Interventional neuroradiology: an emerging subspeciality.
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Angiography, Digital Subtraction↗
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Multidetector row computed tomographic angiography of the abdominal aorta and lower limbs arteries. A new diagnostic tool in patients with peripheral arterial occlusive disease.
AIM: The aim of this study is to evaluate the accuracy of multidetector row CT angiography (MDCTA) of the abdominal aorta and lower extremities arteries in patients with peripheral arterial occlusive disease who did not receive any prior treatment whether interventional or surgical. METHODS: Twenty-two patients with peripheral vascular occlusive disease (16 male, 6 female, age range 44-85 years) underwent MDCTA of the abdominal aorta and lower extremities. Digital subtraction angiography (DSA) of the same districts was performed within 3 months. Images were blindly interpreted by 2 interventional radiologists and compared with the results of digital subtraction angiography. RESULTS: Sensitivity and specificity of MDCTA were 92% and 94%, respectively, with positive and negative predictive values of 93% and 95%. Overall diagnostic accuracy was 93%. Normal arterial segments and 100% occlusions were correctly identified in all cases by MDCTA. Moderately stenotic segments interpretation in the calves appeared to be more controversial, but no statistical difference in accuracy in this district was noted with respect to accuracy in more proximal arteries. CONCLUSION: MDCTA of the abdominal aorta and lower extremities is a feasible, accurate imaging modality in clinical practice when compared to DSA.
Adult↗
Techniques for reducing interventional neuroradiologic skin dose: tube position rotation and supplemental beam filtration.
PURPOSE: To limit the side effects of interventional neuroradiologic radiation, such as epilation, by applying a technique involving tube position rotation and by adding a supplemental inexpensive primary beam filter; and to show the dose effect of modifying technical factors. METHODS: Combined skin dose from fluoroscopy and digital subtraction angiography was measured with an array of 16 thermoluminescent dosimeters during interventional neuroradiologic procedures in 12 control subjects, in 18 patients whose procedures included addition of an inexpensive primary beam filter (0.5 mm aluminum/0.076 mm copper), and in 10 patients in whom the tube position was rotated, additional primary beam filtration was used, and close attention was paid to technique. RESULTS: Maximum thermoluminescent dosimetric measurements obtained with existing machine filtration ranged from 0.31 to 2.70 Gy in the control group (mean, 1.51 +/- 0.88); 0.25 to 2.42 Gy in the group with additional filtration alone (mean 0.96 + 0.64; average dose reduction, 36%); and 0.13 to 1.23 Gy in the group with additional filtration, tube position rotation, and close attention to technique (mean, 0.58 +/- 0.34; average dose reduction, 63%). Differences were statistically significant. CONCLUSIONS: Greater than 50% skin dose reductions were documented during interventional neuroradiologic procedures by combining tube position rotation, supplemental primary beam filtration, and technical modifications.
Adolescent↗
A study on radiation doses and irradiated areas in cerebral embolisation.
Patient radiation doses during interventional radiology procedures may reach the thresholds for radiation-induced skin and eye lens injuries. This study investigates the irradiated areas and doses received by patients undergoing cerebral embolisation, which is regarded as a high dose interventional radiology procedure. For each procedure the fluoroscopic and digital dose-area product (DAP), the fluoroscopic time, the total number of acquired images and entrance-skin dose (ESD) calculated by the angiographic unit were recorded. The ESD was measured by means of thermoluminescent dosimeters. In this study, the skin, eye and thyroid gland doses and the irradiated area for 30 patients were recorded. The average ESD was found to be 0.77 Gy for the posteroanterior plane and 0.78 Gy for the lateral plane. The average DAP was 48 Gy cm(2) for the posteroanterior plane and 58 Gy cm(2) for the lateral plane. The patient's average right eye dose was 60 mGy and the dose to the thyroid gland was 24 mGy. Seven patients received a dose above 1 Gy, one patient exceeded the threshold for transient erythema and one exceeded the threshold for temporary epilation. A good correlation between the DAP and the ESD for both planes has been found. The doctor's eye dose has also been measured for 17 procedures and the average dose per procedure was 0.13 mGy.
Embolization, Therapeutic↗
Where is imaging going in rheumatology?
