Impact of the COVID-19 Pandemic on Interventional Radiology in Germany. / Auswirkung der COVID-19-Pandemie auf die Interventionelle Radiologie in Deutschland.

PURPOSE: To investigate the effect of the ongoing COVID-19 pandemic on interventional radiology (IR) in Germany in 2020 and 2021. MATERIALS UND METHODS: This retrospective study is based on the nationwide interventional radiology procedures documented in the quality register of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR-QS-Register). The nationwide volume of interventions in the pandemic years 2020 and 2021 was compared with the pre-pandemic period (Poisson-test, Mann-Whitney test). The aggregated data were additionally evaluated by intervention type with differentiated consideration of the temporal epidemiological infection occurrence. RESULTS: During the two pandemic years 2020 and 2021, the number of interventional procedures increased by appr. 4 % compared to the same period of the previous year (n = 190 454 and 189 447 vs. n = 183 123, respectively, p < 0.001). Only the first pandemic wave in spring 2020 (weeks 12-16) showed a significant temporary drop in the number of interventional procedures by 26 % (n = 4799, p < 0.05). This primarily involved interventions that were not immediately medically urgent, such as pain treatments or elective arterial revascularization. In contrast, interventions in the field of interventional oncology, such as port catheter implantations and local tumor ablations, remained unaffected. The decline of the first wave of infection was accompanied by a rapid recovery and a significant, partly compensatory, 14 % increase in procedure numbers in the second half of 2020 compared to the same period of the previous year (n = 77 151 vs. 67 852, p < 0.001). Subsequent pandemic waves had no effect on intervention numbers. CONCLUSION: The COVID-19 pandemic in Germany led to a significant short-term decrease in interventional radiology procedures in the initial phase. A compensatory increase in the number of procedures was observed in the subsequent period. This reflects the adaptability and robustness of IR and the high demand for minimally invasive radiological procedures in medical care. KEY POINTS: · The study shows the nationwide pandemic-related effects on interventional radiology in Germany.. · In quantitative terms, the ongoing pandemic caused a significant, temporary decline in intervention cases only in the initial phase.. · Subsequent waves of infections had no effect on the scope of services provided by interventional radiology.. · Short-term deficits, especially in elective interventions, could be partially compensated.. CITATION FORMAT: · Schmidbauer M, Busjahn A, Paprottka P et al. Impact of the COVID-19 Pandemic on Interventional Radiology in Germany. Fortschr Röntgenstr 2023; 195: 597 - 604.

"Invictus".

While attempting to thrombose a pseudoaneurysm, an interventional radiology resident provides important care to a patient beyond the procedure.

Leveraging the virtual learning environment to enhance medical student engagement with interventional radiology.

PURPOSE: To evaluate medical student engagement with Interventional Radiology (IR) before and after a virtual elective course. METHODS: The elective was nine, one-hour lectures over ten weeks. An anonymous pre and post-course survey was administered to students. The hypothesis was that this course would increase student engagement with IR. Respondents answered nine questions to score their interest in, exposure to, familiarity with, and understanding of IR using a five-point Likert scale. Demographics were reported for the pre-course group only. A Wilcoxon signed-ranked test was performed to assess for significant mean change in pre and post-course responses. Among the 276 registered students, there were 144 individual, complete responses for the pre-course survey, and 60 paired responses for both surveys. RESULTS: Thirty-seven percent of respondents were first or second year medical students. Thirty percent of participants were enrolled at an institution outside of the United States, 26% are the first in their family to attend college, and 41% identified as female. Thirty-six percent reported this virtual course was one of their earliest experiences with IR. There was a significant increase in student exposure to IR generally, familiarity with IR compared to other specialties, familiarity with the IR training pathway(s), understanding of what an Interventional Radiologist does, understanding of the difference between IR and Diagnostic Radiology, and understanding of when to consult IR for patient care after completion of the course. CONCLUSION: A virtual IR elective is an effective means to increase exposure to, familiarity with, and understanding of IR.

Establishing a telemedicine program for interventional radiology: a study of patient opinion and experience.

