ORCID Profile
0000-0003-1859-5850
Current Organisations
Monash University
,
Alfred Health
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Publisher: Wiley
Date: 12-03-2019
Abstract: Computed tomography-guided cervical nerve root corticosteroid injections are a commonly performed procedure for cervical radiculopathy. There have been major complications such as spinal cord infarction and posterior circulation stroke reported mostly with X-ray fluoroscopic-guided methods, however, there is relatively little data on the safety of newer CT-guided methods. The purpose of this study was to identify any major complications and evaluate the rate of minor complications from CT-guided cervical nerve root corticosteroid injections performed in a tertiary public hospital. Four hundred and three CT-guided cervical nerve root injection procedures were identified over a period from July 2015 to January 2018 using the radiology information system (RIS) and data collected about the technique and any immediate complications. Patient follow-up and delayed complications were then reviewed, either via outpatient clinic records or telephone consultation. Two hundred and eighty-six procedures were performed by radiology registrars or fellows, and 117 by radiologists, most commonly via an anterolateral approach and injecting 4 mg (in 1 mL) of dexamethasone. Follow-up data were obtained for all 403 procedures and identified 16 minor complications, but no major neurovascular complications. The overall recorded rate of minor complications with CT-guided nerve root injection was 4.0% with no major neurovascular complications, suggesting that CT-guided transforaminal cervical corticosteroid injection is a safe procedure.
Publisher: Springer Science and Business Media LLC
Date: 20-09-2019
DOI: 10.1007/S00270-018-2080-3
Abstract: Over recent times, procedural Radiologists have begun to establish themselves as the distinct subspecialty of Interventional Radiology (IR). The Interventional Radiology Society of Australasia (IRSA) was established in 1982 to share collaborative ideas, encourage research, and promote education. IRSA developed a weekend registrar workshop attended by Radiology Registrars from Australia and New Zealand. In the 2018 event, we surveyed the Registrars to identify their interest in IR training before and after the workshop. The event was held over a weekend and consisted of both lectures and hands-on workshops. A survey was handed to all 67 registrants of the workshop and there was a 55% response rate including 78% of females in attendance. Before the workshop, trainees rated their interest in IR training at a mean of 3.7 out of 5. After the workshop, trainees rated their interest in IR training as an average of 4.4 out of 5 (p < 0.001). The difference in interest between males and females before the workshop (4.0 vs. 3.1) was significant (p = 0.003), however after the workshop (4.5 vs. 4.1) was not significant (p = 0.07). The change in interest from attending the workshop was significant between genders, p = 0.03 (male interest increased mean 0.5, female increased mean 1.0). We show that a program of lectures and workshops designed to generate interest in IR leads to a significant increase in training interest, particularly amongst females. Other subspecialty groups should consider this type of intervention and promote ongoing education and inspiration. Cross-sectional study, Level IV.
Publisher: Wiley
Date: 22-05-2020
Abstract: Balloon‐occluded retrograde transvenous obliteration (BRTO) is recommended for secondary prevention of gastric variceal bleeding in the American Association for the Study of Liver Disease (AASLD) guidelines, as an alternative to Transjugular intrahepatic portosystemic shunt (TIPS). However, there is significant heterogeneity in how BRTO is performed, including how and how long to occlude the outflow venous shunt amongst other variables such as variceal size, flow rate, agent used, and preparation technique. We propose a method using foam sclerotherapy and reducing balloon occlusion to as little as 30 min, with assessment of the efficacy of this shorter balloon inflation time. Retrospective single‐centre analysis of BRTO procedures between July 2015 and February 2019 for isolated gastric varices in a non‐acute setting, where inflation time was 2 h or less. Six patients underwent BRTO with a short inflation time, with a mean age of 66 years. The median balloon inflation and thus 3% athoxysclerol foam contact time was 30 min (range 30–60 min). Four of the 6 patients showed complete resolution of varices, while 2 of the 6 showed a partial response. Mean follow‐up was 27 months. There were no patients who did not show a response to treatment and no episodes of clinically significant upper gastrointestinal bleeding. This technique using a shortened balloon occlusion time resulted in complete or partial clinical and technical success in all patients and suggests that the threshold for initiation of gastric variceal thrombosis may be below 30 min. This timepoint may provide a balance between adequate balloon inflation, angiography room efficiency and hospital resource allocation with resultant procedural cost implications.
Publisher: Medical Journals Sweden AB
Date: 08-12-2010
Publisher: Wiley
Date: 07-09-2021
Abstract: Pseudoaneurysms are uncommon but potentially life‐threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound‐guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. Retrospective single‐centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010–2020). There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound‐guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting.
Publisher: Georg Thieme Verlag KG
Date: 10-05-2023
Abstract: Purpose Uterine artery embolization (UAE) evidence is increasing in the setting of adenomyosis, which shares pathological similarities to endometriosis. Endometriosis is characterized by the presence of endometrium-like tissue outside of the uterus, and the retrograde menstruation hypothesis may account for disease development. In women where fertility is no longer desired, hysterectomy can be offered to improve pain-related symptoms. The authors hypothesize that this cohort of patients may similarly respond to UAE. The aim of this pilot study is to assess the safety and effectiveness of UAE in the management of endometriosis-related symptoms. Methods Six-patient prospective single-arm pilot study in female, premenopausal patients over 40 years with symptoms of endometriosis. Institutional review board approval was obtained. Inclusion criteria include completed family, premenopausal, pelvic endometriosis as confirmed by laparoscopy within the last 5 years, and symptoms of endometriosis impacting quality of life as evidenced by the British Society of Gynaecological Endoscopy pelvic pain and Short Form-36 questionnaires. Results The primary endpoint will be safety, as assessed by the composite number of procedural and postprocedural complications during procedure, predischarge, and at 6 weeks, 3 months, 6 months, and 12 months. Secondary endpoints will include technical success, clinical success, and durability. Discussion This study will be a novel application of UAE in the setting of endometriosis and has the potential to improve patient quality of life. This pilot study will assess safety and allow the investigators to design a prospective randomized controlled study.
Publisher: Wiley
Date: 03-08-2021
DOI: 10.1002/JMRS.533
Abstract: Peripherally inserted central catheters (PICCs) offer a convenient long‐term intravenous access option. Different methods exist for insertion including the use of continuous fluoroscopy for guidance, or bedside insertion techniques. The blind pushing technique is a bedside approach which involves advancing a PICC through the access sheath without imaging guidance, before taking a mobile chest radiograph to confirm tip position. Obtaining optimal position is a critical aim of PICC placement as malpositioned lines have been associated with higher complications including death. We aimed to assess the accuracy of PICC placement by comparing the tip position and complications for lines placed under fluoroscopic guidance to those placed without fluoroscopic guidance. The Radiology Information System was used to identify 100 continuous PICC insertions in each group (fluoroscopic and blind pushing) between 1 January and 12 May 2019. Patients were excluded if there was a known history of central venous occlusion/stenosis. In the fluoroscopic‐guided group, 0% of the lines were malpositioned compared with 60% of the lines placed using the blind pushing technique, P 0.001. Fluoroscopic‐guided PICC insertions were in place for a total of 2446 days and demonstrated 6 complications (2.45 complications per 1000 catheter days). This compared with blind pushing technique PICC insertions which were in place for a total of 1521 days and demonstrated 18 complications (11.83 complications per 1000 catheter days), P = 0.004. The use of fluoroscopy for PICC placement leads to significant improvements in tip accuracy than for PICCs placed using the blind pushing technique. While the use of these imaging resources incurs cost and time, these factors should be balanced in order to offer patients the safest and most accurate method of line insertion.
Publisher: Wiley
Date: 31-03-2022
Abstract: Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide and its incidence is increasing in Australia. Transarterial therapy, predominantly transarterial chemoembolization (TACE) but increasingly transarterial radioembolization (TARE), plays an important role in patients with intermediate‐stage disease and preserved liver function. However, despite advances in TACE, TARE and adjunctive procedures, overall survival has only modestly increased over the last 20 years. Immunotherapy has emerged as a newer cancer treatment and uses antibodies directed at checkpoint inhibitors to upregulate T‐cell mediated tumour‐specific death. These drugs have been shown to increase survival in patients with HCC and have changed the landscape for advanced disease. Trials are now ongoing combining transarterial therapy and immunotherapy. This manuscript introduces these trials and interventional radiologists should be aware of the changing landscape so that they can partner with immunotherapy and remain relevant in the HCC multidisciplinary group as immunotherapy use increases.
