhage., (© 2023. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and Springer International Publishing AG.)

Prostate cancer (PCa) is the most common malignant tumor in males. The benefits in terms of overall reduction in specific mortality due to the widespread use of Prostate Specific Antigen (PSA) screening and the advancements in the curative treatments (radical prostatectomy or radiotherapy) appear to have reached a plateau. There remains, however, the questions of overdiagnosis and overtreatment of such patients. Currently, the main challenge in the treatment of patients with clinically organ-confined PCa is to offer an oncologically efficient treatment with as little morbidity as possible. Amongst the arising novel curative techniques for PCa, cryoablation (CA) is the most established one, which is also included in the NICE and AUA guidelines. CA is commonly performed under ultrasound guidance with the inherent limitations associated with this technique. The recent advancements in MRI have significantly improved the accuracy of detecting and characterizing a clinically significant PCa. This, alongside the development of wide bore interventional MR scanners, has opened the pathway for in bore PCa treatment. Under MRI guidance, PCa CA can be used either as a standard whole gland treatment or as a tumor targeted one. With MR-fluoroscopy, needle guidance capability, multiplanar and real-time visualization of the iceball, MRI eliminates the inherent limitations of ultrasound guidance and can potentially lead to a lower rate of local complications. The aim of this review article is to provide an overview about PCa CA with a more specific insight on MR guided PCa CA; the limitations, challenges and applications of this novel technique will be discussed., (© 2019 The Authors. Published by the British Institute of Radiology.)

Patients with cancer can present with bone metastases (BM), which are frequently complicated by different types of fractures necessitating prompt management to avoid serious impairment in terms of quality of life and survival.Percutaneous image-guided bone consolidation has rapidly emerged as an alternative to surgical fixation and is mainly reserved for patients who are deemed unfit for surgical management. Two percutaneous techniques, osteoplasty and osteosynthesis, are available and are selected based on the biomechanics of the target bones as well as the fracture types.The aim of this narrative review is to present the different types of BM-related fractures and the interventional strategies and techniques underpinning their minimally invasive percutaneous fixation.

The metastatic disease from thyroid cancer represents a complex clinical scenario, which mandates a case-based multi-disciplinary approach in tertiary referral centers. Direct localised treatments such as minimally invasive interventional radiology procedures can play a vital role in providing a timely palliative or curative treatment in accordance with the patients' clinical status. In this narrative review, we present the current status of interventional radiology treatments for the management of thyroid cancer distant metastases., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objective: To retrospectively assess the safety and oncological efficacy of percutaneous image-guided cryoablation (CA) of T1b (> 4 cm/< 7 cm) renal tumors., Materials and Methods: Institutional electronic records were retrospectively reviewed to identify the patients who had undergone percutaneous CA of T1b renal tumors between 2008 and 2016. CA was proposed by a multidisciplinary tumor board for cases with poor renal function or a single kidney; unsuitable for surgical resection; or genetic syndromes predisposing to multiple hereditary renal tumors. Patients' demographics, procedural and follow-up data were accurately collected and analyzed., Results: Twenty-seven consecutive patients (12 females, 15 males; mean age 72.3 ± 14.3 years) were included. Mean tumor diameter was 47.9 ± 6.3 mm. MRI guidance was used in 6/27 cases (22.2%) and CT guidance in the remaining 21/27 (77.8%) cases. Hydro- and/or carbo-dissections were necessary in 21/27 cases (77.8%). Complications graded ≥ II were reported in three (11.1%) patients. Technical success and technical efficacy were 100 and 87.5%, respectively. Local tumor control (LTC) evaluated at imaging follow-up ≥ 6 months was 82.6, 72.3 and 60.3% at 12-, 24- and 36-month follow-up, respectively. One patient passed away 3 months after CA due to the metastatic evolution of the primary kidney cancer., Conclusion: Percutaneous CA of T1b renal tumors is safe and satisfactory rates of LTC are expected at the early follow-ups. Further studies are needed to confirm the long-term efficacy of this procedure.

Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.

In the last decade, the spectrum of interventional magnetic resonance imaging (MRI)-guided procedures, including percutaneous ablation, has substantially grown, and among the available MRI-compatible ablative techniques, cryoablation is progressively gaining a predominant position.The aim of the present narrative review is to discuss the technical requirements necessary to perform a percutaneous MRI-guided cryoablation in a closed-bore machine; to highlight the relative advantages and drawbacks; and to briefly summarize the results available in the literature.