Four new approaches to imaging are now becoming available. First is filmless radiology, with flat detectors that 'permit access' to PACS, the picture archiving communication system, and teleteaching. Second is ultrasonography (US), involving three-dimensional volume, harmonic Doppler energy and digital technology techniques, with contrast agents and biopsy needles. Next is computer tomography (CT), using volume acquisition multislices, spiral reconstruction and solid detectors, as well as multidetectors. Finally comes magnetic resonance imaging (MRI). A low magnetic field with an open MRI scan permits interventional radiology in musculoskeletal disease. High magnetic fields are mainly used for clinical research and permit rapid examination, in approximately 10 minutes. In interventional radiology, many procedures can be performed with the guidance of digital radiography, US or MRI. Two areas of localization have to be considered: the spine and the peripheral joints, particularly the shoulder, wrist and foot. Guidelines contribute to good medical practice, but there are other considerations, such as machine accessibility, the nature of the treatment, the personality of the patient and the role of the hospital. Overinvestigation has to be avoided for four reasons: an increase in patient anxiety, the cost of health-care management, the risk of irradiation and sometimes the lack of diagnostic value of these procedures. In rheumatoid arthritis, MRI can detect lesions at an earlier stage of their development and identify subtle lesions and synovitis. Imaging (using x-rays, MRI and US) is important in the assessment of the effectiveness of slow-acting drugs in rheumatoid arthritis, especially since joint damage can progress in spite of a clinical improvement in joint inflammation. In the future, teletransmission, by the Internet or intranet and using PACS, will change our approach to the diagnosis of musculoskeletal disease. Future developments therefore include PACS, filmless radiology, the Internet and intranet, harmonic US, multidetector CT scanning and open MRI on the technical side, as well as the study of cartilage and international radiology on the clinical side.
Arthritis, Rheumatoid↗
A case for electronic manipulation of medical images?
Two ophthalmic case histories requiring differing techniques to document the long-term outcomes of ocular tumours are presented. In the first case, after documenting a treated choroidal melanoma it was necessary to intervene with digital manipulation to enhance the images for clinical interpretation. Conversely, after documenting an iris tumour over an eight-year period, it was considered that the original images were suitable for interpretation without intervention. This raises the issue of images presented as legal evidence when digital technology is used to manipulate and enhance the images. Are these images admissible as evidence in court, and should the original data also be archived to prevent conflicting interpretations by the legal system? In light of The House of Lords recommendations on digital images as evidence, it is suggested that both the manipulated and original images are archived to avoid debate on the extent to which an image has been altered.
Choroid Neoplasms↗
[Experimental study of pseudo-stenosis artifact on three-dimensional DSA].
Rotational three-dimensional digital subtraction angiography (3D-DSA) is very useful for interventional neuroradiology, especially in the endovascular therapy of cerebral aneurysms. However, pseudo-stenosis artifact on the vessel, which runs vertically to the rotational axis, was observed clinically. In this study, this artifact was confirmed in an experiment with 4.5-millimeter diameter vessel phantoms. The attenuation of the phantom at each degree of exposure (44 directions) was measured on the workstation (DSA pixel value). DSA pixel values were plotted from data of 10, 20, 30, 40, and 50 millimeter lengths, respectively. The saturated DSA pixel value of tangent projection on phantoms of 30 millimeters or more in length was observed. This phenomenon induces pseudo-stenosis artifact on 3D-DSA. The maximum reduction in the diameter of the phantom was 27.4% on the length of 50 millimeters. We confirmed that the two-dimensional data vertical to the rotational axis were inaccurate when a straight-coursed, long, segmented vessel was present. Under this special condition, vessels on 3D-DSA were displayed as smaller than their actual diameter.
Angiography, Digital Subtraction↗
Flat-panel detectors: how much better are they?