Publisher: Wiley
Date: 09-02-2020
Publisher: Wiley
Date: 05-07-2018
Abstract: Advanced techniques have been described to remove embedded inferior vena cava (IVC) filters including the loop snare and modified loop snare (Hangman) techniques. Retrieval of embedded filters have been associated with higher rates of complications including IVC injury and stenosis. We report two challenging embedded retrievals complicated by IVC injury and haemorrhage. Haemostasis was successfully achieved with prolonged balloon t onade, suggesting that injury to the IVC during filter retrieval may not need urgent surgery. However, both patients received short-term complications related to caval thrombosis and patients in this cohort should be closely observed after retrieval. These cases support rigorous attention to filter indication and follow-up.
Publisher: SAGE Publications
Date: 12-03-2020
Abstract: Intrahepatic arterio-portal fistulas are rare complications of blunt hepatic trauma. We describe a case of a 35-year-old male sustaining blunt abdominal trauma resulting in a grade IV liver injury complicated by arterio-portal fistula, portal venous pseudoaneurysm and concomitant bile duct injury. Although arterial embolisation is the mainstay of treatment for arterio-portal fistula, we describe a rationale for early involvement of a hepatobiliary surgeon for multidisciplinary management. Hepatic resection for acute hepatic trauma can, in selected cases, promptly manage all elements of portal triad injury, and in this particular case facilitated early uncomplicated discharge.
Publisher: Springer Science and Business Media LLC
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 21-09-2019
DOI: 10.1007/S00270-018-2077-Y
Abstract: Risks of IVC filter insertion are numerous but include IVC stenosis or thrombosis and may result in caval occlusion. Acute IVC occlusion is almost always symptomatic, and treatment can be aggressive such as catheter-directed thrombolysis or conservative such as anticoagulation. The more challenging cohort of patients is those where there has been chronic complete occlusion of the IVC without symptoms, sometimes only identified at the time of routine filter retrieval. We explore the available evidence and discuss different management approaches in this circumstance ranging from aggressive to conservative. However, given that the overall incidence of filter-related complications is very low, at this stage we find no compelling evidence to support aggressive management without symptoms.
Publisher: Springer Science and Business Media LLC
Date: 20-10-2020
Publisher: Springer Science and Business Media LLC
Date: 15-02-2022
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.INJURY.2022.06.034
Abstract: Inferior vena cava (IVC) filters play a role in preventing venous thromboembolism after major trauma where deep venous thrombosis (DVT) risk is up to 80%. It has been suggested that IVC filters are thrombogenic and many patients are therefore placed on therapeutic anticoagulation during IVC filter dwell citing concern of in situ IVC thrombosis, even in the absence of existing DVT. Between 1 June 2018 and 31 December 2021, this retrospective study assessed the incidence of IVC thrombosis following prophylactic IVC filter insertion. Groups were defined according to the presence or absence of therapeutic anticoagulation during filter dwell. The primary outcome was the presence or absence of IVC thrombus at retrieval. A total of 124 patients were included. Anticoagulation was prescribed in 29 and anticoagulation was not prescribed in 63. A further 32 patients developed a new thrombosis episode after the prophylactic IVC filter was placed, and 29 were prescribed anticoagulation part-way during filter dwell as a result of this diagnosis. No cases of IVC occlusion were observed in any patient group. Caval thrombosis was not observed after prophylactic filter placement, with or without the prescription of anticoagulation. While prospective trials are needed to increase the level of evidence, based on these results the use of therapeutic anticoagulation during IVC filter dwell should not be dictated by the presence of an IVC filter alone but rather by the presence of a related thrombosis event.
Publisher: Wiley
Date: 03-09-2020
Publisher: Springer Science and Business Media LLC
Date: 07-02-2020
Publisher: Georg Thieme Verlag KG
Date: 25-07-2019
Abstract: Occurrence of a symptomatic renal arteriovenous malformation (AVM) is rare. The authors present the case of a patient with a background of Turner's syndrome, hemophilia B, and horseshoe kidney, who presented with hematuria and was successfully treated with endovascular embolization. The use of a microballoon catheter Scepter XC (Microvention, Inc.) to safely embolize the feeding arterial supply, using ethylene vinyl alcohol (EVOH) copolymer (Onyx Medtronic/ev3) has not, to the authors’ knowledge, previously been described for the treatment of renal AVM. This novel use of an occlusal balloon catheter is permitted by the precipitation rate of Onyx, and allowed a safe and effective procedure, reducing the risk of reflux, allowing a forward push of embolic material in a controlled manner.
Publisher: Wiley
Date: 18-11-2021
Publisher: Georg Thieme Verlag KG
Date: 18-07-2019
Abstract: Robotic endovascular technology is an emerging concept, and is being developed to allow more precise navigation of anatomy in challenging endovascular cases. The Magellan Endovascular System allows either direct or remote steerability of a 2-point articulating robotic platform with the ability to place a conventional microcatheter through the catheter tip. Such flexibility may help to reach an otherwise difficult anatomic location, especially in variant anatomy. To date, this platform has been shown to be technically successful in a small number of different settings. This case series shows another potential platform for such technology and explores the technical use and overall safety in conventional transarterial chemoembolization (cTACE). The study retrospectively assessed 6 patients undergoing selective cTACE. Treatments were performed in a single center by two experienced interventional radiologists. Fluoroscopy time, radiation dose, anatomic target, and adverse events were logged. In spite of a longer than expected average fluoroscopy time, which can be expected for a first-generation technology, the average radiation dose was comparable to literature and technical success was able to be shown in all 6 patients with no adverse events. This technology has wide scope for future use and once overcoming a learning curve, may allow us to avoid repeat procedure attempts thus reducing fluoroscopy time and leading to earlier successful treatment. Providing a platform of interest and usability in the interventional radiology world may also lead to further development of smaller, cheaper, and more widely-accessible devices.
Publisher: Wiley
Date: 08-03-2022
Abstract: There are few female Interventional Radiologists worldwide and this is a significant issue for many countries. There is little known about the current status and attitudes to women in Interventional Radiology in Australia and New Zealand. The purpose of this study was to explore the gender balance, workforce challenges and perceptions towards women in Interventional Radiology in Australia and New Zealand. An anonymised voluntary survey exploring the current demographics of Interventional Radiologists and opinions on multiple gender issues in Interventional Radiology was conducted. The survey was sent to all members of the Interventional Radiology Society of Australasia. Statistical analysis was performed using independent s les t ‐tests, the non‐parametric Mann–Whitney U testing and proportions of binary variables using logistic regression. Seventy seven responses were received, 83% males and 17% females. The majority of participants worked full time (83%) and identified as an Interventional Radiologist with/without some sessions of diagnostic radiology per week (83%). There was general consensus in many issues however, males tended to disagree more than females that female IRs are treated differently than male IRs (p 0.037), and that male IRs are paid more than female IRs ( P = 0.020). Females agreed it was harder for female IRs to gain academic or clinical promotion however, males disagreed ( P 0.001). There is a clear gender imbalance in Interventional Radiology in Australia and New Zealand. Multiple issues should be investigated and addressed by the major stakeholders such as the Royal Australian and New Zealand College of Radiologists and the Interventional Radiology society of Australasia.
Publisher: Wiley
Date: 02-12-2019
Abstract: Uterine fibroids have the potential to cause morbidity, and there is a substantial cost to both the healthcare system and society. There is support for minimally invasive intervention, and uterine fibroid embolisation (UFE) is an established cost-effective option for women wishing for an alternative to surgery. There is a lack of local Australian costing data to compliment use in the public hospital system, and we offer a costing analysis of running a public hospital service. We reviewed the costs for 10 sequential uterine fibroid embolisation cases, by assessing the direct and indirect hospital costs. The total cost of providing a uterine fibroid embolisation service using our model in a public hospital including initial outpatient assessment, procedure costs, overnight hospital ward stay and outpatient follow-up is $3995 per admission. Using our model, the overall cost to perform this procedure is low, and lower than prior estimates for surgical alternatives. We encourage government and regulatory bodies to support UFE through guidelines and remuneration models, and encourage more public Australian interventional radiology departments to offer this service.
