Survey of current status and physician opinion regarding ancillary staffing for the IR suite.

PURPOSE: To survey the status quo of ancillary staffing in predominantly hospital-based interventional radiology (IR) suites and to assess interventional radiologist attitudes toward current IR procedure room staffing availability and appropriateness. MATERIALS AND METHODS: Invitations to an online survey composed of 26 questions focused on levels of IR suite ancillary staffing as well as operators' opinions of current IR procedure room staffing were sent via email to 2,284 active Society of Interventional Radiology members. RESULTS: There were 777 survey responses. Nurse staffing count per IR room was at least one in 90% (n = 699) during regular hours and 93.6% (n = 730) during off-hours, respectively. A second technologist was frequently used during regular hours and, to a lesser extent, during on-call hours (n = 341 [43.9%] and n = 122 [15.7%]), respectively. Ten and 15% of IR respondents believe staffing support is inadequate for most interventional procedures requiring moderate sedation during normal business hours and off-hours/weekends, respectively, and 69% and 56% of IR respondents believe anesthesia support is inadequate during normal business hours and during off-hours, respectively. CONCLUSIONS: The number of technologists used per IR suite varies across practices and frequently exceeds that of earlier American College of Radiology recommendations, whereas use of IR suite nurse staffing is consistent with approximately one per suite and constant. However, there is dissatisfaction among surveyed interventional radiologists with availability and appropriateness of staffing of the IR procedure room, particularly during on-call hours and weekends, as well as with anesthesia support for emergent cases. No evidence-based guidelines for staffing the IR suite currently exist. This underscores the need for further investigation with the ultimate goal of creating such guidelines.

Experimental dengue virus challenge of human subjects previously vaccinated with live attenuated tetravalent dengue vaccines.

BACKGROUND: Protection against dengue requires immunity against all 4 serotypes of dengue virus (DENV). Experimental challenge may be useful in evaluating vaccine-induced immunity. METHODS: Ten subjects previously vaccinated with a live attenuated tetravalent dengue vaccine (TDV) and 4 DENV-naive control subjects were challenged by subcutaneous inoculation of either 10(3) plaque-forming units (PFU) of DENV-1 or 10(5) PFU of DENV-3. Two additional subjects who did not develop DENV-3 neutralizing antibody (NAb) from TDV were revaccinated with 10(4) PFU of live attenuated DENV-3 vaccine to evaluate memory response. RESULTS: All 5 TDV recipients were protected against DENV-1 challenge. Of the 5 TDV recipients challenged with DENV-3, 2 were protected. All DENV-3-challenge subjects who developed viremia also developed elevated liver enzyme levels, and 2 had values that were >10 times greater than normal. Of the 2 subjects revaccinated with DENV-3 vaccine, 1 showed a secondary response to DENV-2, while neither showed such response to DENV-3. All 4 control subjects developed dengue fever from challenge. Protection was associated with presence of NAb, although 1 subject was protected despite a lack of measurable NAb at the time of DENV-1 challenge. CONCLUSIONS: Vaccination with TDV induced variable protection against subcutaneous challenge. DENV-3 experimental challenge was associated with transient but marked elevations of transaminases.

Sonographic findings of healthy volunteers infected with dengue virus.

PURPOSE: Sonography has historically been used in developing countries to help diagnose dengue infection during epidemics of dengue hemorrhagic fever in endemic areas and to predict the clinical course. In this article, we describe the sonographic findings in subjects infected with attenuated, monovalent strains of dengue virus. METHODS: As part of a major research protocol to validate challenge strains of dengue virus for use in vaccines, 12 subjects were infected with 1 of 4 strains of dengue virus, and 3 subjects received placebo. The challenge was followed by an observation period. During this time, they were imaged regardless of the development of symptoms. RESULTS: Seven of 12 subjects infected with dengue virus showed sonographic evidence of subclinical plasma leakage, including perihepatic and perisplenic ascites, pericardial effusion, and gallbladder wall thickening. None of the 3 placebo recipients developed effusions. CONCLUSION: Sonographic evidence of fluid collection was seen in over half of subjects infected with dengue virus who did not show any evidence of dengue hemorrhagic fever. These findings shed light on possible mechanisms of plasma leakage and its role in the pathogenesis of dengue fever and dengue hemorrhagic fever.

Advances in vascular imaging.

Advances in vascular surgery have mirrored advances in diagnostic imaging. Indeed, the endovascular revolution has been made possible largely by advances in computed tomography, magnetic resonance imaging, and vascular ultrasound. As technology allows better noninvasive vascular diagnosis, conventional angiography, once the gold standard for the diagnosis of vascular disease, is now reserved largely for intervention. This article discusses the current state of vascular imaging. Specific emphasis is placed on the comparative clinical utility of different imaging modalities in the detection and management of vascular disease.

Disease and nonbattle injury in the combat zone.

Given the current tempo of military operations in the global war on terror, the military radiologist must be prepared to diagnose surgical and medical conditions. The imaging of blunt and penetrating trauma remains the critical mission. However, a more challenging part of the day's work involves the imaging of medical diseases encountered in the third world. The majority of such entities are infectious in nature, but unusual presentations of congenital diseases are common. It is important for the deployed radiologist to have knowledge of diseases and conditions not ordinarily seen in the USA and to have a high index of suspicion for unusual processes.

Human immunodeficiency virus arteriopathy of the adult cerebral circulation.

Arteriopathy associated with human immunodeficiency virus infection and clinical acquired immunodeficiency syndrome is well-documented. The pathophysiology of this arteriopathy may vary in different vascular beds. Although arteriopathy of central nervous system (CNS) circulation has been recognized in pediatric patients since the late 1980s, there are no reported cases of CNS arteriopathy in adults. We present the first reported case of adult CNS arteriopathy in a human immunodeficiency virus-positive patient who succumbed to complications secondary to diffuse aneurysmal disease of the Circle of Willis.

Radiology in a hostile environment: experience in Afghanistan.

Imaging equipment deployed with the combat support hospital in Afghanistan represented new technology not previously used in a hostile environment for a prolonged period. In general, the equipment performed well in a stationary location. Having computed tomography and ultrasound scans, in addition to plain radiographs, was very helpful for patient care. Redundancy of digital radiography and ultrasound systems proved prudent. It is recommended that a radiologist continue to be sent with the combat support hospital, particularly when computed tomography and ultrasound systems are in the deployment package. This report acquaints the medical community with information to aid in the planning and performance of future deployments that bring digital imaging to the battlespace.

Totally percutaneous aortic aneurysm repair: experience and prudence.

OBJECTIVE: Totally percutaneous aortic aneurysm repair has been shown to be technically feasible, with low morbidity. Complications from percutaneous arterial closure are not insignificant, however, and can be fatal. We sought to evaluate our experience with this technique, compare it with the published literature, and identify factors associated with conversion to open repair and complications. METHODS: A retrospective review of a prospectively collected database was performed. All patients who underwent percutaneous closure of large-bore-sheath (>12F) access sites with off-label use of a suture-mediated closure device (Prostar XL) between December 2002 and August 2005 were reviewed. Outcome measures evaluated were rates of technical success, conversion to open femoral arterial repair, and complications. Axial diameter measurements of the accessed vessels were assessed with computed tomographic (CT) angiography both before and after the procedure. Patient variables were compared by using chi2, Fisher exact, and paired and independent samples t tests where appropriate. The mean follow-up interval was 1.5 years. RESULTS: During the study period, 49 patients underwent percutaneous closure of 79 large-bore-sheath access sites after successful endovascular aneurysm repair. Seven patients (14%) were morbidly obese (body mass index >35 kg/m2). Successful closure was achieved in 74 access sites (93.7%). Percutaneous closure was unsuccessful in five access sites (6.3%), all of which required open femoral repair at the same setting. Two converted patients experienced complications (4.1%): one retroperitoneal hematoma requiring transfusion of blood products and one iliac artery injury leading to death from myocardial infarction. Both of these patients were morbidly obese. Both complications occurred after closure of larger than 20F sheath sites. Morbid obesity and sheath size greater than 20F were associated with a significantly increased complication rate (P = .02 and P = .01, respectively). No thrombotic or infectious complications occurred in this series. Upon comparison of preoperative and postoperative CT angiograms, one (1.3%) small pseudoaneurysm was detected. No arteriovenous fistulas or hematomas larger than 3 cm were detected. The pseudoaneurysm occurred after closure of a 20F sheath access site. There were no significant differences in minimum intraluminal (7.38 +/- 1.8 vs 7.48 +/- 1.8) or maximum extraluminal (11.25 +/- 2.8 vs 12.02 +/- 2.7) diameters between preoperative and postoperative CT angiograms, respectively. CONCLUSIONS: Totally percutaneous aortic aneurysm repair is technically feasible in most cases, with no effect on the luminal diameter of the accessed femoral artery. Complications occur more often in morbidly obese patients and with sheaths larger than 20F. These complications can be minimized with meticulous technique and good patient selection. The capability for expeditious open femoral arterial repair is mandatory with this approach.

Computed tomography of craniofacial trauma at a combat support hospital in Afghanistan.

Complex craniofacial injuries are encountered among both soldiers and civilians in combat zones. Computed tomography is a necessary and effective tool for the evaluation and treatment of these injuries in the forward-deployed combat support hospital.

Intravascular bullet migration: a report of two cases.

In the trauma setting, penetrating vascular injuries secondary to gunshot wounds need to be addressed promptly and carefully. By identifying the entry and exit sites, the pathway of injury can usually be determined. Vessel injury is typically related to direct vascular trauma or secondary blast injury. On rare occasions, the involved vessels can serve as conduits, transporting projectiles to various locations remote from the entry wounds. The cases described demonstrate different manifestations of bullet embolism within the arterial and venous systems. We provide a literature review and we discuss therapeutic options available in these unique scenarios.