ANALYSIS OF AVERAGE CONTRAST USAGE FOR HEMODIALYSIS ACCESS PROCEDURES

This study was performed to analyze the average amount of radiopaque contrast utilized by a single interventionist to perform hemodialysis vascular access procedures. The average contrast use for six different categories of procedures performed over a 4 month period was calculated from contrast usage data compiled on Braintree software. The procedures investigated were angioplasty (n=217), angiogram (n=79), fistula thrombectomy (n=37), graft thrombectomy (n=30), de novo tunneled catheter placement (n=7), and tunneled catheter exchange (n=18). The results indicate that radiopaque contrast usage coincides with the complexity of the procedure type

ANALYSIS OF AVERAGE X-RAY DURATION REQUIRED TO PERFORM HEMODIALYSIS VASCULAR ACCESS PROCEDURES

This study was performed to analyze the average X-Ray duration required by a single interventionist to perform hemodialysis vascular access procedures. The average amount of radiation released by the C-arm for five different categories of procedures performed over a 9 month period was calculated from X-Ray usage data compiled on Braintree software. These procedures included: fistula angioplasty, graft angioplasty, tunneled catheter insertion and exchange, as well as graft thrombectomy. From the data, one may conclude that the radiation amount released coincides with the complexity of the procedure type

Focal Plane Alignment and Detector Characterization for the Subaru Prime Focus Spectrograph

We describe the infrastructure being developed to align and characterize the detectors for the Subaru Measurement of Images and Redshifts (SuMIRe) Prime Focus Spectrograph (PFS). PFS will employ four three-channel spectrographs with an operating wavelength range of 3800 $\AA$ to 12600 $\AA$. Each spectrograph will be comprised of two visible channels and one near infrared (NIR) channel, where each channel will use a separate Schmidt camera to image the captured spectra onto their respective detectors. In the visible channels, Hamamatsu 2k x 4k CCDs will be mounted in pairs to create a single 4k x 4k detector, while the NIR channel will use a single Teledyne 4k x 4k H4RG HgCdTe device.Comment: 16 pages, 27 figures, SPIE ATI Montreal 201

Modulating C-Arm Settings to Reduce Radiation Exposure During Vascular Access Procedures

The purpose of this study was to analyze the effect of different C-arm settings on radiation exposure to physicians performing dialysis vascular access procedures. Over the course of 9 months, radiation exposure was compared between one center utilizing a C-arm set a 4 fps and the second center with a C-arm set at 8 fps. The data indicates a trend toward decreased radiation exposure to physicians in the lab with the 4 fps C-arm setting. Thus, it is recommended to utilize lower frame rate settings for vascular access procedures if possible

Retrospective Analysis of X-Ray Usage in Vascular Access Procedures

Dialysis vascular access procedures are x-ray guided interventions that function to correct issues with patients’ vascular accesses- which include fistulas, grafts, and dialysis catheters. This study analyzes the amount of x-ray exposure to interventionists for each of the major vascular access procedures. The goal of this analysis is to signal out the procedures that result in the greatest amount of radiation exposure, therefore prompting interventionists to implement strategies to reduce it

Quality Improvement Conference: Effect of Patient Safety Intelligence Inservice Training on Resident PSI Entry

Hospital administrators rely heavily on incident reporting systems to capture adverse events. 13.5% of Medicare beneficiaries discharged in October 2008 experienced adverse events. 62% were not reported because staff did not perceive an event as reportable; 25% were not reported because staff commonly reported but did not report in this case. Nurses reported events most often. The Patient Safety Intelligence (formerly PSN) is an online adverse event reporting service provided by UNM Hospital. System-wide and departmental efforts to improve quality have included attempts to increase PSI reporting. A comprehensive ducational intervention program for anesthesiology resident physicians at the University of Illinois Medical Center at Chicago increased the number of adverse events reports and improved attitudes of reporting. Anyone can report a safety incident. All patient safety incidents are reviewed by the parties involved in order to improve quality of care