Publisher: Wiley
Date: 20-01-2020
DOI: 10.1111/AJO.13120
Abstract: Uterine leiomyomata (fibroids) are symptomatic in up to 35% of women and treatment can be a costly burden to the in idual and society. Options for treatment range from non-hormonal, hormonal, minimally invasive, to surgery. While symptoms from smaller fibroids may respond to simple treatment, those with larger fibroids or with a large volume of disease require a more definitive option. Surgery (hysterectomy or myomectomy) are both well-established treatment modalities with good clinical outcomes. Since the 1990s, uterine fibroid embolisation has emerged as a less invasive option for women than for surgical techniques, while level 1 evidence shows that in the short to mid-term, there is a similar improvement in symptom-related quality of life outcomes to surgery, but with reduced hospital stay and reduced cost. However, in the longer term there may be a need for further treatment or retreatment in some patients compared with surgery. Since its introduction, uptake of this procedure in Australia has been low relative to surgical options. This manuscript reviews the current literature surrounding treatment, along with the trends in uptake of embolisation by Australian women, places this in context of current guidelines from major societies, and encourages gynaecologists and interventional radiologists to be aware of the advantages and limitations of embolisation.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.INJURY.2021.09.020
Abstract: The spleen is the most commonly injured solid organ following blunt abdominal trauma. Over recent decades, splenic artery embolization (SAE) has become the mainstay treatment for haemodynamically stable patients with high-grade blunt splenic trauma, with splenectomy the mainstay of treatment for unstable patients. Splenic function is complex but the spleen has an important role in immune function, particularly in protection against encapsulated bacteria. Established evidence suggests that following splenectomy immune function is impaired resulting in increased susceptibility to overwhelming post-splenectomy infection, however, immune function may be preserved following SAE. This review will discuss the current state of the literature on immune function following different treatments of blunt splenic injury, and the controversies surrounding what constitutes a quantitative test of splenic immune function.
Publisher: Georg Thieme Verlag KG
Date: 15-02-2021
Publisher: Wiley
Date: 03-02-2023
Publisher: Wiley
Date: 05-07-2023
Abstract: Undifferentiated abdominal pain in the emergency setting is frequently investigated with an intravenous contrast enhanced CT as a first line diagnostic test. However, global contrast shortages restricted the use of contrast for a period in 2022, altering standard practice with many scans performed without intravenous contrast. Whilst IV contrast can be useful to assist with interpretation, its necessity in the setting of acute undifferentiated abdominal pain is not well described, and its use comes with its own risks. This study aimed to assess the shortcomings of omitting IV contrast in an emergency setting, by comparing the rate of CT scans with “indeterminate” findings with and without the use of IV contrast. Data from presentations to a single centre emergency department for undifferentiated abdominal pain prior to and during contrast shortages in June 2022 were retrospectively compared. The primary outcome was the rate of diagnostic uncertainty, where the presence or absence of intra‐abdominal pathology could not be ascertained. 12/85 (14.1%) of the unenhanced abdominal CT scans provided an uncertain result, compared with 14/101 (13.9%) of control cases performed with intravenous contrast ( P = 0.96). There were also similar rates of positive and negative findings between the groups. Omitting intravenous contrast for abdominal CT in the setting of undifferentiated abdominal pain demonstrated no significant difference in the rate of diagnostic uncertainty. There are significant potential patient, fiscal and societal benefits as well as potential improvements to emergency department efficiency with the reduction of unnecessary intravenous contrast administration.
Publisher: Wiley
Date: 25-09-2012
DOI: 10.1111/J.1754-9485.2012.02453.X
Abstract: Treatment of gastric variceal rupture remains difficult with current options including transjugular intrahepatic portosystemic shunt and endoscopic therapies having significant side effects or reduced efficacy. We report five cases of gastric varices that were successfully treated with balloon-occluded retrograde transvenous obliteration of varices (BRTO) using Polidocanol foam as an alternative sclerosant to ethanolamine oleate. Patients were recruited with cirrhotic liver disease, a history of upper gastrointestinal bleeding, and large gastric fundal varices confirmed on gastroscopy and CT venogram. BRTO was performed as a same-day procedure using a balloon catheter inserted via a gastro-renal shunt with Polidocanol foam injected and a balloon inflated for 2 h. Follow-up was with repeat CT portovenogram, gastroscopy at 6 weeks post-procedure, and in a gastroenterology liver clinic at 1- to 3-month intervals. Between January and December 2009, five patients safely underwent BRTO therapy of gastric varices without complication. At 6 weeks following the procedure, upper gastrointestinal endoscopy showed complete resolution of varices in 5 out of 5 patients, while CT portovenography showed resolution of varices in 4 out of 5 patients, with results in the last patient inconclusive. Clinical follow-up at 1, 3 and 6 months indicated no further episodes of bleeding. Our study further supports the use of foam sclerosants including Polidocanol in BRTO, showing it is a safe and effective minimally-invasive procedure to treat gastric fundal varices in the short term.
Publisher: Springer Science and Business Media LLC
Date: 21-05-2020
Publisher: Georg Thieme Verlag KG
Date: 06-06-2023
Abstract: von Hippel-Lindau disease is an inherited autosomal dominant multisystem cancer syndrome. Multiple malignancies including renal cell carcinoma (RCC) occur in approximately 40%. A 69-year-old female presented with recurrent RCC in a solitary kidney, after previous partial nephrectomy and ablation. The 19-mm lesion was anterior and adherent to the descending colon, obviating percutaneous hydrodissection. A combined urology-interventional radiology procedure was performed including laparoscopic ision of adhesions and mobilization of the colon, followed by direct laparoscopic and ultrasound-guided radiofrequency ablation. This novel approach was technically and clinically successful, which highlights the advantages of working in a multidisciplinary environment.
Publisher: Georg Thieme Verlag KG
Date: 22-10-2021
Abstract: Background Many incidental liver lesions are benign and require no additional workup. Investigation of such lesions can have a negative impact of both the patient and health care system. However, the impact of how radiologists report these incidental lesions is not clear. We aimed to investigate how reporting of incidental liver lesions on trauma computed tomography (CT) scan affects follow-up. Methods This is a retrospective single-center analysis of body CT scans performed following abdominal trauma. Information was collected on the reporting of incidental low-density liver lesions and any additional imaging performed. Results A total of 3,595 trauma body CT scan reports were reviewed. Incidental liver lesions were identified in 527 (15%) patients, with 347 (10%) fulfilling the inclusion criteria. Additional imaging was requested by the referring doctor for 43 out of 285 patients (15%) when lesions were mentioned in the body of the report only, compared with 41 out of 62 patients (66%) when mentioned in the conclusion (odds ratio [OR] = 10.99, p 0.0001). When additional imaging was recommended in the report, follow-up was arranged for 36 out of 52 patients (69%), compared with 48 out of 285 patients (16%) when it was not suggested (OR = 11.58, p 0.0001). Additional imaging was requested for 84 of the 347 patients (24%), with 24 of these performed at our institution. All patients followed-up at our institution were diagnosed with a benign lesion. Conclusion Reporting incidental hypodense liver lesions in the conclusion or specifically recommending further additional imaging, both led to significantly increased likelihood of additional imaging being performed. Radiologists who encounter such lesions should consider excluding them from the conclusion if there are no malignant features or patient risk factors.
