Techniques in vascular and interventional radiology
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Many interventionalists face physical challenges almost daily for years or decades. The burden of assuming awkward positions while carrying extra weight can take its toll on the musculoskeletal system to such an extent that the career is ended or modified to exclude procedural aspects. The proliferation of lighter aprons has unfortunately resulted in reduced protection with poor correlation of protection to labeling due to the inadequacies of testing methods for nonlead materials. ⋯ The suspended personal radiation protection system is a recent development which provides substantially greater radiation protection than conventional lead aprons combined with other shields, while also taking all of the weight off of the operator. It is composed of an expansive and thick (1mm Pb equiv) apron with a large face-shield to protect the neck, head, and eyes, and is suspended overhead to provide motion in the x, y, and z planes. Exposures may also be substantially reduced by leaving the area during acquisition sequences and use of power injectors.
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Medical staff should not be exposed to the primary X-ray beam during fluoroscopy-guided interventional procedures (FGIP). The main source of staff exposure is scatter radiation from the patient, which can be significant. Although many aspects of X-ray exposure to the patient as well as occupational exposure to interventional radiologists and other staff are strongly regulated and monitored in most countries, it is surprising how loosely the labeling and testing of the protective aprons is regulated. ⋯ Each interventionist should choose garments that are appropriately protective for that individual's practice. Review of past personal dosimetry results and consultation with a medical physicist can help the IR make the best decision. This article will help the reader to understand why all protective garments are not created equally, and provides some practical tools that will allow safe and healthy practice in FGIP.
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Tech Vasc Interv Radiol · Dec 2017
Review Case ReportsBronchial Artery Embolization for the Treatment of Acute Hemoptysis.
Massive hemoptysis is a life-threatening condition often defined as coughing up 300-600mL of blood in 24 hours in an adult, or >8mL/kg in 24 hours in a child. Although the definition is controversial, one should view massive hemoptysis as any volume of expectorated blood that can cause respiratory failure. This is because mortality in the setting of hemoptysis is usually associated with asphyxiation, rather than exsanguination. ⋯ Treatment begins with resuscitation and airway protection, followed by minimally invasive bronchoscopic and endovascular techniques. Surgical interventions are considered last line therapy due to mortality rates of 37%-43% in the setting of massive hemoptysis. Bronchial artery embolization is now considered the treatment of choice for massive hemoptysis.
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Tech Vasc Interv Radiol · Dec 2017
Review Case ReportsEvaluation and Management of Blunt Solid Organ Trauma.
Trauma is a leading cause of death in patients under the age of 45 and generally associated with a high kinetic energy event such as a motor vehicle accident or fall from extreme elevations. Blunt trauma can affect every organ system and major vascular structure with potentially devastating effect. When we consider abdominal solid organ injury from blunt trauma, we usually think of the liver, spleen, and kidneys. ⋯ Renal injuries are less common, and evidence of arterial injury such as active extravasation or pseudoaneurysm is warranted before endovascular therapy. Pancreatic trauma is uncommon and usually secondary to steering wheel/handlebar mechanism injuries. Adrenal injuries are rare in the absence of megatrauma or underlying adrenal abnormality.
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Tech Vasc Interv Radiol · Dec 2017
Review Case ReportsEvaluation and Treatment of Blunt Pelvic Trauma.
Trauma is a significant contributor to mortality, especially in the young. Pelvic trauma with pelvic ring fractures may result in associated arterial injury, necessitating endovascular intervention. ⋯ Management is determined by the acuity of the patient's clinical status, radiographs, ultrasound, and the results of computed tomography imaging when available. Numerous embolic agents are available for treatment of arterial hemorrhage.