The success of the technique was assessed by the bit of‘sampled tissue’ obtained through the biopsies, as well asthe fluid aspirated from the ‘cysts’.

TEACHING POINTS: The phantom produced from the gel-atin-corn flour mix showed excellent simulation of tissuetextures on ultrasound and CT imaging. The MR signalcharacteristics allowed good differentiation of the simulatedlesions from background signal. The shelf life of the phan-tom was prolonged by refrigeration. Interventional tech-niques such as biopsy and aspiration were easily applied tothe phantom, with good visualization of needle tips ap-proaching that seen during in vivo procedures. The biopsysamples obtained were comparable to tissue samples ob-tained from actual procedures done on patients. The aspi-ration of cysts was also successful as indicated by the needletip visualization, evacuation of cyst contents and observa-tion of aspirated fluid. These procedures were easily doneusing both ultrasound and CT. The phantom helps theradiologist in training to gain the confidence to reproducethese techniques on patients. Given the prohibitive costs ofcommercially available training phantoms, the use of aneasily produced home-made phantom using common house-hold material is a simple and cost-effective method forteaching interventional techniques and gaining the confi-dence to reproduce the same on patients.

Abstract No. 444

The July Phenomenon: Does It Exist in InterventionalRadiology?S. Dhand, Northwestern University Medical School, Chi-cago, IL, USA � S. Rajeswaran � H.B. Chrisman � A.A.Nemcek � R.L. Vogelzang � R.A. Omary, et al.

PURPOSE: It has been suggested that procedures per-formed in July, which marks the beginning of the academicyear in teaching hospitals, can result in increased adverseevents due to operator inexperience. Currently there doesnot exist an analysis of this “July Phenomenon” within thefield of interventional radiology. We hypothesize that pa-tient adverse events are not impacted by procedures beingperformed in July when compared with the remainder of theyear.

MATERIALS AND METHODS: We performed a retrospec-tive review of a prospectively acquired patient computerdatabase (Hi-IQ ™) from a single academic medical center.Data were analyzed from 74,463 cases between 1996 and2005. We defined major and minor adverse events accord-ing to SIR standards of practice guidelines. The total num-ber of major and minor adverse events in July were com-pared to the average incidents per month for the rest of theyear and analyzed for significance with a �2 test. A p valueof � 0.05 was deemed statistically significant.

RESULTS: Between 1996 and 2005, the mean number ofmajor adverse events in July was 45, while the mean majoradverse events per month in the remaining 11 months was46.2. This difference was not statistically significant (p �.453). The mean minor adverse events in July was 223,while the mean minor adverse events per month in theremaining 11 months was 188. While there was a strongtrend towards a difference, technically the increase in minorevents in July was not statistically significant (p � 0.051).

CONCLUSION: There is no increased risk for interven-tional radiology major adverse events in July when com-pared with the rest of the year. However, there is strongtrend towards increased minor adverse events in July. The

clinical relevance of these increased minor adverse eventsfor July is unclear.

Abstract No. 445

Recording Datasets for Performance Assessment duringMedical Procedures.A. Parikh, Mallinckrodt Institute of Radiology at Washing-ton University in St. Louis School of Medicine, St. Louis,MO, USA � J.R. Duncan � C.B. Glaiberman

PURPOSE: Test and establish methods of recording datafrom the multiple sources used by interventional radiolo-gists during patient procedures.

MATERIALS AND METHODS: During procedures, inter-ventional radiologists integrate information from the pa-tient, coworkers as well as from one or more imagingsystems. Datasets which capture the information presentedby these different sources are needed to assess and/or im-prove performance. After initial feasibility testing, multiplevideo and audio recorders have been used to capture datafrom patient procedures. Standard and high definition videocameras were positioned in front of a fluoroscopy monitorto capture the fluoroscopy image. Video recorders weredirectly connected to ultrasound units via cables. A station-ary video camera was positioned in the procedure room tocapture an overview of the procedure. The multiple audioand video datastreams were transferred to a computer wherethey were synchronized and compiled into a single file.

