Lumbar nerve root blocks using MRI – the effectiveness and safety of ultrasound/MRI fusion image guidance

Objective: To compare the outcome of nerve root injection guided by ultrasound/MRI fusion with radiofrequency needle tracking (eTRAX©) and the same procedure undertaken by fluoroscopic guidance. Methods: This is a retrospective audit of anonymised clinical records from before and after a change in the imaging technique used to perform nerve root blocks. We studied 181 consecutive patients who had undergone a nerve root block, the first 124 guided by fluoroscopic technique and the next 57 guided by ultrasound/MRI fusion with radiofrequency needle guidance. Using pain diaries, we reviewed the outcome scores at 24 h and 2 weeks. We recorded the use of analgesia, the patient’s satisfaction, complications and the duration of the procedures. Results: Completed pain diaries were returned by 61% in the fluoroscopy group and 67% in the fusion imaging group. The visual analogue pain score was reduced at 24 h by 3.29 [standard deviation (SD) 2.35] for the fluoroscopy group and by 3.69 (SD 2.58) in the fusion group (p 0.399). At two weeks the pain reduction was 3.27 (SD 2.57) for the fluoroscopic group and 4.21 (SD 2.95) for the fusion group (p 0.083). There was no statistically significant difference between the groups. The patient’s satisfaction scores were similar for both groups. The procedure by the two guidance methods took a similar time to perform. There were no serious complications in either group. One patient in the fusion-guided nerve root block group experienced paraesthesia in the nerve distribution for 2 h. Conclusion: Ultrasound/MRI fusion imaging with needle tracking is an effective alternative to fluoroscopic image-guided injection. Advances in knowledge: Fusion imaging guidance provides the same outcome as fluoroscopic guidance. Fusion imaging guidance avoids the need for ionising radiation.

Preclinical Trial of the Effectiveness of the Safety Nasogastric Tube to Detecting Tube Position Based on Tidal Volume and Pepsin Assay Results in the Gastrointestinal Tract of Macaca Fascicularis

Background: Generally, insertion of a nasogastric tube (NGT) does not use imaging guidance. This procedure has a risk of malposition to the lungs from 0.3–15%. The NGT verification only detects the position of the tube in the end of procedure. Misplacement of NGT into the respiratory tract can result in damage to the lungs. Safety nasogastric tube (SNGT) has been created to detect the position of the tube in real-time, simple, and inexpensive. This study aims to prove the effectiveness of the SNGT prototype in Macaca fascicularis. Result: The SNGT with an airbag size of 50% of tidal volume (SNGT 50% TV) had 100% sensitivity and specificity in detecting the position of the tube. While the SNGT with an airbag size of 100% of TV (SNGT 100% TV) has sensitivity of 100% and specificity of 87.5%. There was significant difference between the movement of airbag of SNGT 50% TV and SNGT 100% TV (p ≤ 0.05). However, there was no significant difference between the accuracy of placement of 50% TV SNGT, 100% TV SNGT, and conventional NGT (p > 0.05). The pepsin enzyme has better sensitivity (100%) than pH paper (91.66%) in detecting the end position of tube. Conclusion: SNGT tube has high effectiveness in detecting the position of the tube inside of the respiratory and digestive tracts to prevent misplacement.

Current Practice of Imaging-Guided Interventional Procedures in Rheumatic and Musculoskeletal Diseases: Results of a Multinational Multidisciplinary Survey

