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INTRODUCTION: During Interventional Cardiology (IC) and Interventional Radiology (IR) procedures operators' gloves, guide wires and catheters may stick together due to the inherent stickiness of Iodine Containing Contrast Media (ICCM). This may result in displacement of materials, compromising technical success. In this study we compare the stickiness of seven frequently used types of ICCM. MATERIAL AND METHODS: Xenetix 300, Hexabrix 320 (Guerbet, Villepinte, France), Ultravist 300 (Bayer, Leverkusen, Germany), Visipaque 270, Omnipaque 300, Visipaque 320 (GE, Wauwatosa, WI) and Iomeron300 (Bracco, Milano, Italy) are compared using a probe-tack test. Pieces of surgical gloves are put together with 0.1 ml of of ICCM in between, and subsequently pulled apart under computer control. Stickiness is measured as the work needed to separate the probes. RESULTS: From least to most sticky results were: Hexabrix 320 (mean Work (mJ); range: 0.70; 0.16-1.23), Visipaque 270 (1.18; 0.47-1.89), Visipaque 320 (1.70; 0.59-2.81), Iomeron 300 (3.01; 1.82-4.20), Xenetix 300 (5.83; 3.96-7.69), Ultravist 300 (5.83; 2.83-8.84), Omnipaque 300 (8.14; 6.95-9.33). The four least sticky ICCM differ statistically significantly (p = 0.000-0.004) from the remaining. In this research Omnipaque 300, Ultravist 300 and Xenetix 300 are the stickiest and may hence pose the greatest practical problems during procedures; in contrast, Hexabrix 320, Visipaque 270 and Visipaque 320 are the least sticky in this research and may therefore aid in constraining complications caused by stickiness. CONCLUSION: A significant and reproducible difference in stickiness exists between commercially available ICCM, Hexabrix 320, Visipaque 270, Visipaque 320 and Iomeron 300, being least sticky.

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Shielding design is an essential aspect of radiation protection. It is necessary to ensure that barriers safeguard workers, patients, the general public, and the environment from the harmful radiation emitted by X-ray machines. The National Council on Radiation Protection and Measurements (NCRP) 147 method is widely accepted within the radiation protection experts' (RPEs) community for structural shielding design for medical X-ray imaging facilities. However, these indications are based on data collected in 1996. In recent years, interventional radiology procedures have seen significant developments. Therefore, it is important to evaluate whether updating the data on workload in the different specialities is necessary. We extracted all interventional radiology exposure data parameters from three angiographs from two vendors using dose monitoring software for 3066 procedures and 214,697 individual exposures. The workload distribution as a function of the kVp for five interventional rooms was calculated by summing all exposures and then normalising them by the number of patients. Analysing this data, we obtained new transmission curves through lead, concrete and gypsum wallboard, finding the parameters (α, ß, and γ) in the Archer equation for the secondary radiation. Finally, our aim was to share an example of shielding calculations for haemodynamics and neuroangiography rooms to illustrate the impact of updated transmission data.

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BACKGROUND: Mentorship is the foundation for training and career development. However, only about half of interventional radiology (IR) residency programs in the United States have a formal mentorship program at their institution. A new tiered mentorship program was introduced at our institution. METHODS: A structured mentorship program was created at our institution in 2020 for IR residents to pair 1-2 faculty advisors with a group of residents, one from each PGY class, based on personal interests and career paths. A quality improvement survey with Likert scale format (1-5) was sent to IR residents and faculty members. RESULTS: Responses were recorded from 11 IR residents in addition to all 6 IR faculty mentors. IR respondents reported satisfaction with feeling more assimilated in the department and all would recommend the current mentorship model to other institutions. Most respondents agreed the program made them comfortable conducting effective mentorship relationships as an attending and that the tiered structured of being mentee and mentor simultaneously was beneficial. Both IR residents and faculty agreed that the program helped prevent burnout. CONCLUSIONS: The tiered mentorship model has had a positive impact on the IR program by providing structured mentoring and longitudinal relationships. The most notable benefits for IR residents is the early integration into the program, sustained mentorships relationships, and the prevention of burnout. Similar models can help other programs establish structured faculty and peer mentorship for residents early in training.

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Minimally invasive interventional radiology procedures play an adjunctive role in treating the symptoms of osteoarthritis (OA) with the hopes of delaying total knee arthroplasty (TKA). However, currently available intra-articular injections offer only short-term benefits. This has led to evolution of new techniques such as genicular artery embolization and genicular nerve ablation, which show benefit in pain control and quality of life, especially for mild-to-moderate OA, positioning these techniques as potential alternatives to intra-articular injections to help delay TKA.

