Survey of Intern Year Experiences for Those Going into Interventional Radiology: Comparing Surgery, Medicine and Transitional Year Internships.

SURGERY, INTERNAL MEDICINE, OR TRANSITION YEAR FOR INTERNS GOING INTO INTERVENTIONAL RADIOLOGY: Comparison of intern year specialty in regards to preparation for interventional radiology (IR) with results and analysis of the resident, fellow, and student (RFS) survey of trainees. PURPOSE: Evaluate trainee experiences regarding internship variables with respect to IR preparedness. MATERIALS: A questionnaire created by members of the Society of Interventional Radiology (SIR) RFS IR Residency Training Committee was distributed to RFS members at SIR 2017 conference and via an online survey. The anonymous survey consisted of Likert scale, dichotomous questions, and free response questions. Results were analyzed utilizing a one-way analysis of variance (ANOVA), calculation of mean, standard deviation (SD) and 95% confidence interval (CI). RESULTS: A total of 112 residents completed the survey (47 Surgery, 33 Medicine, 29 Transitional Year [TY]), and 3 nontraditional internships categorized as other (2 Pediatric, and 1 Neurosurgery). The average procedures performed as intern were; Surgery: 51-75, Medicine: 0-25, TY: 25-50, Other: 25-50. Trainees who completed a surgical internship reported an overall higher comfort level with procedures (Mean: 4.23, SD: 0.81, CI: 0.21, p < 0.00001) compared to medicine interns (2.84, SD: 1.42, CI: 0.48), and TY interns (3.03, SD: 1.48, CI: 0.55). There was no statistical difference between subgroups when comparing; months of night float, maximum consecutive hours worked, ancillary work, etc. Preliminary surgery residents reported a higher quality preparation for IR in their programs (4.3, SD: 0.93, CI: 0.27, p < 0.01) in comparison to Medicine (3.4, SD: 1.1, CI: 0.4), and TY residents (3.6, SD: 1.2, CI: 0.46). Ninety-four percent of surgery residents would choose to repeat a surgery internship. TY residents were next likely to choose the same type of internship at 83%, while the remaining 17% would choose to do surgery year. Medicine residents were least likely to choose medicine again, 23/33 (70%). Surgery, TY, and then medicine residents would choose the same program again (83%, 79%, 75%, respectively). CONCLUSION: In alignment with SIR recommendations, the general consensus of trainees surveyed support that a preliminary surgery internship provides the greatest preparation for IR training. Surgical internships provided the greatest opportunity to perform procedures, corresponding with greater comfort levels, and self-reported better preparedness for future training in IR.

Recruiting Medical Students to Interventional Radiology: Current State of Affairs.

OBJECTIVE: Interventional radiology/diagnostic radiology (IR/DR) is the newest primary specialties offered to trainees, one that medical students can now apply to directly out of medical school. However, medical students are disadvantaged in that the integrated IR/DR pathway requires early decision when often radiology rotations are not part of the core clerkship curriculum. Based upon results from a survey to Integrated IR/DR Program Directors, we report strategies being used by programs to introduce and attract medical students to IR. MATERIALS AND METHODS: A questionnaire was written touching on various aspects of medical student engagement. The questionnaire was sent out electronically to 51 IR/DR Program Directors and answers were collated by the Society of Interventional Radiology Resident Fellow Student Section, IR Residency Training Committee. RESULTS: Eighteen responses were recorded from programs across the country. All programs encouraged applying to both DR and IR programs. All except one offered research opportunities (94%). The majority offered shadowing opportunities, had dedicated IR interest groups, and invited medical students to device workshops (78%). Planned informal opportunities for medical students to meet faculty and a dedicated department website were made available by most (67%). Little more than half invited medical students to journal clubs (59%). Formal medical student-faculty mentorship program and social media outreach initiatives like Facebook, Student Doctor Network, Twitter, LikedIn, Youtube, and podcasts rounded out the bottom two (50%). Importantly, respondents indicated that they were interested in hearing the results of the survey. CONCLUSION: Our survey offers a snapshot of exactly what program directors are doing to address the issue of medical student recruitment.

Percutaneous access planning, techniques and considerations for endovascular aortic repair (EVAR).

Percutaneous endovascular aortic repair (EVAR) has transformed the field of aortic repair. As techniques and devices improve, interventionalists continue to expand the boundaries of what is possible, enabling these life-saving procedures to be performed on a wider range of more technically challenging cases. This article discusses endovascular access considerations for EVAR including; ultrasound guidance, preclose technique, access vessel options, innovative devices, and bailout strategies that interventionalists should be familiar with to optimize patient outcomes.

Quality-of-life assessment after palliative interventions to manage malignant ureteral obstruction.

PURPOSE: Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys. METHODS: Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal-Wallis and Friedman's test were used to compare patients at 7, 30, and 90 days. Spearman's rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL. RESULTS: Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent-related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes. CONCLUSION: QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.

Semi-automated volumetric quantification of tumor necrosis in soft tissue sarcoma using contrast-enhanced MRI.

BACKGROUND: Response Evaluation Criteria in Solid Tumors (RECIST)-defined measurements are limited when evaluating soft tissue sarcoma (STS) response to therapy. Histopathological assessment of STS response requires a determination of necrosis following resection. A novel semi-automated technique for volumetric measurement of tumor necrosis, using enhanced magnetic resonance imaging (CE-MRI), is described. PATIENTS AND METHODS: Eighteen patients with STS were treated with neoadjuvant therapy and then resected. CE-MRI, obtained prior to resection, were evaluated by two observers using semi-automated segmentation. Tumor volume and percent necrosis was compared with histology and RECIST measurements. RESULTS: The median percent necrosis, determined histologically and from CE-MRI, was 71.9% and 67.8%, respectively. Accuracy of these semi-automated measurements was confirmed, being statistically similar to those obtained at histopathological assessment of the resected tumor. High Intra-class correlation co-efficients suggest good inter-observer reproducibility. Tumor necrosis did not correlate with the RECIST measurements. CONCLUSION: Semi-automated determination of tumor volume and necrosis, using CE-MRI, is suggested to be accurate and reproducible.

Design and synthesis of 4,5-disubstituted-thiophene-2-amidines as potent urokinase inhibitors.

A study of the S1 binding of lead 5-methylthiothiophene amidine 3, an inhibitor of urokinase-type plasminogen activator, was undertaken by the introduction of a variety of substituents at the thiophene 5-position. The 5-alkyl substituted and unsubstituted thiophenes were prepared using organolithium chemistry. Heteroatom substituents were introduced at the 5-position using a novel displacement reaction of 5-methylsulfonylthiophenes and the corresponding oxygen or sulfur anions. Small alkyl group substitution at the 5-position provided inhibitors equipotent with but possessing improved solubility.