Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience.

PURPOSE: To report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters. MATERIALS AND METHODS: In this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed. RESULTS: Intravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique. CONCLUSIONS: Intravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.

Evaluating Resident On-Call Performance: Does Volume Affect Discrepancy Rate?

OBJECTIVE: To examinehow study volume affects discrepancy rates for on-call radiology residents. Inparticular, we studied how both total shift volume and volume at a particularpoint in time might effect performance. MATERIALS/METHODS: Weretrospectively analyzed 518 weekend call shifts at our institution. The totalnumber of computed tomography (CT) studies per shift was recorded. For everyabdomen-pelvis (AP) or chest-abdomen-pelvis (CAP) CT, preliminary and finalreports were compared for possible discrepancy and rated (by effect on short-termmanagement). We also developed "peristudy volume," defined as CTs read within ±30minutes of a given CT, an estimate of how busy a resident might be at a giventime. We performed logistic regressions to determine whether overall shiftvolume or peristudy volume were predictors of discrepancies. RESULTS: CTvolume/day increased from 58.1 ± 10.1 in 2011 to 75.3 ± 12.5 in 2015(p<0.001). 4695 AP (or CAP) CTs were reviewed, with 145 discrepancies thatcould affect short-term management (3.1%). When reading a study during a shift with≥51 total CTs,residents had increased odds of an error compared to reading a study during ashift with ≤30 studies (OR: 2.97, CI: 1.19-6.46) (p=0.01). When reading a CTwith a peristudy volume of ≥6, residents had increased odds of an error comparedto reading a study with ≤5 peristudy CTs (OR: 1.6, CI: 1.1-2.3) (p=0.01). CONCLUSION: Whenon-call residents interpret AP CT during high volume shiftsor during busy time-points, odds of discrepancies increase. Awareness of thesedata may inform residency programs in staffing decisions.

Factors affecting marine debris deposition at French Frigate Shoals, Northwestern Hawaiian Islands Marine National Monument, 1990-2006.

Data on the amount and type of small debris items deposited on the beaches of the Hawaiian Islands National Wildlife Refuge Tern Island station, French Frigate Shoals were collected over 16 years. We calculated deposition rates and investigated the relationship among deposition and year, season, El Niño and La Niña events from 1990 to 2006. In total 52,442 debris items were collected with plastic comprising 71% of all items collected. Annual debris deposition varied significantly (range 1116-5195 items) but was not influenced by season. Debris deposition was significantly greater during El Niño events as compared to La Niña events. Although often deduced to influence floating marine pollution, this study provides the first quantitative evidence of the influence of El Niño/La Niña cycles on marine debris deposition.