Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Authors:Englander; Meridith J. Pages: 395 - 398 Abstract: Health care policy in the United States is made by nonphysician lawmakers and government employees. Through advocacy and lobbying, physicians have an opportunity to be involved in the process. Interventional radiologists (IRs) are the experts on issues related to IR. Government relation offers IRs the opportunity to engage with members of Congress, officials in Federal and State agencies, and State legislators to inform and influence their decision making. The Society of Interventional Radiology PAC (SIRPAC) is the only PAC to represent the interests of interventional radiology. Increased contributions to SIRPAC are essential to be sure that the voice of IR is heard. Citation: Semin intervent Radiol 2023; 40: 395-398 PubDate: 2023-11-02T14:50:55+0100 DOI: 10.1055/s-0043-1772813 Issue No:Vol. 40, No. 05 (2023)
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Authors:Spies; James B. Pages: 399 - 402 Abstract: Many interventional radiologists express concern about communicating their practice needs to their radiology department chairs. As a result, they may have difficulty getting support for hiring of additional physicians and staff, capital investments in equipment, and marketing of IR services. Some perceive that chairs have a preference for diagnostic radiology initiatives over interventional and want to know why. More importantly, they want to know how to approach their chair and succeed in their advocacy for IR. The key to success is understanding the perspective of the chair and the pressures and demands they face. That understanding allows the IR to propose their initiatives in a form that helps address some of the chair's needs and thus eases their path to success. Citation: Semin intervent Radiol 2023; 40: 399-402 PubDate: 2023-11-02T14:50:56+0100 DOI: 10.1055/s-0043-1775719 Issue No:Vol. 40, No. 05 (2023)
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Authors:Fassia; Mohammad-Kasim, Charalel, Resmi, Talenfeld, Adam D. Pages: 403 - 406 Abstract: While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services. Recognizing the shift in reimbursement to high-value care, it is imperative that interventional radiology (IR) develop the evidence needed to articulate to all relevant stakeholders how IR contributes value to the system. Citation: Semin intervent Radiol 2023; 40: 403-406 PubDate: 2023-11-02T14:50:56+0100 DOI: 10.1055/s-0043-1774407 Issue No:Vol. 40, No. 05 (2023)
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Authors:McLaughlin; Joseph N., Lamus, Daniel, Hegde, Siddhi, Kalva, Sanjeeva P. Pages: 407 - 410 Abstract: The authors report a case of endobronchial migration of a POD packing coil following embolization of a pulmonary artery pseudoaneurysm in a patient with cavitary tuberculosis and its successful management by bronchoscopy-assisted removal of the coil. Coil migration may be secondary to continued cough and persistence of a bronchial to pulmonary artery fistula from tuberculous infection and inflammation. Citation: Semin intervent Radiol 2023; 40: 407-410 PubDate: 2023-11-02T14:50:55+0100 DOI: 10.1055/s-0043-1774408 Issue No:Vol. 40, No. 05 (2023)
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Authors:Findeiss; Laura K. Pages: 411 - 418 Abstract: The mechanisms of payment for medical services are complicated and create predictable incentives. Physicians can benefit from understanding how hospitals, practices, employers, and payers understand payment, since this has a role in determining how certain patient care services are valued and prioritized. Type of hospital, location of service delivery, and a physician's relationship with the payer or provider entity can greatly impact the value of a physician's work. The landscape of payers is large, but Medicare payment has come to drive the behavior of many private payers. This article will outline the key components of Medicare and how they apply to physicians, hospitals, and ambulatory surgical centers to provide a basic structure for thinking about payment for medical services. This review of the fundamentals of Medicare payment will provide a framework for physicians to understand the financial incentives that underlie clinical and operational decisions in the healthcare system. Citation: Semin intervent Radiol 2023; 40: 411-418 PubDate: 2023-11-02T14:50:56+0100 DOI: 10.1055/s-0043-1775722 Issue No:Vol. 40, No. 05 (2023)
