Disección carotídea espontánea: Presentación de un caso clínico con revisión de la literatura / Carotid Artery Dissection. Case Report and Literature Review

Resumen Introducción: La disección carotídea consiste en el desgarro de la pared del vaso. Es una patología infrecuente, pero es la causa más común de enfermedad vascular cerebral (EVC) isquémica en personas menores de 45 años. Las manifestaciones clínicas son muy variables. Método: Utilizamos las recomendaciones CARE para el reporte de casos clínicos. Caso clínico: Hombre de 45 años previamente sano, con debilidad aguda de la extremidad torácica derecha sin causa aparente. La tomografía simple de cráneo no evidenció alteraciones. La resonancia magnética mostró una oclusión completa de la arteria carótida interna en todos sus segmentos y disminución del flujo de la arteria cerebral media izquierda. La evolución clínica fue desfavorable. Conclusión: La disección carotídea debe sospecharse en personas con EVC sin factores de riesgo cardiovascular.

Abstract Introduction: Carotid dissection consists of a tear in the vessel wall. It is a rare pathology, but it is the most common cause of ischemic cerebral vascular disease (CVD) in people under 45 years of age. The clinical manifestations are very variable. Method: We used CARE recommendations for reporting clinical cases. Clinical case: Previously, a healthy 45-year-old man with acute weakness of the right thoracic extremity without apparent cause. The simple skull tomography did not show any alterations. MRI showed complete occlusion of the internal carotid artery in all its segments and decreased flow of the left middle cerebral artery. The clinical evolution was unfavorable. Conclusion: Carotid dissection should be suspected in people with CVD without cardiovascular risk factors.

Primeros pasos en el intervencionismo. Lecciones de la práctica diaria / First steps in interventionism. Lessons from daily practice

Resumen Las características del paciente y la localización de la lesión diana pueden hacer más complejo un procedimiento intervencionista. Una adecuada formación basada en el conocimiento de los instrumentos, manejo de técnicas alternativas y complementos hacen que estos procedimientos sean efectivos y seguros. Destacaremos la planificación anticipada, los enfoques seguros, el papel de la integración y la discusión interdisciplinaria. Los elementos descritos aquí y la bibliografía adjunta pueden tomarse como una guía para comenzar una carrera en radiología intervencionista.

Abstract The characteristics of the patient and the location of the target lesion can make an interventional procedure more complex. An adequate training based on the knowledge of instruments, handling of alternative techniques and supplementary tools make these procedures effective and safe. We will emphasize advanced planning, safe approaches, the role of integration, and interdisciplinary discussion. The items described here and the accompanying bibliography can be taken as a guide to starting a career in interventional radiology.

Safe radiological spinal intervention: A multicenter snapshot survey of musculoskeletal radiologists in the UK and India

Objectives: Research, knowledge, and technological advances have promoted minimally invasive image-guided diagnostic and therapeutic intervention. Such interventions are increasingly performed for musculoskeletal diseases by radiologists within outpatient settings. The objective of this study was to ascertain levels of safe practice among musculoskeletal radiologists in the United Kingdom and the Indian public health-care system, as defined by access to spinal surgeons and anesthetists during radiological spinal procedures. Material and Methods: An online cross-sectional survey of eight questions (multiple choice and free text) was circulated among musculoskeletal radiologists in the UK and India, to evaluate: (i) Image-guided practice among musculoskeletal radiologists. (ii) Types of interventions undertaken. (iii) Practice setting. (iv) Availability of supportive, backup access to spinal surgery services. Results: A total of 53 replies were received of which 43 (81.1%) were from musculoskeletal radiologists who perform spinal interventional procedures. Spinal biopsies and injections were the most common procedures performed by the 43 eligible radiologists (79.1% and 74.4%, respectively), with vertebroplasty and sacroplasty performed by only 16.3% and 11.6%, respectively. Less than half (46.5%) of musculoskeletal radiologists performing interventional procedures did so within a hospital setting with both a spinal surgeon and an anesthetist on site, 20.9% had an anesthetist on site but no spinal surgeon and 16.3% had neither on-site. Conclusion: Minimally invasive image-guided diagnostic and therapeutic intervention is a niche sub-specialty practiced by a few musculoskeletal radiologists. Enhanced resource allocation, skills training, and multidisciplinary service provision will ultimately minimize existing deficiencies, improving patient-related clinical outcomes, and quality of care.

