AVIR 2022 Poster

Linda Kusters

lkusters@comcast.net

3022938189

Christiana Care

1231 Gilbert Ave
Wilmington, DE 19808

Abstract Body:

This will be a clinical poster.
This poster will show images from several AngioVac procedures performed at Christiana Care. The AngioVac system is a vacuum-assisted aspiration cannula which can be used to treat iliocaval, right atrial, and pulmonary artery thrombosis. All of these cases were performed for right atrial or tricuspid valve mass retrieval. Images will include TEE and fluoroscopic images as well as photographs of device setup and retrieved matter.

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Teaching points:

Uploaded files: []

Leona Benson

seattleavir@hotmail.com

2069545194

Providence Medical Center Everett

20519 14th Dr SE
Bothell, WA 98012

Abstract Body:

Purpose of the study
To address the gap in follow-up of patients in interventional radiology. Study was tracking of Y90 patients for follow-up. The main goal of the study was to identify problems with patient follow-up and to evaluate an electronic method of tracking.
Brief description of methods
Retrospective study that looked at a 6-question questionnaire. Questionnaires were sent out to multiple sites.
Summary of results with sample size and statistical results
Questionnaires resulted in 168 patients from September 2019 to September 2020. No sites were following up at the hospital level. Some sites were unable to provide documentation that patients received follow-up (29/168) as they may go to another area for follow-up imaging. Sites relied on providers to follow-up in their clinical practice. Both PACS and EPIC were evaluated for way to track these patients in the future.
Conclusions
Hospitals were not involved in patient follow-up. It was important for the performing sites to be able to follow-up electronically on the patient to assure that there were no gaps. After evaluating both PACS and EPIC it was determined that EPIC provided the most ease and flexibility in tracking IR patients. Utilizing the built-in feature in EPIC of recall appointments we were able to set an appointment flag to remind IR staff to check to see if patients received follow-up. Due to Covid there was decline in Y90 patients at the home facility during the tracking evaluation process, so IVC filter and drain patients were tracked to test the use of recalls in a live environment. Using recalls we were able to identify patients that had not received their follow-up and were able to send a message to the provider in EPIC to order follow-up testing. Recalls can be utilized by anyone viewing the IR department, they can enter the recall reminder, send messages, and complete the patient off the list when they no longer needed to be tracked.
Still need to develop the poster for presentation

Relevant History, Physical Exam & Test Results

Recall appointment is an appointment feature in EPIC that is usually utilized by clinics.

Teaching points:

How to utilize built in features of EPIC to track IR follow-up.

Lee Ann Kitamura

leeann.kitamura@sickkids.ca

6472069965

The Hospital for Sick Children

555 University Avenue
Toronto, Ontario M5G 1X8

Abstract Body:

Hi! My poster was accepted under the Clinical category for AVIR 2020 in Seattle, unfortunately the conference was cancelled. I would love to present my poster this year in Boston. I have attached my abstract once again for the poster. Thanks, Lee Ann Kitamura

Here is some background for my poster “Hybrid MRI suite in a Pediatric Interventional Radiology Department: Applications, Challenges and The Role of a Hybrid MRI/IR Technologist”

Patients often require multi-modality imaging during various procedures within our institution. With a heavy focus on radiation reduction, MRI has proven to be a useful diagnostic tool for our pediatric population. The challenge in the past has been access to MRI for both invasive and non-invasive surgical scenarios. The goal is to significantly decrease obstacles related to MRI imaging for our Interventional Radiology patients and to incorporate IR/OR procedures within the hybrid MRI suite. Hybrid procedures require meticulous planning for execution, devices and MR safety. This requires a teamwork approach in the hybrid suite with radiologists, technologists and nurses playing key roles. Thus, the need for a hybrid MRI suite that allows for intra-procedural imaging.