RESULTS: The ultrasound image was easily captured at fullresolution. The fluoroscopy image on liquid crystal displayswas readily captured using standard and high definitionvideo cameras. The high definition recordings providedsufficient resolution to easily discern details of the image.The wide angle camera provided an overview of the proce-dure. Composite recordings were created using personalcomputers but displaying these recordings at full resolutionrequired consideration of screen and file size.

CONCLUSION: Capturing high quality datasets from inter-ventional radiology procedures is technically possible.Multi-camera recording affords the opportunity to assess theprocedure from multiple vantage points. Much like flightdata recorders have been used to improve the safety of airtravel, data recorded during medical procedures holds prom-ise as a means of assessing performance and developingdata based methods for improving patient care.

Other: Health Care Policy

Abstract No. 446

Who Performs Peripheral Endovascular Interventions?The Changing Shares among Specialties.J.S. Lee, Georgetown University Hospital, Washington, DC,USA

PURPOSE: To evaluate market share among physiciansperforming percutaneous peripheral vascular interventions.

MATERIALS AND METHODS: Five-percent Medicaresample data from 1997-2001 was analyzed to examinetrends in specialty distribution, market share and percentchange among specialties for percutaneous peripheral vas-cular interventions. Current Procedural Terminology Codesfor percutaneous peripheral vascular procedures were ex-tracted and matched with a corresponding provider specialtycode for each year.

S158

RESULTS: Overall there was an increase of 10,438 proce-dures performed from 1997 to 2001, representing growth of25% within the market. Radiologists performed the greatestnumber of procedures each year. Medical specialties pro-vided the next largest percentage with surgical and all otherspecialties accounting for the remaining procedures. Allspecialty groups saw a rise in the absolute numbers ofprocedures performed. However, Radiologists showed sta-ble or a yearly loss in their market share totaling a five-yeardecrease of 12.2%, while medical and surgical specialtiessaw a yearly gain in market share with a cumulative five-year increase of 7.7% and 3.6%, respectively.

CONCLUSION: Percutaneous peripheral vascular interven-tions are rapidly diffusing within the endovascular market,however, the diffusion has not occurred with equal distri-bution among specialists. There is much speculation regard-ing the market share of these procedures with relativelylittle evidence in the literature to support any claims regard-ing market distribution. Using Medicare data from 1997 to2001, radiology has experienced a relative loss in marketshare, while medical and surgical specialties have seen rapidgrowth. Specifically, Cardiologists and Vascular Surgeonshave realized the largest gains in market share while Radi-ology specialties have experienced declines. The data sug-gest that as clinicians are more willing to broaden andchange their scope of practice, healthcare technology mar-kets will be impacted. Several factors that may play a rolein the expansion of practice are the increase in the providerswilling to supply these procedures, patient referral patternsfor the treatments and managed care reimbursement.

Other: Pediatric Interventions

Abstract No. 447 EE

Complex Interventional Procedures Performed in theNeonatal Intensive Care Unit with a Portable C Arm.P. Stanley, Childrens Hospital Los Angeles, Los Angeles,CA, USA � A. Panigrahy

PURPOSE: To review the experience of performing com-plex invasive procedures with a portable C arm in theneonatal intensive care unit.

MATERIALS AND METHODS: Twelve interventional ra-diological procedures were performed on 7 neonates in theunit using a portable C arm equipped with a vascular soft-ware package. Six were ventilated with high frequencyoscilators and one was on Extra Corporeal Membrane Ox-ygenator. Three diagnostic arteriograms performed for (1)Umbilical arteriovenous fistula in a two day old weighing1348 grams (24 weeks gestational age). (2) Subclavianartery fistula on a five day old weighing 6140 grams whowas on ECMO (3) suspected hepatic artery fistula in a fourmonth old weighing 5715 grams. Therapeutic embolizationsperformed for vascular malformation of the face and scalpat 17 and 18 days of age in a patient weighing 6140 gramsand four times for hepatic hemangioma between 11 and 41days in a patient weighing 4230 grams. Three percutaneousnephrostomy tube placements were performed in two pa-tients (1) Sacrococcygeal teratoma at two days (25 weeksgestational age) weight 1779 grams and twice for cysticrenal disease at three and five days, in a patient weighing2600 grams.