The essential role of thoracic duct embolization in management of traumatic iatrogenic chylothorax / O papel fundamental da embolização do ducto torácico no manejo de quilotórax traumático iatrogênico

Abstract This study aims to describe a case series of patients who underwent thoracic duct embolization (TDE) to treat traumatic iatrogenic chylothorax (TIC). Three patients were included: Case #1, a 49-year-old woman with follicular lymphoma developed a TIC following video-assisted thoracoscopic surgery to resect a solid right paravertebral mass and was treated with TDE using microcoils and N-butyl cyanoacrylate (NBCA) glue. Case #2, a 68-year-old man with cardiac amyloidosis developed a TIC following heart transplantation and was treated with TDE using microcoils and ethylene vinyl alcohol copolymer. Case#3: A 6-year-old patient with congenital heart disease developed a TIC following a Fontan procedure and was treated with TDE using NBCA glue. All lesions were identified during lymphangiography and TDE was successfully performed in all cases. TDE is a safe and valuable technique that provides minimally invasive treatment for TCI.

Resumo Este estudo objetiva descrever uma série de casos de pacientes submetidos a embolização do ducto torácico (EDT) para tratamento de quilotórax iatrogênico (QI). Três pacientes foram incluídos. Caso 1: um homem de 49 anos com linfoma folicular apresentou QI após ressecção de uma massa paravertebral por toracoscopia vídeo-assistida e foi submetido a EDT com micromolas e n-butil-cianoacrilato (NBCA). Caso 2: um homem de 68 anos com amiloidose cardíaca apresentou QI após ser submetido a transplante cardíaco e foi submetido a EDT com micromolas e copolímero de etileno e álcool vinílico. Caso 3: um paciente de 6 anos com malformação cardíaca congênita apresentou QI após cirurgia de Fontan e foi submetido a EDT com NBCA. Todas as lesões foram identificadas durante a linfangiografia, e a EDT foi realizada com sucesso. A EDT é uma técnica segura e valiosa, que pode oferecer um tratamento minimamente invasivo em casos de QI.

Research Progress in Diagnostic Reference Levels in Interventional Radiology / 中国医学科学院学报

During interventional procedures,subjects are exposed to direct and scattered X-rays.Establishing diagnostic reference levels is an ideal way to optimize the radiation dose and reduce radiation hazard.In recent years,diagnostic reference levels in interventional radiology have been established in different countries.However,because of the too many indicators for characterizing the radiation dose,the indicators used to establish diagnostic reference levels vary in different countries.The research achievements in this field remain to be reviewed.We carried out a retrospective analysis of the definition,establishment method,application,and main factors influencing the dose difference of the diagnostic reference level,aiming to provide a basis for establishing the diagnostic reference level for interventional procedures in China.

The investigation and analysis of eye lens dose to interventional radiology workers in China from 2019 to 2021 / 中华放射医学与防护杂志

Objective:To investigate and analyze the eye lens dose to interventional radiology workers in China from 2019 to 2021.Methods:The monitoring data on eye lens dose to interventional radiology workers from 31 province-level units during 2019-2021 were collected through the National Radiological Health Information Platform. The eye lens dose evaluation indicator was Hp(3), with each monitoring period of no more than 3 months. Kusall-Wallis H test was used for the comparison of multiple groups and pairwise. Results:A total of 6 643 interventional radiology workers were investigated from 2019 to 2021. The average annual eye lens dose was 1.03 mSv, with the median of 0.17 mSv and the maximum of 94.88 mSv. The annual eye lens dose to 59 workers exceeded 20 mSv. It was also found that the annual eye lens dose to the doctors in 2019 and 2020 was slightly higher than that to nurses (rank mean difference=118.29, 129.71, P<0.01), and the lens dose to interventional radiology workers who performed cardiac interventions in 2019 was higher than that to workers who performed peripheral vascular interventions (rank mean difference=46.52, P<0.05). Conclusions:The lens dose to interventional radiology workers is lower than the limits given in Chinese national standard currently in effect, but exceed the latest internationally recommended limit for a few ones. In order to protect the occupational health of interventional radiology workers, the monitoring of lens dose should be strengthened.

