Implementation of a hybrid angiography-CT system: increased short-term revenue at an academic radiology department.

PURPOSE: To analyze the financial impact following implementation of a hybrid Angio-CT system at a tertiary care academic medical center. METHODS: Aggregate case types and volumes were compared 24 months before and 12 months after a hybrid Angio-CT system replaced a traditional interventional C-arm angiography suite at an academic medical center. Procedure revenues from this 36-month study period were derived from five payors mixes (Medicare, Medicaid, commercial insurance, out-of-pocket and managed care program) and Medicare-rate adjusted to each individual payor types. RESULTS: Average case volume per month increased 12% in the hybrid Angio-CT suite when compared to the previous traditional angiography suite (P < 0.05). The variety of IR procedures in the hybrid Angio-CT suite also expanded to include more complex interventional radiology and interventional oncology procedures; the breadth of cases performed in the hybrid Angio-CT suite were associated with CPT codes of higher rates (average CPT value/case increased from $2,334.61 to $2,567.25). The estimated average annual revenue of the hybrid Angio-CT suite increased 23% as compared to previous traditional angiography suite. CONCLUSION: A hybrid Angio-CT system is a financially feasible endeavor at a tertiary care academic medical center that facilitated higher complexity procedure codes and increased procedure-related revenue.

Bronchial artery embolization for malignant hemoptysis: a single institutional experience.

OBJECTIVE: To assess the effectiveness of bronchial artery embolization (BAE) in patients with malignant hemoptysis. METHODS: An IRB-approved retrospective study at our academic institution was conducted on all patients treated by BAE for hemoptysis from lung malignancy. Outcome and safety measures were documented according to Society of Interventional Radiology (SIR) practice guidelines. RESULTS: A total of 26 patients (13 male, 13 female) with lung malignancy underwent BAE for hemoptysis from 2003-2013. Histologic analysis revealed 80% (21/26) of cases were from primary lung malignancies, while the remaining 20% (4/26) represented metastatic disease. Sixty-five percent (17/26) of patients underwent bronchoscopy prior to BAE. Follow-up ranged from 2 to 1,909 days, with average of 155 days. Technical success was achieved in 77% of patients (20/26). Clinical success rate was 75% (15/20). Eighty-five percent of embolized patients (17/20) were treated with particles, 15% (3/20) with gelfoam, and 20% (4/20) with coils. Single-vessel embolization was performed in 70% (14/20), two-vessel in 20% (4/20), and multiple vessels in 10% (2/20). No complications were reported. Six-month all-cause mortality of treated cases was 55% (11/20) with an in-hospital mortality of 25% (5/20). Ten percent (2/20) had remote re-bleeding events beyond 6 months. Statistically significant predictors of mortality were intubation status, hemoglobin/hematocrit at presentation, and thrombocytopenia. CONCLUSIONS: BAE is a safe and useful treatment for clinically significant hemoptysis in patients with primary or metastatic lung masses despite high overall mortality. Intubation status, low hemoglobin/hematocrit, and thrombocytopenia may represent clinical predictors of short term mortality following BAE. ADVANCES IN KNOWLEDGE: Most patients undergoing BAE for malignant hemoptysis achieve high clinical success despite suffering a high mortality from underlying disease.

Outcomes of Patients with Left Ventricular Assist Devices Undergoing Mesenteric Angiography for Gastrointestinal Bleeding.

