New and improved orthopedic hardware for the 21st century: part 1, upper extremity.

OBJECTIVE: The purpose of this article is to provide a survey of new orthopedic products for use in the upper extremity. CONCLUSION: Knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications is important in assessing new orthopedic devices.

New and improved orthopedic hardware for the 21st century: part 2, lower extremity and axial skeleton.

OBJECTIVE: The purpose of this article is to provide a survey of new orthopedic products for use in the lower extremity and axial skeleton. CONCLUSION: Knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications is important in assessing new orthopedic devices.

A survey-based evaluation of the radiology residency interview process.

PURPOSE: The aim of this study was to assess the diagnostic radiology residency interview process and determine variability among programs in their approach to interviewing candidates. METHODS: A survey of the residency interview process was sent to diagnostic radiology program directors through an e-mail address list provided by the Association of Program Directors in Radiology. Questions addressed were (1) the number of applicants interviewed per residency position offered; (2) the number of interviews scheduled for each applicant on the interview day; (3) whether interviews were performed by staff members, residents, or both; and (4) whether interviewers were granted time away from clinical services to interview applicants. RESULTS: Two electronic mailings were sent to 313 individuals. Responses were received from 89 of 188 accredited diagnostic radiology residency programs (response rate, 47.3%). The average number of interviews per residency position was 12.6 (range, 3-28), with university-based programs interviewing significantly fewer candidates (mean, 11.5) than non-university-based programs (mean, 15.3). The average number of individual interviews during the interview day was 3.9 (range, 1-8) per candidate at each program. Of responding programs, 69% of responding programs included residents in interviews, and 67% compensated their interviewing staff members with time off clinical service, with no statistical difference between large and small programs. CONCLUSION: There is a large amount of variability present in the residency interview process. Applicants to programs may have very different experiences while visiting programs. Further study of this variation may allow programs to optimize resource utilization while maintaining success in the match process.

Single-institution results of image-guided nonplugged percutaneous versus transjugular liver biopsy.

PURPOSE: To retrospectively review patients who underwent transjugular and image-guided percutaneous biopsy and compare the relative risk of ascites, thrombocytopenia, and coagulopathy. MATERIALS AND METHODS: From August 2001 through February 2006, a total of 238 liver biopsies were performed. The radiologist reviewed all patient referrals for transjugular biopsy. These patients either underwent transjugular biopsy or were reassigned to percutaneous biopsy (crossover group). Patients referred to percutaneous image-guided liver biopsy underwent this same procedure. Biopsies were considered successful if a tissue diagnosis could be made from the samples obtained. RESULTS: A total of 36 transjugular biopsies were performed with 3 total (8.3%) and 1 major (2.8%) complications. A total of 171 percutaneous biopsies were performed with 10 (5.8%) total and 3 (1.8%) major complications. The crossover group showed a total of 4 (12.9%) complications with 1 (3.2%) major complication. Sample adequacy was 91.9% for transjugular and 99.5% for percutaneous biopsy. CONCLUSION: Both transjugular and percutaneous liver biopsy techniques are efficacious and safe. Contraindications such as thrombocytopenia, coagulopathy, and ascites are indicators of greater complications but are not necessarily prevented by transjugular biopsy. Percutaneous biopsy more frequently yields a diagnostic specimen than transjugular biopsy.

Complication rates and outcomes of 536 implanted subcutaneous chest ports: do rates differ based on the primary operator's level of training?

RATIONALE AND OBJECTIVES: Totally implanted subcutaneous central venous access devices (chest ports) are an attractive option for patients in need of intermittent, recurrent venous access. In our department, these are placed by different operator types including interventional radiology (IR) attending physicians, dedicated IR nurse practitioners (NP), and IR fellows/radiology residents. The purpose of our study is to assess the rate of complications of subcutaneous chest port placement among the different operator types. MATERIALS AND METHODS: A retrospective review of all subcutaneous central venous access devices implanted in our department between October 8, 2004, and October 19, 2007, was undertaken. Total numbers of port days, overall complication rates for all operators, as well as complication rates for the various operator types were calculated and were compared using the chi square test. RESULTS: A total of 558 patients had totally implanted subcutaneous central venous access devices placed during the period of study. Of these, 536 had documented follow-up and comprise the study population. A total of 89 were placed by attending physician alone, 133 by an NP, and 314 by an IR fellow or resident, with supervision by an attending physician. Mean duration of port usage was 341 days with 182,522 total port days. A total of 39 complications occurred (7.28%), including 27 infections (5%). There was no statistically significant difference in overall complication rates, including infection rates, among operator groups (P = .925). CONCLUSIONS: Our results confirm that well-trained physician extenders and trainees can safely perform chest port placement and that these providers, under appropriate supervision, can help provide improved access to chest port placement for patients and referring clinicians.