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Debra Barnes

debra.barnes@froedtert.com

414-805-3052

Froedtert Hospital

9200 West Wisconsin Ave
Milwaukee, Wisconsin 53226

Abstract Body:

Objectives: Offer formalized didactic and clinical training for radiologic technologists who are interested in specializing in Interventional Radiology (IR) to aid in their understanding and knowledge of procedures, commonly used inventory and patient care in an educational setting.
Background: The majority of IR technologists learn the roles and responsibilities of this specialty through on the job training. This can be intimidating when considering the extensive knowledge base required and high expectations of a dynamic IR lab and can deter potential candidates.
Clinical Findings: Froedtert Hospital developed an IR Internship program in 2004 to create a formalized curriculum around the foundation of IR to meet the needs of a new IR technologist.
The program is a 10-month program that incorporates 1.5 hours of didactic education daily. Discussions include; procedural indication, contraindication, complications, disease processes and anatomy and physiology. Clinical experience is provided through one on one instruction with an assigned IR technologist preceptor.
Upon completion of the program, the interns have logged over 110 didactic hours. They are awarded a certificate of completion and are prepared to take The American Registry of Radiologic Technologists (ARRT) Vascular-Interventional (VI) Radiography certification. Since the inception of the IR internship program; 34 interns have completed the program. Upon graduation, 85% of the interns were hired as IR staff technologists in our department. Today, 51% are still employed in IR at Froedtert Hospital. The success of the program continues to be proven in the preparedness of the interns who take their VI certification. 27 of the 34 interns took the exam, with 100% receiving a passing score.
Conclusion: The IR internship program at Froedtert Hospital has successfully allowed us to train new technologists to meet the high expectations of a dynamic IR lab. The interns gain valuable experience and can confidently operate in an IR department. The program has enabled us to retain high performers after the completion of the program by hiring them as staff IR technologists within in our department, thus providing a constant pool of potential candidates for open positions.

Relevant History, Physical Exam & Test Results

NA

Teaching points:

The IR internship program at Froedtert Hospital is used to creatively address IR Technologist staffing issues in the department by developing a pathway to train and educate the next generation of IR Technologists.

Evan Kitamura

evan.kitamura@sickkids.ca

4165546496

The Hospital for Sick Children

555 University Ave
Toronto, Ontario M5G 1X8

Abstract Body:

Hello, please see the attached abstract for my poster “Multi-modality Imaging in Pediatric Interventional Radiology: Techniques and Optimization”.
I was fortunate to be able to present and win best educational poster at AVIR 2019 in Austin and had an amazing time. I would love to present my poster this year in Boston. My poster focuses on how we incorporate MR imaging into our Pediatric IR procedures.

Thanks for your consideration,
Evan

Relevant History, Physical Exam & Test Results

Teaching points:

Incorporating MR imaging to assist our Interventional Radiologists during procedures has many advantages when combined with x-ray and ultrasound. MR/CBCT fusion has been shown to be advantageous for the eventual procedural outcome. Through this clinical/pictorial representation, we show how these procedures can be planned and executed effectively and safely in a pediatric population.

Diane Forbes, Mohammed Loya

dianeforbesra@gmail.com, mohammed.loya@emory.edu

7578790156, 3016422100

Emory University Hospital, Emory University Hospital

1364 E. Clifton Rd NE
Atlanta, Georgia 30322

Abstract Body:

Radial access is being used more and more with Interventional procedures, such as visceral angiograms which includes interventional oncology as well as GI bleeds, PAE, and UFE. We will discuss pros and cons as well as patient positioning, which is imperative to the success of the procedure. The purpose of this poster is to show ways to optimize success with radial access by discussing patient positioning and the recommended criteria for patient selection.

Relevant History, Physical Exam & Test Results

N/A as this is an educational poster

Teaching points:

1. Proper Patient Selection
2. Proper Patient Positioning
3. Equipment needed
4. Pros and Cons of radial access

Uploaded files: []

Leona Benson

seattleavir@hotmail.com

206-954-5194

Providence Medical Center Everett

20519 14th Dr SE
Bothell, WA 98012

Abstract Body:

In previous submission. This submission has a pdf of the full poster.

