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Techniques in Vascular and Interventional Radiology

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https://www.readbyqxmd.com/read/29472000/get-the-lead-off-our-backs
#1
Chet R Rees, Barrett W C Duncan
Many interventionalists face physical challenges almost daily for years or decades. The burden of assuming awkward positions while carrying extra weight can take its toll on the musculoskeletal system to such an extent that the career is ended or modified to exclude procedural aspects. The proliferation of lighter aprons has unfortunately resulted in reduced protection with poor correlation of protection to labeling due to the inadequacies of testing methods for nonlead materials. The protective quality of the non-leads is not superior to lead-containing composites on a weight basis, and the user no longer knows how well they are protected unless buying aprons containing lead...
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29471999/make-radiation-protection-a-habit
#2
Donald L Miller
This review describes the basic concepts and methods for optimization of occupational dose in the interventional suite. In fluoroscopy, the source of virtually all radiation exposure to the operator is scattered radiation from the patient. All other things being equal, reducing patient radiation dose will reduce operator and staff dose. Most tools and methods of occupational radiation protection are entirely operator dependent. These methods must be used routinely and properly to be effective. Your occupational dose depends on how well you follow good radiation protection practices and on the kinds of procedures you do...
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29471998/baby-on-board-managing-occupational-radiation-exposure-during-pregnancy
#3
M Victoria Marx
This article reviews the issue of occupational radiation exposure as a deterrent to recruitment of women into the field of interventional radiology and provides the reader with three strategies to optimize radiation protection during fluoroscopically guided procedures. These include personal protective shielding, use of ancillary shielding, and techniques that limit fluoroscopy x-ray tube output. When optimal radiation safety practices are implemented as the norm in the IR suite, very little extra needs to be done to ensure that fetal dose of a pregnant interventionalist is negligible...
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29471997/always-on-my-mind
#4
Stephen Balter
This article is focused on occupational radiogenic brain tumors and some radioprotective techniques used to manage this risk. Published case reports have stimulated concern among operators. The anatomical pattern of tumor locations is not consistent with measured radiation dose distributions at operators' heads. In addition, the lack of statistically positive findings in these reports, and a recently published survey on radiologist's mortality both indicate that the current level of fluoroscopists' radiation safety practices is likely to be adequate...
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29471996/the-eyes-have-it
#5
Lindsay Machan
The ocular lens is one of the most susceptible structures in the body to radiation damage. Unfortunately, much of the traditional academic and regulatory thinking on thresholds to develop radiation-induced opacities or cataracts has proven to be false. Individual vulnerability to the effects of radiation is extremely variable, largely because each individual is variably genetically equipped to repair the damage caused by radiation. Therefore many people, including some unsuspecting interventional radiologists may have no, or almost no, threshold at all for cataract development after radiation injury...
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29471995/should-we-keep-the-lead-in-the-aprons
#6
Gabriel Bartal, Anna M Sailer, Eliseo Vano
Medical staff should not be exposed to the primary X-ray beam during fluoroscopy-guided interventional procedures (FGIP). The main source of staff exposure is scatter radiation from the patient, which can be significant. Although many aspects of X-ray exposure to the patient as well as occupational exposure to interventional radiologists and other staff are strongly regulated and monitored in most countries, it is surprising how loosely the labeling and testing of the protective aprons is regulated. Interventional radiologists (IRs) have to be experts in interventional radiology as well as in basic facts regarding ways to provide a satisfactory level of protection from occupational exposure...
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29471994/ergonomics-in-the-development-and-prevention-of-musculoskeletal-injury-in-interventional-radiologists
#7
Jamaal L Benjamin, Quinn C Meisinger
Interventional radiology is a constantly evolving specialty overlapping with multiple other specialties, including cardiology, vascular surgery, orthopedic surgery, urology, and minimally invasive surgery. Unique ergonomic considerations for interventional radiology include utilization of intraoperative viewing monitors and personal radiation protection equipment. Work-related injuries are common in interventional radiologists,1 often leading to pain while performing procedures or during time away from work...
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29471993/live-without-regret
#8
EDITORIAL
M Victoria Marx
No abstract text is available yet for this article.