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Authors:Koech; Cornelius K., Rivera, Victor I., Anton, Kevin, Dixon, Robert G. Pages: 419 - 426 Abstract: Simulation facilitates learning by imitating real-world systems or processes utilizing educational tools and models. Various fields, including business, aviation, and education use simulation for training. In healthcare, simulation provides trainees opportunities to develop procedural skills in a safe environment, building their understanding through hands-on interactions and experiences rather than passive didactics. Simulation is classified into low, medium, and high fidelity, based on how closely it mimics real-life experience. Its use in education is a valuable adjunct to instructional support and training with multiple potential benefits. Interventional radiology (IR) trainees can build technical and clinical proficiency prior to working directly on a patient. Simulation promotes experiential learning, constructivist learning, and student centeredness, thus giving students control over their learning and knowledge acquisition. More recently, the creative use of remote simulation has augmented traditional virtual didactic lectures, thereby further engaging international learners and enhancing remote collaboration. Despite the challenges to implementation, the addition of simulation in IR education is proving invaluable to supporting trainees and physicians in underserved regions. Citation: Semin intervent Radiol 2023; 40: 419-426 PubDate: 2023-11-02T14:50:56+0100 DOI: 10.1055/s-0043-1775723 Issue No:Vol. 40, No. 05 (2023)
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Authors:Marchak; Katherine, Singh, Davinder, Malavia, Mira, Trivedi, Premal Pages: 427 - 436 Abstract: Racial, ethnic, and gender disparities have received focused attention recently, as they became more visible in the COVID era. We continue to learn more about how healthcare disparities manifest for our patients and, more broadly, the structural underpinnings that result in predictable outcomes gaps. This review summarizes what we know about disparities relevant to interventional radiologists. The prevalence and magnitude of disparities are quantified and discussed where relevant. Specific examples are provided to demonstrate how factors like gender, ethnicity, social status, geography, etc. interact to create inequities in the delivery of interventional radiology (IR) care. Understanding and addressing health disparities in IR is crucial for improving real-world patient outcomes and reducing the economic burden associated with ineffective and low-value care. Finally, the importance of intentional mentorship, outreach, education, and equitable distribution of high-quality healthcare to mitigate these disparities and promote health equity in interventional radiology is discussed. Citation: Semin intervent Radiol 2023; 40: 427-436 PubDate: 2023-11-02T14:50:54+0100 DOI: 10.1055/s-0043-1775878 Issue No:Vol. 40, No. 05 (2023)
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Authors:Krol; Katharine L. Pages: 437 - 440 Abstract: The mechanisms for Medicare payment to physicians are complicated and, in fee for service Medicare, the value of a procedure code explicitly determines the payment to the physician and the out-of-pocket cost to the beneficiary. These codes are created and then valued for payment through a complex but reproducible and transparent process that allows for physician and specialty society input. This article describes the process and its implications for interventional radiology. Citation: Semin intervent Radiol 2023; 40: 437-440 PubDate: 2023-11-02T14:50:57+0100 DOI: 10.1055/s-0043-1775841 Issue No:Vol. 40, No. 05 (2023)
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Authors:Ray; Charles E. Pages: 441 - 448 Abstract: Organizational structure has evolved over the past several decades, with physicians assuming more or fewer leadership positions over time. Regardless of the role of physicians in health care organizational leadership, constant meaningful communication with the hospital, radiology group, or greater physician group administrative leadership is vital for any group of IR physicians to be successful. Understanding what is considered important to hospital administration and, in particular, being closely aligned with the C-suite leadership, is paramount to having successful communication with these stakeholders. Although each situation will obligatorily be unique, certain themes can be followed to optimize the working relationship between an interventional radiology service and organizational administration. This article provides guidelines and suggestions specifically in communicating with health care system leadership. Citation: Semin intervent Radiol 2023; 40: 441-448 PubDate: 2023-11-02T14:50:55+0100 DOI: 10.1055/s-0043-1775879 Issue No:Vol. 40, No. 05 (2023)
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Authors:Balesh; Elie, Hund, Hannah, Keller, Eric J. Pages: 449 - 451 Abstract: Private equity acquisition of medical groups and health care organizations is becoming increasingly important in medicine and is a trend that is likely to continue for the foreseeable future. Some question the ethical implications of private equity acquisitions, since the clear goal of such organizations is maximizing profitability, which may or may not be in the best interests of either the patient population or the provider group. This article will describe the role of private equity in the medical marketplace, with a focus on the role of private equity in radiology and interventional radiology specifically. Additionally, this article will explore this growing trend in the radiology marketplace and its anticipated effects upon patient care and professional satisfaction for radiologists. Citation: Semin intervent Radiol 2023; 40: 449-451 PubDate: 2023-11-02T14:50:55+0100 DOI: 10.1055/s-0043-1775720 Issue No:Vol. 40, No. 05 (2023)