PURPOSE The COVID-19 pandemic forced healthcare officials to implement new policies, such as the use of virtual consultations over office-based medical appointments, to reduce the transmission of the virus. The purpose of this study is to quantitatively compare patients' experiences with virtual outpatient telemedicine encounters at a single academic institution in Interventional Radiology (IR) and in-person visits during the course of the COVID-19 pandemic. METHODS The TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were used to survey patients' satisfaction with both in-person and virtual office visits. RESULTS Ninety respondents (38 in-person, 52 virtual) acknowledged numerous benefits of virtual visits versus in-person office visits including reductions in time, cost, and potential viral transmission risk during the COVID-19 pandemic. No statistically significant difference was noted, based on a Likert scale from 1 to 7, between in-person and virtual visits (all p > 0.05) for scheduling related factors. No statistically significant difference was noted in any of the MCCS subscales between the two cohorts in regards to medical information communication (all p > 0.05). A majority of patients with virtual encounters (82.7%) stated that it was easy to obtain an electronic device for use during the telemedicine visit, and 73.1% of patients felt that setting up the telemedicine encounter was easy. CONCLUSION This study demonstrates that telemedicine is an acceptable alternative to in-office appointments and could increase access to IR care outside of the traditional physician-patient interaction. With telemedicine visits, patients can communicate their concerns and obtain information from the doctor with noninferior communication compared to in-person visits.

The Role of Interventional Radiology and Management of an Angiography Suite in the Treatment of COVID-19 Patients: Single-Center, 2-Year Experience.

Background and Objectives: Hospital angiography suites with negative-pressure ventilation facilities are challenging to equip. During the COVID-19 pandemic, we aimed to introduce interventional radiology procedures performed on COVID-19 patients and understand management of the angiography suite without a negative-pressure ventilation facility before and after the procedures to prevent the spread of infection. Materials and Methods: Between December 2020 and November 2022, 52 COVID-19 patients underwent interventional radiology procedures in an angiography suite, where no negative-pressure ventilation facility was installed. During the procedure, all staff members wore full personal protection equipment, and after the procedure for the COVID-19-positive patient was completed, the angiography suite was disinfected and entry to the angiography suite was prohibited for 1-3 h. In this angiography suite, procedures for COVID-19 patients and non-COVID-19 patients were performed. Results: A total of 61 interventional radiology procedures were performed in 52 patients with COVID-19. Of 52 patients, 21 underwent procedures under intubation and mechanical ventilation. All procedures were performed according to the guidelines set by the Infection Control Committee of our hospital. No major or minor complications were associated with the procedures. There were no cases of infection among staff members or other non-COVID-19 patients related to procedures on COVID-19 patients. Conclusions: Interventional radiology can play an important role in solving the complications of COVID-19 and the problems caused by patients' underlying diseases. In addition, if accurate guidelines are followed, both COVID-19 and non-COVID-19 patients can undergo procedures in an angiography room without negative-pressure ventilation while preventing infection.

Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation.

In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.

The Impact of COVID-19 on Interventional Radiology Practice Worldwide: Results from a Global Survey.

BACKGROUND: The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves. METHODS: An anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis. RESULTS: Interventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis. CONCLUSION: While the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic.

Vertebral artery dissection managed by interventional radiology.

A 21-year-old patient presented with sudden-onset headache, visual disturbance and left hand incoordination. She was diagnosed with a left vertebral artery dissection of the V3 segment resulting in multiple cerebellar and cerebral infarcts. There were no risk factors for dissection other than recent COVID-19 infection. She was treated initially with antiplatelets, followed by anticoagulation, but experienced recurrent ischaemia. Although guidance suggests endovascular repair may be beneficial for patients with cerebral artery dissection (CAD) who experience recurrent strokes on medical therapy, evidence is limited. After multidisciplinary team consideration of the individual patient anatomy and risks and benefits of different endovascular techniques, the patient was treated with endovascular coiling. At 10 months follow-up, she had no further strokes and improving neurological symptoms. The case highlighted COVID-19 as a potential trigger for CAD and the use of endovascular coiling in preventing catastrophic cerebral ischaemia in CAD refractive to medical therapy.

Impact of the first year of the COVID-19 pandemic on an interventional radiology unit.

