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1.
J Cardiovasc Med (Hagerstown) ; 23(5): 290-303, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1883852

ABSTRACT

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.


Subject(s)
Cardiology , Cardiomyopathies , Heart Diseases , Neoplasms , Chest Pain , Coronary Artery Bypass , Humans , Radiology, Interventional , Stents , Tomography, X-Ray Computed/methods
2.
Cardiovasc Intervent Radiol ; 45(8): 1152-1162, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1739297

ABSTRACT

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.


Subject(s)
COVID-19 , Humans , Pandemics/prevention & control , Radiologists , Radiology, Interventional , Surveys and Questionnaires
3.
J Med Imaging Radiat Sci ; 53(2 Suppl): S18-S21, 2022 06.
Article in English | MEDLINE | ID: covidwho-1729933
4.
BMJ Case Rep ; 15(2)2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1714385

ABSTRACT

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.


Subject(s)
COVID-19 , Endovascular Procedures , Vertebral Artery Dissection , Adult , Endovascular Procedures/methods , Female , Humans , Radiology, Interventional , SARS-CoV-2 , Vertebral Artery , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery Dissection/therapy , Young Adult
5.
Radiologia (Engl Ed) ; 64(1): 3-10, 2022.
Article in English | MEDLINE | ID: covidwho-1708839

ABSTRACT

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.


Subject(s)
COVID-19 , Humans , Pandemics , Radiography , Radiology, Interventional , SARS-CoV-2
6.
J Am Coll Radiol ; 19(2 Pt A): 243-250, 2022 02.
Article in English | MEDLINE | ID: covidwho-1635312

ABSTRACT

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.


Subject(s)
COVID-19 , Telemedicine , Female , Humans , Male , Middle Aged , Pandemics , Radiology, Interventional , SARS-CoV-2
7.
Abdom Radiol (NY) ; 47(3): 1167-1176, 2022 03.
Article in English | MEDLINE | ID: covidwho-1616117

ABSTRACT

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.


Subject(s)
COVID-19 , Personal Protective Equipment , Cross-Sectional Studies , Humans , Radiology, Interventional , SARS-CoV-2
8.
Br J Radiol ; 95(1129): 20210835, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1575206

ABSTRACT

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.


Subject(s)
Infectious Disease Transmission, Patient-to-Professional/prevention & control , Protective Devices , Radiology, Interventional/instrumentation , Adult , COVID-19/transmission , Cough , Equipment Design , Fluorescence , Humans , Male , Phantoms, Imaging , Radiation Dosage , Signal-To-Noise Ratio , Supine Position
12.
Acad Radiol ; 29(3): 413-415, 2022 03.
Article in English | MEDLINE | ID: covidwho-1432704

ABSTRACT

Interventional Radiology residency training programs experienced significant impacts secondary to the COVID-19 pandemic. Prospective resident recruitment and resident education were particularly affected due to limitations on in-person gatherings in effort to curb exposure. Finding ways to mitigate the pandemic's effect on recruitment and education was a challenge faced by residency programs across the nation. This article discusses a single Interventional Radiology program's approach to adapting to the reality of limited interpersonal interaction as well as efforts to maintain engagement for resident recruitment and education in a virtual setting.


Subject(s)
COVID-19 , Internship and Residency , Humans , Pandemics , Prospective Studies , Radiology, Interventional/education , SARS-CoV-2
16.
Radiol Med ; 126(10): 1258-1272, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1290023

ABSTRACT

PURPOSE: Chest imaging modalities play a key role for the management of patient with coronavirus disease (COVID-19). Unfortunately, there is no consensus on the optimal chest imaging approach in the evaluation of patients with COVID-19 pneumonia, and radiology departments tend to use different approaches. Thus, the main objective of this survey was to assess how chest imaging modalities have been used during the different phases of the first COVID-19 wave in Italy, and which diagnostic technique and reporting system would have been preferred based on the experience gained during the pandemic. MATERIAL AND METHODS: The questionnaire of the survey consisted of 26 questions. The link to participate in the survey was sent to all members of the Italian Society of Medical and Interventional Radiology (SIRM). RESULTS: The survey gathered responses from 716 SIRM members. The most notable result was that the most used and preferred chest imaging modality to assess/exclude/monitor COVID-19 pneumonia during the different phases of the first COVID-19 wave was computed tomography (51.8% to 77.1% of participants). Additionally, while the narrative report was the most used reporting system (55.6% of respondents), one-third of participants would have preferred to utilize structured reporting systems. CONCLUSION: This survey shows that the participants' responses did not properly align with the imaging guidelines for managing COVID-19 that have been made by several scientific, including SIRM. Therefore, there is a need for continuing education to keep radiologists up to date and aware of the advantages and limitations of the chest imaging modalities and reporting systems.