Interventional and fluoroscopic imaging procedures for pediatric patients are becoming more prevalent because of the less-invasive nature of these procedures compared to alternatives such as surgery. Flat-panel X-ray detectors (FPD) for fluoroscopy are a new technology alternative to the image intensifier/TV (II/TV) digital system that has been in use for more than two decades. Two major FPD technologies have been implemented, based on indirect conversion of X-rays to light (using an X-ray scintillator) and then to proportional charge (using a photodiode), or direct conversion of X-rays into charge (using a semiconductor material) for signal acquisition and digitization. These detectors have proved very successful for high-exposure interventional procedures but lack the image quality of the II/TV system at the lowest exposure levels common in fluoroscopy. The benefits for FPD image quality include lack of geometric distortion, little or no veiling glare, a uniform response across the field-of-view, and improved ergonomics with better patient access. Better detective quantum efficiency indicates the possibility of reducing the patient dose in accordance with ALARA principles. However, first-generation FPD devices have been implemented with less than adequate acquisition flexibility (e.g., lack of tableside controls/information, inability to easily change protocols) and the presence of residual signals from previous exposures, and additional cost of equipment and long-term maintenance have been serious impediments to purchase and implementation. Technological advances of second generation and future hybrid FPD systems should solve many current issues. The answer to the question "how much better are they?" is "significantly better", and they are certainly worth consideration for replacement or new implementation of an imaging suite for pediatric fluoroscopy.
Body Burden↗
Use of wearable technologies for physical activity promotion in older adults: A systematic review.
This systematic review, conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251055299), examined the use of wearable technologies for promoting physical activity (PA) in adults aged 60 years and older. Searches across five databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane) identified 2438 records, of which only six randomized controlled trials published between 2021 and 2025 met inclusion criteria, with sample sizes ranging from 36 to 551 participants and mean ages between 65 and 79 years. Given the small number of included studies, findings should be interpreted as preliminary. The studies ranged from the standalone use of commercial trackers (Fitbit, Polar, ActiGraph) to multicomponent interventions combining wearables with physiotherapist feedback, telephone counseling, web-based platforms, or interactive cognitive-motor training. Wearables used alone, as in the REACT trial, produced small or non-significant PA effects. In contrast, interventions integrating devices with personalized feedback, professional support, or digital platforms, such as PROMOTE and TASMANIA, were associated with more consistent improvements in PA, physical function, and cognitive outcomes. Multicomponent programs, such as PEER and ICMT, reported broader benefits, including cognition, balance, and reductions in sedentary behavior, though these findings derive from individual trials and require replication. Risk of bias, assessed with the Cochrane Risk of Bias tool version 2 (RoB 2.0), was rated as "some concerns" for five studies and low for only one, mainly due to gaps in randomization reporting, missing data, and lack of preregistration. Tentatively, and based on a very limited evidence base, wearables may have greater impact when embedded within broader behavioral systems, incorporating feedback, coaching, or interactive components, rather than when used in isolation as passive monitoring tools. Adherence and psychosocial outcomes appeared related to comfort and perceived usefulness among older adults, though larger and more robust trials are needed to confirm these patterns.
Humans↗
Improving cognitive function after brain injury: the use of exercise and virtual reality.
OBJECTIVE: To assess the impact of exercise and virtual reality (VR) on the cognitive rehabilitation of persons with traumatic brain injury (TBI). DESIGN: Before-after trial assessed cognitive function after a 4-week intervention program. A random allocation crossover assessed changes in reaction and movement times after a single bout of VR exercise and a no-exercise control condition. SETTING: Brain injury rehabilitation unit in Edinburgh, Scotland. PATIENTS: (1) Four-week intervention: a consecutive sample of 13 suitable TBI adults were compared to control populations (n > 25) of previous TBI patients of similar age, severity, and time postinjury. (2) Single-bout intervention: a consecutive sample of 13 suitable adults with moderate TBI, 6.29 to 202.86 weeks postinjury. INTERVENTION: Nonimmersive VR exercise. MAIN OUTCOME MEASURES: (1) Tests of attention, information processing, learning, and memory. (2) Reaction and movement times. RESULTS: After the 4-week intervention patients performed significantly better than controls on the digit symbol (p < .01). verbal (p < .01), and visual learning tasks (p < .05). Significant improvements in reaction times (p < .01) and movement times (p < .05) were gained following a single bout of VR exercise. CONCLUSION: Exercising in a virtual environment offers the potential for significant gains in cognitive function.
Adolescent↗
Venous complications after insertion of a transvenous pacemaker.