Aim: To present a new blunt-tip coaxial needle (SoftGuard) applied to access "hard-to-reach" targets undergoing percutaneous image-guided biopsy or drainage., Materials and Methods: All consecutive patients presenting between August and December 2016 with "hard-to-reach" (<10 mm from a critical nearby structure such as vessels, nerves, bowel or adjacent parenchymal organs) solid lesions requiring biopsy (group A) or abscesses requiring drainage for sepsis (group B) were prospectively included. The individual features of each patient and lesion as well as technical and clinical data were collected and analysed., Results: Twenty-six patients (18 males, 8 females, mean age 59.81 ± 17.53 years) were enrolled in group A and nine (6 males, 3 females, mean age 58.33 ± 13.8 years) in group B. Technical success was achieved in 92.3% of cases from group A and 100% of cases from group B. Five (19.2%) minor complications were noted in group A (four small self-limiting pneumothoraces and one small self-limiting peri-pancreatic haematoma). There were no complications in group B. Histological results in group A accounted for 95% sensitivity, 100% specificity and 95.2% diagnostic accuracy. In group B, mean post-operative C-reactive protein was 41 ± 48.3 mg/L in comparison with 155 ± 117.5 mg/L at baseline (P = 0.004)., Conclusions: The SoftGuard blunt-tip needle is a safe and effective tool when applied as a coaxial working cannula for percutaneous biopsy or drainage of "hard-to-reach" targets.

We report the case of a 74-year-old male with an incidental finding of a pseudoaneurysm at the base of his neck arising from the left subclavian artery. Initial treatment with ultrasound-guided thrombin injection was unfortunately unsuccessful with early recanalization. An Amplatzer Vascular Plug 4 device was introduced into the neck of the pseudoaneurysm endovascularly with successful thrombosis and occlusion of the pseudoaneurysm., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This study aims to discuss MRI-guided cryoablation (CA) of in-transit (IT) metastases from melanoma and to retrospectively present our preliminary experience in such a specific field. Three female patients (mean age 55.6 years; range 39-64) were included, and eight IT metastases (mean size 12.4 ± 6.5 mm, range: 5-25) were treated in three different sessions. Technical success was 100%; and mean procedural time 129.3 ± 103 min. (range 42-243). Primary local tumour control was 100% at 1-, 6- and 12-month follow-up; and 87.5% at 18-month follow-up. Two complications were recorded (one minor and one major). MRI-guided CA is a novel therapy, which may be included in the armamentarium of local therapies of IT metastases.

Introduction: Open inguinal Hernia repair is one of the most commonly performed operative procedure. Despite this, hernia repair can cause considerable morbidity and rarely mortality. Some of these complications such as chronic pain and testicular complications can be easily disregarded, thereby leading to medico-legal claims being made. As a result, the quality of consent process is crucial in increasing patient satisfaction after inguinal hernia repair. This is a prospective study exploring patient's recall of the consenting practice after elective open inguinal hernia repairs at our institute., Methods: Patients who had an elective, Lichtenstein inguinal hernia repair between January to October 2009 were identified. Patients were contacted by telephone after 3 days and a questionnaire was completed., Results: There were 86 patients included in our study. The male:female ratio was 70:16 whilst the average age was 63.2+/-19.2 years. 42 patients stated pain relief as the main indication for having the operation whilst 30 patients feared incarceration or strangulation as the main indication. Infection was the complication recalled most by patients in our study (31 patients), followed by bleeding (30 patients). Only 2 patients were aware of developing potential chronic pain and 10 patients realised the potential for testicular problems. 57 patients were aware of having a mesh inside their groin. There were 61 patients who were aware of laparoscopic approach as an alternative to open inguinal hernia repair., Conclusions: Recall of consent is very poor. As a result, repeating the information stated and providing additional resource may reinforce the consent process., (Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Primitive neuroectodermal tumour (PNET) is a rare tumour mainly found in children under ten years old. It may be broadly categorised into those occurring from the central or peripheral nervous system of which the majority arise centrally. We report a 61 year-old lady who had previous lobular breast cancer presenting with a rapidly expanding lesion in her anterior right upper abdominal wall. Clinically it appeared to be benign, however, histopathology of the excised lesion revealed a localised PNET. This case is an unusual case of a PNET in an adult that is peripheral in nature arising from subcutaneous tissue in the abdominal wall.

This report presents a case illustrating the complications of Kasabach-Merritt syndrome in a 22-year-old man. The patient presented with acute abdominal pain and profound anaemia; a CT scan revealed intraperitoneal bleeding from spontaneous splenic rupture. The patient underwent initial emergency laparotomy and splenectomy, with a subsequent further laparotomy to control haemorrhage. Blood products requirements were extensive: 28 units red blood cells, 14 units fresh frozen plasma, 10 units platelets, 10 units cryoprecipitate and 2× Novo VII. He was then transferred to a nearby tertiary care unit for further management to control his coagulaopathy and he made a full recovery after 4 weeks.