Subject(s)
COVID-19/diagnostic imaging , Health Care Surveys , Lung/diagnostic imaging , Radiologists/statistics & numerical data , Tomography, X-Ray Computed , Ultrasonography , COVID-19/epidemiology , Consensus , Humans , Italy/epidemiology , Pandemics , Practice Guidelines as Topic , Radiography, Thoracic , Radiology Department, Hospital , Radiology, Interventional , Sensitivity and Specificity , Societies, Medical , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/statistics & numerical data , Ultrasonography/statistics & numerical data
17.
Acad Radiol ; 28(9): 1209-1218, 2021 09.
Article in English | MEDLINE | ID: covidwho-1260626

ABSTRACT

PURPOSE: To report the impact of the coronavirus disease 2019 (COVID-19) pandemic on interventional radiology (IR). MATERIALS AND METHODS: A 78-question survey was distributed to practicing interventional radiologists and IR trainees. The survey consisted of demographic and practice environment queries. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) screener, and coping strategies were assessed using the Brief-Coping Orientation to Problems Experienced (Brief-COPE) questionnaire. RESULTS: There were 422 respondents including 333 (78.9%) attending interventional radiologists and 89 (21.1%) interventional radiologists-in-training from 15 counties. Most respondents were from academic medical centers (n = 218; 51.7%). A large majority (n = 391; 92.7%) performed a procedure on a patient with confirmed COVID-19 infection. An N95 mask was the most common (n = 366; 93.6%) safety measure employed. Cancellation or limitation of elective procedures were reported by 276 (65.4%) respondents. Many respondents (n = 177; 41.9%) had self-reported anxiety (GAD-7 score >5) with an overall mean GAD-7 score of 4.64 ± 4.63 (range: 0-21). Factors associated with reporting anxiety included female gender (p = 0.045), increased call coverage (p = 0.048), lack of adequate departmental adjustments (p <0.0001), and lack of adjustments in a timely manner (p <0.0001). The most utilized coping strategy was acceptance (mean of 5.49 ± 1.88), while the most employed dysfunctional coping strategy was self-distraction (mean of 4.16 ± 1.67). The odds of reporting anxiety increased by >125% with adoption of dysfunctional strategies. CONCLUSION: The COVID-19 pandemic induced practice alterations and high rates of self-reported anxiety in IR. Female gender, increased call coverage, and lack of adequate or timely departmental adjustments were associated with increased anxiety levels.


Subject(s)
COVID-19 , Radiologists/psychology , Radiology, Interventional , Adaptation, Psychological , Anxiety , Female , Humans , Male , Pandemics , Radiology, Interventional/trends
18.
Curr Opin Anaesthesiol ; 34(4): 476-481, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1254865

ABSTRACT

PURPOSE OF REVIEW: This review discusses the general anesthetic approach of endovascular stroke therapy and highlights recent advances and considerations for optimal intraoperative management of acute ischemic stroke. RECENT FINDINGS: Recent randomized controlled trials have shown no differences in clinical outcomes between monitored anesthesia care with sedation compared with general anesthesia for endovascular stroke therapy. The COVID-19 pandemic has complicated decision-making in the neurointerventional setting. Advances in imaging techniques have extended the window of treatment for endovascular therapy. SUMMARY: Optimal time to intervention, hemodynamic stability, novel imaging techniques, and careful consideration of anesthetic plan can impact patient outcomes in reperfusion stroke therapy.


Subject(s)
Anesthetics , Brain Ischemia , COVID-19 , Endovascular Procedures , Ischemic Stroke , Stroke , Brain Ischemia/therapy , Conscious Sedation , Endovascular Procedures/adverse effects , Humans , Pandemics , Radiology, Interventional , SARS-CoV-2 , Stroke/therapy , Treatment Outcome
20.
Clin Radiol ; 76(8): 621-625, 2021 08.
Article in English | MEDLINE | ID: covidwho-1233402

ABSTRACT

AIM: To review data on the impact of the COVID-19 pandemic on interventional radiology (IR) services. MATERIALS AND METHODS: A systematic review of the available studies was performed according to the PRISMA guidelines. RESULTS: A total of 14 studies met the inclusion criteria. IR caseload reduced between 16.8-80%, with elective activity affected more than emergency work. Trainees also experienced a 11-51.9% reduction in case volumes and many were redeployed to critical care. IR departments re-organised operations and personnel, and many continued to offer 24/7 services and support critical care areas through redeployment of staff. The majority of studies report no significant issues with the availability of personal protective equipment and that local or national governing body or radiology society guidelines were followed. CONCLUSION: The COVID-19 pandemic reduced case volumes and training opportunities. IR departments showed flexibility in service delivery. The lessons learned offer novel insights into how services and training can be reorganised to ensure that IR continues to thrive.


Subject(s)
COVID-19/epidemiology , Pneumonia, Viral/epidemiology , Radiology, Interventional , Workload , Global Health , Humans , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2
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