The Financial Impact of COVID on Radiology Health Systems.

The coronavirus pandemic of 2019 (COVID-19) was arguably the most pivotal global event that current generations have witnessed, with unprecedented global challenges, and colossal effects on health systems. The financial consequences, in particular, were profound and far-reaching. Staggering estimates of up to $50.7 billion dollars per month in lost revenue for the US health system were reported by the American Hospital Association (Kaye et al., 2021). The pandemic caused significant increases in cost of drugs, disruptions to medical supply chains, day-to-day workflow, and operations in all areas of medicine and various healthcare systems. Radiology experienced a significant burden of the damage, finding itself at the forefront of the pandemic's economic fallout (American Hospital Association).

The Impact of COVID on Health Systems: The Workforce and Telemedicine Perspective.

The COVID-19 pandemic significantly strained global health systems, leading to the rapid adoption of telemedicine and changes in workforce management. Previously underused, telemedicine became an essential means of delivering healthcare while adhering to physical distancing guidelines. This transition addressed longstanding barriers like connectivity issues. Simultaneously, the radiology sector innovated by widely implementing remote reading stations, which helped manage exposure risks and conserve human resources. Moreover, the pandemic highlighted the critical role of technological advancements beyond telemedicine, such as the accelerated integration of AI in diagnostics and management. This article examines these comprehensive effects, emphasizing the remote work adaptations and innovations in healthcare systems that have reshaped both healthcare delivery and workforce dynamics during the pandemic.

Incrementally Expandable Transjugular Intrahepatic Portosystemic Shunts: Single-Center Experience.

OBJECTIVE: The purpose of this study is to investigate the long-term safety and efficacy of a small-diameter expandable transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. MATERIALS AND METHODS: This single-center retrospective study included 28 patients (12 women and 16 men; mean age, 56.9 years) who underwent small-diameter expandable TIPS creation between 2008 and 2010 for refractory ascites (n = 15; mean [± SD] model for end-stage liver disease [MELD] score, 15.5 ± 5.3) or gastrointestinal variceal bleeding (n = 13; mean MELD score, 15.2 ± 8.4). An expandable TIPS was created by deploying a covered stent inside a balloon expandable stent. For patients with recurrent symptoms, TIPS adjustment was made by balloon expandable stent balloon dilation. The TIPS diameter was defined as the diameter of the final angioplasty balloon. TIPS patency and efficacy and the rate of post-TIPS hepatic encephalopathy were evaluated. RESULTS: The median diameter of the initial TIPS was 8 mm in the group with variceal bleeding compared with 6 mm in the group with ascites (p = 0.003). The primary patency rate at 1 and 5 years was 90.8% and 73.3%, respectively. Eighty percent of patients with ascites required no or less-frequent large-volume paracentesis. The clinical success rate for patients with acute variceal bleeding was 92.3%. Six patients with ascites (initial TIPS diameter, 6 mm) and two patients with variceal bleeding (initial diameter, 6 mm and 8 mm) required subsequent TIPS adjustment. Of the 22 patients with no prior history of enecphalophy, seven patients (31.8%) experienced new hepatic encephalopathy within 90 days. CONCLUSION: A small-diameter expandable TIPS is technically feasible and safe, with efficacy falling within the range of that of conventional TIPS. This technique offers the possibility of individualizing the degree of portal decompression.

The 4 Quadrants: Acute Pathology in the Abdomen and Current Imaging Guidelines.

With several different imaging options available, it is not surprising that health care providers are unsure which imaging study is most appropriate for evaluating patients who present to the emergency department with abdominal pain. The American College of Radiology, currently, has appropriateness criteria for patients presenting with right upper, right lower, and left lower quadrant pain, and there are different variants for each of these quadrants. Clinicians should be aware of the American College of Radiology appropriateness criteria and, whenever possible, should be using criteria as guide to help them order the most appropriate imaging study.

Internal Hernia After Laparoscopic Antecolic Roux-en-Y Gastric Bypass.

BACKGROUND: We evaluated the incidence and presentations of internal hernias (IH) after laparoscopic antecolic Roux-en-Y gastric bypass (RYGB) at our institution. METHODS: We retrospectively reviewed the records of 594 patients who underwent laparoscopic antecolic RYGB at our institution between December 2004 and December 2010. RESULTS: Five hundred ninety-four patients underwent laparoscopic antecolic RYGB with a mean follow-up of 50.5 months. Thirty-six patients developed 37 IH (6.2 %) requiring surgical intervention. Mean age of IH patients was 36.9 years. Thirty-one out of 36 were female. Mean preoperative BMI was 44.3 Kg/m(2). The mean time of presentation after their RYGB was 25.9 months. The mean % excess body weight loss at time of presentation was 54.0 %. Twenty-five out of 37 of IH occurred at Petersen's space; 9/37 IH occurred under the jejunojejunostomy; three patients had hernias at both locations. Mesenteric swirling was the most common CT scan finding in 20/36 (55.6 %). Six out of 36 CT were initially read as normal; however, on retrospective review by a radiologist, abnormalities indicating IH were found in 4/6. Patients presented with different degrees of acuity: 6/37 with chronic abdominal pain and 28/37 with acute abdominal pain. Bowel necrosis was found in 3/37. CONCLUSION: IH is a serious and potentially fatal complication of RYGB. Presentation can vary from chronic abdominal pain to bowel necrosis. CT is helpful in providing diagnosis; however, careful attention to the specific signs of small bowel volvulus, such as mesenteric swirl sign, should be given. IH should be considered in RYGB patients who present with even vague symptoms.