A survey of interventional radiology resources and radiation protection equipment and personal dosimeter wearing rate in Qingdao, China / 中国辐射卫生

Objective To investigate the current status of interventional radiology resources, radiation protection equipment, and the rate of wearing of personal dosimeters in Qingdao, China, and to provide a data basis for strengthening radiation protection and health management for interventional radiation workers. Methods A questionnaire survey was performed on all medical institutions with interventional radiation services in Qingdao. The data from April 1, 2020 to March 31, 2021 were pooled and analyzed. Results A total of 31 medical institutions in Qingdao were investigated, including 23 (74.20%) tertiary hospitals and 8 (25.80%) secondary hospitals. There were 88 pieces of interventional radiation equipment in total in Qingdao, 89.77% of which were in tertiary hospitals. A total of 921 interventional professionals participated, with 865 (93.92%) from tertiary hospitals and 56 (6.08%) from secondary hospitals. The mean annual number of visits to interventional services was 5.72 per 1000 people. Among personal protective equipment, the equipment rates of lead-rubber aprons, lead-rubber caps, and lead-rubber collars were highest, all being 100%. The rate of equipment of interventional protective gloves was lowest, which was only 51.61%. The mean number of each accessory protective equipment for each interventional machine was less than 1. The rate of wearing of dual-dosimeters was 84.36%. Conclusion Tertiary hospitals were dominant among the medical institutions in this survey of interventional radiology services in Qingdao. The most frequently equipped personal protective goods were lead-rubber aprons, caps, and collars. The equipment rates of interventional protective gloves and protective accessories and the rate of wearing of dual-dosimeters were relatively low.

Evaluación de la anatomía angiográfica de las arterias hepáticas y sus variantes / Evaluation of the angiographic anatomy of the hepatic arteries and its variants

Resumen Objetivo: Evaluar y describir la prevalencia de variantes anatómicas arteriales hepáticas observadas en una serie multicéntrica de pacientes con patologías hepatobiliares. Método: Estudio retrospectivo de anatomía arterial según la clasificación de Michels de angiografías digitales y tomografías computadas helicoidales abdominales realizadas entre febrero de 2009 y diciembre de 2020 en tres hospitales del Área Metropolitana de Buenos Aires. Resultados: Se incluyeron 275 pacientes en el estudio. Edad mediana 58,5 años. Sexo masculino 73,1%. Variante anatómica tipo 1 (normal) de la arteria hepática en 192 casos (69.8%); tipo 2 en 18 casos (6.5%); tipo 3 en 19 casos (6.9%); tipo 4 en 7 casos (2.5%); tipo 5 en 4 casos (1.5%); tipo 6 en 3 casos (1.1%); tipo 7 en 2 casos (0.7%); tipo 8 en 7 casos (2.5%); tipo 9 en 17 casos (6.2%) y otros tipos fuera de la clasificación de Michels en 6 casos (2.2%). También hallamos la presentación de 3 casos (1.1%) con arco de Bühler. Conclusiones: En nuestra serie se observaron variantes anatómicas no clásicas de la arteria hepática aproximadamente en un tercio de los casos. El conocimiento de las variantes anatómicas fue esencial para los procedimientos radiológicos y quirúrgicos en el tratamiento de tumores hepáticos, determinando la técnica de abordaje de las arterias involucradas.