Quality Improvement Conference: Radiology Review of Missed Cases

The Quality Improvement (QI) Conference was created in place of the common Morbidity and Mortality\u27 conference, which is not easily applicable to radiology. The common goal of the QI Conference is to discuss cases that contain radiographic-diagnostic errors that could lead to unexpected morbidity, mortality, or suspected medical error. To minimize stigma, cases were presented by the senior resident involved, and attending physicians were not invited to the conference. The Quality Improvement Conference has been active for approximately 30 months. The participating residents were surveyed 18 months after QI conference inception to gauge efficacy. Based on the survey results, the conference was shown to overall be beneficial for education and future call, along with possible benefits in patient care.\u2

Influence of Pesticide Properties on Adsorption Capacity and Rate on Activated Carbon from Aqueous Solution

The adsorbate structural properties such as the type, number, and position of substituents on benzene ring of organic compound, as well as a length and arrangement of hydrocarbon chain in a space, exert a significant influence on the adsorption process. The measurements of adsorption equilibria and kinetics of several pesticides belonging to the group of halogenated phenoxyacids differentiated in terms of structural and physicochemical properties were studied in order to characterize the adsorption mechanism and correlate it with the pollutant properties. Regarding a complexity of investigations (capacity and rate) comprising 21 structurally closely related active substances showing the carcinogenic activity on living organisms and relatively long half-life time in the environment, the proposed intensive studies on the removal of pollutants by adsorption process are very important in cognitive and practical terms

Thermal Analysis of a D0 H-Disk Wedge

Each H-Disk ring assembly is comprised of 24 wedge assemblies. Figures 1-1 and 1-2 show the wedge mechanical layout. Each wedge consists of sets of two single-sided silicon detectors (referred to as inner and outer detectors, corresponding to their radial positioning) as provided by Moscow State University. Since these detectors are single sided, two mated inner/outer sets are arranged back-to-back such that they effectively become a double-sided detector with a 15{sup o} angle between the strips on either side. Six SVX II chips are mounted near the outboard edge of each outer detector since this location provides access to bond pads spanning the entire detector surface. Since the detector and chip bond pads are on significantly different pitches (approximately 80 vs. 48 microns), a pitch adapter is used to transition this jump, thus simplifying wirebonding. With the accompanying electronics required to support detector operation placed adjacent to the chips, the mountirig ring, which also acts as a means of cooling for the wedge, is by necessity located some distance from the chips, which are the primary heat source. The purpose of this report is to document the results of a thermal performance study of a wedge assembly. The methods, assumptions, and results for this investigation are discussed

D0 H-Disk Cooling Channel Fluid/Thermal Design

Each H-disk ring assembly is comprised of 24 wedge assemblies that are mounted to a ring that provides both structural support and cooling to the detector wedges. Figure 1-1 shows the general layout of a disk assembly. In order for the H-disks to operate on the same cooling system as the rest of the silicon detectors, the pressure drop must be compatible with that of the overall system design. That is, the pressure drop for which the system is to operate, which will include cooling channels for bulkheads, Fdisks, and H-disks, should yield unthrottled flowrates in each cooling device that result in acceptable fluid temperature rises due to their respective heat loads. Too low a pressure drop in any channel would either rob flow from other portions of the detector or require that a higher total flow rate be supplied by the cooling system. Too high a pressure drop would yield an unacceptably large fluid temperature rise across the H-disk ring. In order to keep the detector temperatures low, thus reducing the effect of radiation damage to the silicon, the channel design should also minimize the difference between the bulk fluid temperature and the temperature of the mounting surfaces to which the wedges are attached. This is a significant portion of the overall temperature difference between the coolant fluid and the hottest portion of the silicon. This report compares calculated pressure drops to test results measured on ring mock-ups for two different channel designs. The cross-section of the two different channels discussed here are shown in Figure 1-2. Channel A is a simple rectangle with a 1 x 16 mm cross section, while Channel B has a serpentine cross section but maintains a width of 1 mm. Channel A represents an early design concept while Channel B represents the culmination of the design evolution. The serpentine Channel B design has a larger cross-sectional area than Channel A (29 vs. 16 square mm), so it is expected to have a lower {Delta}P. Its larger surface area, while maintaining the same gap height, provides improved heat transfer performance. Both of these channels assume that the ring inlet and outlet are 180{sup o} apart with the flow evenly split between ring halves. Channel configurations that had a single 360{sup o} channel were also considered. However, in order to keep {Delta}Ps low, larger channels were required to accommodate the higher flows through the channel, and larger gap heights lead to larger fluid-to-wall temperature differences. Therefore, this option was not developed further