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The staff of the Radiation Protection Service of a European clinical center measured the radiation dose by type-tested thermoluminescent dosemeter systems to which the medical staff was exposed, to assess the effectiveness of current procedures and equipment for optimalisation prompted by the requirements EU Basic Safety Standard 2013. There were three participating sites, the Site 1 was an external hospital, whereas Sites 2 and 3 are part of the same clinical center, who provided data regarding their personnel, from technologists, nurses and medical doctors. In this preliminary study, only a low number of cases were available and used to establish a new, more realistic yearly dose constraint, namely 6 (from two) mSv for whole-body effective dose, 15 (from two) mSv for eye lens dose and 300 (from 50) mSv for extremity dose. Furthermore, the state of safety culture and protection equipment was assessed. Collection of the sufficient amount of data for statistical evaluation is ongoing.
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Cristalino , Cuerpo Médico , Humanos , Extremidades , Hospitales , Dosis de RadiaciónRESUMEN
CIREL, a prospective, Europe-wide, observational study aimed to assess the real-world feasibility and tolerability of irinotecan-based transarterial chemoembolization (LP-irinotecan TACE) for unresectable colorectal cancer liver metastases with regard to the treatment plan and adverse events (AEs). CIREL enrolled 152 eligible patients (≥18 years) with liver-only or dominant metastases treated with LP-irinotecan TACE following a multidisciplinary tumor board decision. Data were prospectively collected for baseline, the number of planned and performed sessions, and technical information and safety according to CTCAE 4.03/5.0. Results from 351 analyzed treatment sessions showed technical success for 99% of sessions, and 121 patients (79%) completed all planned sessions. Further, 60% of sessions were performed using opioids, 4% intra-arterial anesthetics, and 25% both. Additionally, 60% of patients experienced at least one peri-interventional AE of any grade; 8% of grade 3−4. Occurrence of AEs was related to larger liver-involvement (p < 0.001), bi-lobar disease (p = 0.002), and larger beads (p < 0.001). Using corticosteroids together with antiemetics showed reduced and lower grade vomiting (p = 0.01). LP-irinotecan TACE was tolerated well and had a high proportion of completed treatment plans. This minimally invasive locoregional treatment can be used together with concomitant systemic therapy or ablation.
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PURPOSE: Transarterial chemoembolisation (TACE) using irinotecan-eluting beads is an additional treatment option for colorectal cancer liver metastases (CRLM) patients that are not eligible for curative treatment approaches. This interim analysis focuses on feasibility of the planned statistical analysis regarding data distribution and completeness, treatment intention, safety and health-related quality of life (HRQOL) of the first 50 patients prospectively enrolled in the CIrse REgistry for LifePearl™ microspheres (CIREL), an observational multicentre study conducted across Europe. METHODS: In total, 50 patients ≥ 18 years diagnosed with CRLM and decided to be treated with irinotecan-eluting LifePearl™ microspheres TACE (LP-irinotecan TACE) by a multidisciplinary tumour board. There were no further inclusion or exclusion criteria. The primary endpoint is the categorisation of treatment intention, and secondary endpoints presented in this interim analysis are safety, treatment considerations and HRQOL. RESULTS: LP-irinotecan TACE was conducted in 42% of patients as salvage therapy, 20% as an intensification treatment, 16% as a first-line treatment, 14% a consolidation treatment and 8% combination treatment with ablation with curative intent. Grade 3 and 4 adverse events were reported by 4% of patients during procedure and by 10% within 30 days. While 38% reported a worse, 62% reported a stable or better global health score, and 54% of patients with worse global health score were treated as salvage therapy patients. CONCLUSION: This interim analysis confirms in a prospective analysis the feasibility of the study, with an acceptable toxicity profile. More patients reported a stable or improved HRQOL than deterioration. Deterioration of HRQOL was seen especially in salvage therapy patients. TRIAL REGISTRATION: NCT03086096.
