Faculty Bibliography

PURPOSE/OBJECTIVE:Y radioembolization. MATERIALS AND METHODS/METHODS:for women. Survival at 90 days, 180 days, 1 year, and 3 years following initial treatment was assessed using medical and public obituary records. RESULTS:Sarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days-58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease. CONCLUSION/CONCLUSIONS:Y radioembolization. Sarcopenia was an independent predictor of survival adjusted for BCLC stage with significant deviation in the survival curves of BCLC stage B patients with and without sarcopenia.

PURPOSE/OBJECTIVE:To calculate the volume of greenhouse gases (GHG) generated by a hospital-based interventional radiology department. MATERIALS AND METHODS/METHODS:Life cycle assessment (LCA) was used to calculate GHG emitted by an IR department at a tertiary care academic medical center during a single workweek. The volume of waste generated, the amount of disposable supplies and linens used, and the operating time of electrical equipment were recorded for each procedure performed between 7:00AM-7:00PM on five consecutive weekdays. LCA was then performed using purchasing data, plug loads for electrical hardware, data from temperature control units, and estimates of emissions related to travel in the area surrounding the medical center. RESULTS:e). CONCLUSION/CONCLUSIONS:The practice of interventional radiology generates substantial volumes of greenhouse gases, a majority of which come from energy used to power climate control followed by emissions related to the production and transportation of single use supplies. Efforts to reduce energy consumption and the use of disposable supplies may decrease GHG emissions and IR's contribution to climate change.

Obesity is a major risk factor for nonalcoholic steatohepatitis (NASH). Although weight loss has been shown to reverse histologic features of NASH, lifestyle intervention alone is often challenging and unfeasible. In this case report, we discuss the effects of intragastric balloon (IGB) therapy on steatosis, fibrosis, and portal pressures. We also demonstrate that improvement in histologic features persist at least 6 months after IGB removal. Although there are little data thus far to support IGB therapy in the treatment of NASH, our case provides evidence of the potential benefit of IGB on improving metabolic parameters and markers of liver fibrosis.

Insulinomas are the most common functional pancreatic neuroendocrine tumor. Most insulinomas can be localized non-invasively with cross-sectional and nuclear imaging. Selective arterial calcium stimulation and hepatic venous sampling is an effective and safe minimally-invasive procedure for insulinoma localization that may be utilized when non-invasive techniques are inconclusive. The procedure's technical success and proper interpretation of its results is dependent on the interventional radiologist's knowledge of normal and variant pancreatic arterial perfusion. Accurate pre-operative localization aids in successful surgical resection. Technical and anatomic considerations of insulinoma localization with selective arterial calcium stimulation and hepatic venous sampling are reviewed.

PURPOSE/OBJECTIVE:To evaluate the feasibility and benefits of performing yttrium-90 radioembolization in an office-based lab (OBL) compared to a hospital setting. MATERIALS AND METHODS/METHODS:A radioembolization program was established in March 2019 in an OBL that is managed by the radiology department of a tertiary care center. Mapping and treatment angiograms performed in the OBL from March 2019 through January 2020 were compared to mapping and treatment angiograms performed in the hospital during the same time period. RESULTS:One hundred seventy-six mapping and treatment angiograms were evaluated. There was no difference in the proportion of mapping versus treatment angiograms performed at each site, the proportion of lobar versus selective dose vial administrations, or the mean number of dose vials administered per treatment procedure. Procedure start delays were longer in the hospital than in the OBL (28.6 minutes vs 0.8 minutes; P < .0001), particularly for procedures that were not scheduled as the first case of the day (hospital later case delay, 38.8 minutes vs OBL later case delay, 0.5 minutes; P < .0001). Procedures performed in the hospital took longer on average than procedures performed in the OBL (2 hours, 1.8 minutes vs 1 hour, 44.4 minutes; P = .0004), particularly for procedures that were not scheduled as the first case of the day (hospital later case duration, 2 hours, 7.4 minutes vs OBL later case duration, 1 hour, 43 minutes; P = .0006). CONCLUSIONS:Establishing a radioembolization program within an OBL is feasible and might provide more efficient procedure scheduling than the hospital setting.