We reviewed the incidence, clinical features, current diagnostic evaluations, and treatments of venous complications that can occur after implantation of a transvenous pacemaker. Of the approximately 80 published articles on the potential venous complications after implantation of a permanent transvenous pacemaker, we selected 63 that addressed the clinical features, diagnosis, and treatment of pacemaker lead-induced venous thrombosis, which occurs in approximately 30 to 45% of patients early or late after implantation of a transvenous pacemaker. Most patients with chronic deep venous thrombosis remain asymptomatic because of the development of an adequate venous collateral circulation. Clinical features of pacemaker lead-induced deep venous thrombosis, although rare, are easily recognized. They should be sought routinely during follow-up of all patients with transvenous pacemaker leads because venous obstruction can interfere with intravenously administered therapy, monitoring of central venous pressure, and revision of a pacemaker lead. Acute deep venous thrombosis is likely to be symptomatic. Early recognition and treatment of acute deep venous thrombosis may help to decrease the potential morbidity and mortality. The definitive diagnosis of pacemaker lead-induced venous thrombosis necessitates contrast-enhanced or digital subtraction venography. Management includes anticoagulation, thrombolytic therapy, surgical intervention, and, recently, percutaneous transluminal balloon venoplasty and depends on the duration, extent, and site of venous occlusion as well as the accompanying symptoms.
Cardiac Pacing, Artificial↗
The new operating room environment.
As endovascular procedures become more complex, the need for a suitably equipped endovascular suite is recognized. This specialized theater combines the features of the traditional operating room and the interventional radiology suite. The availability of high-resolution digital fluoroscopy facilitates the precise deployment of endovascular grafts and stents. In addition, combined open and endovascular procedures can be performed simultaneously. In this new environment, vascular surgeons are able to select the most appropriate operation without hindrance.
Angiography↗
Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera.
OBJECTIVE: We sought to determine whether retinopathy of prematurity (ROP) can be evaluated and managed telemedically. DESIGN: Multicenter noncomparative case series. PARTICIPANTS: Ten patients (19 eyes) with ROP were evaluated and treated per standard of care and imaged with the RetCam 120 digital fundus camera (Massie Research Laboratories, Inc., Dublin, CA). INTERVENTION: Images were transmitted to a remote site for evaluation and management recommendations. MAIN OUTCOME MEASURES: Telemedical evaluations and management recommendations were compared with traditional on-site standard of care evaluations and treatments. RESULTS: The identification of Plus disease at the remote site was accurately identified in 95% of eyes. Prethreshold, threshold, and stage 4 or 5 ROP were correctly detected in 17 of 19 (89%) eyes. CONCLUSIONS: Results indicate ROP can be evaluated and treatment recommendations made at remote sites with telemedicine strategies.
Diagnostic Techniques, Ophthalmological↗
Clinical significance of postlaser indocyanine green angiographic hot spots in age-related macular degeneration.
OBJECTIVE: To report the natural history and clinical significance of indocyanine green (ICG) angiographic hot spots in age-related macular degeneration (ARMD) after laser photocoagulation. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Two hundred thirty consecutive patients with exudative ARMD who underwent krypton laser treatment between March 1993 and December 1996. INTERVENTION: Krypton laser photocoagulation was performed on all patients. Digital videoangiograms, including both fluorescein angiography and ICG angiography, were obtained at 2 weeks, 4 weeks, 6 weeks, and 3 months postlaser treatment on each patient and repeated if clinical changes were noted. MAIN OUTCOME MEASURES: Detection by ICG of hyperfluorescent spots (hot spots) within the hypofluorescent laser-treated area. RESULTS: Forty patients (18%) developed ICG hot spots 2 weeks after laser treatment. The hot spots disappeared spontaneously without recurrent choroidal neovascular (CNV) membrane in 31 patients (78%). Recurrent CNV was discovered at the hot spot in four patients and away from the hot spot in five patients. CONCLUSION: The postlaser ICG angiographic hot spot is not rare. These spots tend to disappear spontaneously and do not necessarily represent a recurrent CNV. The presence of a hot spot on ICG angiography is not an indication for immediate laser retreatment.
Aged↗
America's digital divide: 2000-2003 trends.
Computer ownership and literacy, along with Internet access and its many applications, has become, for many, a trademark for the Americans' lifestyle. Research shows that computer ownership and literacy, along with Internet access and expertise, is rapidly changing how Americans go about their business. The technological industry is providing many opportunities for Americans to operate in markets, global and local, not previously available. These changes are apparent across all U.S. sociocultural and geographic boundaries. Yet, upon close analysis, there are individuals and communities less connected with many completely excluded from participation. Those individuals exist below a line called the Digital Divide. Growth in computer ownership and Internet use, while offering optimism that the Digital Divide is narrowing, also illustrates that, without focused intervention will for certain populations, continue. Public and private programs, focus groups, and pocks of community activism, each hope to correct the disparities among on- and-off line Americans. On many fronts, there is evidence that progress is being made by many. Income, race, age, and geographic location are often the determining factors.
