Faculty Bibliography

Objective/UNASSIGNED:To evaluate program director (PD) demographics, training background, and academic productivity in 11 surgical specialties. Summary Background Data/UNASSIGNED:There is currently no comprehensive study comparing educational background, research output, and gender differences between PDs of surgical residencies in the United States. Methods/UNASSIGNED:The Accreditation Council for Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) websites were used to identify residency PDs. Age, information related to service as PD, educational background, and research output were collected utilizing online searches including Doximity, PubMed, and Scopus.. The ACGME Data Resource Book was used to obtain data on the gender makeup of residents in each surgical specialty. Data collection occurred between December 14, 2019, and May 9, 2020. Results/UNASSIGNED:1571 residency PDs across 11 surgical specialties were included. Significant differences between specialties were found with respect to PD gender, current age, age at appointment, years between residency and assignment, term duration, number of PubMed publications, and Scopus h-index. The current age (mean ± SD) ranged from 46.8 ± 8.5 years among Interventional Radiology (IR) PDs to 53.4 ± 9.1 years among Neurological Surgery (NEUROSURG) PDs. The proportion of female PDs ranged from 5.9% in NEUROSURG to 63.5% in Obstetrics and Gynecology (OB-GYN). Completion of a post-residency fellowship was least common for OB-GYN PDs at 9.1%, and most common for IR PDs at 98.8%. The number (mean ± SD) of PubMed publications and Scopus h-index ranged from 13.1 ± 22.3 publications and h index 4.5 ± 5.7 among OB-GYN PDs to 112.5 ± 103.0 publications and h index 27.4 ± 16.7 among Thoracic Surgery PDs. Age and academic productivity as measured by PubMed publications and Scopus h-index were significantly lower among female PDs in multiple surgical specialties. Conclusions/UNASSIGNED:There were significant variations in the PDs of surgical specialties, particularly with respect to gender and academic productivity. Efforts should be made to support and encourage greater female representation in the role of surgical residency PD.

The purpose of this paper is to evaluate whether meteorological variables influence rates of pneumothorax and chest tube placement after percutaneous transthoracic needle biopsy (PTNB) of pulmonary nodules. A retrospective review of 338 consecutive PTNBs of pulmonary nodules at a single institution was performed. All procedures implemented a coaxial approach, using a 19-gauge outer guide needle for access and a 20-gauge core biopsy gun with or without a small-gauge aspiration needle for tissue sampling. Correlation between age, sex, smoking history, lesion size, meteorological variables, and frequency of complications were evaluated. Fisher exact, trend and t tests were used to evaluate the relationship between each factor and rates of pneumothorax and chest tube placement. A p value of less than 0.05 was considered to indicate a statistically significant difference. Pneumothorax occurred in 115 of 338 patients (34%). Chest tube placement was required in 30 patients (8.9%). No significant relationship was found between pneumothorax rate and age (p = 0.172), sex (p = 0.909), smoking history (p = 0.819), or lesion location (p = 0.765). The presence or absence of special weather conditions did not correlate with the rate of pneumothorax (p = 0.241) or chest tube placement (p = 0.213). The mean atmospheric temperature (p = 0.619) and degree of humidity (p = 0.858) also did not correlate with differences in the rate of pneumothorax. Finally, mean atmospheric pressure on the day of the procedure demonstrated no correlation with the rate of pneumothorax (p = 0.277) or chest tube placement (p = 0.767). In conclusion, no correlation is demonstrated between the occurrence of pneumothorax after PTNB of pulmonary nodules and the studied meteorological variables.

Purpose: To compare the incidence of pneumothorax after lung nodule biopsy with fine-needle aspiration versus core biopsy alone. Materials: All CT-guided lung biopsies performed at a university hospital in a single year were identified via chart review. Records were reviewed for patient demographics, nodule location, patient position, biopsy type, presence of pneumothorax on postprocedure CT or follow-up x-ray, and need for chest tube placement. All biopsies were performed via a 19-g coaxial needle with 20-g core device and/or 22-g fine needle. Chi-squared tests were used to examine the association between biopsy method and pneumothorax events. A p value of <0.05 was used to determine statistical significance. Results: 218 lung nodule biopsies were performed in 215 patients. 46.8% of patients were male, with median age of 67.0 years. Overall, pneumothorax occurred after 39 biopsies (17.9%), and chest tube placement was required after 15 biopsies (6.9%). Fineneedle aspiration (FNA), with or without core biopsy, was performed in 97 biopsies (44.5%). Core biopsy alone was performed in 121 biopsies (55.5%). Pneumothorax occurred in 25 of the 97 patients who underwent FNA with or without core biopsy (25.8%), and in 14 of the 121 patients who underwent core biopsy alone (11.6%). Chest tube placement was required 11 of the 97 patients who underwent FNA with or without core biopsy (11.3%), and in 4 out of 121 patients who underwent core biopsy alone (3.3%). The incidences of pneumothorax and chest tube placement were significantly higher after FNA versus core biopsy alone (p = 0.01 and p = 0.02, respectively). Conclusions: FNA of lung nodules, with or without core biopsy, was associated with a significantly higher incidence of both pneumothorax and chest tube placement compared with core biopsy alone in this series. Routine use of FNA for lung biopsy may increase complication rates

