Techniques in Vascular & Interventional Radiology RSS feed: Current Issue. Interventional radiology is an area of clinical diagnosis and management that is highly technique-oriented. Therefore, the format of this quarterly journal, which combines the visual impact of an atlas with the currency of a journal, lends itself perfectly to presenting the topics. Each issue is guest edited by a leader in the field and is focused on a single clinical technique or problem. The presentation is enhanced by superb illustrations and descriptive narrative outlining the steps of a particular procedure. Interventional radiologists, neuroradiologists, vascular surgeons and neurosurgeons will find this a useful addition to the clinical literature. Techniques in Vascular and Interventional Radiology is a quarterly review publication for physicians and allied health professionals interested in image-guided minimally-invasive therapies. Its mission is to improve patient care by educating interventionalists on the latest techniques in catheter-based therapies from experts in the field. 2010 Topics , Volume 13 March Peripheral Arterial Interventions Pena June Renal, Adrenal and Urologic Interventions Part III Saad September Radiation Safety Dixon December Pediatrics I Sidhu I http://www.techvir.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Techniques in Vascular & Interventional Radiology1089-2516133September 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.techvir.com/article/PIIS1089251610000454/abstract?rss=yesEditorial Board10.1053/S1089-2516(10)00045-4Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8iihttp://www.techvir.com/article/PIIS1089251610000478/abstract?rss=yesForthcoming Topics10.1053/S1089-2516(10)00047-8Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8iiiihttp://www.techvir.com/article/PIIS1089251610000880/abstract?rss=yesTable of Contents10.1053/S1089-2516(10)00088-0Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8iiiivhttp://www.techvir.com/article/PIIS1089251610000107/abstract?rss=yesRadiation safety is a hot topic in both the lay press and the medical literature. Within the last couple of years, reports of unrecognized, high radiation doses during brain perfusion studies, accidental exposures of pregnant patients, and high doses delivered to children have made headlines, while articles on the increased contribution to the population's medical radiation exposure and estimations of the cancer risk of computed tomography (CT) have recently been reported in the medical literature. Both patients and health care providers are keenly aware of this issue. Interventional radiology, as a contributor to the collective dose of the US population, comes in third behind CT and nuclear medicine. Nonetheless, for any given complex procedure, the dose to an individual patient has the potential to be quite high. While the actual risks continue to be debated, the machines that we use continue to increase in their sophistication. It makes sense that we master the technology (rather than have the technology master us) so that we can maximize the benefit:risk ratio and avoid making the 6:00 PM Nightly News. This will require a continued effort by every practicing interventionalist.IntroductionRobert G. Dixon10.1053/j.tvir.2010.03.001Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8147147.e1http://www.techvir.com/article/PIIS1089251610000119/abstract?rss=yesUterine embolization has become accepted into the mainstream of fibroid therapies and now is among the most common interventions for the condition. Because the procedure is based on angiographic techniques, it requires fluoroscopic and angiographic imaging, both dependent on exposure to ionizing radiation. Given the increasing popularity of this procedure, it is important to understand the potential impacts of this exposure on both individual patients and also the population as a whole. This review is intended to summarize the our current knowledge of the potential risks associated with the radiation exposure from procedure and how those risks might be controlled and reduced by adjusting techniques used during the procedure.Radiation Exposure and Uterine Artery Embolization: Current Risks and Risk ReductionGary Tse, James B. Spies10.1053/j.tvir.2010.03.002Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8148153http://www.techvir.com/article/PIIS1089251610000120/abstract?rss=yesThis article reviews a practical approach to managing the dose of ionizing radiation during IR procedures where the patient is, or might be pregnant.Interventional Radiology: Management of the Pregnant PatientM. Victoria Marx10.1053/j.tvir.2010.03.003Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8154157http://www.techvir.com/article/PIIS1089251610000132/abstract?rss=yesPediatric interventional radiology procedures are becoming increasingly common in the medical community, in part due to the significant medical benefit derived from these studies. At the same time, the medical radiation used for these studies contributes to the radiation dose to this unique