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Quimioembolización Terapéutica/métodos , Neoplasias Colorrectales/terapia , Irinotecán/uso terapéutico , Neoplasias Hepáticas/terapia , Calidad de Vida , Sistema de Registros , Anciano , Neoplasias Colorrectales/patología , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Masculino , Microesferas , Metástasis de la Neoplasia , Estudios Prospectivos , Inhibidores de Topoisomerasa I/uso terapéuticoRESUMEN
INTRODUCTION AND AIM: The technology, named 'deep learning' is the promising result of the last two decades of development in computer science. It poses an unavoidable challenge for medicine, how to understand, apply and adopt the - today not fully explored - possibilities that have become available by these new methods. METHOD: It is a gift and a mission, since the exponentially growing volume of raw data (from imaging, laboratory, therapy diagnostics or therapy interactions, etc.) did not solve until now our wished and aimed goal to treat patients according to their personal status and setting or specific to their tumor and disease. RESULTS: Currently, as a responsible health care provider and financier, we face the problem of supporting suboptimal procedures and protocols either at individual or at community level. The problem roots in the overwhelming amount of data and, at the same time, the lack of targeted information for treatment. We expect from the deep learning technology an aid which helps to reinforce and extend the human-human cooperations in patient-doctor visits. We expect that computers take over the tedious work allowing to revive the core of healing medicine: the insightful meeting and discussion between patients and medical experts. CONCLUSION: We should learn the revelational possibilities of deep learning techniques that can help to overcome our recognized finite capacities in data processing and integration. If we, doctors and health care providers or decision makers, are able to abandon our fears and prejudices, then we can utilize this new tool not only in imaging diagnostics but also for daily therapies (e.g., immune therapy). The paper aims to make a great mind to do this. Orv Hetil. 2019; 160(4): 138-143.
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Inteligencia Artificial , Aprendizaje Profundo , Mamografía , Interfaz Usuario-Computador , Humanos , Hungría , Motivación , Relaciones Médico-PacienteRESUMEN
INTRODUCTION AND AIM: Surgical tibial bypass for critical limb ischemia is associated with significant morbidity, mortality, and graft failure, whereas percutaneous angioplasty and stenting has promising results. The objective of this study was the investigation of the long term results of below-knee percutaneous angioplasty for restoring straight inline arterial flow in patients with critical limb ischemia. METHOD: The clinical and angiographic data of 281 consecutive patients with critical limb ischemia treated by PTA between 2008 and 2011 was evaluated in a prospective register. The aim of the revascularization was to achieve a straight inline flow to the wound with balloon angioplasty. Stent implantation was done in the case of recoil and flow limiting dissection. Primary end points were clinical success (relief of resting pain, healing of ulceration, limb survival) and major adverse events (death, myocardial infarction, major unplanned amputation, need for surgical revascularization, or major bleeding). Secondary end points were the angiographic result of the intervention, procedural data and consumption of angioplasty equipment. The impact of diabetic leg syndrome and the result of the angioplasty on the limb salvage was also investigated. We have analysed the impact of major amputation on long term mortality. RESULTS: Mean age of patients was 72.5 ± 10.6 years and the follow-up period was 40.8 ± 9.7 months. Technical success was reached in 255 (90.7%) of the patient's: 255 limbs straight inline flow with good angiographic result was restored to at least one tibial vessel. Balloon angioplasty, stent implantation and rotational atherectomy was performed in 278 (98.9%), 74 (26.3%) and 2 patients (0.7%). From clinical end points the rest pain was ceased in 56.6%, the ulcer and the gangrena was healed in 73.5% and 46.5%. The long term limb survival was 73.5%; 65.8% in diabetic and 89.6% in non-diabetic leg syndrome (p = 0.001). The major adverse events at long-term follow-up occured in 122 (43.8%) patients. Death occured in 57 (20.3%) of the patients during the long-term follow-up: 38 (13.5%) vs. 19 (6.8%) in diabetic vs. non-diabetic leg subgroup, respectively (p = 0.932). Long-term limb saving occured in 72.3% vs. 84.6% of the patients dependening the procedure was successful or unsuccessful (p = 0.225). CONCLUSION: Below-knee stent angioplasty for critical limb ischemia results in good clinical outcome, but the major adverse event rate is high. Diabetes mellitus is associated with a high rate of mortality and amputation. Orv. Hetil., 2017, 158(11), 418-425.