Implantable subcutaneous venous access devices: is port fixation necessary? A review of 534 cases.

Conventional surgical technique of subcutaneous venous port placement describes dissection of the port pocket to the pectoralis fascia and suture fixation of the port to the fascia to prevent inversion of the device within the pocket. This investigation addresses the necessity of that step. Between October 8, 2004 and October 19, 2007, 558 subcutaneous chest ports were placed at our institution; 24 cases were excluded from this study. We performed a retrospective review of the remaining 534 ports, which were placed using standard surgical technique with the exception that none were sutured into the pocket. Mean duration of port use, total number of port days, indications for removal, and complications were recorded and compared with the literature. Mean duration of port use was 341 days (182,235 total port days, range 1-1279). One port inversion/flip occurred, which resulted in malfunction and necessitated port revision (0.2%). Other complications necessitating port removal included infection 26 (5%), thrombosis n = 2 (<1%), catheter fracture/pinch n = 1 (<1%), pain n = 2 (<1%), and skin erosion n = 3 (1%). There were two arrhythmias at the time of placement; neither required port removal. The overall complication rate was 7%. The 0.2% incidence of port inversion we report is concordant with that previously published, although many previous reports do not specify if suture fixation of the port was performed. Suture fixation of the port, in our experience, is not routinely necessary and may negatively impact port removal.

Ankle ligaments on MRI: appearance of normal and injured ligaments.

OBJECTIVE: The objective of our study was to provide a pictorial survey of MR images of ankle ligaments in various conditions from intact to disrupted. CONCLUSION: MR images of ankle ligaments from a sample of patients with ankle pain or injury are presented and reviewed.

MRI of isolated distal fibular fractures with widened medial clear space on stressed radiographs: which ligaments are interrupted?

OBJECTIVE: Patient management choices in ankle fractures remain controversial because of ambiguities in assessing ankle stability and lack of information on the integrity of all supporting ligaments. Our objective was to use MRI to identify the range of ankle ligament injuries associated with a problematic subset of ankle fracture: isolated fibular fractures for which widened medial clear space is absent or minimal on standard ankle radiographs but evident on stress images. CONCLUSION: In our retrospective study of 19 patients, we have categorized ligament injury and found partial or complete tears in all cases in at least two of the four major ligament groups--usually the deltoid and syndesmosis groups. The anterior inferior tibiofibular ligament of the syndesmosis suffered complete interruption in every case. The posterior tibiotalar ligament of the deltoid group, a major contributor to stability, was generally injured but, unexpectedly, most of these tears were partial.

Sclerosis of postoperative lymphoceles: avoidance of prolonged catheter drainage with use of a fibrin sealant.

PURPOSE: To review experience with fibrin-based tissue sealant sclerosis of postsurgical lymphoceles at a single institution. MATERIALS AND METHODS: Fifteen patients who presented with postsurgical lymphoceles were treated with injection of fibrin tissue sealant. Procedures were performed under fluoroscopic and sonographic guidance. All lymphoceles were drained and sclerosed with a mixture of fibrin sealant and gentamicin. No drainage catheter was left in place. Postprocedural follow-up consisted of imaging and clinical evaluations. RESULTS: Twelve men and three women (mean age, 52 years) were treated. Eleven patients with lymphoceles were successfully treated with one session of sclerosis. Four patients required more than one treatment (two underwent two sessions, and two underwent three sessions). Seven patients undergoing a single treatment experienced complete resolution, and the remaining patients had smaller, persistent, asymptomatic collections. Imaging mean follow-up was 114 days (range, 5-339 d); mean clinical follow-up was 487 days (range, 195-856 d). There were no periprocedural complications. CONCLUSION: The use of fibrin sealant is safe and effective in the sclerosis of postoperative lymphoceles.