Magnetic-resonance-guided focused ultrasound (MRgFUS), also called high-intensity focused ultrasound (HIFU) is an effective, noninvasive uterine-preserving treatment for symptomatic uterine fibroids. As the use of this therapeutic modality is not yet widespread, it may remain unfamiliar to many interventional radiologists. The purpose of this review is to discuss MRgFUS, including technology, patient selection, technique, outcomes, complications, and recent data on fertility and comparative effectiveness.

Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant comprehensive patient care responsibilities. Providing excellent and thorough clinical care is as essential to the practice of IR as achieving technical success in procedures. Basic clinical skills that every interventional radiologist should learn include routine management of percutaneously inserted drainage and vascular catheters and rapid effective management of common systemic post-procedural complications. A structured approach to post-procedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety. The aim of this second part, in conjunction with part 1, is to complete the comprehensive review of post-procedural care in patients undergoing interventional radiology procedures. We discuss common problems encountered after insertion of drainage and vascular catheters and describe effective methods of troubleshooting these problems. Commonly encountered systemic complications in IR are described, and ways for immediate identification and management of these complications are provided.

Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant patient care responsibilities. Success in IR now requires development of a full clinical practice, including consultations, inpatient admitting privileges, and an outpatient clinic. In addition to technical excellence and innovation, maintaining a comprehensive practice is imperative for interventional radiologists to compete successfully for patients and referral bases. A structured approach to periprocedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety.

PURPOSE: To provide a meta-analysis of currently available literature on the topic of antibiotic prophylaxis for totally implanted venous access device (TIVAD) placement. MATERIALS AND METHODS: A systematic review of MEDLINE/PubMed was performed to identify studies that met Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria reviewing antibiotic prophylaxis in TIVAD placement. Four studies were identified that met criteria. The analysis included 2,154 patients undergoing TIVAD placement; 360 (16.7%) received antibiotic prophylaxis, and 1,794 (83.3%) received no periprocedural antibiotics. RESULTS: In the period after TIVAD placement, 27 (1.25%) infections were identified. Of infections, five occurred in the antibiotic prophylaxis group (1.39%), and 22 occurred in the nonprophylaxis group (1.23%) with an odds ratio of 0.84 (CI = 0.29-2.35). CONCLUSIONS: The odds ratio of infection was 0.85 with antibiotic use but one was contained within the confidence interval suggesting no significant difference in infection rate when antibiotics were used.

Learning Objectives: 1. To demonstrate the importance of post-procedural care in achieving good outcomes. 2. To provide an overview of appropriate general guidelines for clinical and radiographic follow-up of patients in the post-procedural period. 3. To provide a simple post-procedural plan for commonly performed and challenging procedures. 4. To discuss the management plan for the most commonly encountered early and delayed complications in vascular and non-vascular interventions. Background: In thenearly50years sinceDr. Alexander Margulis first proposed it as a new subspecialty of radiology, interventional radiology has transformed into a dynamic fully-developed clinical specialty. Success in interventional radiology in the current era requires strong clinical skills and familiarity with not only a broad range of disease and procedural techniques, but also the diagnosis and management of their possible complications. Adverse events that occur during and immediately after vascular and interventional radiology (VIR) procedures may often be avoided by improved pre-procedural planning, more effective communication between healthcare team members, and more consistent and structured post-procedural care. Clinical Findings/Procedure Details: Structure for Post-procedural Care * Instructions (for outpatients and inpatient referring services) * General * Activity * Antibiotics * Analgesia * Resuming medications, in particular anticoagulation and antiplatelet therapy * Plan for follow-up clinic visits and imaging * Procedure-specific (vascular and non-vascular) * Warning signs * Catheter care * RED FLAGS: ominous signs and symptoms * Tachycardia, dizziness, near-syncope * Increasing pain * Fever * Essentials of managing common complications Conclusions: 1. Excellence in interventional radiology requires not only superb procedural skills, but also consistent and structured post-procedural care. 2. Accurate clinical and radiographic assessment in the post-procedural period, proper management of complications, and close follow-up are essential in appropriate management of patients undergoing interventional procedures