Publisher: Wiley
Date: 02-10-2022
DOI: 10.1002/PD.6241
Abstract: To evaluate the common and severe maternal morbidities associated with medical termination of pregnancy (MTOP) for fetal anomaly ≥20 weeks' gestation. A 10‐year retrospective cohort study (January 2010–December 2019) analyzing 407 consecutive singleton pregnancies MTOP for fetal anomaly ≥20 weeks' gestation, at a quaternary maternity centre in Australia (Royal Women's Hospital, Melbourne). The cohort comprised of 191 primiparous and 216 multiparous women, of whom 75 (34.7%) had at least one prior Cesarean 13 women had a low‐lying placenta or placenta praevia. The average gestation was 23 weeks (interquartile range 22–26 weeks). A spontaneous unassisted vaginal delivery was achieved by the majority ( n = 403, 99.0%). The most common maternal morbidities were transferred to the theater for manual removal of retained placental tissue ( n = 65, 16.0%) and postpartum haemorrhage (PPH) ( n = 45, 11.1%). Severe maternal morbidity occurred in six cases (1.3%) and included amniotic fluid embolism, cardiac arrest, major obstetric haemorrhage, uterine rupture and intensive care unit admission. There were no maternal deaths. The most common complications of MTOP for fetal anomaly ≥20 weeks' gestation were manual removal of placenta and PPH. Severe maternal morbidity affected 1 in 81 women.
Publisher: Wiley
Date: 07-06-2019
Abstract: Blunt renal vascular traumatic injury is uncommon, and most injuries can be managed conservatively in a patient who is clinically stable. Pseudoaneurysm or active bleeding at presentation is rare and in an unstable patient, endovascular techniques offer a low morbidity option for rapid treatment. We present an unusual case of avulsion of a second order renal artery from the main renal artery, with active bleeding at presentation treated by excluding the bleed with a stent graft. This was complicated by delayed pseudoaneurysm formation, treated with a larger stent graft. This resulted in preservation of renal parenchyma and renal function in a young patient.
Publisher: Springer Science and Business Media LLC
Date: 24-01-2023
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.JVIR.2022.02.004
Abstract: Splenic artery embolization (SAE) plays a critical role in the treatment of high-grade splenic injury not requiring emergent laparotomy. SAE preserves splenic tissue, and growing evidence demonstrates preserved short-term splenic immune function after SAE. However, long-term function is less studied. Patients who underwent SAE for blunt abdominal trauma over a 10-year period were contacted for long-term follow-up. Sixteen participants (sex: women, 10, and men, 6 age: median, 34 years, and range, 18-67 years) were followed up at a median of 7.7 years (range, 4.7-12.8 years) after embolization. Splenic lacerations were of American Association for the Surgery of Trauma grades III to V, and 14 procedures involved proximal embolization. All in iduals had measurable levels of IgM memory B cells (median, 14.30 as %B cells), splenic tissue present on ultrasound (median, 122 mL), and no history of severe infection since SAE. In conclusion, this study quantitatively demonstrated that long-term immune function remains after SAE for blunt abdominal trauma based on the IgM memory B cell levels.
Publisher: Springer Science and Business Media LLC
Date: 19-07-2020
Publisher: Springer Science and Business Media LLC
Date: 05-08-2023
DOI: 10.1186/S42155-023-00388-5
Abstract: As modern Interventional Radiology (IR) evolves, and expands in scope and complexity, it will push the boundaries of existing literature. However, with all intervention comes risk and it is the shared judgement of the risk–benefit analysis which underpins the ethical and legal principles of care in IR. Complications in medicine are common, said to occur in 9.2% of in-hospital healthcare interactions. Healthcare complications also come at considerable cost. It is estimated that in the UK, prolonging hospital stays to manage complications can cost ₤2 billion per year. However, complications can’t be viewed in isolation. Clinical governance is the umbrella within which complications are viewed. It can be defined as a broadly integrated and systematic approach to clinical care and accountability, that seeks to focus on quality of healthcare. This concept incorporates complications but acknowledges their interplay within a complex healthcare system in which negative adverse events are influenced by a range of intrinsic and extrinsic factors. It also includes the processes that result from monitoring and learning from complications, with feedback leading to systems-based improvements in care moving forward. The reality is that complications are uncommonly the result of medical negligence, but rather they are an unfortunate by-product of a healthcare industry with inherent risk. It is also important to remember that complications are not just a number on an audit sheet, but a potentially life-changing event for every patient that is affected. The events that follow immediately from an adverse outcome such as open disclosure are vital, and have implications for how that patient experiences healthcare and trusts healthcare professionals for the rest of their life. We must ensure that the patient and their family maintain trust in healthcare professionals into the future. Credentialling and accreditation are imperative for Interventional Radiologists to meet existing standards as well deal with challenging situations. These should integrate and align within the structure of an organization that has a safety and learning culture. It is the many layers of organisational clinical governance that arguably play the most important role in IR-related complications, rather than apportioning blame to an in idual IR.
Publisher: Springer Science and Business Media LLC
Date: 21-04-2021
Publisher: Georg Thieme Verlag KG
Date: 18-05-2021
Abstract: Paradoxical cerebral embolism, although rare, can be secondary to acquired causes such as superior vena cava (SVC) occlusion and development of a mediastinal right-to-left shunt. Such shunts allow undisturbed passage of thromboemboli to bypass the pulmonary circulation and enter the systemic circulation. This report presents a case of paradoxical cerebral embolism due to a right-to-left shunt originating from occlusion of the SVC. The etiology of the SVC occlusion stems from a prior central venous access line used for treatment of lymphoma. The patient underwent endovascular treatment with successful coil embolization of the mediastinal shunt.
Publisher: Springer Science and Business Media LLC
Date: 12-04-2023
Publisher: Wiley
Date: 25-03-2020
Publisher: Wiley
Date: 06-2022
Abstract: A/Prof Eric Hau is a clinician‐scientist with interest in lung and CNS tumours. His clinical and laboratory research focuses on understanding the mechanisms of radiation resistance and investigating drugs which may be utilised for radiation sensitisation to improve outcomes for patients. Associate Professor Warren Clements is an Interventional Radiologist at Alfred Health and has an Adjunct appointment with the Department of Surgery, Central Clinical School, Monash University. A/Prof Clements completed post‐fellowship subspecialty training in Interventional Radiology, consolidated by completion of the EBIR certification. A/Prof Clements is actively involved in medical research with over 80 peer‐reviewed publications, and has presented his research at national and international conferences. He is an Associate Editor for JMIRO and editorial board member of both CVIR and CVIR Endovascular. He volunteers his time for RANZCR as a member of the Interventional Radiology Committee and as an editorial board member for RANZCR’s Inside Radiology website. A/Prof Clements has a keen interest in education and training, and is the supervisor of Intern Training in the Radiology Department. Dr. Joseph (Joe) Sia is a Consultant Radiation Oncologist at the Peter MacCallum Cancer Centre, Melbourne, Australia. He obtained his medical degree from the University of Otago, New Zealand and completed his radiation oncology training in Melbourne in 2017. He then undertook a laboratory‐based PhD in tumour immunology at the University of Melbourne, which was awarded in 2020.
Publisher: Wiley
Date: 21-02-2022
Abstract: Incorporating artificial intelligence (AI) in diagnostic medical imaging reports has the potential to improve efficiency. Although perception of radiologists, radiographers, medical students and patients on AI use in image reporting has been explored, there is limited literature on non-radiologist clinicians' opinion on this topic. Single-centre online survey targeting non-radiologist medical staff conducted from May to August 2021 at a tertiary referral hospital in Melbourne, Australia. Survey questions revolved around clinicians' level of comfort acting on AI-generated reports with varying levels of radiologist involvement and scan complexity, opinion on medicolegal responsibility for erroneous AI-issued reports and perception of data privacy and security. Eighty-eight responses were collected, including 47.9% of consultants. Non-radiologist clinicians across all seniorities and specialties felt significantly less comfortable acting on AI-issued reports compared with radiologist-issued reports (mean comfort radiologist 6.44/7, mean comfort AI 3.35/7, P < 0.001) but felt equally comfortable with an AI-hybrid model of care (mean comfort hybrid 6.38/7, P = 0.676). Non-radiologist clinicians believed that medicolegal responsibility with errors in AI-issued reports mostly lay with hospitals or health service providers (65.9%) and radiologists (54.5%). Regarding data privacy and security, non-radiologist clinicians felt significantly less comfortable with AI issuing image reports instead of radiologists (P < 0.001). A hybrid AI-generated radiologist-confirmed method of image reporting may be the ideal way of integrating AI into clinical practice based on the perception of our referring non-radiologist medical colleagues. Formal guidelines on medicolegal responsibility and data privacy should be established prior to utilising AI in the clinical setting.