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PURPOSE: This study aimed to determine whether ChatGPT-4o, a generative artificial intelligence (AI) platform, was able to pass a simulated written European Board of Interventional Radiology (EBIR) exam and whether GPT-4o can be used to train medical students and interventional radiologists of different levels of expertise by generating exam items on interventional radiology. METHODS: GPT-4o was asked to answer 370 simulated exam items of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) for EBIR preparation (CIRSE Prep). Subsequently, GPT-4o was requested to generate exam items on interventional radiology topics at levels of difficulty suitable for medical students and the EBIR exam. Those generated items were answered by 4 participants, including a medical student, a resident, a consultant, and an EBIR holder. The correctly answered items were counted. One investigator checked the answers and items generated by GPT-4o for correctness and relevance. This work was done from April to July 2024. RESULTS: GPT-4o correctly answered 248 of the 370 CIRSE Prep items (67.0%). For 50 CIRSE Prep items, the medical student answered 46.0%, the resident 42.0%, the consultant 50.0%, and the EBIR holder 74.0% correctly. All participants answered 82.0% to 92.0% of the 50 GPT-4o generated items at the student level correctly. For the 50 GPT-4o items at the EBIR level, the medical student answered 32.0%, the resident 44.0%, the consultant 48.0%, and the EBIR holder 66.0% correctly. All participants could pass the GPT-4o-generated items for the student level; while the EBIR holder could pass the GPT-4o-generated items for the EBIR level. Two items (0.3%) out of 150 generated by the GPT-4o were assessed as implausible. CONCLUSION: GPT-4o could pass the simulated written EBIR exam and create exam items of varying difficulty to train medical students and interventional radiologists.

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Remimazolam is an ultrashort acting intravenous sedative-hypnotic approved for procedural sedation. We report a series of 8 cases of radiographically placed gastrostomy tubes using remimazolam as the sole anesthetic agent. Interventional radiology (IR) gastrostomy tube placement entails anesthetizing often complex patients in a nonoperating room environment. All 8 patients reported here underwent successful gastrostomy tube placement without the need for conversion to general anesthesia. Remimazolam is a feasible option to sedate patients for gastrostomy tube placement in the IR suite.

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Ectopic varices are rare but potentially life-threatening conditions usually resulting from a combination of global portal hypertension and local occlusive components. As imaging, innovative devices, and interventional radiologic techniques evolve and are more widely adopted, interventional radiology is becoming essential in the management of ectopic varices. The interventional radiologist starts by diagnosing the underlying causes of portal hypertension and evaluating the afferent and efferent veins of ectopic varices with CT. If decompensated portal hypertension is causing ectopic varices, placement of a transjugular intrahepatic portosystemic shunt is considered the first-line treatment, although this treatment alone may not be effective in managing ectopic variceal bleeding because it may not sufficiently resolve focal mesenteric venous obstruction causing ectopic varices. Therefore, additional variceal embolization should be considered after placement of a transjugular intrahepatic portosystemic shunt. Retrograde transvenous obliteration can serve as a definitive treatment when the efferent vein connected to the systemic vein is accessible. Antegrade transvenous obliteration is a vital component of interventional radiologic management of ectopic varices because ectopic varices often exhibit complex anatomy and commonly lack catheterizable portosystemic shunts. Superficial veins of the portal venous system such as recanalized umbilical veins may provide safe access for antegrade transvenous obliteration. Given the absence of consensus and guidelines, a multidisciplinary team approach is essential for the individualized management of ectopic varices. Interventional radiologists must be knowledgeable about the anatomy and hemodynamic characteristics of ectopic varices based on CT images and be prepared to consider appropriate options for each specific situation. ©RSNA, 2024 Supplemental material is available for this article.

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INTRODUCTION: Augmented reality (AR) and virtual reality (VR) are emerging tools in interventional radiology (IR), enhancing IR education, preprocedural planning, and intraprocedural guidance. AREAS COVERED: This review identifies current applications of AR/VR in IR, with a focus on studies that assess the clinical impact of AR/VR. We outline the relevant technology and assess current limitations and future directions in this space. We found that the use of AR in IR lags other surgical fields, and the majority of the data exists in case series or small-scale studies. Educational use of AR/VR improves learning anatomy, procedure steps, and procedural learning curves. Preprocedural use of AR/VR decreases procedure times, especially in complex procedures. Intraprocedural AR for live tracking is accurate within 5 mm live patients and has up to 0.75 mm in phantoms, offering decreased procedure time and radiation exposure. Challenges include cost, ergonomics, rapid segmentation, and organ motion. EXPERT OPINION: The use of AR/VR in interventional radiology may lead to safer and more efficient procedures. However, more data from larger studies is needed to better understand where AR/VR is confers the most benefit in interventional radiology clinical practice.

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The landscape of healthcare is shifting towards outpatient settings such as Office-Based Labs (OBLs) and Ambulatory Surgery Centers (ASCs). This transition, driven by the Centers for Medicare & Medicaid Services (CMS), presents various business and corporate models for interventional radiologists seeking to practice outside traditional hospital environments. The role of private equity and management services in facilitating these transitions is highlighted, offering opportunities for growth, efficiency, and enhanced control over practice operations. The document also discusses the financial aspects of establishing an OBL or ASC, the benefits of outpatient procedures, and the adaptability of private equity deals to the specific needs of medical practices. It concludes by emphasizing the potential for long-term wealth creation and the adaptability of these models to individual physician needs.

