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Interventional Radiology - Science topic

Those involved in Research regarding interventional Radiology.
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I have to summarize model of care for staffing of diagnostic imaging that includes the following modalities: Xray, CT, MRI, interventional radiology, nuclear medicine.
Looking at number of staff required on a shift based on number of inpatients and outpatients
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I have been asked this question at my work quite frequently. I think the general agreement is that it is difficult to overgeneralise - cannot use the answer from one hospital/facility/practice to another. Some places have a very specific type of population/patient and it can be much more tedious than another that reports a lot of "normal" studies - which would be much easier/faster.
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I want to know , i search interventional radiology for unresectable colorectal cancer, but i don't get the answers, i get about colorectal liver metastasis treatment with interventional radiology. I ask can resectable or unresectable colorectal cancer treat with interventional treatment like embolisation or such as?
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Thank you for your answer Mr @Ishan Kumar, @Yan-Lin li,@Aron Michael Devane
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Would like to ask of any experience or evidence of anyone in Nuclear medicine or Interventional radiology regarding MAA lung shunting pre therapy for a case of SIRT therapy of Hepatocellular carcinoma?
1. If there is evidence of portal vein thrombosis, how accurate are the findings of MAA lung shunting percentage?
2. If there is no uptake on the MAA, at the site of liver lesions seen on CT, is there any value to do a FDG PET CT for this case, even though its a Hepatocellular carcinoma? Given that HCC has low FDG avidity unless it is an aggressive tumour?
Please share your experience. Thank you in advanced!
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The degree of the portal vein thrombosis is important since in cases with severe abnormality you cannot perform SIRT.
As you have mentioned, FDG is not a valuable tool for evaluation of most of HCC cases. FCH PET/CT would be a good choice where it is available.
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Interventional Radiologist or Radiologist with a inclinations towards intervention is a very handy resource especially at peripheral or community level health care centres and help the patient and clinicians in a variety of situations provided the radiologist is aware of 'what he can offer in a given situation'. The problem may be inserting a central line, local injections into joints to treat a painful condition or a nerve block or simple FNAC or aspiration.
Exposing the residents to such procedures, rather, exposing them to think out of the box in such situations and help them to develop an attitude in intervention ingrained is surely going to help patients at large.
What according to you can be done and how this can be achieved. Please share your views.
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I think exposure to IR should right from the medical student level. If we want to increase the outreach of IR its important that DR residents who take PG in radiology are actually interested in pursuing an IR fellowship in the future. Here is an article I wrote in CVIR for increasing medical student exposure to IR:
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We have many techniques for revascularization [angiplasties, new stents, vascular bypass], yet we are not doing early screening in patients with multiple vascular risk factors.
Should we be more active in our early screening of the carotid and cerebral vessel circulations?
Are we missing the boat?
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We have new innovative patented moleculs who are able to treat Demencia vascular .
Look inside if its possible to participe ( preclinical and clinical developpement needed to dispose of new drug for neurodegenerescences )
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Currently I am employed in a hospital based patient care center that supports several hospital areas including: Interventional Radiology, surgery, Infusion therapy, Endoscopy and Procedural Sedation. Cardioversion and the post care of the of the patient has been added. Although not a telemetry unit the phase 2 nurses were given an EKG class and ACLS class. The patients currently seen in the phase 2 area include: Surgical outpatient, Monitored Anesthesia Care (MAC) anesthesia patients (inhouse and outpatient), interventional radiology patients (including angiograms, AV fistuala declot, organ biopsy etc), post endoscopy patients, Blood transfusion, IV infusion, bone marrow transfusion, and apheresis. I am attempting to clarify if there has been any studies to determine limits in nursing knowledge to diluted to maintain proficient and safe care.
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Hi Ruth Novack
There is one PhD dissertation, I hope it will be relevant to your research.
The reference is down below.
Best regards
Richardson S. Transition to the Professional Role for Graduate Nurses in a Hospital Orientation Program (Doctoral dissertation, Walden University).
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Looking for a  validated questionnaire on occupational radiation exposure for interventional radiology/cardiology. Study is on using FISH to assess translocation frequencies of low dose ionizing radiation.  Questionnaire to asses occupational exposure history and other confounding factors of translocation. 
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I would also recommend the paper 'Assessment of radiological protection systems among diagnostic radiology facilities in North East India'.
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a. Allow them to transfer into DR.
b. Make them finish their IR residency commitment first.