Objectives: To investigate opinion and routine practice of specialists from different disciplines on imaging techniques for interventional procedures related to rheumatic and musculoskeletal diseases (RMDs).Methods: An English-language questionnaire was developed by an international working group and distributed to health care providers of various disciplines involved in the care of people with RMDs via an online survey tool (SoSci Survey®) from December 2019 to May 2020.Results: A total of 1,105 respondents from 56 countries completed the survey, over 60% of participants were rheumatologists. The majority of respondents (88%) performed interventional procedures in RMDs patients and 90% of them used imaging guidance. Ultrasonography was the most frequently used technique, particularly among rheumatologists. X-ray and computed tomography were mainly used by radiologists. A discrepancy emerged between the importance assigned to certain items such as the availability of a second operator and their actual implementation in clinical practice. Local barriers, lack of resources and facilities were mentioned as the most relevant obstacles in this regard. Lack of training on imaging and/or imaging guided procedures did not emerge as a barrier to perform such interventions; in fact, 19% of respondents performing the procedures indicated not to have received adequate training in this field.Conclusions: This is the first multinational multidisciplinary survey exploring in detail the opinions and practice on imaging guidance for interventional procedures in RMDs. A harmonization of protocols based on international guidelines, along with adequate training programmes and interventions on barriers at national/local levels are the main unmet needs requiring attention.

α-Fe2O3@Pt heterostructure particles to enable sonodynamic therapy with self-supplied O2 and imaging-guidance

Sonodynamic therapy (SDT), presenting spatial and temporal control of ROS generation triggered by ultrasound field, has attracted considerable attention in tumor treatment. However, its therapeutic efficacy is severely hindered by the intrinsic hypoxia of solid tumor and the lack of smart design in material band structure. Here in study, fine α-Fe2O3 nanoparticles armored with Pt nanocrystals (α-Fe2O3@Pt) was investigated as an alternative SDT agent with ingenious bandgap and structural design. The Schottky barrier, due to its unique heterostructure, suppresses the recombination of sono-induced electrons and holes, enabling superior ROS generation. More importantly, the composite nanoparticles may effectively trigger a reoxygenation phenomenon to supply sufficient content of oxygen, favoring the ROS induction under the hypoxic condition and its extra role played for ultrasound imaging. In consequence, α-Fe2O3@Pt appears to enable effective tumor inhibition with imaging guidance, both in vitro and in vivo. This study has therefore demonstrated a highly potential platform for ultrasound-driven tumor theranostic, which may spark a series of further explorations in therapeutic systems with more rational material design. Graphical Abstract

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part V, knee

Objectives Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. Methods We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. Results A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. Conclusions Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. Key Points • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.

Future Directions of Percutaneous Biliary Interventions

We are at an exciting cross-road in biliary interventions. While other services such as surgery and gastroenterology have learned to use imaging guidance to improve the safety and efficacy of their procedures, it is time for interventional radiologist to learn endoscopic interventions to achieve the same. The future of interventional radiologists in managing patients with biliary disease depends on (1) increasing comfort of our procedures, (2) publishing our data on biliary interventions, and (3) increasing collaboration with other services to manage biliary disease. We need to appropriately understand the limitations of interventional radiology to help guide the future directions of our specialty in this very interesting space.

Utilisation of Image Guidance to Enhance Safety of Deployment of the Mynx Control Vascular Closure Device

The Mynx Control device (Cardinal Healthcare, Dublin, Ohio, USA) was recently licensed and allows for entirely extravascular arteriotomy closure. It uses a polyethylene glycol sealant plug which is absorbed fully within 30 days, alleviating concerns around difficulties with regaining access in future. The Mynx device uses a balloon, inflated within the artery and retracted against the arteriotomy to achieve haemostasis, with the extravascular sealant plug then deployed outside the vessel wall. While the manufacturer’s instructions for use do not include utilisation of imaging guidance, we routinely employ fluoroscopic and/or ultrasound to ensure safe use of the device. These techniques allow confirmation of balloon position against the arteriotomy, hence avoiding inadvertent deployment of the plug partially or fully intraluminally. Visualisation of the balloon within the lumen also eliminates risk of plaque disruption in diseased vessels on retraction of the device. Image guidance adds little time to device deployment, and the safety benefits are such that we recommend that practitioners elsewhere consider adopting our techniques. Here, we describe the process involved in both techniques.