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BackgroundThe adequacy of leptomeningeal collateral flow has a pivotal role in determining clinical outcome in acute ischemic stroke. The American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score is among the most commonly used scales for measuring this flow. It is based on the extent and rate of retrograde collateral flow to the impaired territory on angiography.ObjectiveTo evaluate inter- and intraobserver agreementin angiographic leptomeningeal collateral flow assessment.Materials and methodsThirty pretreatment angiogram video loops (frontal and lateral view), chosen from the randomized controlled trial THRombectomie des Artères CErebrales (THRACE), were sent for grading in an electronic file. 19 readers participated, including eight who had access to a training set before the first grading. 13 readers made a double evaluation, 3 months apart.ResultsOverall agreement among the 19 observers was poor (κ = 0,16 ± 6,5.10 -3), and not improved with prior training (κ = 0,14 ± 0,016). Grade 4 showed the poorest interobserver agreement (κ=0.18±0.002) while grades 0 and 1 were associated with the best results (κ=0.52±0.001 and κ=0.43±0.004, respectively). Interobserver agreement increased (κ = 0,27± 0,014) when a dichotomized score, ‘poor collaterals’ (score of 0, 1 or 2) versus ‘good collaterals’ (score of 3 or 4) was used. The intraobserver agreements varied between slight (κ=0.18±0.13) and substantial (κ=0.74±0.1), and were slightly improved with the dichotomized score (from κ=0.19±0.2 to κ=0.79±0.11).ConclusionInter- and intraobserver agreement of collateral circulation grading using the ASITN/SIR score was poor, raising concerns about comparisons among publications. A simplified dichotomized judgment may be a more reproducible assessment when images are rated by the same observer(s) in randomized trials.

Interventional radiology (IR) has evolved rapidly, but the clinical integration of interventional radiologists has not kept pace with technical advancements. This trial will address a gap in the literature by providing a robust investigation into specific measures for enhancing the clinical role of interventional radiologists, with potential implications for improving patient experiences and outcomes. The single-center randomized controlled trial will include 428 patients undergoing IR procedures. The control group will receive information about the procedure from the ordering physician, while the experimental group will have an additional consultation with an interventional radiologist and be shown procedure-specific explanatory videos. The primary outcomes are patients’ knowledge, satisfaction with the information and communication, and anxiety. Data collection will involve specific questionnaires and scales. This trial is designed to investigate the importance of proactive clinical roles in patient care within IR. The study explores the potential of consultations and audiovisual tools, highlighting their role in educating patients about procedures. The results may help foster a more widespread acceptance of clinical responsibilities in IR and underscore the pivotal role of audiovisual aids in patient education and satisfaction. Trial registration NCT05461482 at clinicaltrials.gov. Relevance statement This randomized controlled trial will assess the impact of clinical consultations and explanatory audiovisual tools on patient understanding, satisfaction, and anxiety in interventional radiology. The findings could help establish a more proactive clinical role for interventional radiologists and improve the overall quality of patient-centered care. Key Points We describe the protocol of an interventional radiology randomized clinical trial. The control group will receive procedure information from the referring physician and the experimental group receives additional consultation with interventionalists and views a video. Knowledge, satisfaction with information, and patient anxiety will be evaluated. This study will provide insights about the benefits of consultations and videos in interventional radiology. Graphical Abstract

Excel at clinical IR with insightful perspectives from both current residents and senior interventionalists! Interventional radiology training has evolved rapidly during the last decade, with recent recognition as a primary medical specialty by the American Board of Medical Specialties. The number of IR residency positions continues to increase each year with a greater number of trainees rotating through the IR elective. The bar is set high and expectations of trainees have increased. Written clearly, concisely, and at a trainee's level, Pocketbook of Clinical IR: A Concise Guide to Interventional Radiology by Shantanu Warhadpande, Alex Lionberg, and Kyle Cooper is the first IR pocketbook written specifically for medical students and junior residents to help them excel on their IR rotation. This book will help trainees to intelligently field IR consults, effectively round on patients, and develop an understanding of IR disease processes. Concise yet thorough, it provides a solid clinical foundation to underlying pathologies and procedures, and embodies the authors' philosophy that the IR education paradigm should be transformed into one in which the clinical care of patients is of equal importance to technical procedural training. Key Features * Clinical background on hepatobiliary, oncologic, arterial, venous, genitourinary, and neurologic diseases frequently encountered in IR * Insightful clinical algorithms provide guidance on how the IR procedure fits into the big picture * Concise procedure boxes provide an overview of how the procedure is performed so the trainee can be an active participant in any IR procedure This practical white-coat companion is essential for all trainees involved with interventional radiology.

