Interventional radiology training: a comparison of 5 English-speaking countries.

OBJECTIVE: To compare key characteristics of interventional radiology (IR) training in the UK with four other English-speaking countries (USA, Canada, Australia and New Zealand) and summarise requirements for training. METHODS: Main features examined were career pathway and requirements, examinations required, specific competition for IR and the process of applying for training as an international medical graduate. Data were collected from official governing body publications, literature and personal experience. RESULTS: Several differences were highlighted, including length of training (ranging from 6 to 9 years after medical school), length of IR-specific training (ranging from 1 to 3 years) and examinations required (USA and Canada have additional IR-specific examinations). The level of competition is generally high, in all countries. CONCLUSIONS: With the demand for IR services set to increase over the next few years, it is crucial that more IR specialists are trained to meet this demand. Awareness of training structures in other countries can highlight opportunity and pitfalls, and help ensure the number of highly trained interventional radiologists in the UK continues to grow.

Circulating tumor cells and EpCAM expression in neuroendocrine tumors.

PURPOSE: Neuroendocrine tumors (NET) are heterogeneous tumors with widely variable survival. It is unknown whether they express EpCAM (epithelial cell adhesion molecule) and thus whether NET circulating tumor cells (CTC) are detectable. We systematically investigated EpCAM expression and CTC detection in patients with metastatic NETs and evaluated the potential of CTCs to predict radiological progression. EXPERIMENTAL DESIGN: EpCAM protein expression was evaluated in 74 samples of formalin-fixed, paraffin-embedded NET tissue by immunohistochemistry. Seventy-nine patients with metastatic NETs (42 midgut, 5 unknown primary, 19 pancreatic, 13 bronchopulmonary) had blood samples drawn for CTC isolation and enumeration utilizing the CellSearch platform. Patients were classified as having progressive or nonprogressive disease on the basis of serial imaging. RESULTS: Strong homogeneous, membranous EpCAM expression was observed in all ileal (n = 26) and pancreatic NETs (n = 16), whereas variable EpCAM expression was observed in bronchopulmonary NETs (n = 13). Forty-three percent of midgut and 21% of pancreatic NETs had CTCs detected with a range of 0-62 and 0-11, respectively. The absence of CTCs was strongly associated with stable disease (P < 0.001). There was a moderate correlation between CTC levels and urinary 5-hydroxyindole acetic acid (r = 0.5, P = 0.007) and between CTC levels and burden of liver metastases (B = 8.91, P < 0.001). There was no or low correlation between CTC levels and Ki-67 (r = 0.08, P = 0.59) and serum chromogranin A (r = 0.246, P = 0.03). CONCLUSIONS: This is the first systematic analysis showing EpCAM expression and CTC detection in NETs. CTCs seem to be associated with progressive disease and may provide useful prognostic information given the variable survival rates in these tumors.

Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications on cross-sectional imaging.

Radical pelvic surgery is often required in patients with advanced, persistent or recurrent gynaecological and anorectal malignancies. In the last decade, pedicled flap reconstructions have been increasingly used for pelvic floor and neovaginal reconstruction, introducing well-vascularised non-irradiated tissue into the wound cavity and hence reducing wound complications. The aim of this pictorial review is to describe the normal post-operative cross-sectional imaging appearances of the most commonly used pelvi-perineal flap reconstructions and to illustrate the complications that may arise at the flap donor and recipient sites.