• Title/Summary/Keyword: Interventional study

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Review of National Diagnostic Reference Levels for Interventional Procedures

  • Lee, Min Young;Kwon, Jae;Ryu, Gang Woo;Kim, Ki Hoon;Nam, Hyung Woo;Kim, Kwang Pyo
    • Progress in Medical Physics
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    • v.30 no.4
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    • pp.75-88
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    • 2019
  • Diagnostic reference level (DRL) is employed to optimize the radiation doses of patients. The objective of this study is to review the DRLs for interventional procedures in Korea and abroad. Literature review was performed to investigate radiation dose index and measurement methodology commonly used in DRL determination. Dose area product (DAP) and fluoroscopy time within each major procedure category were systematically abstracted and analyzed. A wide variation was found in the radiation dose. The DAP values and fluoroscopy times ranged 0.01-3,081 Gy·㎠ and 2-16,878 seconds for all the interventional procedures, 8.5-1,679 Gy·㎠ and 32-5,775 seconds for the transcatheter arterial chemoembolization (TACE), and 0.1-686 Gy·㎠ and 16-6,636 seconds for the transfemoral cerebral angiography (TFCA), respectively. The DRL values of the DAP and fluoroscopy time were 238 Gy·㎠ and 1,224 seconds for the TACE and 189 Gy·㎠ and 686 seconds for the TFCA, respectively. Generally, the DRLs of Korea were lower than those of other developed countries, except for the percutaneous transluminal angioplasty with stent in arteries of the lower extremity (LE PTA and stent), aneurysm coil embolization, and Hickman insertion procedures. The wide variation in the radiation doses of the different procedures suggests that more attention must be paid to reduce unnecessary radiation exposure from medical imaging. Furthermore, periodic nationwide survey of medical radiation exposures is necessary to optimize the patient dose for radiation protection, which will ultimately contribute to patient dose reduction and radiological safety.

Analysis on Content and Trend of Nursing Intervention Studies Published in Adult Nursing Area (성인간호학 영역에서의 간호중재논문 내용 분석)

  • Suh, Moon-Ja;Jeong, Jae-Sim;Oh, Hyo-Sook
    • Journal of Korean Biological Nursing Science
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    • v.5 no.2
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    • pp.41-51
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    • 2003
  • Purpose : This descriptive study was performed to analyze the trends of nursing interventional studies in adult nursing area. Method : All interventional studies of 'Journal of Korean Academy of Adult Nursing Society', fifty three articles, from 1989 to 2000 were collected and reviewed Result : The research subject were patients in 38(66.7%) and 81.8% of researches was performed in hospital environment. There was only one true experimental design and most of articles(79.2%) were designed by quasi-experimental method Only 17% of articles have theoretical framework and 73.6% of articles described research hypotheses. The data collection methods for variables were as follows: Psychosocial measurement 60.8%, physiological measurement 25.7%, and observation 13.5%, respectively. Lecture(16.7%), audio-visual(16.7%), and book, pamphlet, or leaflets(13.6%) were the most frequently used instruments of the interventions. Behavioral domain(60.3%) and Physiological: Basic domain(29.3%) was the most common, when the interventions were classified by Nursing Intervention Classification. Physiological(50.8%) and psychosocial variables(49.2%) were the two major dependent variables. Conclusion : Considering the above results obtained, the nursing intervention studies in adult nursing area have been tested with quasi-experimental studies through clinical trials. For the development of clinical nursing practice and advancement of nursing theories, the amount of interventional studies should be increased and the quality of research methods refined more to develop nursing science and practice in adult nursing area.

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Development of Drug Eluting Stent for the Treatment of Benign Biliary Stricture by Electro-spray Method (전기분사를 이용한 양성담관 협착 치료용 약물방출 스텐트 개발)

  • Shin, Il-Gyun;Kim, Dong-Gon;Kim, Han-Ki;Kim, Sang-Ho;Jeon, Dong-Min;Suh, Tae-Seok;Jang, Hong-Seok
    • Polymer(Korea)
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    • v.36 no.2
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    • pp.163-168
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    • 2012
  • Recently, along with technology development of endoscopic equipment, the stent technology has been developed for the convenience of operation, shortening of recovery times, and reduction of patient's pain. In this study, paclitaxel-eluting metal stents for treatment of biliary benign stenosis were developed through an electrospray-coating method. Polyether-based polyurethane (PELLETHANE 2363-80AE$^{(R)}$)) and paclitaxel were coated onto the surface of a metallic stent and Pluronic F127 was used as an additive. As a result, physicochemical characterization of paclitaxel via SEM, FTIR, contact angle and XRD techniques revealed the information of solid state of paclitaxel-loaded PU film. The in vitro release profile showed a slower release rate with a higher content of paclitaxel.

Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome

  • Alex Wing Hung Ng;James Francis Griffith;Carita Tsoi;Raymond Chun Wing Fong;Michael Chu Kay Mak;Wing Lim Tse;Pak Cheong Ho
    • Korean Journal of Radiology
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    • v.22 no.7
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    • pp.1132-1141
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    • 2021
  • Objective: To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods: This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0-3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results: All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion: Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.