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Authors:Marchak; Katherine, Malavia, Mira, Trivedi, Premal S. Pages: 452 - 460 Abstract: Health services research (HSR) is a multidisciplinary field which studies access to drivers of health care service utilization, the quality and cost of services, and their outcomes on groups of patients. Since its foundations in the 1960s, there has been a large focus on HSR and using large data sets to study real-world care. Because interventional radiology (IR) is a dynamic field with foundations in innovation, research often focuses on small-scale projects. This review will discuss HSR including data sources, focus areas, methodologies, limitations, and opportunities for future directions in IR. Citation: Semin intervent Radiol 2023; 40: 452-460 PubDate: 2023-11-02T14:50:55+0100 DOI: 10.1055/s-0043-1775849 Issue No:Vol. 40, No. 05 (2023)
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Authors:Ozen; Merve, Patel, Ronak, Hoffman, Mark, Raissi, Driss Pages: 327 - 334 Abstract: Uterine fibroids and adenomyosis are prevalent benign neoplasms that can lead to serious deleterious health effects including life-threatening anemia, prolonged menses, and pelvic pain; however, up to 40% of women remain undiagnosed. Traditional treatment options such as myomectomy or hysterectomy can effectively manage symptoms but may entail longer hospital stays and hinder future fertility. Endovascular treatment, such as uterine artery embolization (UAE), is a minimally invasive procedure that has emerged as a well-validated alternative to surgical options while preserving the uterus and offering shorter hospital stays. Careful patient selection and appropriate techniques are crucial to achieving optimal outcomes. There have been advancements in recent times that encompass pre- and postprocedural care aimed at enhancing results and alleviating discomfort prior to, during, and after UAE. Furthermore, success and reintervention rates may also depend on the size and location of the fibroids. This article reviews the current state of endovascular treatments of uterine fibroids and adenomyosis. Citation: Semin intervent Radiol 2023; 40: 327-334 PubDate: 2023-08-10T22:29:13+01:00 DOI: 10.1055/s-0043-1770713 Issue No:Vol. 40, No. 04 (2023)
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Authors:Kwon; Caroline S., Abu-Alnadi, Noor Dasouki Pages: 335 - 341 Abstract: Uterine fibroids are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which can range from heavy menstrual bleeding and bulk-related symptoms such as pelvic pressure with bladder and bowel dysfunction to reproductive dysfunction (e.g., infertility or obstetric complications) and pain. The choice of treatment is primarily guided by the type of symptoms in the individual patient and whether they prefer to retain fertility. While hysterectomy provides definitive resolution of fibroid symptoms and remains the most common treatment option, this procedure is invasive with a long recovery window. Radiofrequency ablation (RFA) is now emerging as a uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, growing evidence for safety and efficacy of RFA has been generated with low rates of complications. This review will discuss RFA for the management of symptomatic uterine fibroids with a special focus on technical approaches, short- and long-term outcomes including fertility outcomes. Citation: Semin intervent Radiol 2023; 40: 335-341 PubDate: 2023-08-10T22:29:14+01:00 DOI: 10.1055/s-0043-1770734 Issue No:Vol. 40, No. 04 (2023)
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Authors:Matsumoto; Monica M., Caridi, Theresa M. Pages: 342 - 348 Abstract: Uterine vascular anomalies (UVAs), while rare, can result in severe, life-threatening hemorrhage. An understanding of the presentation and management options for UVAs is important for interventional radiologists to appropriately evaluate and care for these patients. The authors propose a standardized terminology for UVAs to avoid confusion and conflating congenital from acquired vascular lesions, which have a different pathophysiology. Limited high-level evidence and no definitive guidelines for UVA management exist, although endovascular treatment with uterine artery embolization has generally become the first-line approach for symptomatic or persistent UVAs with high technical and clinical success rates. There is also no consensus on the optimal embolization technique; the authors propose an initial approach to first embolize the dominant uterine artery supplying the UVA with gelatin sponge, with the option to embolize the contralateral side at the time of initial embolization if there is persistent supply (avoiding bilateral empiric embolization). Repeat embolization is feasible and recommended in the setting of recurrence, and both clinical and imaging follow-up is important. Ultimately, a multidisciplinary approach with individualized patient management is needed, particularly in the face of a lack of consensus guidelines for the management of symptomatic UVAs. Citation: Semin intervent Radiol 2023; 40: 342-348 PubDate: 2023-08-10T22:29:14+01:00 DOI: 10.1055/s-0043-1770714 Issue No:Vol. 40, No. 04 (2023)