TEACHING POINTS: There were no procedure-relatedcomplications. Four patients were discharged from the hos-pital after further therapy. In patients too fragile to bemoved to an interventional suite, complex procedures can

be performed safley with a portable C arm in the neonatalunit preserving the critical supportive environment.

Abstract No. 448

Triple Agent Sedation: Midazolam, Fentanyl and Ket-amine for Pediatric Interventional Procedural Sedation.M.J. Temple, Hospital for Sick Children, Toronto, ON,Canada � D. Murray � S. Kemp

PURPOSE: The goal of this study is to assess the safety andefficacy of nurse administered, radiologist supervised seda-tion consisting of midazolam, fentanyl and ketamine bo-luses used to perform interventional procedures in children.

MATERIALS AND METHODS: All patients who underwentprocedures and received intravenous midazolam, fentanyland ketamine sedation are reviewed. Data were collectedfrom sedation records, quality assurance forms, patient chartand the ESH-IGT Database. Demographics, vitals, doses,adverse events, postprocedure patient follow-up and proce-dural performance data (fluoroscopy time, room time, abil-ity to perform procedure, procedural complications) wererecorded.

RESULTS: From May 2005 - September 2006, 316 patientsunderwent procedural sedation. 34 patients undergoing bi-opsy (n � 13), central venous access (7), abscess drainage(4), steroid injection (9) and cecostomy tube insertion (1)who received 3 sedation agents are included in the study.Age ranged from 14 m - 16 yrs (avg. 7.4 � 4.3 yrs) andweight from 11-90 kg (avg. 29.3 � 18.9 kg). Patients areASA 1 (n � 13); ASA 2 (15) and ASA 3 (6). Total drugdoses were midazolam 0.07 � 0.03 mg/kg, range 1- 3 doses;fentanyl 1.7 � 0.6 �g/kg, range 1- 5 doses and ketamine0.4 � 0.2 mg/kg, range 1-3 doses. Transient hypoxia treatedwith nasal O2 in 1 patient. Emergence reaction controlledwith midazolam in 2 patients. All procedures performedsuccessfully within 75 minutes (avg. 41 � 14 mins). Therewere no procedural complications. All sedations were suc-cessful. All patients that were questioned after recoverywere either happy with result or amnestic of event. 22/23patients questioned did not remember any pain or the pro-cedure itself. 1/23 patients remembered discomfort/pain butwould undergo sedation again.

CONCLUSION: All sedations were successful. There wereno significant adverse events. Synergistic effect of sedationagents allows potentially lower doses of ketamine with lowincidence of emergence reaction seen. Titration of 3 agentsallows: 1) individualized sedation optimization, 2) avoid-ance of general anesthesia in younger patients, and 3) widerrange of procedures to be performed under sedation.

Abstract No. 449 EE

Selective Unilateral Balloon Bronchial Occlusion in theManagement of Pulmonary Interstitial Emphysema.A. Robinson, BC Children’s Hospital, Vancouver, BC,Canada � M. Heran � G. Culham � A. Singh � D. Ori

PURPOSE: To demonstrate our experience with selectivemainstem bronchial balloon occlusion in the management ofsevere pulmonary interstitial emphysema in preterm neo-nates that have failed more conservative management.

MATERIALS AND METHODS: Retrospective selection ofcases was performed using our RIS-PACS system, identi-fying four cases in the last year. Selective bronchial accesswas achieved via the existing endotracheal tube using a

S159

PO

ST

ER

SE

SS

ION

S