population of patients. As children are more sensitive to radiation than adults and have a longer lifetime to manifest those changes, a concerted effort should be made toward radiation protection in this setting. Pediatric interventional procedures may differ from adult examinations in several ways, including the small size of the patient, the proximity of the operator's body and hands to the beam, and small body spaces resulting in precarious wire purchase. We describe specific strategies to improve patient and staff safety. These include staff education, safety checklists, a team approach, and formalized review and quality assurance programs. Practical steps to reduce patient dose are reviewed, and tools to assist in achieving the goal of optimizing radiation safety in children undergoing interventional procedures are provided.Radiation Safety in Pediatric Interventional RadiologyManrita Sidhu, Keith J. Strauss, Bairbre Connolly, Terry T. Yoshizumi, John Racadio, Brian D. Coley, Tara Utley, Marilyn J. Goske10.1053/j.tvir.2010.03.004Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8158166http://www.techvir.com/article/PIIS1089251610000144/abstract?rss=yesStaff are exposed to potentially high levels of radiation exposure during interventional radiology procedures. Radiation protection shielding devices should be used to help maintain personnel exposures as low as reasonably achievable. Body protection tools include lead aprons, thyroid shields, radiation protection cabins, and floor- and table-mounted shields. Eye protection tools include leaded glasses, ceiling-mounted shields, and protective patient drapes. Hand protection tools include leaded surgical gloves and protective patient drapes. For the most part, these radiation protection tools provide substantial dose reduction for personnel, with several notable exceptions. Leaded glasses without lateral protection do not provide adequate protection to operators because they are typically exposed to scatter radiation from the side. Leaded surgical gloves are not useful for hand protection when hands are placed in the primary x-ray beam. Although other radiation protection tools are effective, they come with drawbacks, including staff physical discomfort and reduced procedure efficiency. As a result, further development of new protection devices is encouraged.Operator Shielding: How and WhyBeth A. Schueler10.1053/j.tvir.2010.03.005Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8167171http://www.techvir.com/article/PIIS1089251610000156/abstract?rss=yesIn the recent past, computed tomography (CT) use has grown by approximately 10% per year, with 62 million examinations performed in the USA in 2006. While these studies make up only 15% of the total number of radiologic examinations, they contribute approximately half of the public exposure due to medical radiation. CT-guided procedures comprise a small, but important minority of the total number of CT scans performed each year, as a significant dose can be delivered in this setting. This article reviews techniques to optimize patient exposure during CT-guided interventions.Optimizing Dose in Computed Tomographic Guided ProceduresRobert G. Dixon, Kent Ogden10.1053/j.tvir.2010.03.006Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8172175http://www.techvir.com/article/PIIS1089251610000168/abstract?rss=yesProtection of patients from excessive medical radiation has become a high priority in health care. As clinical physicians, interventional radiologists must remain cognizant of the radiation we use in daily practice. Radiation reduction begins before the procedure itself, as with appropriate preprocedural planning the amount of fluoroscopy and angiography used can then be reduced. Patients should be counseled regarding the potential for use of significant amounts of radiation when procedures associated with such doses are planned, as part of the process of obtaining informed consent. If significant radiation is used, patients should be alerted to have appropriate follow-up. The amount of radiation used can be reduced by careful attention to imaging technique.Patient Radiation Management and Preprocedure Planning and ConsentMichael S. Stecker10.1053/j.tvir.2010.03.007Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8176182http://www.techvir.com/article/PIIS108925161000017X/abstract?rss=yesAngiographic equipment used for intervention has evolved dramatically over the last 20 years. As a result, attainable image quality has improved significantly. Since image quality and radiation dose are intricately related, the potential patient dose has risen as well. Image quality must therefore be managed in a manner that meets the needs of the procedure with the most beneficial limitation of radiation delivery. This article reviews the basic tenets of minimizing patient dose in the angiography suite. In addition, it investigates technical parameters that can be manipulated, allowing the operator to achieve the image quality needed to successfully complete the task with the least dose delivered