Warren Clements

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Verified

Warren verified their affiliation via an institutional email.

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• MBBS, MHA, BBiomedScHons, FRANZCR, EBIR-ES, FCIRSE, AFCHSM
• Interventional Radiologist at Alfred Hospital

Importance The successful implementation of artificial intelligence (AI) in health care depends on its acceptance by key stakeholders, particularly patients, who are the primary beneficiaries of AI-driven outcomes. Objectives To survey hospital patients to investigate their trust, concerns, and preferences toward the use of AI in health care and d...

Background Embolization is a vital endovascular procedure that can be used to quickly achieve hemostasis in patients experiencing uncontrolled bleeding. This study was conducted to describe real-world outcomes following embolization with a pre-cut absorbable gelatin sponge to control bleeding. Methods This prospective study was conducted across fi...

Objectives To identify the rate of clinically significant post-embolisation syndrome (csPES) in our cohort of patients after uterine artery embolisation for symptomatic fibroids, and to identify risk factors associated with the development of csPES. Methods Retrospective case-control study. All patients that underwent uterine artery embolisation f...

The rapid adoption of artificial intelligence (AI) raises challenges related to ethics, safety, equity, and governance that require robust regulatory frameworks. In most jurisdictions, AI-driven medical devices are already covered by existing medical device frameworks, although new AI-specific legislation may be required to address the challenges p...

Given the rapidly expanding capabilities of generative AI models for radiology, there is a need for robust metrics that can accurately measure the quality of AI-generated radiology reports across diverse hospitals. We develop ReXamine-Global, a LLM-powered, multi-site framework that tests metrics across different writing styles and patient populati...

This presentation discusses the challenges of implementing Clinical Decision Support (CDS) systems for radiology referrals in a hospital setting. It emphasizes the importance of active change management strategies, including ongoing education, stakeholder engagement, and feedback loops, to ensure the CDS system effectively reduces unnecessary imagi...

Inferior vena cava (IVC) filter is vital to prevent pulmonary embolisms (PE) in patients unable to have anticoagulant therapy. However, injury distribution patterns amongst patients and those most likely to benefit from prophylactic IVC filter placement have not been well defined. Our aim is to determine the rates of PE post prophylactic IVC filter...

Inferior vena cava (IVC) filters are vital to prevent pulmonary embolisms (PE) in patients unable to have anticoagulant therapy. However, prolonged filter dwell times include risks of caval perforation, IVC occlusion, filter migration and fracture, and thus should be removed when no longer indicated. This project aims to determine the impact of a d...

Background The successful integration of artificial intelligence (AI) in healthcare depends on the global perspectives of all stakeholders. This study aims to answer the research question: What are the attitudes of medical, dental, and veterinary students towards AI in education and practice, and what are the regional differences in these perceptio...

Introduction It is estimated that 8% of hospitalised patients require treatment from Interventional Radiology (IR). However, little is known about the potential impact of IR on regional and remote Australians, including Indigenous patients. This study aimed to assess treatments performed by IRs on regional/remote patients to predict future IR workf...

Bladder inflation may be a temporizing measure to tamponade pelvic bleeding in select trauma cases to bridge the patient to definitive interventions. Ultrasonographic confirmation of an intact bladder with an adjacent pelvic haematoma in a shocked adult with pelvic fracture is used for subject selection. An illustrative example of physiologic and i...

Given the rapidly expanding capabilities of generative AI models for radiology, there is a need for robust metrics that can accurately measure the quality of AI-generated radiology reports across diverse hospitals. We develop ReXamine-Global, a LLM-powered, multi-site framework that tests metrics across different writing styles and patient populati...

Introduction Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related mortality and transarterial chemoembolisation (TACE) is an established technique to treat patients with intermediate‐stage HCC. The aim of this study was to generate accurate costing data on cTACE and DEB‐TACE in an Australian setting and assess whether one of the proc...

Introduction Varicocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed t...

Objectives A 2021 safety alert restricted endovascular gelfoam use in Australia and resulted in an embargo on gelfoam sales to IR departments. This study aimed to show that gelfoam is safe in a population of trauma patients with pelvic injury, and discuss the basis of the recent controversies. Methods Retrospective cohort study between 1 January 2...

Introduction Trauma to the pelvic ring and associated haemorrhage represent a management challenge for the multidisciplinary trauma team. In up to 10% of patients, bleeding can be the result of an arterial injury and mortality is reported as high as 89% in this cohort. We aimed to assess the mortality rate after pelvic trauma embolisation and wheth...

