On the Need for a Taxonomy for Interventional Radiology: Initiating Dialogue for the Future.

OBJECTIVE: Interventional radiology (IR) needs comprehensive structure. The reactive structure of the past is strategically unwise for long-term growth of IR. CONCLUSION: IR needs a structured approach to move forward most effectively. A preliminary taxonomic scaffold is put forth and critically analyzed to illustrate new areas of research for the field, to identify new opportunities for growth, and to serve as a starting point for future discussion.

Positive Impact of an Aortic Center Designation.

BACKGROUND: In January 2015, we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, Interventional Radiology, Anesthesia and Hospital Administration. We report the initial success of creating a Comprehensive Aortic Center. METHODS: All aortic procedures performed from January 1, 2015 until December 31, 2016 were entered into a prospectively collected database and compared with available data for 2014. Primary outcomes included the number of all aortic related procedures, transfer acceptance rate, transfer time, and proportion of elective/emergent referrals. RESULTS: The Aortic Center included 5 vascular surgeons, 2 cardiac surgeons, and 2 interventional radiologists. Workflow processes were implemented to streamline patient transfers as well as physician and operating room notification. Total aortic volume increased significantly from 162 to 261 patients. This reflected an overall 59% (P = 0.0167) increase in all aorta-related procedures. We had a 65% overall increase in transfer requests with 156% increase in acceptance of referrals and 136% drop in transfer denials (P < 0.0001). Emergent abdominal aortic cases accounted for 17% (n = 45) of our total aortic volume in 2015. The average transfer time from request to arrival decreased from 515 to 352 min, although this change was not statistically significant. We did see a significant increase in the use of air-transfers for aortic patients (P = 0.0041). Factorial analysis showed that time for transfer was affected only by air-transfer use, regardless of the year the patient was transferred. Transfer volume and volume of aortic related procedures remained stable in 2016. CONCLUSIONS: Designation as a comprehensive Aortic Center with implementation of strategic workflow systems and a culture of "no refusal of transfers" resulted in a significant increase in aortic volume for both emergent and elective aortic cases. Case volumes increased for all specialties involved in the center. Improvements in transfer center and emergency medical services communication demonstrated a trend toward more efficient transfer times. These increases and improvements were sustainable for 2 years after this designation.

Capture of complexity of specialty care in pediatric cardiology by work RVU measures.

OBJECTIVE: We sought to determine the relationship between relative value units (RVUs) and intended measures of work in catheterization for congenital heart disease. METHODS: RVU was determined by matching RVU values to Current Procedural Terminology codes generated for cases performed at a single institution. Differences in median case duration, radiation exposure, adverse events, and RVU values by risk category and cases were assessed. Interventional case types were ranked from lowest to highest median RVU value, and correlations with case duration, radiation dose, and a cases-predicted probability of an adverse event were quantified with the Spearman rank correlation coefficient. RESULTS: Between January 2008 and December 2010, 3557 of 4011 cases were identified with an RVU and risk category designation, of which 2982 were assigned a case type. Median RVU values, radiation dose, and case duration increased with procedure risk category. Although all diagnostic cases had similar RVU values (median 10), adverse event rates ranged from 6% to 21% by age group (P < .001). Median RVU values ranged from 9 to 54 with the lowest in diagnostic and biopsy cases and increasing with isolated and then multiple interventions. Among interventional cases, no correlation existed between ranked RVU value and case duration, radiation dose, or adverse event probability (P = .13, P = .62, and P = .43, respectively). CONCLUSIONS: Time, skill, and stress inherent to performing catheterization procedures for congenital heart disease are not captured by measurement of RVU alone.

An aberrant independent origin of the serratus anterior pedicle: Case report

During routine dissection of the right upper limb in a male cadaver by the medical students in the department, an unusual artery was found on the side of the chest wall. The anomalous, aberrant artery was the first branch from the first part of the axillary artery. It crossed deep to the superior thoracic and lateral thoracic arteries, passed in front of the subscapular artery on the serratus anterior muscle and terminated, distributing that muscle, opposite the 8th intercostal space. There are known vascular anatomical variations in the supply to the serratus anterior. Due to serratus anterior or serrato-costal flap reconstructive surgery, an anomalous and aberrant vascular pedicle to the serratus anterior muscle is of interest to anatomists, surgeons, reconstructive surgeons and radiologists (AU)

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Páncreas divisum: tratamiento combinado por cirugía abierta y radiología intervencionista / Pancreas divisum: combined treatment with open surgery and interventional radiology

Presentamos un caso de páncreas divisum con dolor abdominal recurrente, siendo el intento de canalización endoscópica de la papila accesoria infructuoso. Guiados por ecografía intraoperatoria canalizamos el conducto pancreático; el ductograma evidenció una estenosis papilar y del tercio proximal. El tratamiento consistió en la dilatación con balón de la estenosis y la esfinteroplastia quirúrgica. Cinco años más tarde la paciente sigue asintomática (AU)