Gender-Based Survey Analysis of Research and Mentoring in Interventional Radiology.

PURPOSE: This study sought to define gender-related differences in attitudes, perceptions, and aspirations among trainees interested in interventional radiology (IR) and to analyze their experiences in research and mentorship. MATERIALS AND METHODS: A cross-sectional survey study was conducted among the members of the Society of Interventional Radiology Resident, Fellow, and Student section and Medical Student section in the summer of 2020. The anonymous, internally validated 27-item survey assessed demographics, research attitudes and experiences, mentorship, and career aspirations. Descriptive statistics were calculated using Fisher exact analyses and Student t-tests. The institutional review board approved the protocols for this study. RESULTS: Of 105 respondents who indicated their gender, 30% were women and 70% were men. Although both genders reported similar levels of research experience, female trainees were less likely to feel valued and encouraged by their institution to engage in research (2.79 out of 4 vs 3.16 out of 4, P = .02) and were less likely to indicate that their program required them to participate in research (2.47 vs 3.06, P = .01). Female residents and fellows reported more difficulty in finding a mentor (2.88 vs 3.28, P = .04) and received less mentorship relating to IR education (29% vs 64%, P = .002). CONCLUSIONS: This work provides a perspective on the perceived obstacles faced by female trainees in pursuing research and finding effective mentorship in the field of IR. These data may guide future interventions to boost interest and engagement in IR research and residency programs in a way that promotes gender diversity and equity in the field.

Mentorship in Interventional Radiology: Addressing Obstacles to Pursuing Research and Innovation Among IR Trainees.

RATIONALE AND OBJECTIVES: To ascertain the perceived obstacles that medical students and Interventional Radiology (IR) residents face performing IR research during training and incorporating research into their future careers. MATERIALS AND METHODS: The study was reviewed and exempt from Institutional Review Board review. Participants' attitudes and perceived barriers toward performing IR research, and experience with mentorship in IR were assessed using a 27-item survey sent to all members of the Society of Interventional Radiology Resident, Fellow and Student (SIR-RFS, n = 445), and Medical Student Council (SIR-MSC, n = 267) sections between July and September 2020. Descriptive statistics were computed for all assessed categorical variables. Fisher's exact tests were performed to measure the significance of association between categorical variables. RESULTS: Of the 712 students and residents surveyed, 151 (∼21%) responded. Of respondents, 100% reported that conducting research is important to advancing the field of IR. The highest ranked factors and obstacles to performing IR research were increased clinical demands (67.9%), lack of time (46.2%), lack of institutional support (41.5%), and lack of research experience (35.8%). Interestingly, those with a mentor were more likely to report an interest in pursuing a career in IR compared to those without a mentor (98.6% vs 41.0%, p < 0.0001). Furthermore, those with a mentor were more likely to report an interest in pursuing IR research compared to those without a mentor (32.5% vs 14.4%, p < 0.0001). CONCLUSION: There are many obstacles to performing IR research. Strong mentorship is an avenue to address these deterrents. The deployment of mentorship programs in IR is needed to ensure trainees can overcome the barriers outlined in this study and successfully pursue research careers in IR.

Adjunctive Coil Embolization of the Prostatic Arteries After Particle Embolization for Prostatic Artery Embolization.

PURPOSE: To describe the feasibility, safety and short-term results of prostatic artery embolization (PAE) performed with adjunctive coil embolization of the main prostatic arteries (PA) following particle embolization. MATERIALS AND METHODS: A total of 95 patients who underwent PAE with adjunctive bilateral coil embolization of the PAs following particle embolization between September 2018 and May 2021 were included. The patients had a mean prostate size of 115 ± 64 ml, 18/95 with hematuria symptoms, and 16/95 with indwelling urinary catheters. Coil embolization was performed in the main PAs prior to the bifurcation into the anteromedial and posterolateral branches using detachable microcoils. International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum flow rate (Qmax) and adverse events were recorded. RESULTS: IPSS were improved by - 11.2 ± 7.9 (n = 49, P < 0.001) and QOL by - 2.4 ± 1.8 (n = 49, P < 0.001) over a mean follow-up of 10.7 ± 7.9 weeks. Qmax did not demonstrate statistical significance. Twelve patients with hematuria (67%) showed improvement or resolution and twelve patients with indwelling or intermittent catheters (75%) were no longer catheter dependent. Two patients underwent a repeat PAE. There were no adverse events which were attributable to coil embolization. CONCLUSION: Adjunctive coil embolization of the main PAs following particle embolization is a technically feasible technique with similar short-term clinical outcomes compared to prior studies. This novel technique warrants further prospective investigation with controls.

Endovascular Stenting in a Rare Case of Multiple Spontaneous Visceral Arterial Dissections.

Spontaneous dissection of abdominal aortic branches is rare. Prior reports discuss incidents of isolated renal artery dissections and isolated splanchnic artery dissections; however, these types of dissections almost never occur simultaneously. Based on literature review, only one other case report has described spontaneous dissections of multiple visceral arteries. This brief report presents the successful endovascular treatment of a previously healthy man with spontaneous dissection of the proximal celiac artery and bilateral renal arteries. Due to the patient's acute presentation and renal injury, stenting of bilateral renal arteries was undertaken with successful medical outcomes on postprocedural follow up.