PURPOSE/OBJECTIVE:To characterize burnout, as defined by high emotional exhaustion (EE) or depersonalization (DP), among interventional radiologists using a validated assessment tool. MATERIALS AND METHODS/METHODS:An anonymous 34-question survey was distributed to interventional radiologists. The survey consisted of demographic and practice environment questions and the 22-item Maslach Burnout Inventory-Human Services Survey (MBI). Interventional radiologists with high scores on EE (≥ 27) or DP (≥ 10) MBI subscales were considered to have a manifestation of career burnout. RESULTS:Beginning on January 7, 2019, 339 surveys were completed over 31 days. Of respondents, 263 (77.6%) identified as male, 75 (22.1%) identified as female, and 1 (0.3%) identified as trans-male. The respondents were interventional radiology attending physicians (298; 87.9%), fellows (20; 5.9%), and residents (21; 6.2%) practicing at academic (136; 40.1%), private (145; 42.8%), and hybrid (58; 17.1%) centers. Respondents worked < 40 hours (15; 4.4%), 40-60 hours (225; 66.4%), 60-80 hours (81; 23.9%), and > 80 hours (18; 5.3%) per week. Mean MBI scores for EE, DP, and personal achievement were 30.0 ± 13.0, 10.6 ± 6.9, and 39.6 ± 6.6. Burnout was present in 244 (71.9%) participants. Identifying as female (odds ratio 2.4; P = .009) and working > 80 hours per week (odds ratio 7.0; P = .030) were significantly associated with burnout. CONCLUSIONS:Burnout is prevalent among interventional radiologists. Identifying as female and working > 80 hours per week were strongly associated with burnout.

Purpose: To assess the impact of muscle mass on survival in patients with hepatocellular carcinoma undergoing yttrium-90 radioembolization. Materials: The medical records of 186 patients undergoing Yttrium-90 radioembolization for hepatocellular carcinoma between April 2014 and May 2017 were retrospectively reviewed. Fifty patients with an abdominal MRI performed within 90 days prior to treatment were identified. All patients underwent standardized abdominal and liver MRI sequence protocols. Axial T2-weighted fat-suppressed sequences were used for image analysis. The paraspinal musculature was manually segmented at the level of the origin of the superior mesenteric artery using syngo.via (Siemens Healthineers, USA) and used to calculate skeletal muscle area (cm²) and skeletal muscle index (cm²/m²). Sarcopenia was defined as skeletal muscle area < 35.23 cm² for men and < 31.53 cm² for women. Medical records were reviewed to determine patient survival following treatment. Descriptive statistics, including Mann-Whitney tests and receiver operating characteristic curves, were performed.
Result(s): Fifty patients (86% male) with mean age 64 years (range, 31-83 years) met inclusion criteria. Death was reported for 49% (21/43) of male and 57% (4/7) of female patients, with average follow-up of 21 months (range, 0.7-56 months). Sarcopenia was identified in 16% (7/43) of male and 29% (2/7) of female patients. There were statistically significant differences in skeletal muscle area (48.72 +/- 12.01 cm² vs. 42.18 +/- 15.13 cm²) (P = 0.047) and skeletal muscle index (16.26 +/- 2.69 cm²/m² vs. 14.56 +/- 5.83 cm²/m²) (P = 0.024) between men who survived and died. Differences for the seven female patients included in the study did not achieve statistical significance, likely due to small sample size. Median survival was estimated as 1403 days for nonsarcopenic men (36/43) and 243 days for sarcopenic men (7/43) (P = 0.272).
Conclusion(s): Muscle mass on pre procedure MRI predicts survival in patients with hepatocellular carcinoma undergoing Yttrium-90 radioembolization. Sarcopenia may be associated with shorter survival and ongoing analysis of additional patients will improve study power to detect significant differences.
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Purpose: To determine whether routine preoperative evaluation of patient coagulation status, as reflected by the calculated International Normalized Ratio (INR), is necessary prior to placement of a tunneled subcutaneous port. Materials: We conducted a retrospective analysis of tunneled subcutaneous port placements performed by interventional radiology in the ambulatory setting at a single institution over a 6-month period from March to September 2017. The INR values at time of initial outpatient referral, as well as any subsequent preoperative coagulation testing, were compiled from the electronic medical record. Any INR abnormalities, defined as a value greater than 1.5, were then cross-referenced with specific patient past medical history. Results: A total of 263 patients had subcutaneous ports placed during the 6-month study period (29.7% male, mean age 59). INR testing was performed within 30 days of port placement for every patient, as per departmental protocol based on the Society of Interventional Radiology (SIR) guidelines for management of patient coagulation status. Of the 263 port placements, only 4 patients (1.5%) demonstrated INR values above the threshold limit: Two patients were on Coumadin therapy for chronic thromboembolic disease and atrial fibrillation respectively, one patient was on Apixaban (Eliquis) for atrial fibrillation and one patient had known non-Alcoholic steatohepatitis (NASH) cirrhosis. Conclusions: The incidence of an abnormal INR in patients is very low. Within the study period, only 1.5% of patients undergoing tunneled subcutaneous port placement demonstrated a coagulation abnormality on routine preoperative testing. All noted abnormalities were explained by a review of the individual patient medical history; specifically, these patients were either on anticoagulation or had known hepatic dysfunction. These findings suggest that the majority of patients do not require routine preoperative testing of coagulation status and that a preprocedural INR can be obtained on a case-by-case basis as predicted by relevant patient medical history