Lindsay S. Machan’s research while affiliated with University of British Columbia and other places

LEARNING OBJECTIVES 1) Obtain hands-on experience with fallopian tube catheterization using uterine models and commercially available catheters and guidewires. 2) Review the evolution of interventions in the fallopian tubes. 3) Learn safe techniques for fallopian tube recanalization for promoting fertility, and fallopian tube occlusion for preventing pregnancy. 4) Discuss the outcomes regarding pregnancy rate and complications. 5) Appreciate ways to improve referrals from the fertility specialists and expand your practice. ABSTRACT Fallopian tube catheterization using fluoroscopic guidance is a relatively easy, inexpensive technique within the capabilities of residency trained radiologists. Fallopian tube cathterization can be used to dislodge debris from the tube in women with infertility,or to place FDA-approved tubal occlusion devices in women who do not desire fertility. The fallopian tube is the 1 mm gateway between the egg and the sperm. Noninvasive access to this structure for promoting, and preventing, pregnancy has been sought for over 160 years. This hands-on course allows participants use commercially available catheters and devices in plastic models for fallopian tube catheterization, and to speak directly to world experts about this exciting procedure. ACTIVE HANDOUT http://media.rsna.org/media/abstract/2013/3990740/TESTSIR.pdf

LEARNING OBJECTIVES 1) Understand the technique of fallopian tube catheterization and its applications in unblocking and blocking the tubes. 2) Appreciate the role of fallopian tube catheterization in the complex evaluation and treatment of the infertile couple. 3) Review the technique and the results of uterine artery embolizaiton for the treatment of uterine fibroids. 4) Discuss where uterine artery embolization fits in the management of symptomatic women with uterine fibroids. 5) Recognize the symptoms of pelvic congestion syndrome, and its non-invasive work-up. 6) Review the percutaneous techniques for treating pelvic congestion syndrome.

LEARNING OBJECTIVES 1) Describe the diagnostic work-up and medical treatment of peripheral arterial disease (PAD). 2) Understand the current status and likely outcomes traditional treatements for PAD including angioplasty, stents, and bypass surgery. 3) Explore the potential role of newer endovascular modatlities being used in the treatment of PAD including drug-coated stents, stent-grafts, cryoplasty, atherectomy, and laser recanalization.

LEARNING OBJECTIVES 1) Obtain hands on experience with fallopian tube catheterization using uterine models and commercially available catheters and guidewires. 2) Receive insight from eight global experts on adapting fallopian tube catheterization to your radiology practice. 3) Review the evolution of interventions in the fallopian tubes. 4) Learn safe techniques for fallopian tube recanalization. 5) Discuss the outcomes regarding pregnancy rate and complications. 6) Discuss ways to improve referrals from the fertility specialists and expand your practice. ABSTRACT The delicate fallopian tube is the anatomic pathway to human reproduction. Simple, inexpensive radiology tools allow us access to the tube for promoting, and preventing pregnancy. For treatment of proximal tubal occlusion, results from centers worldwide have shown that catheter recanalization is possible in about 90% of patients using angiographic techniques learned in most radiology residencies. The pregnancy rate following fallopian tube recanalization can be as high as 60% when the unblocked tubes are found to be otherwise normal and there is no history to suggest tubal disease. In a population where the cause of infertility is less well-defined, tubal catheterization helps us image tubal abnormalities and may also help the woman conceive. The American Society for Reproductive Medicine has recommended that patients in whom the HSG demonstrates proximal tubal occlusion undergo fallopian tube catheterization with selective salpingography prior to more invasive and costly infertility treatments. For prevention of unwanted pregnancy, numerous materials and devices have been tested for blocking the tubes. The ESSURE coil was FDA approved in 2002 for tubal sterilization by hysteroscopic placement. In some locales, radiologists are being asked to assist with this procedure or to place the coils fluoroscopically through fallopian tube catheterization.

LEARNING OBJECTIVES 1) Review the evolution of interventions in the fallopian tubes. 2) Learn safe techniques for fallopian tube recanalization. 3) Discuss the outcomes regarding pregnancy rate and complications. 4) Learn ways to improve referrals from the fertility specialists and expand your practice. ABSTRACT The first hysterosalpingogram (HSG) was peformed just a few years after Roentgen discovered the X-ray. HSG remains a "gold standard" in treatment planning for many of the 6.5 million infertile couples in the United States alone. The application of angiographic techniques in the late 1980's has revolutionized the diagnosis and treatment of proximal tubal obstruction. Results from centers worldwide have shown that nonsurgical recanalization of proximally occluded tubes is possible in about 90% of patients using commonly-used catheter techniques. The pregnancy rate following fallopian tube recanalization can be as high as 58%, when the unblocked tubes are found to be otherwise normal and there is no history to suggest tubal disease. In a population where the cause of infertility is less well-defined and where additional tubal disease may be present, the rate of conception drops below 30%, with an ectopic pregnancy rate that is comparable to the general population, which still compares favorably with in vitro fertilization results. It is estimated that there are nearly 300,000 women in the U.S who have infertility due to tubal disease that is amenable to catheter-directed therapy. The American Society for Reproductive Medicine has recommended that patients whose HSG demonstrates proximal tubal occlusion undergo selective salpingography prior to more invasive and costly infertility treatment.