Purpose of Study To identify the remediable factors in the quality of care provided to patients with severe gastrointestinal (GI) bleeding. Method All hospital admissions in the first four months of 2013 with ICD10 coding for GI bleeding who received a transfusion of 4 units or more of blood. Up to five cases/hospital randomly selected for structured case note peer review. National availability of GI bleeding services data derived from organisational questionnaire completed by all hospitals. Results 4563/29,796 (15.3%) of GI bleeds received 4 or more units of blood with a mortality rate of 20.2% compared to 7.3% without blood transfusion. 30.8% of GI bleeds received a blood transfusion. 32% (60/185) of hospitals admitting acute GI bleeds lacked 24/7 endoscopy. 26% (48/185) had on-site embolisation 24/7 with a further 34% (64/185) accessing embolisation by transfer within a validated formal network. Blood product use was inappropriate in 20% (84/426). Improved management, principally earlier senior gastroenterologist review and/or endoscopy, would have reduced blood product use in 25% (113/457). 14.5% (90/618) had a CT scan which identified the site of bleeding in 32% (29/90). 7.8% (36/459) underwent an Interventional Radiology (IR) procedure but a further 6.3% (21/33) should have had IR. 6% (36/586) underwent surgery with 21/36 for uncontrolled bleeding. In 20/35 IR was not considered despite the majority being suitable for IR. Overall 44% (210/476) received an acceptable standard of care according to peer review. Conclusions 26 recommendations were made to improve the quality of care in GI bleeding, with six principle recommendations.

This Manual of Interventional Oncology by Douglas Coldwell is the culmination of more than 30 years of training, hands-on practice, and skills learned from oncology colleagues. The successful practice of interventional oncology (IO) requires familiarity with all cancer interventions, and the ability to recognize each of their strengths and weaknesses. Acquiring basic knowledge of all facets of the vast, ever-evolving cancer treatment paradigm enables greater understanding of how IO fits into the broad cancer management continuum. The first five chapters lay a solid foundation, detailing essentials of medical and surgical oncology and radiation, followed by interventional radiology cancer treatments and agents used in cancer chemotherapy. Twelve cancer-specific chapters cover tumor management and discussion of minimally invasive, image-guided tumor ablation techniques for each type of cancer, as well as IO for pain management and palliative care. Key Highlights * IO interventions for prevalent cancers such as colorectal, pancreatic, prostate, liver, bladder, breast, lung, and gynecologic - and less common pathologies including neuroendocrine tumors of the gastrointestinal tract and cholangiocarcinoma * More than 125 illustrations accompany succinct discussions of pathology, epidemiology, genetics, staging, treatment, outcomes, and IO options for each type of tumor * An overview of clinical trials provides a glimpse of future IO innovations * A road map to a successful IO career includes pearls gleaned from years of managing a thriving practice This definitive guide is a must-have for clinicians working in the field of vascular and interventional radiology. It provides interventional radiologists with the necessary building blocks, information, and techniques to thrive in this rapidly evolving specialty.

The highest-yield, most complete vascular and interventional radiology exam prep and learning tool available today! Top 3 Differentials in Vascular and Interventional Radiology – A Case Review by David D. Gover is one in a series of radiology case books mirroring the format of the highly acclaimed O'Brien classic, Top 3 Differentials in Vascular and Interventional Radiology – A Case Review. Image-guided procedures used in vascular radiology, such as angiography, are presented concisely, with easy-to-remember, high-yield information. Each of the 144 cases is formatted as a two-page unit. The left page features radiologic or interventional imaging findings, succinct clinical information with presenting symptoms, and ancillary studies. The right page includes the key imaging gamut, differential diagnoses rank-ordered by the Top 3, additional diagnostic considerations, final diagnosis, clinical pearls, and resources for additional learning. Key Features: * The five chapters cover preprocedural evaluation and patient management, standard cases, Roentgen Classics, anatomy relevant to interventional radiology (IR), complications and postprocedural care * More than 400 high-quality images, tables, and detailed algorithms enhance understanding of common and clinically pertinent interventional radiology cases * Case pearls at the end of each scenario succinctly summarize major teaching points * Unique section on management of procedural complications provides invaluable guidance to residents on call This book is a robust radiology board review for radiology and IR residents. Veteran radiologists who wish to hone their diagnostic skills will also find it to be a valuable resource.

