John D. Statler

Guidelines for Patient Radiation Dose Management

Michael S. Stecker, MD, Stephen Balter, PhD, Richard B. Towbin, MD, Donald L. Miller, MD, Eliseo Vano, PhD,Gabriel Bartal, MD, J. Fritz Angle, MD, Christine P. Chao, MD, Alan M. Cohen, MD, Robert G. Dixon, MD,Kathleen Gross, MSN, RN-BC, CRN, George G. Hartnell, MD, Beth Schueler, PhD, John D. Statler, MD,Thierry de Baere, MD, and John F. Cardella, MD, for the SIR Safety and Health Committee and the CIRSEStandards of Practice Committee

Sonographic findings of healthy volunteers infected with dengue virus

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.

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.

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.

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.

Society of Interventional Radiology Position Statement: Prevention of Unintentionally Retained Foreign Bodies during Interventional Radiology Procedures

From Virginia Interventional and Vascular Associates (J.D.S.), Fredericksburg; Department of Radiology (W.E.A.S.), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology (J.D.S.), Uniformed Services University of the Health Sciences; Center for Devices and Radiological Health (D.L.M.), Food and Drug Administration, Silver Spring; Department of Interventional Radiology (K.G.), Greater Baltimore Medical Center, Baltimore, Maryland; Department of Radiology (R.G.D.), University of North Carolina, Chapel Hill, North Carolina; Department of Radiology (M.D.K.), University of California, Los Angeles, Medical School, Los Angeles; Department of Radiology (R.L.G.), University of California, San Francisco, San Francisco, California; Department of Vascular and Interventional Radiology (A.M.C.), University of Texas Health Science Center, Houston; Department of Radiology (R.S.), University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Mallinckrodt Institute of Radiology (J.R.D.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.E.S.), Beth Israel Medical Center; Department of Radiology, Interventional Radiology Service (R.H.T.), Memorial Sloan-Kettering Cancer Center, New York, New York; Division of Angiography and Interventional Radiology (M.S.S.), Brigham and Women’s Hospital, Boston, Massachusetts; and Department of Diagnostic and Interventional Radiology (G.B.), Meir Medical Center, Kfar Saba, Israel. Final revision received and accepted July 18, 2011. Address correspondence to J.D.S., c/o Debbie Katsarelis, 3975 Fair Ridge Dr., Suite 400 N., Fairfax, VA 22033; E-mail: jstatrad@aol.com

Society of Interventional Radiology: Occupational Back and Neck Pain and the Interventional Radiologist

INTRODUCTION Interventional radiology is a unique specialty that involves vascular and nonvascular procedures involving virtually every patient population. Currently, most interventional radiologists perform several procedures per day, some lasting hours, and also typically provide on-call coverage for hospitals 24 hours a day, 7 days a week. The physical demands are distinctly different from those of diagnostic radiology, as interventional radiology requires standing while wearing heavy personal protective garments, performing technically complex procedures, moving equipment, and changing positions to accomplish the task at hand. An interventionalist who has spent a career providing procedural care for patients and is affected by occupational musculoskeletal problems ought to be able to refer to a corresponding topic-specific societal document. As no such official Society of Interventional Radiology (SIR) document exists, it is hoped that this document will fill that void. Standing occupations are associated with higher levels of low back pain (LBP) compared with sitting occupations (1). In addition, the use of ionizing radiation requires personal protection, typically in the form of heavy protective garments. This, combined with standing for most of the day and performing procedures with repetitive motions in awkward positions, has been associated with occupational neck and back pain (2). Whereas the hazards of radiation and bloodborne pathogen exposure are well established (3–5), the musculoskeletal

Tissue plasminogen activator in the percutaneous drainage of splenic abscess.

parallel orientation of the electrode relative to the vessel. Several explanations are possible. First, excessive ablation time to overcome the heat-sink effect may have critically compromised the vessel wall integrity. The hepatic vein is known to be more susceptible to thermal injury than the hepatic artery or portal vein because of its relative lack of protective smooth muscle or perivascular connective tissue (3). Second, previous radiation therapy may have been contributory, even though large veins seem to be relatively unaffected by radiation damage (4). Therefore, prolonged ablation and irradiation may have played synergistic roles. Last, it is conceivable that any microinvasion of the hepatic vein by the abutting tumor may have weakened the vessel and contributed to formation of the pseudoaneurysm after RF ablation. There are no established recommendations for the management of hepatic vein pseudoaneurysms. It is indeed controversial whether invasive procedures such as embolization or stent-graft placement are warranted for a clinically silent intraparenchymal pseudoaneurysm. However, our patient’s worsening anemia and the compromised tissue support around the pseudoaneurysm— composed of tenuous necrotic tissue providing only a thin layer of separation from the peritoneum in some portions—prompted the decision for stent-graft repair. Exclusion of normal hepatic venous radicles and resulting congestion in the draining segments is a potential concern following deployment of a long stent-graft (60 mm in this case) (5). However, serial laboratory tests showed no decrease in hepatic function, and it was assumed that intrahepatic collateral venous flow was sufficiently developed. In conclusion, hepatic vein pseudoaneurysm is a rare but possible vascular complication of RF ablation. Although management guidelines are not established, stent-graft repair is a safe treatment option.

Recommendations for the Implementation of Joint Commission Guidelines for Labeling Medications

j John D. Statler, MD; Richard B. Towbin, MD; Joseph A. Ronsivalle, DO; Anne Oteham, RN, BSN; Donald L. Miller, MD; Clement J. Grassi, MD; Daniel B. Brown, MD; Horacio R. D’Agostino, MD; Arshad Ahmed Khan, MD; Sanjoy Kundu, MD; Anne C. Roberts, MD; Cindy Kaiser Saiter, NP; Marc S. Schwartzberg, MD; Suresh Vedantham, MD; Michael J. Wallace, MD; and John F. Cardella, MD for the SIR Standards of Practice Committee

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.