Adolescent↗
Abdominal magnetic resonance angiography: principles and practical applications.
Abdominal magnetic resonance (MR) angiography has become a robust technique for evaluation of the aorta and its major branch vessels. Its safety and accuracy make MR angiography an ideal choice for screening and diagnostic angiography of the abdominal aorta and renal and visceral arteries; however, interventional procedures (i.e., angioplasty and stenting) still require conventional digital subtraction angiography. This article focuses on practical applications of abdominal MR angiography that have been made possible by recent technological advances in MR hardware and software.
Abdomen↗
Intrinsic hematoma of the oculomotor nerve: case report and review of the literature.
OBJECTIVE AND IMPORTANCE: Intrinsic oculomotor nerve hematoma is an exceptional cause of third nerve palsy. This case report illustrates the clinical, radiological, and intraoperative relevance of this rare pathological finding. CLINICAL PRESENTATION: A 25-year-old woman with a 12-year history of gross total resection of cerebellar medulloblastoma and posterior whole-brain radiotherapy presented with complete left oculomotor palsy. Magnetic resonance imaging revealed a left-sided, perimesencephalic cistern, small, round lesion with a fluid level. Digital subtraction angiography demonstrated no evidence of vascular abnormalities. INTERVENTION: A pterional craniotomy was performed, and the left oculomotor nerve was exposed. A blackish intrinsic lesion was detected in its cisternal segment near the uncus. The lesion was incised, and liquid compatible with a subacute noncoagulated hematoma was drained. Three months after surgery, the patient had partial recovery from diplopia and extraocular muscle function. CONCLUSION: We reviewed the literature and found four cases of oculomotor nerve intrinsic hematoma. These cases were all associated with hematological diseases, trauma, or solid tumors, and, as a group, these patients had poor outcomes. In the present report, the possibility of radiotherapy-induced vasculopathy as a predisposing factor is discussed. Surgical removal of an intrinsic nerve hematoma is probably helpful in the functional recovery of these patients.
Adult↗
Prostate cancer risk is three-fold higher among men, aged 50-64, of African descent compared with men of Asian-Indian descent in Trinidad and Tobago.
OBJECTIVE: To test the hypothesis that the screening-detected prevalence of prostate cancer is higher among men of African descent than among men of Asian-Indian descent living in Trinidad & Tobago. DESIGN: Population-based prostate cancer screening study among men aged 50-64. SETTING: Caribbean islands of Trinidad and Tobago. PARTICIPANTS: Tobago, population-based sample of 1196 male residents of African descent; Trinidad, 173 agricultural workers of Asian-Indian descent. INTERVENTIONS: Serum prostate specific antigen (PSA, Abbot AxSYM) and digital rectal exam (DRE) were used to screen men for prostate cancer. Men with elevated PSA (> or = 4 ng/mL) and/or abnormal DRE were offered an ultrasound guided sextant biopsy of the prostate gland. MAIN OUTCOME MEASURES: Prevalence of abnormal screen; prevalence of prostate cancer. RESULTS: Elevated PSA and/or abnormal DRE were observed in 29% (348/1196) of Afro-Tobagonian men. Three hundred sixteen men underwent biopsies. Screening-detected prostate cancer prevalence was: 4.9% (23/468) for those aged 50-55; 7.7% (28/366) for those aged 55-59; and 13.3% (48/362) for those aged 60-64 years. Screening was abnormal in 18% (31/173) of Asian-Indian men; 25 underwent biopsies. Prostate cancer prevalence in Asian Indian men was: 1.6% (1/63) for those aged 50-54; 1.4% (1/71) for those aged 55-59; and 5.1% (2/39) for those aged 60-64 years. Mantel-Haenszel age-adjusted rate ratio was 3.4, 95% CI 1.3-9.0. CONCLUSIONS: This study establishes a high prevalence of screening-detected prostate cancer among Afro-Tobagonians compared with Indo-Trinidadians. Comparison of candidate genes, environmental, and lifestyle factors between these populations may identify factors that increase risk for, or provide protection against, prostate cancer.
Africa↗