Abstract Objective: To evaluate and describe the prevalence of hepatic artery anatomical variants observed in a multicenter series of patients with hepatobiliary pathologies. Method: Retrospective study of arterial anatomy according to Michels classification of digital angiographies and abdominal helical computed tomography performed between February 2009 and December 2020 in three hospitals of the Buenos Aires Metropolitan Area. Results: 275 patients were included in the study. Median age 58.5 years. Male sex 73.1%. Type 1 (normal) variant of hepatic artery anatomy in 192 cases (69.8%); type 2 in 18 cases (6.5%); type 3 in 19 cases (6.9%); type 4 in 7 cases (2.5%); type 5 in 4 cases (1.5%); type 6 in 3 cases (1.1%); type 7 in 2 cases (0.7%); type 8 in 7 cases (2.5%); type 9 in 17 cases (6.2%), and other types out Michels classification in 6 cases (2.2%). We also found 3 cases (1.1%) with Bühler's arch. Conclusions: In our series, non-classical anatomical variants of the hepatic artery were observed in approximately one third of cases. Knowledge of anatomical variants was essential for radiological and surgical procedures in the treatment of liver tumors, determining the approach technique of the arteries involved.

Biopsia percutánea de nódulos y masas pulmonares bajo ecografía: una alternativa a la tomografía computada / Ultrasound guided percutaneous biopsy of pulmonary nodules and masses: an alternative to CT

Resumen Los nódulos y masas pulmonares tradicionalmente son biopsiados mediante tomografía computada (TC). La ecografía está subestimada como guía para biopsias pulmonares. Las imágenes pulmonares factibles de biopsia con ecografía son aquellas en contacto pleural. Las contraindicaciones específicas incluyen ventilación mecánica asistida, neumonectomía contralateral, paciente no colaborador, tos incontrolable. En el monitoreo posbiopsia deberán controlarse los signos vitales, el dolor y la presencia de complicaciones. Por la localización de las lesiones abordables por este método, el neumotórax y el sangrado parenquimatoso como complicación son menos frecuentes que en las biopsias dirigidas por TC. En este artículo describimos los conceptos básicos para la correcta selección de paciente, planificación y ejecución segura de una biopsia de nódulo pulmonar bajo ecografía.

Abstract Pulmonary nodules and masses are traditionally biopsied under computed tomography (CT) guidance. Ultrasound remains underrated as lung nodule biopsy guide. Ultrasound can be employed to target pleural based lung nodules. Specific contraindications include: mechanical ventilation, contralateral pneumonectomy, non-cooperative patient and uncontrollable coughing. Post procedural care should cover vital signs check, pain assessment and complication evaluation. Due to lesion localization, complications such as pneumothorax and parenchymal bleeding are less frequent than in CT guided biopsies. In this article we provide basic concepts for patient selection, plan and safe execution of ultrasound guided pulmonary nodule biopsy.

Biopsias pelvianas percutáneas: guía iconográfica de abordajes seguros / Percutaneous pelvic biopsies: An illustrative guideline for safe approaches

Resumen Las biopsias percutáneas a nivel de la pelvis plantean un desafío dada la compleja anatomía regional. El conocimiento de las estructuras afectadas y el tipo de lesión a intervenir son algunos de los aspectos que van a influenciar la técnica que se utilice. Se han propuesto distintas vías de abordaje, pero aún carecen de sistematización. El objetivo de este artículo es destacar accesos seguros ejemplificando con casos ilustrativos de nuestra institución. Además, agregamos comentarios basados en nuestra experiencia.

Abstract Pelvic percutaneous biopsies are challenging due to complex regional anatomy. Knowledge of affected structures and lesion type are some of the aspects that will condition the technique applied. Different approaches to pelvic percutaneous biopsies have been proposed, but still lack systematization. The aim of this article is to highlight safe approaches supported with illustrative cases. Furthermore, we provide opinion based on our experience.

