Yttrium-90 Radioembolization for Colorectal Cancer Liver Metastases: A Single Institution Experience

Purpose. We sought to evaluate our experience using yttrium-90 (90Y) resin microsphere hepatic radioembolization as salvage therapy for liver-dominant metastatic colorectal cancer (mCRC). Methods. A retrospective review of consecutive patients with unresectable mCRC who were treated with 90Y after failing first and second line systemic chemotherapy. Demographics, treatment dose, biochemical and radiographic response, toxicities, and survival were examined. Results. Fifty-one patients underwent 90Y treatments of which 69% were male. All patients had previously undergone extensive chemotherapy, 31% had undergone previous liver-directed therapy and 24% had a prior liver resection. Using RECIST criteria, either stable disease or a partial response was seen in 77% of patients. Overall median survival from the time of first 90Y treatment was 10.2 months (95% CI = 7.5–13.0). The absence of extrahepatic disease at the time of treatment with 90Y was associated with an improved survival, median survival of 17.0 months (95% CI = 6.4–27.6), compared to those with extrahepatic disease at the time of treatment with 90Y, 6.7 months (95% CI = 2.7–10.6 Conclusion: 90Y therapy is a safe locoregional therapy that provides an important therapeutic option to patients who have failed first and second line chemotherapy and have adequate liver function and performance status

Carotid Artery and Jugular Vein Tracking and Differentiation Using Spatiotemporal Analysis

Abstract. We have derived and evaluated parameters from ultrasound images of the neck to permit a computer to automatically characterize and differentiate between the carotid artery and jugular vein at image acquisition time during vascular interventions, given manually placed seed points. Our goal is to prevent inadvertent damage to the carotid artery when targeting the jugular vein for catheterization. We used a portable 10 MHz ultrasound system to acquire cross sectional B-mode ultrasound images of these great vessels at 10 fps. An expert user identified the vessels in the first frame by touching the vessels on the screen with his fingertip, and the computer automatically tracked the vessels and calculated a best-fit ellipse for each vessel in each subsequent frame. Vessel location and radii were further analyzed to produce parameters that proved useful for differentiating between the carotid artery and jugular vein. These parameters include relative location of the vessels, distension of the vessel walls, and consistent phase difference between the arterial and venous pulsations as determined by temporal Fourier analysis.

Interventional Techniques in the Management of Airway Complications Following Lung Transplantation

The last four decades have seen tremendous advances in the field of pulmonary transplantation. Vast improvements in the areas of surgical transplantation techniques, immunosuppressive agents, and postoperative care have all contributed to improved survival of patients. Advances in noninvasive imaging and bronchoscopy have allowed the pulmonary transplant team to intervene early in patients presenting with airway complications, often using minimally invasive procedures such as endobronchial balloon dilation or stent placement, or both. Stent technology itself has also improved and stents may sometimes be customized for treatment of short airway lesions or to optimize continued airflow through the sides of stents by creating openings using balloons or bronchoscopically directed laser. Preliminary work with brachytherapy may be decreasing the need for secondary reinterventions. The authors present an overview of some of these conventional and novel approaches to the treatment of airway complications after lung transplantation

Wireless Connection between Guide Wires and Bone Cement: Extravasated Methyl Methacrylate Mimicking a Retained Guide Wire

We present the case of a 56-year-old double lung transplant recipient with chest pain who underwent an attempted endovascular retrieval of what was described as a retained guide wire in the azygos vein. After successfully grasping the tip, the object further migrated to the right pulmonary artery complicating the retrieval. It was realized that the “wire” was extravasated methyl methacrylate from a recent percutaneous kyphoplasty. This is believed to be the first report of attempted endovascular retrieval of extravasated methyl methacrylate in the azygos system. We include the details of this case and briefly review the current literature on the management of extravasated methyl methacrylate from vertebral augmentation procedures. Extravasated methyl methacrylate in the venous system is a common finding after vertebral augmentation procedures and any radiopaque stripe arising from a cemented vertebral body should be first described as probable cement leakage

(podium presentation) REFINING THE SONIC FLASHLIGHT FOR INTERVENTIONAL PROCEDURES

Ultrasound (US) is often used in interventional procedures such as accessing blood vessels, performing biopsies, and placing drains. The Sonic Flashlight (SF) is a handheld device that uses a mirror to reflect a real-time US image into the body, making that body part appear translucent. The latest generation handheld SF has been improved to the point where it can be applied to procedures involving fine structures such as vasculature and small tumors. We have dramatically decreased the size, weight, and display lag-time, while increasing resolution. With these improvements, the operator can now clearly visualize and discriminate between small structures. We believe that this version of the SF is ready for clinical trials. 1

Peripherally Inserted Central Catheters by Nurses using the Sonic Flashlight

Our lab has developed a novel ultrasound device for guiding invasive procedures called the Sonic Flashlight (SF). The SF replaces the conventional ultrasound (CUS) monitor with a small display and a semi-reflective/transparent mirror to reflect real-time US images into the body. Looking through the mirror, the virtual US image appears to float beneath the skin, precisely where the scan is being obtained. The SF merges the US image, probe, needle, operator's hands, and patient into the same field of view, making procedures more intuitive. In contrast, CUS displaces hand-eye coordination by forcing the operator to look away from the operating field to see the US display. The RTTR system functions by fixing the relative geometry of the ultrasound transducer, the display, and a half-silvered mirror to produce a virtual image at the scanned anatomy within the body. Through the halfsilvere

Vascular access: comparison of US guidance with the sonic flashlight and conventional US in phantoms.

PURPOSE: To prospectively evaluate whether ultrasonography (US)-guided vascular access can be learned and performed faster with the sonic flashlight than with conventional US and to demonstrate sonic flashlight-guided vascular access in a cadaver. MATERIALS AND METHODS: Institutional review board approval and oral and written informed consent were obtained. The sonic flashlight replaces the standard US monitor with a real-time US image that appears to float beneath the skin and is displayed where it is scanned. In studies 1 and 2, participants performed sonic flashlight-guided needle insertion tasks in vascular phantoms. In study 1, 16 participants (nine women, seven men) with no US experience performed 60 simulated vascular access trials with sonic flashlight or conventional US guidance. With analysis of variance (ANOVA) and power-curve fitting, improvement with practice rate and mean differences between techniques and tasks were examined. In study 2, 14 female nurses (mean age, 50.1 years) proficient with conventional US performed simulated vascular access trials on three tasks with the sonic flashlight and conventional US. With random assignment, half the participants used the sonic flashlight first and half used conventional US first. Mean performance with each technique and that with each task were compared by using ANOVA. In study 3, feasibility of sonic flashlight guidance for access to internal jugular and basilic veins was demonstrated in a cadaver. RESULTS: For study 1, learning rates (ie, decrease in access time over trials) did not differ for vascular access with sonic flashlight and conventional US. Overall, participants achieved faster vascular access times with sonic flashlight guidance (P CONCLUSION: Learning and performance of vascular access were significantly faster with the sonic flashlight than with conventional US, and vascular access could be gained in a cadaver; the sonic flashlight is ready for clinical trials.</p