Percutaneous tissue biopsy is a mainstay of diagnostic and interventional radiology, providing a minimally invasive method for diagnosing malignant and benign disease. The purpose of this review was to collect and summarize the best available evidence regarding the risk factors associated with bleeding complications in image-guided liver biopsy. A literature review was performed, searching Medline, EMBASE, CINAHL, the Cochrane Library, the National Institute for Health and Care Excellence (NICE) and Canadian Agency for Drugs and Technology in Health (CADTH) databases for any studies evaluating bleeding complications in image-guided liver biopsy. A total of 68 articles, published between January 1994 and April 2015, were reviewed in full, with 34 ultimately eligible for inclusion in the review. Bleeding of any kind occurred in up to 10.9% of image-guided liver biopsies, with major bleeding episodes ranging from 0.1% to 4.6% and minor bleeding events occurring in up to 10.9% of biopsies. The overall rate of bleeding was, however, found to be less than 2%. Several risk factors (patient, operator, and procedure-related) were identified as potentially indicative of an increased risk of post-biopsy bleeding. Patient-related risk factors included patient age (>50 years or <2 years), inpatient status (8/12 vs. 4/12, P < 0.001), comorbidities and/or concurrent diagnoses and coagulation status (rate of bleeding was 3.3% for international normalized ratio [INR] 1.2-1.5 vs. 7.1% for INR >1.5, P < 0.001). There was no consensus on impact of operator experience (>200 biopsies/year vs. <50/year) on post-biopsy bleeding rate. Procedure-related risk factors included needle size (cutting biopsy vs. fine needle aspiration, P < 0.001) and the presence of a patent track on post-biopsy ultrasound (P < 0.001). Lastly there was no difference found between targeted vs. nontargeted biopsies and number of needle passes. Reported rate of post-biopsy bleeding ranges between 0% and 10.9%, although the vast majority of studies reported bleeding rates under 2%. Several patient, operator, and procedure-related risk factors are associated with a higher risk of bleeding following liver biopsy.

Objectives Percutaneous image-guided tumor ablation of liver malignancies has become an indispensable therapeutic procedure. The aim of this evaluation of the prospectively managed multinational registry of the voluntary German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) was to analyze its use, technical success, and complications in clinical practice. Materials and methods All liver tumor ablations from 2018 to 2022 were included. Technical success was defined as complete ablation of the tumor with an ablative margin. Results A total of 7228 liver tumor ablations from 136 centers in Germany and Austria were analyzed. In total, 31.4% (2268/7228) of patients were female. Median age was 67 years (IQR 58–74 years). Microwave ablation (MWA) was performed in 65.1% (4703/7228), and radiofrequency ablation (RFA) in 32.7% (2361/7228). Of 5229 cases with reported tumor etiology, 60.3% (3152/5229) of ablations were performed for liver metastases and 37.3% (1950/5229) for hepatocellular carcinoma. The median lesion diameter was 19 mm (IQR 12–27 mm). In total, 91.8% (6636/7228) of ablations were technically successful. The rate of technically successful ablations was significantly higher in MWA (93.9%, 4417/4703) than in RFA (87.3%, 2061/2361) ( p  < 0.0001). The total complication rate was 3.0% (214/7228) and was significantly higher in MWA (4.0%, 189/4703) than in RFA (0.9%, 21/2361, p  < 0.0001). Additional needle track ablation did not increase the rate of major complications significantly (24.8% (33/133) vs. 28.4% (23/81), p  = 0.56)). Conclusion MWA is the most frequent ablation method. Percutaneous image-guided liver tumor ablations have a high technical success rate, which is higher for MWA than RFA. The complication rate is generally low but is higher for MWA than RFA. Clinical relevance statement Percutaneous image-guided liver ablation using microwave ablation and radiofrequency ablation are effective therapeutic procedures with low complication rates for the treatment of primary and secondary liver malignancies. Key Points • Percutaneous image-guided liver tumor ablations have a high technical success rate, which is higher for microwave ablation than radiofrequency ablation. • Microwave ablation is the most frequent ablation method ahead of radiofrequency ablation. • The complication rate is generally low but is higher for microwave ablation than radiofrequency ablation.

This review is a brief overview of the current status and the potential role of robotics in interventional radiology. Literature published in the last decades, with an emphasis on the last 5 years, was reviewed and the technical developments in robotics and navigational systems using CT-, MR- and US-image guidance were analyzed. Potential benefits and disadvantages of their current and future use were evaluated. The role of fusion imaging modalities and artificial intelligence was analyzed in both percutaneous and endovascular procedures. A few hundred articles describing results of single or several systems were included in our analysis.