Background Splenic artery embolisation (SAE) has become a vital strategy in the modern landscape of multidisciplinary trauma care, improving splenic salvage rates in patients with high-grade injury. However, due to a lack of prospective data there remains contention amongst stakeholders as to whether SAE should be performed at the time of presentat...

Artificial intelligence is a rapidly evolving area of technology whose integration into healthcare delivery infrastructure is predicted to have profound implications for medicine delivery in the 21st century. Artificial intelligence as it relates to healthcare is a term used to cover a wide scope of computer‐based algorithms whose application varie...

Background Splenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low‐grade injuries or with splenectomy for high‐grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes...

Venous thromboembolism (VTE) remains a significant cause of morbidity in the trauma patient, and early placement of an inferior vena cava (IVC) filter is considered to mitigate the risk of fatal VTE amongst this patient cohort. To avoid complications of in-situ filters, removal is indicated when the filter is no longer needed. The objective of this...

As modern Interventional Radiology (IR) evolves, and expands in scope and complexity, it will push the boundaries of existing literature. However, with all intervention comes risk and it is the shared judgement of the risk–benefit analysis which underpins the ethical and legal principles of care in IR. Complications in medicine are common, said to...

Introduction: Undifferentiated abdominal pain in the emergency setting is frequently investigated with an intravenous contrast enhanced CT as a first line diagnostic test. However, global contrast shortages restricted the use of contrast for a period in 2022, altering standard practice with many scans performed without intravenous contrast. Whilst...

Objective: Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries. Methods: A retrospective review was conducted of patients with bl...

Introduction: Clinical radiology is a popular career. However, academic radiology in Australia and New Zealand (ANZ) has not traditionally been a strength of the specialty which has a focus on clinical medicine and has been influenced by corporatisation of the specialty. The aim of this study was to review the source(s) of radiologist-led research...

von Hippel-Lindau disease is an inherited autosomal dominant multisystem cancer syndrome. Multiple malignancies including renal cell carcinoma (RCC) occur in approximately 40%. A 69-year-old female presented with recurrent RCC in a solitary kidney, after previous partial nephrectomy and ablation. The 19-mm lesion was anterior and adherent to the de...

Purpose Uterine artery embolization (UAE) evidence is increasing in the setting of adenomyosis, which shares pathological similarities to endometriosis. Endometriosis is characterized by the presence of endometrium-like tissue outside of the uterus, and the retrograde menstruation hypothesis may account for disease development. In women where ferti...

Background Mechanism of injury (MOI) plays a significant role in a decision to perform whole-body computed tomography (CT) imaging for trauma patients. Various mechanisms have unique patterns of injury and therefore form an important variable in decision making. Methods Retrospective cohort study including all patients >18 years old who received a...

Background and aims: Recent guidelines recognize the limitations of standard coagulation tests in predicting bleeding and guiding pre-procedural blood component prophylaxis in cirrhosis. It is unclear whether these recommendations are reflected in clinical practice. We performed a nationwide survey to investigate pre-procedural transfusion practic...

Patients with venous anomalies are at increased risk of developing venous thromboembolism (VTE) and subsequent complications, but they are often under-recognised. While unprovoked VTE may trigger testing for inherited thrombophilias and malignancy screening, anatomic variants are considered less often. Venous anomalies increase the risk due to veno...

Objectives: Atraumatic needles are known to reduce complication rates of blind lumbar punctures (LP), however, their use in fluoroscopically guided LP is less studied. This study assessed the comparative difficulty of performing fluoroscopic lumbar puncture with atraumatic needles. Methods: Single-centre retrospective case-control study comparin...

Purpose To assess the efficacy of conservative management and embolisation in patients with spontaneous retroperitoneal haemorrhage. Methods Single-centre retrospective case–control study of patients with spontaneous retroperitoneal haemorrhage treated conservatively or with embolisation. Patients aged ≥ 18 years were identified from CT imaging re...

Aim: To clarify manufacturer's instructions for inferior vena cava (IVC) filter use and implications for practice. Materials and methods: Three vendors of IVC filters were contacted for clarification, with all stating that caval diameter limits are to be true maximum and true minimum cross-sectional diameters. To determine the implications of th...

Background The placement of retrievable inferior vena cava (IVC) filters occurs commonly, but retrieval rates remain low. Consequently, there is an unmet clinical need to ensure appropriate follow-up and retrieval of these devices. Objectives To determine the association between an IVC filter surveillance team with filter retrievals or a documente...

Background Existing literature from around the world has shown that teaching of Interventional Radiology (IR) to medical students remains suboptimal. Despite calls for improvement at a “grass-roots” level, most IRs find that junior doctors have limited or no knowledge of IR, and thus reduced awareness of potential IR treatments for their patients o...