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Ask them what about IR is less appealing to them; what has deflated their interest in IR; many times a particular instructor or professor can be harder than the IR resident anticipated. Getting to the basis of their thought process regarding seeing themselves in IR often will be a key to helping them in their decision making.
Dennis
Dennis Mazur
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IR residency will be challenged by being one of the most specialized residencies in the NRMP match and yet not having a required clerkship in the medical school curriculum. How do you plan on ensuring that students have adequate exposure to IR prior to making their career decisions?
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A good lecture session for half a day or one day should be informative.
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a. Heavily. We will likely recruit at least one resident per year on the Independent Pathway.
b. Sporadically. We will likely use it only to fill in gaps every few years.
c. Seldomly. We will likely never use that pathway to recruit.
d. We haven’t thought about this.
e. We won’t have an IR residency.
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e. We won’t have an IR residency.
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Do you currently participate in any of the following activities to improve medical student exposure to IR:
a. IR Student Interest Group
b. IR Sub-Internship
c. IR Electives
d. Participation in an IR Medical Student Symposium
e. IR faculty teaching in the M1-M3 medical school curriculum
f. Encourage student engagement in the SIR RFS
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A medical or surgical rotation should include students on rounds with the team to see all radiographs (interventional or non-interventional) taken on each day of the medical student rotation on any service where radiographs are taken.
The radiologist should begin questioning of the interpretation of the radiographs with the medical student going first.
Dennis
Dennis Mazur
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In the course of measuring the transmission of lead glass shielding for fluoro in interventional radiology machines, I got different results in my ion chamber , for mSv/h or mSv ( for 10 ms irradiation) mode.
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Thank you for all the answers .First of all I made a mistake when writing the measuring time: it was 10 sec and not 10msec.And it was measured with  a stopwatch. 
The only answer that I think is correct came from Dr.Pete Burgess (from the Linkedin Group-Ionizing Radiation), and with his permission I quote:
"A 10 s pulse appears at the input of the electrometer basically as a charge spike. The dose mode will deal with this, provided it's not a huge ion chamber, as recombination of the positive and negative charges during collection will be minimal. So repeated tests should give very similar results. In rate mode, however, what is displayed will be dependent on the way the instrument averages the current from the ion chamber, particularly for digital instruments and can often lead to erratic values depending where the exposure occurs in the instrument cycle time."
Therefore It is not recommended to measure dose-rate in diagnostic radiology precision measurements, and of course,for pulsed radiation machines like in  diagnostic radiology or medical linear accelerators, only ion chambers must be used.
Of course a question should arise when dealing with radiation protection surveys: is it possible to measure dose rates around the external walls? If you get a small fluctuation in the results for every position, it's reasonable to assume that the measurement is correct. 
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Continuing my previous question on the the dose rate measurements as compared to integral dose in interventional radiology, I used the ion chamber RAM ION Of ROTEM as the main detector but also tried the DMC3000 of Mirion ; but I was disappointed by its performance ( low sensitivity and difficulty to move from dose to dose rate).Do you have experience with this new model?
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I'm sorry but I do not have the latest model either.
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Hello!
I am a field physicist and I perform QA measurements of various types of X-ray units. Due to recent changes in legal requirements in my country, we have to provide the radiation output value for each unit/tube measured (in mGy/mA.s at 1 meter from focal spot) at filtration of 2,5 mm Al equivalent. This unfortunately cannot be directly achieved for interventional radiology units, some CTs and occasionally other types of X-ray inits.
My question is: how can one calculate the dose at filtration of 2.5 mm Al equivalent from the measured dose at other filtration, assuming HF generators and 0% ripple?
For example: GE Innova 2100 interventional radiography unit, dose rate at 83 kVp and 165,5 mA (single shot) is 14,47 mGy/s and total filtration is 8,33 mm Al equivalent (actual filtration is combination of Al and Cu filters, but I do not have the precise values of both of these).
Thank you very much!
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Regarding ref 3. in my previous posting. It has been taken down! If you still want a copy. Contact me.
I also add this more recent paper on the subject of Anode roughness:
"Quantifying the effect of anode surface roughness on diagnostic x-ray spectra using Monte Carlo simulation". https://www.ncbi.nlm.nih.gov/pubmed/20229884
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Looking for privileging criteria for pediatric interventional radiology
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You could contact Gregory Blackman - an interventional radiologist. His speciality is not pediatrics but his experience in the field is extensive. Let me know if you would like contact information.