PURPOSE: To compare measures of clinical success, such as the need for subsequent intervention and mortality, in patients with left ventricular assist devices (LVADs) undergoing mesenteric angiography for gastrointestinal (GI) bleeding with respect to a control group. MATERIALS AND METHODS: A retrospective study was conducted on 48 consecutive patients undergoing anticoagulation whose GI bleeding was assessed with angiography between August 2007 and June 2014: 24 patients with LVADs and 24 control patients without LVADs. The χ2 and t tests were used for statistical analysis. RESULTS: Mean ages were 62.1 years ± 9.6 and 74.5 years ± 11.3 in the LVAD and control groups, respectively. No significant difference was observed in hemodynamic instability, presenting hemoglobin level and International Normalized Ratio, or hemoglobin nadir. Two patients with LVADs (8.3%) and 8 control patients (33.3%) had bleeding detected on angiograms (P = .032). Six embolizations were performed in patients with LVADs and 8 were performed in control patients. Clinical success was achieved in 2 of 6 patients with LVADs (33.3%) and 7 of 8 control patients (87.5%; P = .036). Seven patients with LVADs (29.2%) and 1 control patient (4.5%) underwent repeat angiography within 14 days (P = .020). Seven patients with LVADs (29.2%) and 4 control patients (18.2%) required postprocedural endoscopic or operative intervention as definitive therapy (P = .302). All-cause in-hospital mortality rates were 16.7% in the LVAD group and 4.2% in the control group (P = .032), and the respective all-cause 1-year mortality rates were 33.3% and 9.1% (P = .080). CONCLUSIONS: A higher rate of clinical failure is observed in patients with LVADs presenting with GI bleeding compared with those without LVADs, with a more frequent need for subsequent endoscopic or surgical intervention.

Computed tomography-guided percutaneous lung biopsy: impact of lesion proximity to diaphragm on biopsy yield and pneumothorax rate.

PURPOSE: The purpose of this study was to investigate the impact of lesion proximity to the diaphragm on computed tomography (CT)-guided percutaneous biopsy yield and pneumothorax rates. MATERIALS AND METHODS: An Institutional Review Board-approved retrospective review of all CT-guided percutaneous core lung biopsies at a single institution performed between August 1, 2011 and July 31, 2013 yielded 168 patients who underwent a total of 174 lung biopsies. The shortest distance of the target lesion from the diaphragm was measured on preprocedure sagittal reformatted CT images. Pathology and 2-hour postprocedure chest radiograph results were then collected from these patients. RESULTS: The average distance of the target lesion from the diaphragm was 8.3 cm, and biopsies resulted in nondiagnostic pathology in 27 (16%) cases. Proximity to the diaphragm was a significant predictor of nondiagnostic biopsy, with the odds of a successful biopsy increased by 67% for every 5 cm the target lesion is farther from the diaphragm (P=0.026). Distance from the diaphragm was not a significant predictor of postbiopsy pneumothorax or need for chest tube placement. These relationships hold true after adjusting for patient demographic parameters, presence of emphysema, operator level of experience, distance of the lesion from the pleural surface, target lesion size, and cavitary nature. CONCLUSIONS: The odds of nondiagnostic biopsy increase for lesions closer to the diaphragm; however, the odds of pneumothorax are not significantly different.

Use of retrievable filters in alternative common iliac vein location in high-risk surgical patients.

PURPOSE: To evaluate the use of retrievable filters placed in bilateral common iliac veins in high-risk surgical patients. MATERIALS AND METHODS: During the 4-year study period, 10 patients received bilateral common iliac vein placement of retrievable filters for pulmonary embolism (PE) prophylaxis. These patients were at risk for venous thromboembolism (VTE) but had no evidence of VTE at the time of filter placement. In nine patients undergoing bariatric surgery, placement of a filter in the inferior vena cava (IVC) was impossible because of megacava (defined as caval diameter ≥ 3.0 cm). In one patient who had planned dissection of an extensive retroperitoneal tumor, there was concern that IVC location of the filter would be prone to complications secondary to intraoperative manipulation. Filter placement and retrieval were evaluated. All patients were followed clinically until 4-6 weeks after filter retrieval. RESULTS: There were 20 filters placed in 10 attempts, 18 (nine patients) through the right internal jugular vein and 2 (one patient) through bilateral femoral veins. The mean (± standard deviation) dwell time of the filters was 40 days ± 10 (range 30-71 days). All filters were successfully removed. There were no procedural complications. No clinically evident PE was noted. CONCLUSIONS: Use of retrievable filters in the bilateral common iliac veins was found to be feasible and effective in preventing PE in patients with contraindications to filter placement in the IVC.