Faculty Bibliography

OBJECTIVE: The purpose of this review is to describe the clinical factors related to balloon-occluded retrograde transvenous obliteration, including the preparation needed, the technique and challenges, and the outcomes. CONCLUSION: Although the procedure can be performed when transjugular intrahepatic portosystemic shunt is contraindicated or when endoscopic management fails, balloon-occluded retrograde transvenous obliteration is successful as a first-line or second-line therapy. Gastric variceal rebleeding rates are low and serious complications are rare. Randomized controlled trials are required to evaluate the superiority of this procedure over other methods of treating gastric varices and to determine which sclerosant should be used. In the near future, this procedure may play a larger role in emergency care and in the management of nongastric varices.

PURPOSE: To review a single-center experience with elective coil embolization of splenic artery aneurysm (SAA) and analyze efficacy of the technique at midterm follow-up. MATERIALS AND METHODS: From 2002 through 2011, 50 patients (28 women, 22 men; age range, 24-89 y; mean age, 53.5 y +/- 13.6) underwent transcatheter coil embolization for treatment of SAAs. Pseudoaneurysms and ruptured aneurysms were excluded. A total of 63 SAAs were treated (size, 13-97 mm; mean, 29 mm). Ninety-eight percent of aneurysms were treated with coils alone. Regular follow-up consisted of an office visit and imaging. Patient medical records were reviewed for aneurysm location, procedural approach, and technical and clinical outcomes. RESULTS: Ninety-eight percent of procedures were technically successful at thrombosing the aneurysm at the time of procedure. Repeat intervention was performed in four of 47 patients (9%) because of continued aneurysm perfusion at follow-up. Mean time to repeat intervention was 125 days (range, 42-245 d). All repeat interventions were technically successful. Neither aneurysm growth nor aneurysm rupture was observed in any patient during the follow-up period (mean, 78 weeks; range, 9 d to 7.1 y). There were no major adverse events. Major splenic infarction occurred in three of 33 patients (9%) with no underlying liver disease and normal splenic volume and in seven of 14 patients (50%) with portal hypertension. CONCLUSIONS: Percutaneous transcatheter coil embolization is a safe, effective, and minimally invasive treatment for SAAs as evidenced by high rates of technical success and freedom from aneurysm rupture.

PURPOSE: Although a 12-month clinical internship is the traditional precursor to a radiation oncology residency, the continuance of this mandated training sequence has been questioned. This study was performed to evaluate the perceptions of current radiation oncology residents with respect to the value of their internship experience. METHODS AND MATERIALS: A survey was sent to all US radiation oncology residents. Each was queried about whether they considered the internship to be a necessary prerequisite for a career as a radiation oncologist and as a physician. Preferences were listed on a Likert scale (1 = not at all necessary to 5 = absolutely necessary). RESULTS: Seventy-one percent considered the internship year mostly (Likert Scale 4) or absolutely necessary (Likert Scale 5) for their development as a radiation oncologist, whereas 19.1% answered hardly or not at all (Likert Scale 2 and 1, respectively). With respect to their collective considerations about the impact of the internship year on their development as a physician, 89% had a positive response, 5.8% had a negative response, and 4.7% had no opinion. Although both deemed the preliminary year favorably, affirmative answers were more frequent among erstwhile internal medicine interns than former transitional program interns. CONCLUSIONS: A majority of radiation oncology residents positively acknowledged their internship for their development as a specialist and an even greater majority valued it for their development as a physician. This affirmative opinion was registered more frequently by those completing an internal medicine internship compared with a transitional internship.

RATIONALE AND OBJECTIVES: The purposes of the study were to determine (a) if radiology residents and fellows view their internship year as a valued prerequisite for their career as a radiologist and as a physician, (b) how their postgraduate year (PGY)-1 was perceived with regard to a specific type of internship (i.e., internal medicine, transitional year, or surgery), and (c) how their internship is considered from the vantage point of their current year of training and subspecialty career choice. MATERIALS AND METHODS: A survey was sent to all current U.S. radiology residents and fellows from a list derived from the American College of Radiology database. They were polled regarding their experiences in their preliminary year (PGY-1). Responses were coded on a 5-point Likert scale. RESULTS: Response rate for the study was 35%. Although 70% of respondents maintained that their internship year was necessary for their development as a physician, only 49% indicated that it was necessary for their development as a radiologist. Of respondents who graduated from surgical internships, 72% claimed that their PGY-1 was important for their development as a radiologist, compared to 44% of former transitional year interns and 49% of internal medicine interns (P<.001). When disaggregated by subspecialty career choice, participants were evenly divided about their perceptions of their intern year. However, among those considering interventional radiology, 67% of respondents considered their internship important to their development as a radiologist (P<.001). CONCLUSION: Overall, these data suggest that although the internship year was believed to have merit, the transitional year was least liked by radiology trainees. Efforts should be made to determine why the transitional year does not fare so well in the hope that structural improvements in it can be undertaken to make the year seem more worthwhile and more highly regarded.