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While office-based laboratories (OBLs) have been increasing in popularity, only a small proportion of the current interventional radiology (IR) workforce works in an OBL. With the relative lack of an IR presence in OBLs compared to other endovascular specialists, combined with the growth of the OBL space, the presence of IR within OBLs will likely increase in the coming years. This article addresses the value interventional radiologists (IRs) can bring to the OBL, with primary impacts being the ability to impact a larger proportion of the population than is traditionally cared for in most hospital settings, the ability to positively influence multidisciplinary care teams and the financial leverage inherent in procedural diversification not readily afforded by other specialists working in the OBL space. IR-specific pitfalls in the OBL space are also addressed, including difficulties in obtaining patient referrals, investor relationships, and group practice arrangements. Despite potential challenges, IRs have a lot to offer within the OBL space, and conversely, the OBL space provides a mechanism for IRs to increase their reach and improve career longevity.

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Owning and operating an Office-Based Lab (OBL) creates a unique career, combining the privilege of practicing Interventional Radiology (IR) with the creativity and excitement of running a complex business. No business is more complicated than the American Healthcare system, with a combination of necessary operational systems, government and commercial reimbursement, local and national regulations, an ever-changing landscape, and various patient populations; the business is always shifting. No field is as complex and exciting as Interventional Radiology, with advanced clinical and technical expertise, device development, rocedural ingenuity, and the ability to solve complex medical problems with elegant solutions. A sole owner and operator in an OBL has full autotomy, and thus full responsibility for the medical and business aspects of the practice.

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PURPOSE: This project examines ChatGPT's potential to enhance the readability of patient educational materials about interventional radiology (IR) procedures. METHODS AND MATERIALS: The descriptions of IR procedures from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) were used as the original text. Readability scores were calculated using three metrics: Flesch Reading Ease (FRE), Gunning Fog (GF), and the Automated Readability Index (ARI) using an online calculator ( https://readabilityformulas.com ). FRE is scored on a scale of 0-100, where 100 indicates easy-to-read texts, and GF and ARI represent the grade level required to comprehend the text. The DISCERN instrument measured credibility and reliability. ChatGPT was prompted to simplify the texts to a fifth-grade reading level, with subsequent recalculation of readability and DISCERN scores for comparison. Statistical significance was determined using a Wilcoxon Signed-Rank Test. Articles were subsequently organized by subgroups and analyzed. RESULTS: 73 interventional radiology procedures from CIRSE were analyzed. The original FRE score was 47.2 (Difficult), improved to 78.4 (Fairly Easy) by ChatGPT. GF and ARI scores dropped from 14.4 and 11.2 to 7.8 and 5.8, respectively, after simplification, showing significant improvement (p < 0.001). However, the average DISCERN score decreased from 3.73 to 2.99 (p < 0.001) post-ChatGPT simplification. CONCLUSION: This study shows ChatGPT's ability to make interventional radiology descriptions more readable but highlights its struggle to maintain the original's reliability, suggesting the need for human review and prompt engineering to enhance outcomes. LEVEL OF EVIDENCE: Level 6.

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Imaging plays a key role in the management of rheumatological pathologies, also as guidance for diagnostic and therapeutic interventional procedures, as it can provide better accuracy and safety compared to palpation-guided interventions. Inflammatory and degenerative conditions nonresponsive to systemic treatment may benefit from intra-articular and periarticular administration of drugs, with therapeutic and symptomatic actions or providing a bridge for surgery. Desired effects include reduction of inflammation and pain and improvement of physical function of patients. Training and knowledge of indications, appropriate procedures, contraindications, and side effects are necessary to obtain maximum accuracy and safety in performing interventional procedures.

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PURPOSE: An international survey was conducted by the Cardiovascular Interventional Radiological Society of Europe (CIRSE) to evaluate radioembolization practice and capture opinions on real-world clinical and technical aspects of this therapy. MATERIALS AND METHODS: A survey with 32 multiple choice questions was sent as an email to CIRSE members between November and December 2022. CIRSE group member and sister societies promoted the survey to their local members. The dataset was cleaned of duplicates and entries with missing data, and the resulting anonymized dataset was analysed. Data were presented using descriptive statistics. RESULTS: The survey was completed by 133 sites, from 30 countries, spanning 6 continents. Most responses were from European centres (87/133, 65%), followed by centres from the Americas (22/133, 17%). Responding sites had been performing radioembolization for 10 years on average and had completed a total of 20,140 procedures over the last 5 years. Hepatocellular carcinoma treatments constituted 56% of this total, colorectal liver metastasis 17% and cholangiocarcinoma 14%. New sites had opened every year for the past 20 years, indicating the high demand for this therapy. Results showed a trend towards individualized treatment, with 79% of responders reporting use of personalized dosimetry for treatment planning and 97% reporting routine assessment of microsphere distribution post-treatment. Interventional radiologists played an important role in referrals, being present in the referring multi-disciplinary team in 91% of responding centres. CONCLUSION: This survey provides insight into the current state of radioembolization practice globally. The results reveal the increasing significance placed on dosimetry, evolving interventional techniques and increased technology integration.

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