Publisher: Wiley
Date: 02-11-2021
Abstract: Cerebral venous sinus thrombosis (CVST) is rare however, it has been observed in patients with vaccine‐induced immune thrombotic thrombocytopaenia syndrome (VITT) following the use of adenovirus vector vaccines against COVID‐19. Adverse vaccine effects have been heavily addressed in mainstream media, likely contributing to vaccination anxiety. This study aimed to assess how the vaccine rollout and media coverage has influenced the use of computed tomography venography (CTV) in an acute care setting of a tertiary hospital. Single‐centre retrospective cohort study from 30 March 2021 to 13 June 2021. Direct comparison to same calendar dates in the preceding 3 years. In 2021, 57 patients received CTV with headache being the reason in 48 (84%) and 40 (70%) had received ChAdOx1 nCov‐19 (AstraZeneca COVID‐19 vaccination). Only 20 of these patients received CTV after platelets and D‐Dimer had returned, and only three patients met existing guidelines for imaging. Zero cases were positive. The number of CTV studies was 5.2 times than in 2020 and 2.7 times the mean number for the 3 preceding years. The use of CTV in patients with headache has markedly increased at our centre since negatively biased vaccination influence of mainstream media. Headache is a common vaccine‐related side effect and VITT is exceptionably rare. With the rates of vaccination increasing in the community, these results highlight the importance of strict adherence to established evidence‐based guidelines. Otherwise, critical care capacity, and in particular imaging resources already under pressure will be strained further.
Publisher: Georg Thieme Verlag KG
Date: 09-02-2021
Abstract: Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way that RIG is performed. In addition, the role for antibiotic prophylaxis during RIG insertion is not clearly established. This study aimed to assess the safety of RIG insertion using our technique including the role of antibiotics in RIG insertion. Method Retrospective study over 5 years at a tertiary teaching hospital. Periprocedural or early complications within the first 2 weeks of the procedure were collected and correlated with the use of prophylactic antibiotics. Results A total of 116 patients met the inclusion criteria. 18-French tube was used in 96.6%. Note that 58.6% of procedures were done with intravenous sedation. Prophylactic 1 g cefazolin was used in 70 patients with 1 case of infection. Procedures were performed without antibiotics in 46 patients with 3 infections, p = 0.20. There were two major complications (1.7%) consisting of right gastric artery injury requiring embolization and gastric wall injury requiring laparotomy. There were 12 minor complications (10.3%) including 4 cases of infection, 3 of severe pain, 1 of minor bleeding, 2 of early dislodgement, and 2 of leak/bypass of gastric contents around the tube. Conclusion The technique used for RIG insertion at our institution results in a low complication rate. In addition, this study shows no significant difference in early peristomal infection rate with the use of antibiotic prophylaxis.
Publisher: Wiley
Date: 25-03-2020
Publisher: Georg Thieme Verlag KG
Date: 16-03-2021
Abstract: This case highlights a hybrid treatment model used successfully in a patient with complicated recurrent renal cell carcinoma (RCC), following partial nephrectomy, in the context of a single kidney. Scar tissue from previous surgery tethered the ureter to the margin of the lesion and combined with obesity, rendered simple percutaneous intervention challenging. The patient was ultimately successfully treated using a hybrid approach of open surgical access, ureterolysis, and intraoperative ultrasound-guided radiofrequency ablation. This approach optimized the volume of conserved normal renal parenchyma and eliminated the need for postoperative dialysis treatment, with no recurrence at 13 months follow-up.
Publisher: Springer Science and Business Media LLC
Date: 31-03-2022
Publisher: XMLink
Date: 2023
Publisher: Wiley
Date: 11-06-2023
Abstract: Clinical radiology is a popular career. However, academic radiology in Australia and New Zealand (ANZ) has not traditionally been a strength of the specialty which has a focus on clinical medicine and has been influenced by corporatisation of the specialty. The aim of this study was to review the source(s) of radiologist‐led research in Australia and New Zealand, to identify areas of relative deficiency and propose plans to improve research output. A manual search was performed of all manuscripts in seven popular ANZ journals, where the corresponding or senior author was a radiologist. Publications between January 2017 and April 2022 were included. There were 285 manuscripts from ANZ radiologists during the study period. This equates to 10.7 manuscripts per 100 radiologists based on RANZCR census data. Radiologists in Northern Territory, Victoria, Western Australia, South Australia and the Australian Capital Territory all produced manuscripts above the corrected mean incidence rate of 10.7 manuscripts per 100 radiologists. However, locations including Tasmania, New South Wales, New Zealand and Queensland were below the mean. The majority of manuscripts arose from public teaching hospitals with accredited trainees (86%), and there were a higher proportion of manuscripts published by female radiologists (11.5 compared to 10.4 per 100 radiologists). Radiologists in ANZ are academically active however, interventions aimed at increasing output could be targeted at certain locations and/or areas within a busy private sector. Time, culture, infrastructure and research support are vital, but personal motivation is also extremely important.
Publisher: Springer Science and Business Media LLC
Date: 20-12-2022
DOI: 10.1186/S42155-022-00344-9
Abstract: Existing literature from around the world has shown that teaching of Interventional Radiology (IR) to medical students remains suboptimal. Despite calls for improvement at a “grass-roots” level, most IRs find that junior doctors have limited or no knowledge of IR, and thus reduced awareness of potential IR treatments for their patients or contemplating IR as a future career. The aim of this study was to survey current medical students to assess perception of whether a wider variety of medical schools are integrating IR into their curriculum, from universities all across Australia. This was a prospective cross-sectional study of members of the Australian Medical Students Association (AMSA) from across Australia. Students were given a 14-question survey of current university teaching and students’ knowledge of the discipline of IR. The primary outcome was perception of current teaching and knowledge of IR. Secondary outcomes include awareness of technical, clinical, and other duties of IRs. Surveys were sent in a newsletter and posted on the AMSA Facebook page to their members. 82 responses were received via students from 20 out of 23 Australian medical schools. 61% of students described poor or no knowledge of IR. Teaching of IR was significantly worse than diagnostic radiology ( p 0.001), only 12% suggested that current IR teaching was adequate, and 99% suggested that IR teaching could be improved. Only 11% of students would consider a career in IR. Medical student perception of exposure to IR is poor compared to diagnostic radiology. Better awareness may lead to improved referral patterns for patients and more career interest in IR.
Publisher: Wiley
Date: 03-08-2021
Abstract: Cataract formation is a tissue reaction effected by radiation exposure. The purpose of this study was to evaluate the occupational exposure to the lens of the eye of interventional radiologists (IR's) and interventional radiology staff, with and without lead glasses. Ethical approval was provided by the hospital research and ethics committee. A prospective cohort study was performed over 1 year, doses recorded, lifetime dose (estimated at working 5 days in angiography, for 30 years) was estimated and dose compared to current guidelines. Thermoluminescent dosimeters (TLDs Landauer, Glenwood, USA) Hp(3) were placed on both the exterior and interior side of the personal lead glasses worn by three interventional radiologists and two radiographers. They were monitored during all procedures performed within 1 year. Lead glasses (AttenuTech ® Microlite ® , Florida, USA) with specifications were 0.75 mm lead equivalent front shield, and Side shield 0.3 mm Pb equivalent. A control TLD was placed in the storage location of the lead glasses when not in use. Yearly dose was measured and lifetime dose was calculated from the data obtained. Calculation of dose received per day(s) spent performing procedures for both annual and lifetime exposure was performed. In addition a record of occurrence of splashes on glasses was made after each case. Eye doses without protection were double the recommended limits for both annual and lifetime dose. For interventional radiologists working between 3 and 4 or more days in the lab per week, annual dose thresholds would be exceeded (20 mSv/year averaged over 5 years, no more than 50 mSv in 1 year). If interventional radiologists worked between 3 and 4 or more days in the lab, lifetime dose thresholds would be exceeded (500 mSv lifetime dose). Lead glasses reduced radiation exposure by an average of 79%. If lead glasses were worn no interventional radiologists would exceed annual or lifetime dose thresholds to the eyes even if working 5 days per week as the primary operator. Radiographers would not exceed annual or lifetime dose thresholds even without lead glasses. Splash incidents occurred for all interventional radiologists and one radiographer. The use of lead glasses even in this small study resulted in a decreased dose of radiation to the lens of the eye. Regular use of radiation protection eyewear will reduce eye dose for primary proceduralists to well below yearly and lifetime thresholds.