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Authors:Sanders; Troy K., Stewart, Jessica K. Pages: 349 - 356 Abstract: Placenta accreta spectrum is increasing in prevalence and poses significant risks to obstetric patients. This article defines characteristics, diagnosis, management, and outcomes of placenta accreta spectrum, highlighting interventional radiology's role in its management as part of a multidisciplinary approach. Citation: Semin intervent Radiol 2023; 40: 349-356 PubDate: 2023-08-10T22:29:13+01:00 DOI: 10.1055/s-0043-1771038 Issue No:Vol. 40, No. 04 (2023)
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Authors:Mikhitarian; Mark, Goodnight III, William, Keefe, Nicole Pages: 357 - 361 Abstract: Interstitial ectopic pregnancy involves the interstitial portion of the fallopian tube and is among the most hazardous of all ectopic pregnancies, with the highest risk of uterine rupture and maternal mortality. Unlike tubal ectopic pregnancy, management of interstitial pregnancy is not well standardized. Systemic methotrexate (MTX) and surgical resection are the primary treatment options; however, failure rates and risk of bleeding remain high. Alternative minimally invasive techniques have been described—including uterine artery embolization (UAE) and local injection of MTX or potassium chloride—and may confer improved success rates. We report a case of a high-risk 28-year-old female with an interstitial ectopic pregnancy successfully treated with combined local injection of MTX plus UAE. We describe our technique and the unique medical management in the setting of a known bleeding disorder. Citation: Semin intervent Radiol 2023; 40: 357-361 PubDate: 2023-08-10T22:29:15+01:00 DOI: 10.1055/s-0043-1770712 Issue No:Vol. 40, No. 04 (2023)
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Authors:Clark; Meghan R., Taylor, Amy C. Pages: 362 - 371 Abstract: Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP with associated vulvar and lower-extremity varicosities, left flank pain and hematuria, and lower extremity pain and swelling secondary to obstruction or reflux in the left renal, ovarian, or iliac veins. This article will focus specifically on the most current nomenclature, evaluation, and management of CPP of venous origin. Citation: Semin intervent Radiol 2023; 40: 362-371 PubDate: 2023-08-10T22:29:14+01:00 DOI: 10.1055/s-0043-1771041 Issue No:Vol. 40, No. 04 (2023)
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Authors:Carey; Erin T., McClurg, Asha B. Pages: 372 - 378 Abstract: Chronic pelvic pain (CPP) is a challenging condition affecting an estimated 15% of females in the United States. Multiorgan system dysfunction results in the complex clinical pain presentation. Similar to other chronic pain syndromes, CPP is influenced by biopsychosocial factors and requires a multimodal approach for optimal pain management. This review summarizes the clinical evaluation and medical management of CPP with a comprehensive approach. Citation: Semin intervent Radiol 2023; 40: 372-378 PubDate: 2023-08-10T22:29:14+01:00 DOI: 10.1055/s-0043-1770715 Issue No:Vol. 40, No. 04 (2023)
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Authors:Mody; Priya, Salazar, Gloria, Kohi, Maureen P. Pages: 379 - 383 Abstract: Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization (FTR) can result in up to 100% technical success rate with pregnancy rates of 12.8 to 51%. More pregnancies occur when oil-soluble contrast media are used versus water-soluble contrast media. Complications of FTR are rare and include tubal perforation, ectopic pregnancy, and pelvic infection. Reocclusion of fallopian tubes may occur in 20 to 50% of patients; however, FTR may be repeated in these cases. Overall, FTR is underutilized in the treatment of infertility secondary to proximal FTO and it can obviate costly and time-consuming assistive reproductive techniques such as in vitro fertilization in some patients, as well as decreasing physical and emotional stress. Citation: Semin intervent Radiol 2023; 40: 379-383 PubDate: 2023-08-10T22:29:13+01:00 DOI: 10.1055/s-0043-1771042 Issue No:Vol. 40, No. 04 (2023)
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Authors:Risner; Victoria, McColgan, Yuko, Salazar, Gloria Pages: 384 - 388 Abstract: Labial varices are commonly seen in women with varicose veins of the pelvis. Initial management is conservative management since labial varies typically resolve, particularly in pregnant patients following delivery. Varices can be seen also in association with pelvic varices in the pelvic venous disease spectrum. Sclerotherapy is often the management. This article reviews the presentation and treatment of patients with labial varices, with a focus on interventional radiologic management. Citation: Semin intervent Radiol 2023; 40: 384-388 PubDate: 2023-08-10T22:29:13+01:00 DOI: 10.1055/s-0043-1771040 Issue No:Vol. 40, No. 04 (2023)
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