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  • Utilizes algorithmic checklists to minimize data entry and validate data 
  • Web based, no installation or direct costs, just your feedback 
  • Procedural data only, outcomes need separate tracking
  • Faster than dictation, avoids abstraction, auto-coded
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Yes. It looks interesting and useful.
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I have been studying about X-ray Fluoroscopy imaging technique lately and it's immense use in medical diagnosis and therapy. However I find there are many disadvantages to it, such as we can only see a 2D image of a 3D object. Minor details are hard to acquire and/or observe on screen.  Monochromatic display is also another problem as I see it.
What type of improvements are being currently being researched to this imaging technique? I have hit dead ends in my search through google, pubmed, Radiographics Journal & so on.
Please let me know. Thank you.
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Thank you all for your suggestions. They were very helpful. From the discussion with my research colleagues, it seems that most people are inclined towards 3D imaging developments of Fluoroscopy. Thanks again.
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Does anyone have an idea or that overuse of the neck can cause cerebral infarction resulted from thrombus in the internal carotid artery?
A 61-year-old male was brought to the emergency department with complaints of left side paralysis and speech disturbance. The symptoms supposedly appeared while he was sleeping. Apparently, the patient could not move his left hand and leg. He was alert and his blood pressure was 120/60 mmHg. He has no history of hypertension, diabetes, or hyperlipidemia. He does not consume alcohol or smoke. According to his wife, he complained of right side neck pain in the preceding day after he played Kendo _ Japanese martial art. There were no apparent bruises or wounds in his right neck. 
USG revealed the thrombus at the trunk of right internal carotid artery. CT revealed no bleeding but the high intensity lesion in the right middle cerebral artery, indicating clots in the vessel. MRI showed the high intensity lesion in the right basal ganglia. MRA showed the deficit of the blood flow in the right ICA. Then, he was diagnosed as acute stroke resulting from thrombosis in the ICA. Thinking of the interval of the onset, he was not considered as a candidate of interventional radiology followed by iv t-PA treatment. Then, conservative treatment by edaravone and antithrombin agent were initiated.
In this case, I wonder if there are some relationships between sports and cerebral infarction. I am interested in the involvement of external force or overuse of neck as the cause of his illness.
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Hi Nobuhiro
There is one case report published on this (Suzuki et al, 2012). The patient was a 66-year-old male who presented with left hemiplegia after having recieved a frontal thrust (tsuki) during the practice of Kendo. The authors state that the frontal thrust of Kendo can cause cervical artery dissection and stroke, but that's quite rare.
The reference is the following:
Hope this is helpful to you
All the best
Rodrigo
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In pulmonary CT angiography, different protocols are applied with different contrast volumes. However, if we know the physiological average amount of CM that fills the pulmonary artery down to the tertiary branches, we can do good exam.
In timing the scan, we need to exclude the CM-filled SVC and the left side of the heart in order to avoid artifacts. So knowing the physiological CM volume on average patient and adjusting the scan time given the size of the chest, and heart rate, a good timing of pulmonary angiography can be performed.
One more technical factor is calculating the scan time in testing bolus technique. This method ensures a maximum concentration of CM in the pulmonary trunk. But giving that we start the scan in the caudo-cranial direction, the CM may be not maximum by the time PA is scanned. It is said that 5 seconds should be added to the time to peak, I don't understand why 5 second? In fact, rationally some seconds should be deducted from the time to peak because this time is consumed by scanning the chest from the base till it reaches the pulmonary artery.
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We use test bolus with ROI in pulmonary trunk and add 2 secs to peak time as delay. Then 30 ml are sufficient for CTPA (on Flash the scan of thorax takes about 3 secs), but aorta is "empty" . However there are plenty of possibilities.  
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I would like to hear on your experience on how to measure and calculate the skin dose to patients in interventional radiology.What is the best detector and what method gives the most accurate results during a clinical procedure?Do you calibrate the Dose-Area detector for each machine?Can you suggest also a simple method to do it?
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Hi. I did my masterdegree paper on this. Measuring Peak Skin Dose (PSD) on patients undergoing PCI and RFA procedures in Cardiac intervention at Our hospital. I did use radiochromic films to measure the skin doses, Garfchromic film XRRV3 type. Both my study and what I found in the litterature is pointing towards that this is the most accurate way to measure these dose Levels. I can give you literature References, because I have not published my study yet. You can also read my abstract and a Powerpoint presentation from my lecture about this at the ISRRT Conference in Helsinki in june 2014. The benefits With radiochromic film is that it does cover the entire exposed area on the patient during the procedure even With multiple radiation Fields, it is easy to read out the dose Levels after the procedure, it is not light sensitive, it is reliable on several energy Levels (from 70-80 kV and above). I did investigate how the measured PSD Levels extracted from the radiochromic film did correlate With Dose Are Product (DAP) and Air Kerma (AK/CAK) values for the same procedures. I did find that the correlation was good for these two procedures. So we have establised Reference Levels for follow up procedures in the daily routine by using DAP value Readings for each patient. Check out my abstract and presentation, and give a notice if you want to have literature References.