Publisher: Springer Science and Business Media LLC
Date: 04-2023
Publisher: Elsevier BV
Date: 07-2023
Publisher: Springer Science and Business Media LLC
Date: 16-05-2022
DOI: 10.1007/S00270-022-03158-3
Abstract: Uterine artery embolisation (UAE) is a safe and effective procedure for symptomatic uterine fibroids with an estimated rate of post-operative intra-uterine infection of 0.9–2.5%. While rates of infection have remained low over the past two decades, there is variation in infection prevention practices. Intra-uterine infection after UAE may occur via access site haematogenous spread or ascension of vaginal flora through the cervical canal. Although the evidence base is immature, risk factors for infection including previous pelvic infection, hydrosalpinx, endocervical incompetence, diabetes, smoking, obesity, respiratory disease, and immunosuppression should be assessed during the pre-operative consultation with the interventional radiologist to tailor a plan for minimising infection, which may include optimisation of any modifiable risk facts and prophylactic antibiotics.
Publisher: Wiley
Date: 08-10-2018
Abstract: Interventional Radiology procedures can provoke anxiety and may be painful. Current practice, Radiologist Controlled Sedation (RCS), involves titrating aliquots of midazolam and fentanyl to patient response but underdosing and overdosing may occur. This study tests a new method of titrating sedation/analgesia during the procedure, Patient Controlled Sedation (PCS), in which a combination of fentanyl and midazolam are administered using a patient-controlled analgesia pump. This allows the patient to self-control their sedation/analgesia during the procedure. We performed a randomised control trial comparing the effects of pain, sedation, amnesia and overall patient satisfaction between PCS and RCS, by enrolling forty patients undergoing insertion of a tunnelled central line. Our results showed that PCS was safe, with no adverse events. PCS was effective in providing sedation, amnesia and overall pain relief comparable to RCS. There was no significant difference in dose given to patients using PCS or RCS. There was a tendency for patients in the PCS group to begin sedation later than those in the RCS group, but both were equally sedated during the procedure. We show that patients in the PCS group were very satisfied with the procedure. We show that PCS is non-inferior to RCS in terms of dosage given and degree of sedation. To the authors' knowledge, this is the first study to show intra-procedural PCS in an Interventional Radiology setting using midazolam and fentanyl as a randomised comparative trial. It has wide applicability in a procedural setting for very low cost and with minimal additional training required.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 11-08-2023
Abstract: Haemorrhagic shock is a life‐threatening complication of trauma, but remains a preventable cause of death. Early recognition of retroperitoneal haemorrhage (RPH) is crucial in preventing deleterious outcomes including mortality. Injury to the 9–11th intercostal arteries (i.e. arteries of the lower thoracic region) are complicit in RPH. However, the associated injuries, implications and management of such bleeds remain poorly characterised. We performed a retrospective review of the medical records of patients diagnosed with RPH who presented to our level‐1 trauma centre (2009–2019). We described the associated injuries, management and outcomes relating to RPH of the lower thoracic region (the 9–11th intercostal arteries) from this cohort to identify potential predictors and evaluate the impact of early identification and management of non‐cavitary bleeds. Haemorrhage of the lower intercostal arteries (LIA) into the retroperitoneal space is associated with an increased number of posterior lower rib fractures and pneumothorax/haemothorax. A higher proportion of patients in the LIA group required massive transfusion, angioembolisation or surgical ligation when compared to other causes of RPH. The present study highlights the importance of injury patterns, particularly posterior lower rib fractures, as predictors for early recognition and management of RPH in the prevention of deleterious patient outcomes. RPH secondary to bleeding of the LIA may require early and aggressive management of haemorrhage through massive transfusion, and angioembolisation or surgical ligation when compared to RPH because of other causes.
Publisher: Wiley
Date: 12-06-2023
Abstract: Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries. A retrospective review was conducted of patients with blunt‐TDI identified from a level 1 trauma registry. Variables associated with early versus delayed diagnosis as well as non‐survivor and survivor groups were collected to examine factors associated with delayed diagnosis. A total of 155 patients were included (mean age 46 ± 20, 60.6% male). Diagnosis was made h in 126 (81.3%), and h in 29 (18.7%). Of the delayed diagnosis group, 14 (48%) were diagnosed days. Overall, 27 (21.4%) patients had a diagnostic initial CXR and 64 (50.8%) had a diagnostic initial CT. Fifty‐eight (37.4%) patients were diagnosed intraoperatively. Of the delayed diagnosis group, 22 (75.9%) had no initial signs on CXR or CT, 15 (52%) of this group had persistent pleural‐effusions/elevated‐hemidiaphragm leading to further investigation and diagnosis. No significant difference in survival was observed between early and delayed diagnoses, no clinically significant injury patterns to predict delayed diagnoses were noted. The diagnosis of TDI is challenging. Without frank signs of herniation of abdominal contents on CXR or CT, the diagnosis is often not made on initial imaging. In patients with the evidence of blunt traumatic injury in the lower‐chest/upper‐abdomen, a high degree of clinical suspicion should be held and follow‐up CXRs/CTs arranged.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2023
DOI: 10.1007/S00270-023-03359-4
Abstract: To assess the efficacy of conservative management and embolisation in patients with spontaneous retroperitoneal haemorrhage. Single-centre retrospective case–control study of patients with spontaneous retroperitoneal haemorrhage treated conservatively or with embolisation. Patients aged ≥ 18 years were identified from CT imaging reports stating a diagnosis of retroperitoneal haemorrhage or similar and images reviewed for confirmation. Exclusion criteria included recent trauma, surgery, retroperitoneal vascular line insertion, or other non-spontaneous aetiology. Datapoints analysed included treatment approach (conservative or embolisation), technical success, clinical success, and mortality outcome. A total of 54 patients met inclusion criteria, who were predominantly anticoagulated (74%), male (72%), older adults (mean age 69 years), with active haemorrhage on CT (52%). Overall mortality was 15%. Clinical success was more likely with conservative management (36/38) than embolisation (9/16 p 0.01), and all-cause (1/38 vs 7/16 p 0.01) and uncontrolled primary bleeding (1/38 vs 5/16 p 0.01) mortality were higher with embolisation. However, embolised patients more commonly had active bleeding on CT (15/38 vs 13/16 p 0.01), shock (5/38 vs 6/16 p 0.04), and higher blood transfusion volumes (mean 2.2 vs 5.9 units p 0.01). After one-to-one propensity score matching, differences in clinical success ( p = 0.04) and all-cause mortality ( p = 0.01) remained however, difference in uncontrolled primary bleeding mortality did not ( p = 0.07). Conservative management of SRH is likely to be effective in most patients, even in those who are anticoagulated and haemodynamically unstable, with variable success seen after embolisation in a more unstable patient group, supporting the notion that resuscitation and optimisation of coagulation are the most vital components of treatment.
Publisher: Springer Science and Business Media LLC
Date: 28-05-2019
DOI: 10.1007/S00270-019-02254-1
Abstract: Assess the safety of inferior vena cava (IVC) filter retrieval in patients taking anticoagulation, compared to a non-anticoagulated cohort. Single-centre retrospective analysis of patients who underwent IVC filter retrieval between January 2012 and February 2018. Information about patient demographics, anticoagulation, tilt, major and minor complications was collected. Major complications were defined as: IVC injury from the filter retrieval, retained fragment of filter, filter fracture and filter embolisation. Minor complications were defined as: neck haematoma and puncture site infection. Total of 357 patients (age 18-95, Male: 231) underwent IVC filter retrieval, comprising of Cook Celect Platinum, Cook Celect, and ALN-branded filters. Of these 182 patients were on anticoagulation and 175 patients were not on anticoagulation, based on the indication for the filter (thrombosis or prophylaxis) and at the discretion of the referring unit who were managing the anticoagulation. IVC filter retrieval was technically successful in 349 patients. Five major complications (1.4% of retrievals) were recorded and no minor complications (0% of retrievals). In the anticoagulation cohort, there were two major complications (1.1% of retrievals) both related to IVC injury. In the non-anticoagulated cohort, there were three major complications (1.7% of retrievals) relating to filter embolisation, IVC injury, and filter fracture. IVC filter retrieval is a safe procedure with a low complication rate. Being on anticoagulation does not increase the risk of a major complication or change the management of major complication compared with a non-anticoagulated cohort. IVC filter retrieval is safe to perform in patients currently taking prophylactic or therapeutic anticoagulation based on our cohort. Level 3, retrospective cohort study.