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Angioplastia/métodos , Isquemia/terapia , Pierna/irrigación sanguínea , Anciano , Angioplastia de Balón , Femenino , Estudios de Seguimiento , Humanos , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Stents , Resultado del TratamientoRESUMEN
"Diabetic foot" as definition covers a multifactorial clinical condition. According to the recent epidemiological data, the role of lower limb ischemia is getting more influential over other pathological causes, like neuropathy, infections and bone or soft tissue deformity. In diabetes, vascular disease leads to increased risk for leg ulcers and minor or major amputations. The traditional diagnostic tools for recognition of peripheral arterial disease have limited value because of diabetes specific clinical manifestations. Available vascular centers with special expertise and diagnostic tools are the prerequisite for efficient diagnosis supporting timely recognition of peripheral arterial disease. In course of treatment of diabetic foot with ischemic origin, beyond effective medical treatment revascularization (open vascular surgery or endovascular procedures) has paramount importance for prevention of limb loss. Vascular teams of vascular specialists, vascular surgeons and interventional radiologist in dedicated centers in multidisciplinary cooperation with other professions represent public health issue in effective prevention. Orv. Hetil., 2017, 158(6), 203-211.
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Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Pie/irrigación sanguínea , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Comorbilidad , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/epidemiología , Pie Diabético/fisiopatología , HumanosRESUMEN
Revascularisation aims to create a patent lumen in an acutely or chronically occluded or stenosed vessel. Interventional radiology has developed and used minimally invasive methods for decades concurring surgical methods and medical therapy. Innovative fields in healthcare may be handicapped since revolutionary solutions usually gain wide acceptance slowly and the results of randomized controlled trials are reported late. At present endovascular recanalization, dilatation and stent placement have achieved a well-established role in the treatment of stenosis or occlusion of the aorta, and renal and peripheral arteries.
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Aorta/cirugía , Estenosis de la Válvula Aórtica/cirugía , Arteriopatías Oclusivas/cirugía , Procedimientos Endovasculares/métodos , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Radiografía Intervencional/métodos , Radiología Intervencionista/métodos , Obstrucción de la Arteria Renal/cirugía , Aorta/patología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Arteriopatías Oclusivas/diagnóstico por imagen , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/cirugía , Arteria Femoral/patología , Arteria Femoral/cirugía , Humanos , Arteria Ilíaca/patología , Arteria Ilíaca/cirugía , Isquemia/diagnóstico por imagen , Isquemia/etiología , Obstrucción de la Arteria Renal/diagnóstico por imagenRESUMEN
Infiltrating many traditional discipline, interventional radiology achieved a dynamic progress during the last 50 years. Collaboration with the modern, personalised, quality-sensitive oncology opened a new horizon for oncologic interventions in the early 1980s. This complex field needs multiple skills and a broadened view from the interventional radiologist. The aim of this paper is to summarize the "menu" of present and prospective therapeutic tools in oncointerventional radiology.