March 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224663/obstruction-of-the-biliary-and-urinary-system
#9
REVIEW
William O'Connell, Jay Shah, Jason Mitchell, J David Prologo, Louis Martin, Michael J Miller, Jonathan G Martin
Biliary and urinary obstructions can be managed endoscopically or cystoscopically, surgically or by percutansous intervention or drainage. If the obtructed system is infected, emergent decompression is needed. Early recognition and treatment is paramount in both conditions. Acute cholangitis can present many different ways, from mild symptoms to fulminant sepsis. It is usually a result of ascending bacterial colonization and biliary obstruction resulting in bacterial overgrowth. Therefore, those patients with recent biliary instrumentation or previous biliary modification are at higher risk...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224662/managing-venous-thromboembolic-disease-on-call
#10
REVIEW
Jason W Mitchell, William G O Connell, Charles A Gilliland, Irwin M Best
Managing venous thromboembolic disease on-call requires the interventional radiologist consider not only potential risk and benefit to the patient but also available resources in the IR suite as well as throughout the hospital, such as intensive care monitoring during treatment. We demonstrate how our practice manages these on-call cases ranging from deep venous thrombosis to acute pulmonary embolism and decide which patients need emergent treatment and which can undergo delayed intervention during working hours...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224661/acute-limb-ischemia
#11
REVIEW
Charles Gilliland, Jay Shah, Jonathan G Martin, Michael J Miller
Acute limb ischemia is technically defined as ischemia of the lower extremities lasting 14 days or less. The condition affects between 15 and 26 persons per 100,000 each year in the United States. The associated morbidity and mortality is extremely high, with 1-year mortality rates reported at over 40%. Acute limb ischemia is 20 times more common in the lower extremities than the upper extremities. Both interventional radiologists and vascular surgeons bring unique skills to the table in caring for these patients, and therefore should approach the care of these patients in a multidisciplinary manner to ensure the best outcomes for each patient...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224660/postpartum-hemorrhage
#12
REVIEW
Janice Newsome, Jonathan G Martin, Zachary Bercu, Jay Shah, Haris Shekhani, Gail Peters
Interventional radiologists are often called for emergent control of abnormal uterine bleeding. Bleeding, even heavy bleeding as a result of uterine fibroids is not a common emergent procedure; instead, pregnancy and pregnancy related conditions, trauma and malignancy associated with bleeding can be the source of many interventional radiology on call events or procedures. Postpartum hemorrhage (PPH) is the most common cause, and is defined as blood loss of 500mL after vaginal delivery or 1000mL after cesarean section...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224659/bronchial-artery-embolization-for-the-treatment-of-acute-hemoptysis
#13
REVIEW
M Cody O'Dell, Anne E Gill, C Matthew Hawkins
Massive hemoptysis is a life-threatening condition often defined as coughing up 300-600mL of blood in 24 hours in an adult, or >8mL/kg in 24 hours in a child. Although the definition is controversial, one should view massive hemoptysis as any volume of expectorated blood that can cause respiratory failure. This is because mortality in the setting of hemoptysis is usually associated with asphyxiation, rather than exsanguination. Massive hemoptysis accounts for only about 5% of cases of hemoptysis, but when treated conservatively, has a reported mortality rate between 50% and 85%...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224658/management-of-acute-lower-gastrointestinal-bleeding
#14
REVIEW
Ethan J Speir, R Mitchell Ermentrout, Jonathan G Martin
Acute lower gastrointestinal bleeding (LGIB), defined as hemorrhage into the gastrointestinal tract distal to the ligament of Treitz, is a major cause of morbidity and mortality among adults. Overall, mortality rates are estimated between 2.4% and 3.9%. The most common etiology for LGIB is diverticulosis, implicated in approximately 30% of cases, with other causes including hemorrhoids, ischemic colitis, and postpolypectomy bleeding. Transcatheter visceral angiography has begun to play an increasingly important role in both the diagnosis and treatment of LGIB...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224657/cta-as-an-adjuvant-tool-for-acute-intra-abdominal-or-gastrointestinal-bleeding
#15
REVIEW
Mitchell Storace, Jonathan G Martin, Jay Shah, Zachary Bercu
Hematemesis and acute postsurgical upper gastrointestinal hemorrhage are common emergent on-call consultations for the interventional radiologist. Upper GI bleleding (UGIB) is a relatively frequent problem. The incidence and mortality vary among patient populations, but studies have shown an overall incidence ranging from 36-172 cases per 100,000 adults per year, with a mortality rate of 5%-14%. The incidence is significantly higher in men. Peptic ulcer disease is the predominant etiology, responsible for 28%-59% of UGIB...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224656/emergent-endovascular-treatment-of-penetrating-trauma-solid-organ-and-extremity
#16
REVIEW
M Cody O Dell, Jay Shah, Jonathan G Martin, Darren Kies
Penetrating injuries can result in acute or subacute arterial injuries of the solid organs or extremities. Although most penetrating injuries are managed conservatively, some patients require endovascular or surgical treatment. Often, the best method for management is controversial and the level of urgency for clinical decision-making is high. Once the decision has been made to intervene, the operator must also determine the best embolization material and technique to use. Not unfrequently, these decisions are made during the course of the procedure...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224655/evaluation-and-treatment-of-blunt-pelvic-trauma
#17
REVIEW
Jonathan G Martin, Michael Kassin, Peter Park, R Mitchell Ermentrout, Sean Dariushnia
Trauma is a significant contributor to mortality, especially in the young. Pelvic trauma with pelvic ring fractures may result in associated arterial injury, necessitating endovascular intervention. As a result, interventional radiology plays a critical role in partnering with trauma providers in the care of these patients. Management is determined by the acuity of the patient's clinical status, radiographs, ultrasound, and the results of computed tomography imaging when available. Numerous embolic agents are available for treatment of arterial hemorrhage...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224654/evaluation-and-management-of-blunt-solid-organ-trauma
#18
REVIEW
Jonathan G Martin, Jay Shah, Craig Robinson, Sean Dariushnia
Trauma is a leading cause of death in patients under the age of 45 and generally associated with a high kinetic energy event such as a motor vehicle accident or fall from extreme elevations. Blunt trauma can affect every organ system and major vascular structure with potentially devastating effect. When we consider abdominal solid organ injury from blunt trauma, we usually think of the liver, spleen, and kidneys. However, all of the abdominal organs, including the pancreas and adrenal glands, may be involved...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29224653/introduction
#19
EDITORIAL
Jonathan G Martin, Michael J Miller
No abstract text is available yet for this article.
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029719/erratum-to-not-just-guess-work-tips-for-observation-brainstorming-and-prototyping-vasc-interv-radiol-20-2017-94-100
#20
Ryan Crone
No abstract text is available yet for this article.
September 2017: Techniques in Vascular and Interventional Radiology
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