Publisher: Wiley
Date: 03-04-2020
Publisher: Wiley
Date: 13-03-2020
Publisher: Springer Science and Business Media LLC
Date: 23-09-2022
Publisher: Wiley
Date: 05-07-2018
Publisher: Wiley
Date: 20-03-2020
Publisher: Wiley
Date: 08-04-2022
Abstract: Acute gastrointestinal bleeding (GIB) is associated with morbidity and mortality. There can be a low threshold for practitioners to assess for active GIB and computed tomography angiography (CTA) examinations are performed frequently, even for stable patients and those who are therapeutically anticoagulated. We aimed to assess the predictive value of CTA for acute GIB and the influence of CTA on treatment. Retrospective single‐centre study over a 2‐year period. A total of 227 patients with mean age 67.7 years (SD 17.86), 58.6% male. 84.4% were for lower GIB. 49 patients were on therapeutic anticoagulation (21.6%). 45 CTAs were positive (19.8%). 22 patients received embolisation, and 15 received acute endoscopic treatment. CTA sensitivity was 68.6% and specificity 89.1%. The PPV was 53.3% and NPV 93.9%. The odds ratio of a positive CTA requiring treatment for patients on therapeutic anticoagulation was 1.1 ( P = 0.932) compared with the odds of patients not taking therapeutic anticoagulation 21.5 ( P 0.001). The risk ratio for requiring treatment if not taking anticoagulation was 6.2. A total of 19 patients (9.1%) met the definition of CI‐AKI as a result of the CTA. A pre‐existing eGFR of less than 20 was associated with significantly increased odds of developing CI‐AKI (OR 3.95, P = 0.031, 95%CI 1.135–13.782). The presence of anticoagulation has a significant impact on the decision not to perform interventional treatments on patients with acute GIB when CTA is positive. Anticoagulant reversal and volume resuscitation are important front‐line measures, and CTA may have a role for those anticoagulated who are haemodynamically unstable after resuscitation.
Publisher: Wiley
Date: 03-07-2022
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.RMED.2022.106784
Abstract: In many patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH), bronchial artery hypertrophy is observed. Patients with bronchial dilatation have been shown to be at increased risk of hemoptysis introducing the risk of airway obstruction. In this study from an academic tertiary referral center, we aimed to assess the incidence of massive hemoptysis in our CTEPH patients, the success of bronchial artery embolization (BAE), recurrence, and hemoptysis-related mortality. Retrospective cohort study of all adults with CTEPH who underwent BAE for massive hemoptysis between 1 January 2015 and 30 July 2021. Primary endpoints were hemoptysis relapse and hemoptysis-related mortality. There were 367 patients who were being treated and managed with a diagnosis of CTEPH at our institution. There were 24 bronchial artery embolization procedures performed for all causes. A total of 3 patients during this time met inclusion criteria with acute massive hemoptysis and CTEPH. All patients were taking therapeutic-dose anticoagulation. Technical success after BAE was 100%. No hemoptysis recurrence was demonstrated at 17, 24, and 40-months follow-up respectively. No patient died from hemoptysis. However, 1 patient died 24 months after the embolization procedure due to a non-hemoptysis cause. This study highlights the low but important incidence of massive hemoptysis in patients with CTEPH. Unlike other causes of hemoptysis, this unique cohort requires balancing anticoagulation and hemorrhage control. Given the high degree of success, BAE is a viable option, allowing continuation or early re-establishment of anticoagulation.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2019
DOI: 10.1007/S00270-019-02373-9
Abstract: Currently, data surrounding predicting difficulty of IVC filter retrievals are heterogenous and conflicting. We aimed to identify which of many variables associated with IVC filters is a risk for procedural difficulty. This study retrospectively reviewed 6 years of IVC filter retrievals at a tertiary center identifying 356 consecutive retrievals. A difficult retrieval was defined as any case where the fluoroscopy time exceeded 7 min, an advanced technique was required, the retrieval attempt failed and required an additional attempt or was left permanent, or there was major complication such as IVC filter fracture/migration/vessel injury. There were 105 filter retrievals defined as difficult (29.5%). Univariate analysis showed significantly increased risk for retrievals with an embedded top. Multivariate analysis assessed the association between dwell time, tilt, age, non-hooked filters, leg penetration and difficult retrieval. This showed a significant increase in the difficulty of retrieval for filters tilted between 5° and 15° (odds ratio 2.38, p < 0.001), for filters tilted more than 15° (odds ratio 7.91, p < 0.001), and dwell time greater than 6 months (odds ratio 2.06, p = 0.033). No significant increase in difficulty was seen with filters with a dwell time of less than 6 months, leg penetration, non-hooked filters, or with increasing patient age. Identifying these risks in patients in advance of the procedure allows appropriate planning and improved workflow efficiency.
Publisher: Wiley
Date: 30-03-2020
Publisher: Wiley
Date: 29-07-2022
Abstract: Morel‐Lavallée lesions (MLL), also referred to as closed degloving injuries, result from traumatic shearing forces with separation of the subcutaneous fat from the underlying fascia. The aim of this study was to determine the incidence and treatment of MLLs at a level 1 trauma centre. Single‐centre retrospective cross‐sectional study of consecutive patients with an imaging diagnosis of a Morel‐Lavallee lesion from 1/1/2010–31/12/2019. Demographic data, mechanism of injury, volume of lesion, management and outcome data were collated. Sixty‐six MLLs were identified in 63 patients (64% Male) with a median age of 49.5 years (19–94 years). Mechanism of injury were road traffic accidents in the majority (66%). Median injury severity score (ISS) was 17 (range 1–33). Patients on oral anti‐coagulants had significantly larger lesions (181.9 cc v 445.5 cc, P = 0.044). The most common lesion location was the thigh (60.5%). Patients that underwent imaging within 72 h of injury had significantly larger lesions than those imaged more than 72 h after the inciting trauma (65 cc v 167 cc, P 0.05). Management data were documented in 59% of lesions (39/66) in which 66.6% ( n = 26) had invasive treatment. In the 31 patients where follow‐up was available, 64.5% ( n = 20) were persistent but decreasing in size. There was no significant difference in follow‐up size for those who had invasive compared to conservative treatment ( P = 0.3). The diagnosis of MLL should be considered for soft‐tissue swelling in the context of shearing trauma. A variety of management options have been employed, with good overall outcomes.