to the patient. While a detailed description of each manufacturer's operating instructions is beyond the scope of this article, general principles are reviewed so that operators can understand the questions and issues involved. The hope is that this will facilitate the adaptation of these principles, which can then be applied to any machine. The responsibility is then on the operators to become facile with their own technical environment, so the maximum benefit/risk ratio can be afforded patients.Managing Image Quality and Patient Dose in the Angiography Suite: Do You Really Need That Image Quality?Robert G. Dixon, Louis Wagner10.1053/j.tvir.2010.03.008Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8183187http://www.techvir.com/article/PIIS1089251610000181/abstract?rss=yesThe principal problem in measuring patient radiation dose during fluoroscopically guided procedures is that dose is not administered uniformly throughout the patient's body. Four dose metrics have been developed to quantify patient radiation dose for fluoroscopically guided procedures: fluoroscopy time, peak skin dose, reference dose, and kerma-area-product. Each metric must be understood to be used appropriately. Fluoroscopy time correlates poorly with other dose metrics. It should not be used as the sole method to estimate, monitor, or record patient radiation dose unless no alternative is available. Kerma-area-product is a good metric for estimating stochastic risk. Reference dose is a conservative method to estimate peak skin dose and deterministic risk and is recommended for this purpose. Every fluoroscope sold in the USA since mid 2006 is able to measure, display, and record reference dose. Radiation dose should be monitored during fluoroscopically guided procedures, either by the operator or by a designated individual in the procedure room, such as a technologist or nurse. Patient radiation dose should be recorded appropriately in the medical record. Patients who have received a sufficiently large radiation dose should have follow-up at 10-14 days and at 1 month after the procedure for possible deterministic effects.Measuring and Monitoring Radiation Dose During Fluoroscopically Guided ProceduresJohn W. Jaco, Donald L. Miller10.1053/j.tvir.2010.03.009Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8188193http://www.techvir.com/article/PIIS1089251610000193/abstract?rss=yesThe practice of medicine is becoming increasingly complex with regard to its economic and academic aspects. In a climate of increasing cutbacks and reduced reimbursements, health care providers are being held more accountable for proving that the services they render are top quality and worthy of the cost of the care provided. Furthermore, patient safety is currently in the public eye and a driving force behind the Pay for Performance initiative. Therefore, quality assurance programs and practice quality improvement systems have been developed to promote patient safety, improve current practice patterns, and help practitioners maintain their board certification. This article very briefly describes one simple example of a radiation safety quality assurance program.How to Create a Quality Assurance Program for Radiation Safety in Interventional RadiologyCraig Glaiberman10.1053/j.tvir.2010.03.010Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8194199http://www.techvir.com/article/PIIS108925161000020X/abstract?rss=yesRadiation protection (RP) knowledge is of paramount importance for interventionalists. All international bodies acknowledge the importance of education and training in reducing patient doses while maintaining the desired level of quality in medical exposures. The basic recommendations of the International Commission on Radiological Protection (ICRP) on RP training for Interventional Radiology (IR) are summarized as follows: a second, specific level of training in RP; specific additional training whenever new X-ray systems or techniques are implemented, and quality assurance programs, including RP training. The European perspective is discussed in the framework of the Directive on Medical Exposures: Competence in RP must be certified. The Member States of the European Union shall ensure that appropriate curricula are established and shall recognize the corresponding diplomas, certificates, or formal qualifications. Some examples of the accredited training courses on RP organized by national IR Societies are described (content, training strategy, training material available, and results obtained). The work carried out in this area and the training material produced by the International Atomic Energy Agency are also quoted, together with a new set of recommendations on RP training and the certification produced by the ICRP that will be published in 2010.Mandatory Radiation Safety Training for Interventionalists: The European PerspectiveEliseo Vano10.1053/j.tvir.2010.03.011Techniques in Vascular & Interventional Radiology 13, 3 (2010)2010-09-01Techniques in Vascular & Interventional Radiology2010-09-01133S1089-2516(10)X0003-8200203