Analysis of 53 cases of transjugular liver biopsy / 中华肝脏病杂志

Objective: To investigate the practicability and safety of transjugular liver biopsy (TJLB). Methods: Data of 53 cases with transjugular liver biopsy from June 2015 to June 2020 were collected. LABS-100 was used in all patients who underwent transjugular liver biopsy. Among them, 45 cases and eight were biopsied via hepatic vein and intrahepatic segment of the inferior vena cava. The surgical indications, related complications, and postoperative pathological diagnosis were analyzed and summarized. Results: TJLB was successful in all patients, with an average of 2.8 punctures per case. Satisfactory liver tissue and histopathological diagnosis was obtained in all patients. Two cases developed a cervical hematoma that was improved spontaneously, and one patient developed an intrahepatic hematoma that was improved after conservative treatment. Conclusion: TJLB is a practical and safe method for patients with contraindications to percutaneous liver biopsy.

Personal dose monitoring results of 307 interventional radiology workers in Liaoning Province, China / 中国辐射卫生

Objective To investigate the personal dose level of occupational external exposure among interventional radiology workers in Liaoning Province of China, and to provide a reference for better occupational radiation protection. Methods According to the national standard GBZ 128—2016 Specifications for individual monitoring of occupational external exposure, the thermoluminescence method was used to measure the monitoring dose inside the lead clothes (HW) and outside the lead clothes (HN) of interventional radiology workers, and the Mann-Whitney U test and the Kruskal-Wallis H test were used for statistical analysis. Results Dual dosimeter monitoring data were collected from 307 interventional radiology workers in Liaoning Province in 2019, with a mean annual effective dose of 0.81 mSv and a maximum annual effective dose of 7.03 mSv, and 72.96% of the workers monitored had an annual effective dose of less than 1 mSv. The interventional radiology workers in tertiary hospitals had a significantly higher mean annual effective dose than those in secondary hospitals (0.95 mSv vs 0.65 mSv, P < 0.05). There was a significant difference in mean annual effective dose between departments (P < 0.05), and the department of interventional radiology had a significantly higher mean annual effective dose than the other departments (0.92 mSv vs 0.64 mSv), while the department of cardiology had a similar mean annual effective dose to the cerebrovascular department (0.78 mSv vs 0.78 mSv). Conclusion The occupational exposure dose of 307 interventional radiology workers in Liaoning Province meets the requirements in national regulations and standards and is higher than the national level, which suggests that radiation protection supervision and personal training should be further strengthened for interventional radiology.

Multi-channel embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair / 中华普通外科杂志

Objective:To evaluate multi-channel transcatheter embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair (EVAR).Methods:Data of 8 cases of type Ⅱ endoleak after EVAR from Oct 2017 to Nov 2020 at the Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital were retrospectively analyzed.Results:All patients who suffered from type Ⅱ endoleak that originated from lumbar arteries after EVAR were successfully treated with coils and mixture of Compant medical glue and iodipin through multi-channel. The technical success rate was 100%, the operative time was 80-150 min. Right lower limb dyskinesia occurred in 1 patient after operation, the symptom disappeared by anticoagulation and trophic neurotherapy for 2 months. Type Ⅱ endoleak didn't recur in all patients, and no mortality during the 4-38(14.1) months follow-up period.Conclusion:Multi-channel transcatheter embolotherapy has definite effects for the treatment of type Ⅱ endoleak from lumbar arteries after EVAR, with high technical feasibility, few perioperative complications, low mortality among other advantages. The results of short and medium term are satisfactory.

Monitoring and analysis of lens dose to interventional radiology workers at some hospitals in Shaanxi province from 2018 to 2020 / 中华放射医学与防护杂志