Publisher: Wiley
Date: 12-07-2019
Abstract: The diagnostic yield of and best approaches for imaging-guided percutaneous biopsy for vertebral osteomyelitis is controversial. Early studies suggest yields of up to 90% however, recent evidence shows lower yields of 30-40%. We aim to determine yield and predictors of yield in percutaneous CT-guided biopsies in vertebral osteomyelitis. We conducted a retrospective observational single-centre study cohort study of all patients presenting for vertebral biopsy or aspiration between 2014 and 2018. Only patients undergoing biopsy for suspected infection were included. Patients with malignant indications were excluded. Comprehensive review of medical records was performed for clinical presentation, comorbidities, imaging, biomarkers, microbiology and treatment. Overall, 40 out of 88 biopsies were performed for suspected infection, in 36 patients. Mean age was 59 ± 18 years 29 (81%) were male. Of the 40 s les, an organism was identified in 14 s les (35%). Gram-positive organisms were most commonly identified Staphylococcus aureus was cultured in 7 (50%) of s les. Mean admission CRP was significantly higher in patients with identified organisms compared to those without (137 ± 106 vs 54 ± 78, P = 0.008). Aspiration was a strong independent predictor of positive microbiological growth on multivariate analysis (OR 6.52 [1.25-34.02], P = 0.026). Biopsy or aspiration aided clinical decision-making in half of cases. Percutaneous CT-guided biopsy has a modest yield for identifying the culprit organism in suspected cases of vertebral osteomyelitis. Elevated CRP and aspiration of fluid collections are associated with improved microbiological yield and should be considered in deciding when and where to biopsy.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S42155-020-00185-4
Abstract: As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma center using the 2018 update to the AAST criteria, and further sub-stratify the role of angiography in AAST grade III injuries with significant hemoperitoneum. All patients between 1 January 2009 and 1 January 2019 who underwent blunt trauma and proceeded to embolization were included. Data was collected concerning initial injury grade, location of embolization, type of embolic material used, complications, and need for subsequent splenectomy. Technical success was defined as successful angiographic occlusion of the target artery at the conclusion of embolization. Clinical success was defined as splenic salvage at discharge. Vascular lesions were characterized including those with active bleeding, pseudoaneurysm, and arterio-venous fistula. Two hundred thirty-two patients were included in the study. Treatments were performed at a median of 0 days (range 0–28 days) and the median AAST grade was IV (range III-V). Technical success was achieved in all patients. There were 13 complications (5.6%) consisting of re-bleed (9, 3.9%), infarction (3, 1.3%), and access site haematoma (1, 0.43%). Clinical success was achieved in 97% of patients with 7 patients requiring splenectomy after SAE (3.0%) at a median time of 4 days (range 0–17 days). Angiography in patients with grade III injuries identified 18 occult vascular injuries not identified at initial CT ( p 0.0001). The SPLEEN-IN study shows that treatment of intermediate-high grade blunt force traumatic splenic injuries using SAE resulted in a low rate of complication and splenic salvage in 97% of patients, providing a safe and effective treatment in stable patients. In addition, angiography of grade III injuries identified occult vascular lesions and may warrant treatment of select patients in this cohort. Level 3.
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.INJURY.2022.07.041
Abstract: Haemorrhagic shock remains a leading preventable cause of death amongst trauma patients. Failure to identify retroperitoneal haemorrhage (RPH) can lead to irreversible haemorrhagic shock. The arteries of the middle retroperitoneal region (i.e., the 1st to 4th lumbar arteries) are complicit in haemorrhage into the retroperitoneal space. However, predictive injury patterns and subsequent management implications of haemorrhage secondary to bleeding of these arteries is lacking. We performed a retrospective cohort study of patients diagnosed with retroperitoneal haemorrhage who presented to our Level-1 Trauma Centre (2009-2019). We described the associated injuries, management and outcomes relating to haemorrhage of lumbar arteries (L1-4) from this cohort to assess risk and management priorities in non-cavitary haemorrhage compared to RPH due to other causes. Haemorrhage of the lumbar arteries (LA) is associated with a higher proportion of lumbar transverse process (TP) fractures. Bleeding from branches of these vessels is associated with lower systolic blood pressure, increased incidence of massive transfusion, higher shock index, and a higher Injury Severity Score (ISS). A higher proportion of patients in the LA group underwent angioembolisation when compared to other causes of RPH. This study highlights the injury patterns, particularly TP fractures, in the prediction, early detection and management of haemorrhage from the lumbar arteries (L1-4). Compared to other causes of RPH, bleeding of the LA responds to early, aggressive haemorrhage control through angioembolisation. These injuries are likely best treated in Level-1 or Level-2 trauma facilities that are equipped with angioembolisation facilities or hybrid theatres to facilitate early identification and management of thoracolumbar bleeds.
Publisher: Elsevier BV
Date: 09-2019
Publisher: Springer Science and Business Media LLC
Date: 09-10-2021
Publisher: Springer Science and Business Media LLC
Date: 11-04-2023
Publisher: Wiley
Date: 15-06-2021
Abstract: This study aimed to risk‐stratify chest pain as a presenting symptom in patients with a diagnosis of pulmonary thromboembolism (PE) to assess for any association. In addition, this study aimed to assess traditionally acknowledged PE risk factors in an Australian population. This was a retrospective single‐centre cohort study assessing patients who presented to our emergency department during the period of 1 January 2019 to 1 January 2020. 730 consecutive patients who went on to computed tomography pulmonary angiography (CTPA) examination after presentation were included. The rate of CTPA being positive in this study was 11.6% (85/730). Chest pain was associated with a non‐significant reduction in the odds of PE (OR 0.774, P = 0.327). Univariate analysis showed significantly increased odds of a diagnosis of PE with presentation for leg pain/swelling (OR 6.670, P 0.001). Multivariate analysis showed increasing age (OR 1.018, 95% CI 1.002–1.034, P = 0.024), clinical signs of a DVT (OR 3.194, 95% CI 1.803–5.657, P 0.001) and positive D‐dimer (OR 1.762, 95% CI 1.011–3.071, P = 0.046) were associated with increased odds of PE. In this study, Emergency Department presentation with chest pain, whilst the most common reason to perform a CTPA, resulted in reduced odds with regard to the diagnosis of pulmonary thromboembolism. The use of CTPA in this setting may be rationalised according to other factors such as localised leg pain as a symptom, signs of DVT, increasing age or positive D‐dimer.
Publisher: Wiley
Date: 17-06-2021
Abstract: To compare the outcomes of proximal (pSAE) versus distal (dSAE) splenic artery embolisation for management of focal distal arterial splenic injuries secondary to blunt splenic trauma. Ethical approval was granted by the hospital research and ethics committee, Project 389/19. All patients who underwent splenic artery embolisation secondary to blunt abdominal trauma from 1 January 2009 to 1 January 2019 were reviewed. Patients with a tandem embolisation (both proximal and distal embolisations) or those with no acute vascular injury on angiography were excluded. Patient demographics, injury type/ AAST grade (2018 classification), technique of embolisation and outcomes were collected. Complications and splenectomy rates up to 30 days were recorded. 136 out of 232 patients had an embolisation performed for a distal vascular injury including active arterial bleeding, pseudoaneurysm or arteriovenous fistula. Mean age was 41 (range 16–84). Mean AAST grade was 4 (range 3–5). Mean Injury Severity Score was 22. pSAE was performed in 79.4% ( n = 108) and dSAE in 20.6% ( n = 28). Major complications occurred in 12 patients (pSAE n = 12, 11.1% dSAE n = 0, P 0.05) 6 pSAE required splenectomy ( n = 6, 5.6%). There was no significant difference in outcomes between the two groups or when based on AAST grading. No significant difference was observed between proximal and distal embolisation techniques for blunt trauma patients with a distal vascular injury in terms of technical and clinical success.
Publisher: Australasian College of Health Service Management
Date: 07-04-2022
Abstract: Objective: Radiology has been at the forefront of medical technology including the use of artificial intelligence (AI) and machine learning. However, there remains scant literature on the perspective of patients regarding clinical use of this technology. This study aimed to assess the opinion of radiology patients on the potential involvement of AI in their medical care. Design: A survey was given to ambulatory outpatients attending our hospital for medical imaging. The survey consisted of questions concerning comfort with radiologist reports, comfort with entirely AI reports, comfort with in-part AI reports, accuracy, data security, and medicolegal risk. Setting: Tertiary academic hospital in Melbourne, Australia. Main outcome measures: Patients’ were surveyed for their overall comfort with the use of AI in their medical imaging using a Likert scale of 0 to 7. Results: 283 patient surveys were included. Patients rated comfort in their imaging being reported by a radiologist at mean of 6.5 out of 7, compared with AI alone at mean 3.5 out of 7 (p .0001), or in-part AI at mean 5.4 out of 7 (p .0001). Patients felt AI should have an accuracy of mean 91.4% to be able to be used in a clinical environment. Patients rated their current comfort with data security at mean 5.5 out of 7 however comfort with data security using AI at mean 4.4 out of 7, p .0001. Conclusions: Patients are trusting of the holistic role of a radiologist however, remain uncomfortable with clinical use of AI as a standalone product including accuracy and data security. If AI technology is to evolve then it must do so with appropriate involvement of stakeholders, of which patients are paramount.
Location: Australia
No related grants have been discovered for Warren Clements.