Exoskeleton System for Radiation Protection in Interventional Radiology

  • Clarissa Hosse;Johannes Kolck;Elif Can;Uli Fehrenbach;Timo A. Auer;Fabio Pivetta;Federico Collettini;Bernhard Gebauer;Maximilian de Bucourt
    • Journal of Radiation Protection and Research
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    • v.49 no.2
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    • pp.78-84
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    • 2024
  • Background: As the quantity and complexity of radiological interventions are constantly increasing, gear that offers optimal protection while maintaining mobility and a low weight burden is becoming more important. A newly developed exoskeleton radiation protection system (ERPS) (StemRad MD; StemRad Ltd.) can carry the weight of the shielding. The aim of our study was to analyze initial experience, especially in terms of advantages and disadvantages, with this new ERPS in interventional radiology. Materials and Methods: Forty-six interventions utilizing the ERPS were analyzed. The interventional radiologists completed a 15-question survey evaluating various aspects of the protective system, including weight, mobility, comfort, and radiation protection adequacy. Results and Discussion: In 98% of procedures, interventionalists reported being very satisfied (89%) or slightly satisfied (9%) and would recommend the system to colleagues. The exoskeleton system was rated as 100% comfortable, not too heavy, and did not restrict mobility in 98% of cases. Conclusion: The ERPS is a recommendable alternative to standard lead aprons, providing flexibility, comfort, and effective weight distribution without restricting mobility.

Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

  • Shyam Vedantam;Sunil Amin;Ben Maher;Saqib Ahmad;Shanil Kadir;Saad Khalid Niaz;Mark Wright;Nadeem Tehami
    • Clinical Endoscopy
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    • v.55 no.3
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    • pp.426-433
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    • 2022
  • Background/Aims: Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. Methods: One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: "Trainees," "Consultants group 1" (performed >75 ERCPs per year), and "Consultants group 2" (performed >100 ERCPs per year). Results: Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77-0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74-0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69-0.95). Conclusions: This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.

Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study

  • Kim, Yeon Dong;Moon, Hyun Seog
    • The Korean Journal of Pain
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    • v.28 no.4
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    • pp.254-264
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    • 2015
  • Background: Pain medicine often requires medico-legal involvement, even though diagnosis and treatments have improved considerably. Multiple guidelines for pain physicians contain many recommendations regarding interventional treatment. Unfortunately, no definite treatment guidelines exist because there is no complete consensus among individual guidelines. Pain intervention procedures are widely practiced and highly associated with adverse events and complications. However, a comprehensive, systemic review of medical-dispute cases (MDCs) in Korea has not yet been reported. The purpose of this article is to analyze the frequency and type of medical dispute activity undertaken by pain specialists in Korea. Methods: Data on medical disputes cases were collected through the Korea Medical Association mutual aid and through a private medical malpractice liability insurance company. Data regarding the frequency and type of MDCs, along with brief case descriptions, were obtained. Results: Pain in the lumbar region made up a major proportion of MDCs and compensation costs. Infection, nerve injury, and diagnosis related cases were the most major contents of MDCs. Only a small proportion of cases involved patient death or unconsciousness, but compensation costs were the highest. Conclusions: More systemic guidelines and recommendations on interventional pain management are needed, especially those focused on medico-legal cases. Complications arising from pain management procedures and treatments may be avoided by physicians who have the required knowledge and expertise regarding anatomy and pain intervention procedures and know how to recognize procedural aberrations as soon as they occur.

Feasibility of the 3D Printing Materials for Radiation Dose Reduction in Interventional Radiology (인터벤션 시술 시 환자의 선량감소를 위한 3D 프린팅 재료의 적용성 평가)

  • Cho, Yong-In
    • Journal of radiological science and technology
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    • v.43 no.3
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    • pp.169-176
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    • 2020
  • Interventional radiology is performed under real-time fluoroscopy, and patients are exposed to a wide range of exposures for a long period of time depending on the examination and procedure. However, studies on radiation protection for patients during an intervention are insufficient. This study aims to evaluate the doses exposed during the intervention and the applicability of 3D printing materials. The organ dose for each intervention site was evaluated using a monte carlo simulatio. Also, the dose reduction effect of the critical organs was calculated when using a shielding device using 3D printing materials. As a result, the organ dose distribution for each intervention site showed a lower dose distribution for organs located far from the x-ray tube. It was analyzed that the influence of scattered rays was higher in the superficial organs of the back of the human body where x-rays were incident. The dose reduction effect on the critical organ using the 3D printing shield showed the highest testis among the gonads, and in the case of other organs, the dose reduction effect gradually decreased in the order of the eye, thyroid, breast, and ovary. Accordingly, it is judged that the 3D printed shield will be sufficiently usable as a shielding device for the radiation protection of critical organs.

Case Analysis of the Effects of Nucleoplasty and Chemonucleolysis on the Intervertebral Disc (척추의 추간판에 대한 수핵성형술과 화학적수핵융해술의 영향 증례분석)

  • Hong, Youngki
    • Archives of Orthopedic and Sports Physical Therapy
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    • v.14 no.2
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    • pp.73-80
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    • 2018
  • Purpose: This study was evaluated the effects of nucleoplasty and chemonucleolysis, as interventional treatments for herniated intervertebral disc disease, on spinal tissues. Methods: Nucleoplasty using plasma beam and chemonucleolysis with collagenase were conducted on the spinal motion segments that were dissected from of human cadaver spine under fluoroscopic guidance. After the procedure, the intervertebral discs were transected, and the changes in gross findings were examined. Subsequently, the influence of the procedure on the nucleus pulposus, annuls fibrosus, and endplate was analyzed through a pathologic examination. Results: Nucleoplasty was confirmed to eliminate the local range of tissues in nucleus pulposus according to the procedure tract and to not affect other tissues. In chemonucleolysis, we found that collagenase diffused from the surgical site within the nucleus pulposus and was not present in the annulus fibrosus and endplate. Conclusions: The clinically-used interventional treatments that were investigated here were not found to do not cause additional damage to areas other than those targeted.