Objective:To analyze and learn about the dose to the lens of the eye of interventional radiology workers in some hospitals in shaanxi province from 2018 to 2020.Methods:From 2018 to 2020, three tertiary hospitals in shaanxi province were selected to monitor the dose to the lens of the eye of interventional radiology workers for three consecutive years. Monitoring was made for 152 person times, lasting for a monitoring period of 3 months. Analysis and comparison were carried out of dose equivalents to the interventional radiology workers in terms of different sexes, positions and departments, together with associated influencing factors during the three years.Results:The difference in equivalent dose between the three years is statistically significant ( χ2=29.15, P<0.05), and a downward trend in the average annual equivalent dose was found from 2018 to 2020. The number of interventional radiology workers who received doses to the lens of the eye mainly between MDL and 5.0 mSv accounted for 69.08%. The difference in the average annual equivalent dose in different positions and departments was statistically significant ( H=18.44, 22.55, P<0.05). The average annual equivalent dose to doctor was higher than for nurses and technicians ( Z=-3.36, -3.02, P<0.05). The average annual equivalent dose in cardiovascular medicine department was higher than in other departments, with statistically significant difference ( Z=-2.58, -3.76, -3.40, P<0.05). Logistics regression analysis showed that radiation working hours, positions, routine personal doses, workload and exposure time are the factors that affect the average annual equivalent dose. Conclusions:The annual equivalent dose to the lens of the eye of interventional radiology workers in shaanxi province meets the relevant national standards. However, the annual dose to some radiological workers has a normal high value. Therefore, it is necessary to strengthen the continued monitoring of the dose to the lens of the eye of the interventional radiology workers, and adjust the types of work for the workers based on radiation work hours, position, routine personal dose, workload and exposure time, so as to effectively reduce the dose level of the eye lens.

Effect of real-time radiation data on radiation exposure of interventional surgical personnel / 中国辐射卫生

Objective To analyze the radiation exposure of medical personnel, and to provide real-time radiation dose monitoring data for medical personnel in interventional surgeries. Methods A total of 96 person-times who participated in cardiac surgeries in interventional operating rooms from September 2019 to March 2022 were selected as subjects. The subjects were divided into two groups according to the time progress, with 43 person-times in intervention group and 53 person-times in control group. The subjects in the intervention group were provided with radiation dose monitoring data during surgeries, while the subjects in the control group performed surgeries with routine procedures. The average intraoperative radiation dose rates of the two groups were compared. Results The median radiation dose rate was significantly lower in the intervention group than in the control group (88.80 μSv/h vs 188.40 μSv/h, U = 637.000, P = 0.000). Conclusion Providing real-time radiation dose monitoring data for medical personnel in interventional surgeries can effectively reduce their occupational radiation exposure and improve their occupational radiation protection.

Analysis of external exposure dose monitoring results of interventional radiology staff in a hospital from 2018 to 2020 / 中国辐射卫生

@#<b>Objective</b> To analyze the monitoring results of external exposure dose of interventional radiology staff in a tertiary general hospital in Beijing, China, 2018—2020, and to provide a basis for safe guarding staff health and hospital radiation protection management. <b>Methods</b> A total of 321 interventional radiology staff in a hospital in Beijing were selected to collect information on the types of interventional work, positions, and personal dose monitoring results in 2018—2020. The dose monitoring results were analyzed using SPSS 22.0. <b>Results</b> The effective monitoring rate for the three years was 78.82%, 81.65%, and 96.85%, respectively, showing an increasing trend (<i>χ</i>²_trend = 16.134, <i>P</i> < 0.001). The annual dose equivalent per capita was 0.142, 0.142, and 0.265 mSv, respectively. The annual dose equivalent per capita in 2020 was significantly higher than those in 2018 (<i>H</i> = 24.562, <i>P</i> < 0.001) and 2019 (<i>H</i> = 39.378, <i>P</i> < 0.001). The annual dose equivalent per capita in 2020 was in the order of interventional clinician > interventional nurse > technician (<i>H</i> = 10.699, 6.562, <i>P</i> < 0.01). The annual dose equivalent per capitain 2020 was higher in the cardiology interventional department than in the comprehensive interventional, neuro interventional, and vascular surgery departments (<i>H</i> = 35.530, 37.614, 35.496, <i>P</i> < 0.001). <b>Conclusion</b> The number of interventional radiology staff monitored from 2018 to 2020 increased year by year, so did the effective monitoring rate.The external exposure dose was at low levels, which generally meets the requirements of national occupational exposure limits. Training on radiation protection for interventional radiology staff should be further strengthened to raise awareness of radiation protection.

