Craig B. Glaiberman

Three-Dimensional C-arm Cone-beam CT: Applications in the Interventional Suite

C-arm cone-beam computed tomography (CT) with a flat-panel detector represents the next generation of imaging technology available in the interventional radiology suite and is predicted to be the platform for many of the three-dimensional (3D) roadmapping and navigational tools that will emerge in parallel with its integration. The combination of current and unappreciated capabilities may be the foundation on which improvements in both safety and effectiveness of complex vascular and nonvascular interventional procedures become possible. These improvements include multiplanar soft tissue imaging, enhanced pretreatment target lesion roadmapping and guidance, and the ability for immediate multiplanar posttreatment assessment. These key features alone may translate to a reduction in the use of iodinated contrast media, a decrease in the radiation dose to the patient and operator, and an increase in the therapeutic index (increase in safety-vs-benefit ratio). In routine practice, imaging information obtained with C-arm cone-beam CT provides a subjective level of confidence factor to the operator that has not yet been thoroughly quantified.

Management of Severe Vena Cava Filter Tilting: Experience with Bard G-2 Filters

The purpose of this article is to discuss the occurrence of abdominal pain associated with severe tilting of the Bard G-2 inferior vena cava filters. Potential reasons for the occurrence of tilting and management of tilting of the filters are discussed.

SIR/RSNA/CIRSE Joint Medical Simulation Task Force Strategic Plan: Executive Summary

From the Department of Radiology, Royal Liverpool University Trust, Liverpool, England (D.G.); Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (A.P.); Department of Radiology, University of Arizona College of Medicine, Tucson, Ariz (G.B.); Radiology Associates of Sacramento, Sacramento, Calif (B.C.); Department of Radiology, Baystate Health System/ Tufts University School of Medicine, Springfield, Mass (J.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (S.D.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.G.); Department of Radiology, Leeds Teaching Hospitals, Leeds, England (D.K.); Department of Radiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland (M.L.); William E Lewandowski Consulting, Daytona Beach, Fla (W.L.); Department of Computer Science, University of Hull, Hull, England (R.P.); Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands (J.R.); Department of Radiology, the Reading Hospital and Medical Center, Reading, Pa (D.S.); Department of Cardiovascular Radiology, Hopital Européen Georges Pompidou, Paris, France (M. Sapoval); and Department of Psychology, Old Dominion University, Norfolk, Va (M. Scerbo). Received February 13, 2007; final revision received May 11, 2007; accepted May 14, 2007. Address correspondence to A.A.P.; E-mail: aalpen. patel@uphs.upenn.eduThis article also appears in the July 2007 issue of Journal of Vascular and Interventional Radiology. An erratum to this article can be found online at 10.1007/s00270-009-9667-7.

Reversible Neuropathy Caused by Overuse Following Radiofrequency Ablation of Metastatic Pelvic Lesions

Adverse events following radiofrequency ablation of skeletal metastases are uncommon. This report describes two patients who developed a delayed neuropathy following radiofrequency ablation of pelvic metastases. Both patients had significant pain relief and normal neurological examinations following the procedure. Each patients neuropathy developed following acute significant increases of activity or stress on surrounding tissues allowed by the pain relief from therapy. Both patients completely recovered after a course of corticosteroids.

SIR/RSNA/CIRSE Joint Medical Simulation Task Force Strategic Plan Executive Summary

Strategic MissionThe Executive Councils of the Society of InterventionalRadiology (SIR), Radiological Society of North America(RSNA), and Cardiovascular and Interventional Radiolog-ical Society of Europe (CIRSE) have charged their MedicalSimulation Task Forces and Work Groups to cooperate toachieve excellence and safety in interventional radiologypatient care by jointly recommending and guiding imple-mentation of a robust infrastructure and process to supportInterventional Radiology (IR) simulation development,assessment, validation, application, and dissemination.The goal of medical training is to create practitionerswho demonstrate mastery of the professionalism (skills,knowledge, attitudes, and behavior) required for the suc-cessful delivery of medical therapy [1]. A well-designedand fully integrated curriculum is the essential mechanism

Patient Factors Affecting Thermal Lesion Size with an Impedance-based Radiofrequency Ablation System

PURPOSE To evaluate factors that affect the size of the thermal lesion created from radiofrequency ablation (RFA) with an impedance-based system. MATERIALS AND METHODS Thirty-two nonresectable liver tumors, including hepatocellular carcinomas (HCC) (N=20; 63%) or metastatic tumors (N=12; 37%) were treated in 29 patients with an impedance based RFA system. Tumor diameter was measured at pre-procedure cross sectional imaging. Follow-up imaging was obtained at 1 month and every 3 months afterward to determine the short axis of the resultant thermal lesion. Success at durable tumor destruction was tracked as well as size of the resulting thermal lesion and the resulting thermal lesion/electrode ratio. Time to impedance roll-off was also correlated with treatment success. RESULTS Twenty-eight (88%) of the 32 tumors were durably ablated in a single session. Two patients had residual disease and two had local recurrence. All residual or recurrent lesions were in patients with cirrhosis. Three of these patients were retreated resulting in a durable result in 97% of lesions with a mean/median follow up 443/503 days. Mean tumor diameter and resulting thermal lesion size was similar for HCC and metastatic lesions. A significant difference (P=.02) was observed when comparing the thermal lesion/electrode ratios of HCC (1.01+/-0.36) with metastases (1.26+/-0.22). Nine of 20 HCC ablations (45%) resulted in a ratio>1.0, whereas 11 of 12 metastatic ablations (92%) attained a ratio>1.0 (P=.01). Thermal lesion size did not correlate with time to impedance roll-off for the entire group (r=-0.22; P=.90) or by tumor type (HCC r=0.10; P=.68; metastases r=-0.36; P=.23). CONCLUSION Thermal lesion size and the ability to obtain a margin of normal tissue are significantly affected by the presence of cirrhosis when using an impedance-based system. Given this limitation, the majority of small hepatic neoplasms can still be successfully treated with RFA.

Creation of radiopaque thrombi for in vivo experiments

PURPOSE A number of percutaneous thrombectomy devices are undergoing investigation for treatment of patients with venous thromboembolism. Use of radiopaque thrombus to monitor thrombus delivery and assess thrombectomy has been previously reported. The purpose of this project was to quantitatively test the effect of mixing different ratios of blood and contrast material to facilitate maximum thrombus formation and radiopacity. MATERIALS AND METHODS The following ratios of blood and contrast material were mixed: 2 mL blood to 8 mL contrast material (ratio = 0.25), 4 mL blood to 6 mL contrast material (ratio = 0.67), 6 mL blood to 4 mL contrast material (ratio = 1.5), and 8 mL blood to 2 mL contrast material (ratio = 4). Contrast material was added at day 0, 3, or 6. Each sample received one of two ionic contrast agents to opacify the clots. At day 14, thrombus mass and opacity were determined. RESULTS Three combinations of blood and contrast material produced maximum thrombus and radiopacity. These were sodium iothalamate 30% with a ratio of 4 with contrast material added on day 0 and sodium iothalamate 60% with a ratio of 1.5 with contrast material added on day 3 or 6. CONCLUSIONS When forming radiopaque thrombi, significant differences can result from the ratio of blood to contrast material used. Contrast material type can also affect radiopacity and mass formed. The use of optimal ratios of blood to contrast material should maximize device evaluation with minimal wasting of valuable resources such as test subjects, physician time, and equipment.