Splenic injury is a rare complication of colonoscopy, estimated to occur in 0.020 to 0.034% of procedures, with a 30-day mortality of 3.6% (1-3). Of the three major severe adverse events during colonoscopy (perforation, bleeding, and splenic injury), splenic injury has the highest mortality but is rarest (1). The spleen is attached to the colonic s...

Objective: Haemorrhagic shock is a life-threatening complication of trauma, but remains a preventable cause of death. Early recognition of retroperitoneal haemorrhage (RPH) is crucial in preventing deleterious outcomes including mortality. Injury to the 9-11th intercostal arteries (i.e. arteries of the lower thoracic region) are complicit in RPH....

Purpose : Haemorrhagic shock remains a leading preventable cause of death amongst trauma patients. Failure to identify retroperitoneal haemorrhage (RPH) can lead to irreversible haemorrhagic shock. The arteries of the middle retroperitoneal region (i.e., the 1st to 4th lumbar arteries) are complicit in haemorrhage into the retroperitoneal space. Ho...

Introduction: Morel-Lavallée lesions (MLL), also referred to as closed degloving injuries, result from traumatic shearing forces with separation of the subcutaneous fat from the underlying fascia. The aim of this study was to determine the incidence and treatment of MLLs at a level 1 trauma centre. Methods: Single-centre retrospective cross-sect...

Author biographies: A/Prof Eric Hau is a clinician-scientist with interest in lung and CNS tumours. His clinical and laboratory research focuses on understanding the mechanisms of radiation resistance and investigating drugs which may be utilised for radiation sensitisation to improve outcomes for patients. Associate Professor Warren Clements is a...

Background : Inferior vena cava (IVC) filters play a role in preventing venous thromboembolism after major trauma where deep venous thrombosis (DVT) risk is up to 80%. It has been suggested that IVC filters are thrombogenic and many patients are therefore placed on therapeutic anticoagulation during IVC filter dwell citing concern of in situ IVC th...

Uterine artery embolisation (UAE) is a safe and effective procedure for symptomatic uterine fibroids with an estimated rate of post-operative intra-uterine infection of 0.9–2.5%. While rates of infection have remained low over the past two decades, there is variation in infection prevention practices. Intra-uterine infection after UAE may occur via...

Splenic artery embolization (SAE) plays a critical role in the treatment of high-grade splenic injury not requiring emergent laparotomy. SAE preserves splenic tissue, and growing evidence demonstrates preserved short-term splenic immune function after SAE. However, long-term function is less studied. Patients who underwent SAE for blunt abdominal t...

Objective: Radiology has been at the forefront of medical technology including the use of artificial intelligence (AI) and machine learning. However, there remains scant literature on the perspective of patients regarding clinical use of this technology. This study aimed to assess the opinion of radiology patients on the potential involvement of AI...

Introduction: Acute gastrointestinal bleeding (GIB) is associated with morbidity and mortality. There can be a low threshold for practitioners to assess for active GIB and computed tomography angiography (CTA) examinations are performed frequently, even for stable patients and those who are therapeutically anticoagulated. We aimed to assess the pr...

Objectives Trauma chest radiographs may contain subtle and time-critical pathology. Artificial intelligence (AI) may aid in accurate reporting, timely identification and worklist prioritisation. However, few AI programs have been externally validated. This study aimed to evaluate the performance of a commercially available deep convolutional neural...

Introduction: There are few female Interventional Radiologists worldwide and this is a significant issue for many countries. There is little known about the current status and attitudes to women in Interventional Radiology in Australia and New Zealand. The purpose of this study was to explore the gender balance, workforce challenges and perception...

Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide and its incidence is increasing in Australia. Transarterial therapy, predominantly transarterial chemoembolization (TACE) but increasingly transarterial radioembolization (TARE), plays an important role in patients with intermediate‐stage disease and preserved liver function....

Introduction: Incorporating artificial intelligence (AI) in diagnostic medical imaging reports has the potential to improve efficiency. Although perception of radiologists, radiographers, medical students and patients on AI use in image reporting has been explored, there is limited literature on non-radiologist clinicians' opinion on this topic....

Introduction In many patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH), bronchial artery hypertrophy is observed. Patients with bronchial dilatation have been shown to be at increased risk of hemoptysis introducing the risk of airway obstruction. In this study from an academic tertiary referral center, we aimed to assess the incid...