LEARNING OBJECTIVES 1) Understand the technique of fallopian tube catheterization and its applications in unblocking and blocking the tubes. 2) Appreciate the role of fallopian tube catheterization in the complex evaluation and treatment of the infertile couple. 3) Understand the role of embolization for the treatment of uterine fibroids. 4) Understand the results of embolization for the treatment of uterine fibroids. 5) Recognize the symptoms of pelvic congestion syndrome, and the non-invasive work-up of pelvic congestion syndrome. 6) Understand the techniques of percutaneous therapy for pelvic congestion syndrome. ABSTRACT Fallopian tube catheterization is an interventional outgrowth of hysterosalpingography, used for 18 years to treat proximal tubal occlusion, and recommended by the American Society for Reproductive Medicine. Coils for occluding the tubes have been FDA approved since 2003 and are being placed hysteroscopically by gynecologists; radiologists have been asked to place them fluoroscopically via fallopian tube catheterization. Uterine artery embolization has become a well accepted method of treating uterine fibroids. Continuing research has provided information on the longer term results of embolization, information on recurrence rates, and information on appropriate selection of patients, and embolic material. Information on comparison between embolization of fibroids and other therapies is also becoming better understood. Pelvic congestion syndrome tends to be poorly understood and under diagnosed as a cause for chronic pelvic pain. Diagnosis can be performed using non-invasive techniques. Therapy can be performed with percutaneous techniques.

The purpose of our study was to evaluate whether pelvic MRI provides additional clinically relevant information after sonography in the preprocedure evaluation of uterine artery embolization of fibroids. Forty-nine women who presented for consultation for uterine artery embolization were retrospectively reviewed. The MRI and sonography scans were independently evaluated and compared for uterine size, fibroid size and location (categorized as paraendometrial, intramural, subserosal, or pedunculated) of the four largest fibroids in each patient, and the total number of fibroids present. One hundred twenty-two fibroids were measured. The uterine volume was significantly smaller as measured on MRI compared with sonography (p = 0.01). We found good MRI and sonography correlation of the volume of the single largest fibroid in each patient (R = 0.87) but poor correlation of fibroid location (R = 0.17). MRI detected 31 paraendometrial fibroids and three pedunculated fibroids that were thought to be intramural fibroids on sonography. Five fibroids thought to be paraendometrial on sonography were confirmed to be subserosal or intramural on MRI. Discrepancy in the total number of fibroids was noted, with additional fibroids found on MRI in 31 of 49 patients and erroneously suspected on sonography in five of 49 patients. Pelvic MRI affected management in 11 of 49 patients, leading to cancellation of uterine artery embolization in four patients. In another seven patients who were originally thought to be poor candidates on the basis of sonographic findings, uterine artery embolization was performed. MRI did not alter the management plan in 38 patients. MRI provided considerable additional information compared with sonography and affected clinical decision making in a substantial number of patients. MRI should be considered in all patients being evaluated for uterine artery embolization.

LEARNING OBJECTIVES (1) Review the evolution of interventions in the fallopian tubes. (2) Learn safe techniques for fallopian tube recanalization. (3) Discuss the outcomes regarding pragnancy rate and complications. (4) Learn ways to improve referrals from the fertility specialists and expand your practice. ABSTRACT The first hysterosalpingogram (HSG) was peformed just a few years after Roentgen discovered the X-ray. HSG remains a "gold standard" in treatment planning for many of the 6.5 million infertile couples in the United States alone. The application of angiographic techniques in the late 1980's has revolutionized the diagnosis and treatment of proximal tubal obstruction. Results from centers worldwide have shown that nonsurgical recanalization of proximally occluded tubes is possible in about 90% of patients using commonly-used catheter techniques. The pregnancy rate following fallopian tube recanalization can be as high as 58%, when the unblocked tubes are found to be otherwise normal and there is no history to suggest tubal disease. In a population where the cause of infertility is less well-defined and where additional tubal disease may be present, the rate of conception drops below 30%, with an ectopic pregnancy rate that is comparable to the general population, which still compares favorably with in vitro fertilization results. It is estimated that there are nearly 300,000 women in the U.S who have infertility due to tubal disease that is amenable to catheter-directed therapy. The American Society for Reproductive Medicine has recommended that patients whose HSG demonstrates proximal tubal occlusion undergo selective salpingography prior to more invasive and costly infertility treatment.

LEARNING OBJECTIVES (1) Understand the technique of fallopian tube catheterization and its applications in unblocking and blocking the tubes. (2) Appreciate the role of fallopian tube catheterization in the complex evaluation and treatment of the infertile couple. (3) Understand the role of embolization for the treatment of uterine fibroids. (4) Understand the results of embolization for the treatment of uterine fibroids. (5) Recognize the symptoms of pelvic congestion syndrome, and the non-invasive work-up of pelvic congestion syndrome. (6) Understand the techniques of percutaneous therapy for pelvic congestion syndrome. ABSTRACT Fallopian tube catheterization is an interventional outgrowth of hysterosalpingography, used for 18 years to treat proximal tubal occlusion, and recommended by the American Society for Reproductive Medicine. Coils for occluding the tubes have been FDA approved since 2003 and are being placed hysteroscopically by gynecologists; radiologists have been asked to place them fluoroscopically via fallopian tube catheterization. Uterine artery embolization has become a well accepted method of treating uterine fibroids. Continuing research has provided information on the longer term results of embolization, information on recurrence rates, and information on appropriate selection of patients, and embolic material. Information on comparison between embolization of fibroids and other therapies is also becoming better understood. Pelvic congestion syndrome tends to be poorly understood and under diagnosed as a cause for chronic pelvic pain. Diagnosis can be performed using non-invasive techniques. Therapy can be performed with percutaneous techniques.

LEARNING OBJECTIVES (1) Review the state of the art in tubal diagnosis. (2) Learn how to work with the fertility specialists. (3) Practice the technique of fallopian tube catheterization. DISCLOSURE A.S.T.: has a royalty agreement with Cook, Inc