Investigation and analysis on resources and radiation protection status of interventional radiology in Beijing / 中华放射医学与防护杂志

Objective:To ascertain the distribution of interventional radiodiagnosis and treatment resources and the current situation of radiological protection in Beijing, standardize the interventional radiodiagnosis and treatment, and promote the implementation of radiation protection regulatory measures.Methods:Various medical institutions at differetn levels that perform interventional radiodiagnosis and treatment in Beijing were identified as the survey objects. With special questionnaires designed, the investigation groups at two levels of municipality and district was established to investigate the basic situation of interventional radiology and occupational health monitoring by the end of 2020. The indexes and parameters were analyzed and evaluated under the relevant national regulations and standards.Results:By the end of 2020, there were 93 medical institutions performing interventional radiology in Beijing, together with 236 digital subtraction angiography machines (DSA) with higher than 800 mA. A total of 135 593 cases of interventional radiological surgical operation were performed. There were 40 hospitals annually performing more than 1 000 cases and 41 hospitals perfoming 10-1 000 cases. There were 3 539 interventional radiological workers, with 99.0% holding radiological worker certificates. The passing rates of occupational health examination, personal dose monitoring and radiation protection training were 96.9%, 99.5% and 95.8%, respectively. A total of 3 532 sets of protective articles were provided for the workers, of which 98.9% were equipped with split or integrated lead clothing, but 6.5% were not equipped with lead protective glasses and 54.9% were not equipped with lead protective gloves.Conclusions:The radiation protection management for the interventional radiodiagnosis and treatment is generally good. However, the regulatory mechanism should be further improved based on the current distribution of interventional radiodiagnosis and treatment resources, with focus on strengthening the occupational health examination, the radiation protection training, and the configuration and use of protective equipment.

Current situation of radiological health of interventional radiology of different ranks medical institutions in a city / 中国辐射卫生

Object the current radiological health situation of different ranks medical institutions of interventional radiology in a city of Pearl Delta. Methods all the medical institutions in the city, which had carried out interventional radiology before December 31, 2019 as the research objects by survey. By using the method of field epidemiological investigation, the basic situation of general messages, the status of protective facilities, environmental radiation does, personal protective equipment, occupational health monitoring were investigated. Results There were 12 interventional radiology equipment and 180 employees in 7 medical institutions in the city, before December 31, 2019. There was no statistical significance in the composition of employees of different ranks medical institutions (P > 0.05). There was no statistical significance in the composition of protective facilities for interventional treatment in different ranks hospitals (P > 0.05). The environmental radiation dose in interventional radiology devices room of grade A class 3 hospital was higher than that of grade A class 2 hospital (P < 0.05). There was no statistical significance in the composition of individual protective equipment for interventional therapy in different ranks medical institutions (P > 0.05). The proportion of occupational health examination before work and during work in grade A class 2 hospital was higher than A class 3 hospital (P < 0.01). Conclusion The current situation of radiological health of different ranks medical institutions of interventional radiology in a city of Pearl Delta was good momentum. It may be helpful to improve the radiological health protection level of interventional therapy in this city by strengthening the radiological protection management of applying for interventional therapy, actively carrying out the evaluation of radiological protection against occupational disease hazards in construction projects, and urging the employee to carry out the occupational health monitoring inspection as required.

New infusion device for use in acquisition of images during endovascular procedures: an experimental model / Novo dispositivo de infusão para a aquisição de imagens durante procedimentos endovasculares: modelo experimental