Strategies to Prevent Readmission in High-Risk Patients with Diabetes: the Importance of an Interdisciplinary Approach.

PURPOSE OF REVIEW: Patients with diabetes are known to have higher 30-day readmission rates compared to the general inpatient population. A number of strategies have been shown to be effective in lowering readmission rates. RECENT FINDINGS: A review of the current literature revealed several strategies that have been associated with a decreased risk of readmission in high-risk patients with diabetes. These strategies include inpatient diabetes survival skills education and medication reconciliation prior to discharge to send the patient home with the "right" medications. Other key strategies include scheduling a follow-up phone call soon after discharge and an office visit to adjust the diabetes regimen. The authors identified the most successful strategies to reduce readmissions as well as some institutional barriers to following a transitional care program. Recent studies have identified risk factors in the diabetes population that are associated with an increased risk of readmission as well as interventions to lower this risk. A standardized transitional care program that focuses on providing interventions while reducing barriers to implementation can contribute to a decreased risk of readmission.

Apparent diffusion coefficient changes predict survival after intra-arterial bevacizumab treatment in recurrent glioblastoma.

PURPOSE: Superselective intra-arterial cerebral infusion (SIACI) of bevacizumab (BV) has emerged as a novel therapy in the treatment of recurrent glioblastoma (GB). This study assessed the use of apparent diffusion coefficient (ADC) in predicting length of survival after SIACI BV and overall survival in patients with recurrent GB. METHODS: Sixty-five patients from a cohort enrolled in a phase I/II trial of SIACI BV for treatment of recurrent GB were retrospectively included in this analysis. MR imaging with a diffusion-weighted (DWI) sequence was performed before and after treatment. ROIs were manually delineated on ADC maps corresponding to the enhancing and non-enhancing portions of the tumor. Cox and logistic regression analyses were performed to determine which ADC values best predicted survival. RESULTS: The change in minimum ADC in the enhancing portion of the tumor after SIACI BV therapy was associated with an increased risk of death (hazard ratio = 2.0, 95% confidence interval(CI) [1.04-3.79], p = 0.038), adjusting for age, tumor size, BV dose, and prior IV BV treatments. Similarly, the change in ADC after SIACI BV therapy was associated with greater likelihood of surviving less than 1 year after therapy (odds ratio = 7.0, 95% CI [1.08-45.7], p = 0.04). Having previously received IV BV was associated with increased risk of death (OR 18, 95% CI [1.8-180.0], p = 0.014). CONCLUSION: In patients with recurrent GB treated with SIACI BV, the change in ADC value after treatment is predictive of overall survival.

The Added Prognostic Value of Metabolic Tumor Size on FDG-PET at First Suspected Recurrence of Glioblastoma Multiforme.

BACKGROUND AND PURPOSE: Patients with glioblastoma multiforme (GBM) face a dismal prognosis, with an average survival of 6-7 months after recurrence. There remains no consensus for managing these patients due to the heterogeneity of these tumors. Imaging may affect treatment decisions by helping to stratify patient prognosis. The purpose of this analysis was to evaluate the added utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) over magnetic resonance (MR) imaging metrics in predicting survival. METHODS: Forty-four consecutive patients who underwent FDG-PET for first recurrence of GBM were included in this analysis. Tumor sizes, using cross products, and volumes on FDG-PET and MRI, maximum standardized uptake value (SUV), minimum apparent diffusion coefficient (ADC) value, presence of satellite lesions, presence of multifocal lesions, and presence of bilateral tumor were considered as prognostic variables. Survival was assessed using Cox hazard and logistic regression models based on the time interval between the PET scan and the patient's date of death. RESULTS: Tumor volumes on FDG-PET (P = .046), tumor cross products on FDG-PET (P = .017), and tumor cross products on MRI (P = .031) were significant prognostic variables, adjusting for the extent of the initial resection. Enhancing tumor volume, tumor cross product on a T2-weighted MRI sequence, maximum SUV on FDG-PET, minimum ADC value, presence of satellites, multifocality, and bilaterality were not prognostic (P > .5). Prognostic accuracy of predicting short survival increased from 58% with tumor cross product on MRI alone to 74% after including tumor cross product from PET. CONCLUSIONS: Tumor size on FDG-PET adds prognostic information to enhancing tumor size on MRI at first suspected recurrence of GBM.

Interventional radiology fellowship website content: what is the relevance to potential applicants?

PURPOSE: To assess the accessibility and content of query Interventional Radiology (IR) fellowship program websites and determine the impact of these websites on applicants. MATERIALS AND METHODS: All IR fellowship programs were individually evaluated, and all IR fellowship applicants to our institution were surveyed. RESULTS: In 2015, 44.3% of programs had an appropriate functional link to the fellowship website. Most provided a program description and application information. In our survey, applicants reported that website quality was moderately important to their overall impression of a fellowship. The most important aspects were didactics and facilities information. CONCLUSION: Fellowship website content and quality are important to applicants.