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Ablación por Catéter , Embolización Terapéutica , Procedimientos Endovasculares , Biopsia Guiada por Imagen/métodos , Neoplasias/terapia , Radiografía Intervencional , Radiología Intervencionista , Ablación por Catéter/métodos , Criocirugía , Embolización Terapéutica/métodos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Procedimientos Endovasculares/métodos , Humanos , Neoplasias/diagnóstico por imagen , Neoplasias/cirugía , Cuidados Paliativos/métodos , Radiografía Intervencional/métodos , Radiografía Intervencional/tendencias , Radiología Intervencionista/métodos , Radiología Intervencionista/tendencias , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Successful angioplasty is one of the main factor of limb salvage during critical limb ischemia. In complex femoropopliteal to infrapopliteal occlusions, an anterograde recanalization attempt can fail in up to 20% of the cases. The purpose of this dual center pilot study was to evaluate the acute success and clinical impact of retrograde transpedal access for retrograde below-the-knee and femoropopliteal chronic total occlusions after failed anterograde attempt and to access the late complications at the puncture site. METHODS: The clinical and angiographic data of 51 consecutive patients with CLI treated by retrograde transpedal recanalization between 2010 and 2011 were evaluated in a pilot study. We have examined the 2-month and 1 year major adverse events (MAEs) and clinical success. In all cases after failure of the anterograde recanalization of occluded below-the-knee segments due to unsuccessful penetration or failed re-entry, the anterior tibial or posterior tibial artery was punctured under fluoroscopic guidance and retrograde recanalization was performed. Direct revascularization was tried firstly following the angiographic zones, but in failed cases indirect revascularization was carried out with increasing the collateral flow to the wound. RESULTS: Successful direct retrograde revascularization was achieved successfully in 40 patients (78.4%) and indirect revascularization was done in 10 patients (19.6%). Revascularization was failed in one patient (2%). MAE at 2 and 12 months follow-up was 6 (11.7%) and 11 (24%). Limb salvage at 2 and 12 months was 93% and 82.3%, respectively. Balloon angioplasty was performed in all interventions and provisional stenting was done in 34 patients (66.7%). One major and three minor vascular complications occurred after the procedure. The mean basal and control creatinine level was 120.9 ± 133.4 and 123.8 ± 131.3 µmol/L (P = 0.83) after the procedure. CONCLUSION: Failed antegrade attempts to recanalize CTO-s of femoropopliteal and infrapopliteal vessels can be salvaged using a retrograde transpedal access, with a low acute and late complication rate. This technique could be valuable for patients with critical limb ischemia due to femoropopliteal and infrapopliteal occlusions.
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Angioplastia de Balón/métodos , Arteria Femoral , Isquemia/terapia , Enfermedad Arterial Periférica/terapia , Arteria Poplítea , Anciano , Anciano de 80 o más Años , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Constricción Patológica , Enfermedad Crítica , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatología , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Selección de Paciente , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Proyectos Piloto , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/fisiopatología , Estudios Prospectivos , Punciones , Radiografía , Retratamiento , Factores de Riesgo , Stents , Insuficiencia del TratamientoRESUMEN
We report the first European case of cerebral iodized lipid embolism post transcatheter arterial embolization for hepatocellular carcinoma. Lipiodol emboli and corresponding multifocal brain ischemia were documented with computed tomography (CT) and magnetic resonance (MR) in the acutely symptomatic patient. Transcranial Doppler sonography with contrast indicated a right-to-left shunt, while on a follow-up CT scan lipiodol embolization was detected in both lungs. Dilated pulmonary vessels and thick vascular channels were seen in the vicinity of the right diaphragm suggestive of pulmonary arteriovenous shunt. The patient symptoms regressed with supportive care alone, but he died 5 months later due to hepatic failure unrelated to the procedure.
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Derivación Arteriovenosa Quirúrgica , Carcinoma Hepatocelular/complicaciones , Embolización Terapéutica/efectos adversos , Aceite Etiodizado/administración & dosificación , Embolia Intracraneal/terapia , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/terapia , Resultado Fatal , Humanos , Embolia Intracraneal/etiología , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana EdadRESUMEN
This review paper will provide a comprehensive summary about the role radiofrequency ablation in the palliative treatment of primary and metastatic hepatic tumours. Since the recommendations undergo a continuous change, we hope that this paper will generate further multidisciplinary approach in the technique and helps to outline up-to-date guidelines.