Abstract Background The contrast power injector (CPI) is the gold standard method for injecting contrast with the pressure and flow needed to generate a satisfactory images during endovascular procedures, but it is an expensive tool, narrowing its wide-scale applications. One alternative is the manual injection (MI) method, but this does not generate the pressure required for adequate visualization of anatomy. It is therefore imperative to create an alternative low-cost method that is capable of producing high quality images. Objectives To compare the injection parameters of a new mechanical device (Hand-Crank) created in a university hospital with the MI method and with the contrast power injector's ideal values. Methods A circulation phantom was constructed to simulate the pressure in the aorto-iliac territory and the injection parameters of the two methods were compared in a laboratory setting. Student's t test and the Mann-Whitney test were used for statistical analysis. Three vascular surgery residents (the authors) performed the injections (each performed 9 tests using conventional manual injection and 9 tests using the Hand-Crank, totaling 54 injections). Results There were statistical differences between the two methods (p<0.05) in total volume injected until maximum pressure was attained, pressure variation, maximum pressure, total injection time, and time to reach the maximum pressure. Conclusions The Hand-Crank can achieve higher maximum pressure, higher average flow, and lower injection time than the manual method. It is a simple, low-cost, and effective tool for enhancing injection parameters in an experimental setup. It could help to produce higher quality images in a clinical scenario.

Resumo Contexto A bomba injetora é o método padrão-ouro para a injeção de contraste em aortografias. Entretanto, é uma ferramenta de alto custo, o que limita o seu uso. A injeção manual surge como alternativa, mas a pressão gerada com esse método é baixa, e, por isso, a qualidade das imagens não é usualmente satisfatória. Assim, a criação de um método de baixo custo capaz de gerar imagens de qualidade é imperativo. Objetivos Comparar os parâmetros de injeção de um novo dispositivo mecânico (manivela articulada) criado em um hospital universitário com os parâmetros da injeção manual e com os valores ideais da bomba injetora. Métodos Um simulador do território aórtico foi construído, e parâmetros de injeção entre os diferentes métodos em um cenário laboratorial controlado foram analisados. O teste t de Student e o teste de Mann-Whitney foram usados para análise estatística. Três residentes de Cirurgia Vascular realizaram os testes (nove usando o novo dispositivo, e nove usando a injeção manual, totalizando 54 injeções). Resultados Houve diferença estatisticamente significativa (p < 0,05) entre os dois métodos, considerando os parâmetros: variação de pressão, pressão máxima, tempo de injeção, tempo até a pressão máxima e volume até a pressão máxima. Conclusões A manivela articulada atingiu níveis superiores de pressão e de velocidade de injeção, com menor tempo de injeção do que a injeção manual. É um dispositivo simples, de baixo custo e com resultados comparáveis à bomba injetora, o que sugere seu uso potencial na geração de imagens satisfatórias em aortografias.

Should the Oddis sphincter be retained? A clinical analysis of biliary metal stent implantation in patients with malignant obstructive jaundice

Objective: We sought to analyze the efficacy and safety of preserving the Oddis sphincter during metallic biliary stent implantation in patients with malignant obstructive jaundice. Materials and Methods: In a retrospective analysis, 133 patients with malignant obstructive jaundice who were admitted to our hospital from January 2010 to January 2017 and who underwent metallic biliary stent implantation were divided into two groups – the Oddis sphincter retention group (n = 55) and the Oddis sphincter nonretention group (n = 78) – according to whether the Oddis sphincter was left untouched during stent placement. The patient clinical data as well as information on complications, time of stent patency, improvement in liver function, and decline of serum bilirubin were reviewed and evaluated. Statistical analysis was performed using the Statistical Package for the Social Sciences version 19.0 (IBM Corp., Armonk, NY, USA, USA) and Prism version 7 (GraphPad Software, San Diego, CA, USA). Results: The median follow-up time was 9.6 months (range: 1–20 months) and there was no significant difference in general clinical information between the two groups. However, the incidence rates of acute biliary infection, recurrent biliary infection, acute pancreatitis, chronic pancreatitis, and asymptomatic pancreatic enzyme levels were higher in the Oddis sphincter retention group and the differences were all statistically significant (P < 0.05). Conversely, there were no significant differences in bilirubin decline, liver function improvement, and stent patency between the two groups (P > 0.05). Conclusion: Leaving the Oddis sphincter untouched during biliary stent placement can reduce the incidence of postoperative complications, while there was no effect on stent patency or jaundice relief. Therefore, it is recommended to preserve the Oddis sphincter when the stenosis is more than 3 cm above the duodenal papilla