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I am aware of the IEC 61331-1 protocol for X-Ray attenuation measurements, both for narrow beam and broad beam geometry. Do you use table interpolation or you calibrate with known Pb samples? Do you get different lead equivalent thicknesses for these geometries? What are the preferred specification of lead equivalency by the apron manufacturers?
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What I mean is the mean energy, and that's the reason 40 keV is not relevant for interventional radiography. I don't know also interventional techniques with 40 kV.
As a matter of fact the minimum kV ( maximum energy of the bremsstrahlung spectrum for interventional radiology) is 50 keV, as indicated by the IEC and DIN protocols.
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Any further role for the radiologist in this case?
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I agree with Muhammad Shoaib Akhtar. Standard CSF cytology methods, using routine centrifugation followed by resuspension are often not useful for CSF tumor cell cytology. Even "cytocentrifugation", directly on a slide or coverslip, alters cytological features. I used, for critical diagnostic CSF cytology, a sedimentation method developed a long time ago by Prof. Suta (Praha university), followed by May-Grunewald-Giemsa staining. Even so, speed is of the essence: twenty minutes between CSF sampling and lab technique are a maximum. Preliminary results were given in : SUBERO A., FONCIN J.-F., LE BEAU J. : Diagnostic cytologique du liquide céphalo-rachidien par la chambre de sédimentation de Suta. Neurochirurgie (Paris) 1968 14 n°5, 627-634.
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In a prospective study on patients with pelvic malignancies undergoing pelvic radiotherapy, we found an association between vitamin D deficiency and severity of radiation induced proctitis. This association was independent from age, gender, cancer type, and BMI. What could be the mechanisms behind this association?
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Hi 
there is a considerable body of work suggestion that vitamin D has anti-inflammatory effects in inflammatory bowel disease (IBD), particularly from animal models of IBD (Cantrona  and others).  The human translation is less clear at this point, but emerging evidence suggests that vitamin D supplementation may prevent relapse in RCTs in IBD.  As well as anti-inflammatory effects, newer mechanisms such as effects on autophagy, gut barrier functional and on microbiota have been suggested for vitamin D. 
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Hemobilia is not uncommon following PTBD. It is particularly true in cases where the confluence is non-patent and excessive manipulation is required during the procedure. Hemobilia secondary to venous and arterial injury has a clear protocol of management that is well discussed in literature. However, there is paucity of data in general on management of hemobilia not related to vascular injury. Should we clamp the catheter if there is hemobilia in an attempt to create a tamponade effect? My experience is that lesser the manipulation, lesser the chances of hemobilia. However, much needs to be learnt about this distressing complication.
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In case of hemobilia after PTBD, not related to vascular injury do first lavage and aspiration of the PTBD with saline solution to remove major blood clots to prevent tamponade/occlusion of drainage or biliary ducts. Give the patient UDC (ursodesoxycholacid) 250 mg 2-2-2 to have an increase of biliary secretion and to have thinner and more liquid bile resulting in an endogeneous lavage of the biliary system. No clamping of the catheter, allow external drainage. Monitoring of the patient is needed. Mostly after 24 to 48 hrs you will have clear bile secretion over the drainage.
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Those 4D can then be displayed in volume rendering or multiplanar reformations. Imagine, real 3D vascular roadmapping would become feasible ? Can you think of any advantages ? Any new procedures that can be performed ? Will it make vascular interventions faster and more secure ?
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Hi Marcos,
we adressed the dose issue - what are your thoughts on it ?
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Looking for animal models that would be suitable for intra-arterial infusion therapy (eg, chemoembolization) (ie, rabbit size or larger), other than the VX2 (HCC) model. Starting from either biopsy cells or other sources. Can anyone recommend advice for planning, handing, duration, ease of use, cost, or any other useful tips?
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get in contact with Prof. Eckhard Wolf Molecular Animal Breeding and Biotechnology, Gene Centre Munich. They have generated transgenic pigs for colorectal and pancreatic cancer.