PurposeErectile Dysfunction (ED) is defined as the inability to obtain or maintain an erection firm enough for satisfactory sexual performance and affects the quality of life of over 50% of men aged over 40 years. Venogenic ED is elucidated as a cause in a subgroup of patients. The study aims to investigate the clinical success, technical success,...

Introduction: Cerebral venous sinus thrombosis (CVST) is rare; however, it has been observed in patients with vaccine-induced immune thrombotic thrombocytopaenia syndrome (VITT) following the use of adenovirus vector vaccines against COVID-19. Adverse vaccine effects have been heavily addressed in mainstream media, likely contributing to vaccinati...

The spleen is the most commonly injured solid organ following blunt abdominal trauma. Over recent decades, splenic artery embolisation (SAE) has become the mainstay treatment for haemodynamically stable patients with high-grade blunt splenic trauma, with splenectomy the mainstay of treatment for unstable patients. Splenic function is complex but th...

Introduction Pseudoaneurysms are uncommon but potentially life-threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound-guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on ma...

Objectives This study aimed to assess what diameter constitutes clinically-significant left common iliac vein (LCIV) compression in patients with May-Thurner syndrome (MTS). Materials and Methods Nineteen patients with MTS were over a 10-year period. Minimum LCIV diameter was compared to 100 asymptomatic controls and 27 age- and gender-matched con...

Introduction Peripherally inserted central catheters (PICCs) offer a convenient long-term intravenous access option. Different methods exist for insertion including the use of continuous fluoroscopy for guidance, or bedside insertion techniques. The blind pushing technique is a bedside approach which involves advancing a PICC through the access she...

Introduction: Cataract formation is a tissue reaction effected by radiation exposure. The purpose of this study was to evaluate the occupational exposure to the lens of the eye of interventional radiologists (IR's) and interventional radiology staff, with and without lead glasses. Methods: Ethical approval was provided by the hospital research a...

Background This study aimed to risk-stratify chest pain as a presenting symptom in patients with a diagnosis of pulmonary thromboembolism (PE) to assess for any association. In addition, this study aimed to assess traditionally acknowledged PE risk factors in an Australian population. Methods This was a retrospective single-centre cohort study ass...

Introduction To compare the outcomes of proximal (pSAE) versus distal (dSAE) splenic artery embolisation for management of focal distal arterial splenic injuries secondary to blunt splenic trauma. Method Ethical approval was granted by the hospital research and ethics committee, Project 389/19. All patients who underwent splenic artery embolisatio...

Paradoxical cerebral embolism, although rare, can be secondary to acquired causes such as superior vena cava (SVC) occlusion and development of a mediastinal right-to-left shunt. Such shunts allow undisturbed passage of thromboemboli to bypass the pulmonary circulation and enter the systemic circulation. This report presents a case of paradoxical c...

This case highlights a hybrid treatment model used successfully in a patient with complicated recurrent renal cell carcinoma (RCC), following partial nephrectomy, in the context of a single kidney. Scar tissue from previous surgery tethered the ureter to the margin of the lesion and combined with obesity, rendered simple percutaneous intervention c...

There is limited evidence concerning venous thromboembolism (VTE) prophylaxis in the setting of blunt traumatic visceral injury. 181 patients underwent splenic artery embolization (SAE) and began chemical VTE prophylaxis at a median time of 59.5 hours (IQR 46). 6 patients required splenectomy for re-bleed. 51 patients underwent SAE but did not rece...

Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way th...

Patients treated with splenic artery embolization (SAE) >48 hours after a blunt injury for a delayed splenic rupture (DSR) were assessed for the need for a subsequent splenectomy. Thirty-four patients underwent SAE for DSR over 10 years at our level 1 trauma center, performed at a median of 4.5 days after the injury (interquartile range = 5.5), and...

Introduction : CT angiography (CTA) is efficient and accurate in detecting lower limb vascular injury in the setting of trauma (1-6). Less clear is the in-practice correlation between appropriate indications for these examinations and subsequent clinical impacts. Materials and Methods : All CT leg angiography acquired from January 2016 through Apr...

Background Bile leak following blunt liver trauma is uncommon. Management is difficult due to complex vasculo‐biliary and liver parenchymal injury and lack of consensus on optimal care compared with bile leak following elective hepatectomy especially in regards to endoscopic retrograde pancreaticocholangiography (ERCP) timing and patient selection....

Background As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma cente...

Background Many incidental liver lesions are benign and require no additional workup. Investigation of such lesions can have a negative impact of both the patient and health care system. However, the impact of how radiologists report these incidental lesions is not clear. We aimed to investigate how reporting of incidental liver lesions on trauma...