OBJECTIVES: To describe the impact of the Covid-19 pandemic on the interventional radiology unit at our hospital in the first year of the pandemic. MATERIAL AND METHODS: This prospective observational study included 83 consecutive patients with confirmed SARS-CoV-2 infections who underwent an interventional radiology procedure in the period comprising March 13, 2020 through March 13, 2021. We describe the repercussions of the situation on the unit's total activity, as well as on its activity during the different phases of the pandemic. RESULTS: Technical and clinical success were achieved in 96.43% and 82.14% of cases, respectively. During follow-up throughout the year, 68 patients remained alive and 15 died from their underlying disease. No complications related with interventional procedures occurred, and activity declined by only 12% in comparison with the same period in the previous year (2019-2020, without COVID). Similarly, the decrease in relative value units and radiology activity units was only 13% and 12%, respectively. CONCLUSION: The Covid-19 pandemic has been a challenge in our daily work, leading to an overall decrease in the number of procedures. Nevertheless, the interventional radiology unit has been actively involved in caring for Covid-19 patients, performing a wide variety of necessary procedures. Following a series of specific measures and protocols has enabled us to perform interventional radiology procedures safely during the pandemic.

Deployment of an Interventional Radiology Telemedicine Program During the COVID-19 Pandemic: Initial Experience With 10,056 Visits.

OBJECTIVE: To evaluate the clinical, operational, and financial effects of using telemedicine services in an academic interventional radiology setting during the coronavirus disease 2019 pandemic and to identify potential barriers to equitable telemedicine access for patients. METHODS: Evaluation and management (E&M) data over a 104-week period from September 2019 to August 2021 were reviewed. Data related to the visits were recorded including visit type, billing provider, patient demographic information, Current Procedural Terminology code charged, and reimbursement received. The ZIP code pertaining to the patient's primary residence was matched with median household income from the US Census Bureau. RESULTS: In all, 14,754 E&M encounters were performed over the study period, of which 10,056 were conducted using telemedicine. Twenty-two percent of visits were performed with interactive video; the remainder were performed using audio only. Female patients were more likely than male patients to use interactive video visits for telemedicine encounters (23.7% versus 20.4%, P < .001). Patients availing of video visits (mean age, 58.1 years, SD = 14.0) were also significantly younger than those patients who used audio-only (telephone) encounters (mean age, 62.5 years, SD = 13.3). Patients with private insurance and those living in neighborhoods with higher median household income were more likely to avail of interactive video visits (P < .001). Professional E&M monthly revenue was between 23.3% and 53.2% of peak prepandemic levels (mean 37.7%). CONCLUSION: Telemedicine services allowed for rapid restoration of E&M encounter volumes over the study period. Further work is required to determine the potential implementation barriers to increasing the use of video visits.

Variability in personal protective equipment in cross-sectional interventional abdominal radiology practices.

PURPOSE: To determine institutional practice requirements for personal protective equipment (PPE) in cross-sectional interventional radiology (CSIR) procedures among a variety of radiology practices in the USA and Canada. METHODS: Members of the Society of Abdominal Radiology (SAR) CSIR Emerging Technology Commission (ETC) were sent an eight-question survey about what PPE they were required to use during common CSIR procedures: paracentesis, thoracentesis, thyroid fine needle aspiration (FNA), superficial lymph node biopsy, deep lymph node biopsy, solid organ biopsy, and ablation. Types of PPE evaluated were sterile gloves, surgical masks, gowns, surgical hats, eye shields, foot covers, and scrubs. RESULTS: 26/38 surveys were completed by respondents at 20/22 (91%) institutions. The most common PPE was sterile gloves, required by 20/20 (100%) institutions for every procedure. The second most common PPE was masks, required by 14/20 (70%) institutions for superficial and deep procedures and 12/12 (100%) institutions for ablation. Scrubs, sterile gowns, eye shields, and surgical hats were required at nearly all institutions for ablation, whereas approximately half of institutions required their use for deep lymph node and solid organ biopsy. Compared with other types of PPE, required mask and eye shield use showed the greatest increase during the SARS-CoV-2 pandemic. CONCLUSION: PPE use during common cross-sectional procedures is widely variable. Given the environmental and financial impact and lack of consensus practice, further studies examining the appropriate level of PPE are needed.

The effectiveness of the Safety in Interventional Radiology (SIR) Shield in reducing droplet transmission and its effect on image quality and radiation dose.

OBJECTIVE: To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. METHODS: A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. RESULTS: Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. CONCLUSION: Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. ADVANCES IN KNOWLEDGE: This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre.