A. Fadl

Combating the Health Risks of Sedentary Behavior in the Contemporary Radiology Reading Room

OBJECTIVE We detail the association of sedentary behavior with a variety of health problems and provide the radiologist with a number of simple activities and techniques that can improve overall health while still meeting the productivity demands of a high-volume practice. Although these techniques are well known and recognized in the fitness and nutrition literature, they are not widely used in the radiology reading room. The computer- and workstation-based work routinely performed by diagnostic radiologists typically occurs in the seated position, leading to more than 8 hours per day of sitting. Studies have found that even for those who exercise regularly, spending increased time sitting can negate the healthful effects of exercise. Time spent in a seated or sedentary position leads to slowing of ones metabolism, with negative resultant effects. CONCLUSION The concept of nonexercise activity thermogenesis (NEAT) will be described, with examples given of how to burn more calories while at work and, therefore, improve the health of the diagnostic radiologist. NEAT refers to the energy expended during activities of daily living, excluding sportlike or intentional exercise. The concept of NEAT must be understood by radiologists, because it allows the development of multiple strategies to combat the ill effects of sitting while working. Adding intermittent movement and stretching exercises throughout the day can stimulate metabolism. An understanding of the association of sedentary work behavior with a number of health risks is crucial for radiologists so that they can implement basic changes into their work routine, allowing them to increase activity to address and avoid these potential health hazards.

Utilization of the track embolization technique to improve the safety of percutaneous lung biopsy and/or fiducial marker placement ☆,☆☆

PURPOSE The purpose of the study was to describe and present outcomes of the track embolization technique with absorbable hemostat gelatin powder during percutaneous computed tomography (CT)-guided lung biopsy and/or fiducial marker placement versus the standard of care (no track embolization) in an attempt to decrease rates of pneumothorax (PTX), chest tube placement, hemorrhage and/or complications, and average cost per patient. MATERIALS AND METHODS An institutional review board-approved, case-control, retrospective study was performed in which 125 consecutive patients who underwent track embolization were compared with 124 consecutive controls at one institution. For subjects in whom the track embolization technique was utilized, it was performed passively through a coaxial needle as it was removed. All procedures were performed by one of three attending interventional radiologists. For each group, medical records and procedure images were reviewed for PTX occurring postprocedure, PTX requiring chest tube placement, and occurrence of minor or major complication and/or hemorrhage. Comparison was made with published complication rates, and a cost-per-patient analysis was performed. Statistical analysis was performed utilizing Fishers Exact Test. RESULTS In track embolization cases versus controls, there were statistically significant reduction in PTX (8.8% vs. 21%; P=.007) and reduction in PTX requiring chest tube placement (4% vs. 8.1%; P=.195). This compares favorably to previously published rates of PTX and chest tube placement of 8%-64% and 1.6%-17%, respectively. None of the pneumothoraces occurring at time of needle placement increased in size with use of the track embolization technique. There were no major complications (including neurological sequela) in the track embolization group. In track embolization cases versus controls, there was a statistically significant reduction in both the rate of major hemorrhage (0% vs. 4%; P=.029) and average cost per patient (

A Guide to Percutaneous Cryoablation of Renal Masses in Difficult Anatomic Locations

262.40 vs.

A pilot program for use of a homemade phantom for CT biopsy simulation training

352.07; P=.044). CONCLUSIONS CT-guided percutaneous lung biopsy and/or fiducial marker placement were safer utilizing the track embolization technique during trocar removal. In addition, this technique was cost effective in the study population.

Magnetic nanoparticles and drug targeting: development, current use, and future roles in interventional oncology practice

Purpose To discuss the pathophysiology of renal cell carcinoma, describe indications for treatment of small renal masses, present technical aspects of percutaneous cryoablation, and highlight adjunctive techniques used to improve success and safety during cryoablation of renal masses in more difficult anatomic locations. Material and Methods A case-based format will be utilized to highlight techniques to improve outcomes in cryoablation of renal masses in difficult anatomic locations. Four major topics will be presented, including maximizing position of the patient, utilization of retrograde pyeloperfusion, using hydrodissection to displace critical structures away from the zone of ablation, and angioplasty balloon interposition to displace adjacent structures from the ablation zone. In addition, combining ablation and embolization in the most difficult anatomic locations will be described. Results Utilizing adjunctive technique during cryoablation leads to successful cryoablation of renal masses in difficult anatomic locations. Placing patients in lateral decubitus position, with the affected side down, results in less aeration of the adjacent lung and reflex increased aeration of the contralateral lung. This allows for improved window to target upper pole renal masses. Retrograde ureteral catheter can be placed to infuse warm saline into the ureter and renal pelvis in an attempt to protect these structures during cryoablation. Hydrodissection can be used to infuse normal saline through a trocar to displace critical structures away from the zone of ablation. Similar to the concept of combining ablation and embolization for treatment of 3 to 5 cm liver tumors, one can combine therapies in an attempt to achieve a synergistic effect. This is particularly useful when there is concern that a complete ablation may not be possible given lesion location in a poor surgical candidate. Conclusions Nephron-sparing therapies have been increasingly utilized in treatment of renal masses. Lesions typically considered more difficult to ablate include central lesions, size larger than 3 cm, upper pole location, endophytic, and adjacent to ureter, colon, or other abdominal organs. Multiple techniques can be used to maximize the likelihood of successful cryoablation of masses in difficult anatomic locations, including hydrodissection, retrograde pyeloperfusion, maximizing patient positioning, and angioplasty balloon interposition.