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Julie Aguilar, Debra Barnes

julie.aguilar@froedtert.com, debra.barnes@froedtert.com

414-690-2395, 414-690-1039

Froedtert Memorial Lutheran Hospital, Froedtert Memorial Lutheran Hospital

9200 W Wisconsin Ave
Milwaukee, wi 53226

Abstract Body:

Objectives
Discuss the methods to track significant fluoroscopy exposure for proper assessment, follow up and documentation and identify steps to manage these exposures.
Background
The Fluoroscopy Safety Committee (FSC) for Froedtert & Medical College of Wisconsin (MCW) structured a multidisciplinary team. They successfully created a streamlined approach to managing these patients to ensure proper assessment, follow up and education.
Thresholds, process and documentation gaps were identified for follow up. The team focused on creating a workflow that could be replicated for each specialty and hospital site, and meet the Joint Commission (TJC) Standards.
Clinical Findings
The team reviewed the Centers for Disease Control and Prevention documentation and fact sheet for Cutaneous Radiation Injury: Fact Sheet for Physicians1. Based upon this information and recommendations of the physicist and radiation safety officer, a threshold of intervention was identified to be > 2 Gy (200 rads). The process starts at > 2 Gy.
Inpatient and outpatient workflows were identified. The Wound Care Clinic agreed to participate in assessment and follow up of our inpatient population at each site. Physicians and staff were educated in the procedural areas for the new workflow and expectations. Automated work ques were created for follow up. Discharge and educational information were created in our EMR for these patients.
Conclusion
The process implemented is as follows: 1) The technologist in the procedure notifies the physician starting at 2 Gy and for every Gy after; 2) If 5 Gy is reached, than a safety report is entered; 3) A wound care consult is entered for inpatients; 4) An electronic que was developed in our EMR to track patients when 5 Gy is reached for follow up; 5) The inpatients are followed up on by the wound care team; and 6) Outpatients are given discharge instructions and education and are followed up by the clinics two weeks post procedure.
This approach is successful in tracking exposures and insuring that patient follow up and education are completed and documented.

Relevant History, Physical Exam & Test Results

Measurement of Gy

Teaching points:

Standardized follow up is important for high dose exposure

Julie Aguilar

julie.aguilar@froedtert.com

414-690-2395

Froedtert Memorial Lutheran Hospital

9200 West Wisconsin Ave
Milwaukee, WI 53226

Abstract Body:

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Uploaded files: []

Julie Aguilar, Michelle Back

julie.aguilar@froedtert.com, michelle.back@froedtert.com

414-690-2395, 920-207-4383

Froedtert Memorial Lutheran Hospital, Froedtert Memorial Lutheran Hospital

9200 W Wisconsin Avenue
Milwaukee, WI 53226

Abstract Body:

Objectives
100% compliance for antiplatelet and statin medication prescribed at discharge for all patients undergoing a vascular procedure at Froedtert Hospital.
Background
Compliance with antiplatelet and statin medications improves five year survival for patients having vascular procedures. The fall 2018 Vascular Quality Initiative (VQI) Regional Quality Report showed our hospital was below the VQI 25th percentile for antiplatelet and statin medications prescribed at discharge.
Clinical Findings
The Vascular Performance and Program team met and collaborated on strategies to improve our compliance. The following plan was put into place in July of 2018: (1) Collaboration with Pharmacy to develop process of reconciliation at discharge where provider will be contacted if antiplatelet and statin are not prescribed/addressed prior to discharge; (2) Provider note template revision in electronic medical record to include a specific line for addressing antiplatelet and statin medication; (3) Development of workflow for elective procedures. This included review of the chart for antiplatelet and statin medications prior to the procedure, either by the interventional radiology (IR) nurse or the Vascular or IR Clinic nurse; (4) Education to all providers and staff, inclusive of all specialties participating in VQI; (5) Antiplatelet and statin medications added to discharge order set for outpatient peripheral vascular intervention; and (6) Monthly review of VQI registry data, with communication to providers, to address improvement opportunities with documentation of exclusions and ordering of medication if omitted.
Conclusion
A clearly defined action plan, roles and responsibility of each stakeholder, an interdisciplinary collaborative team, and involvement of multiple departments, engagement of providers and ongoing education and monitoring are all factors that drove success in this project.
A significant improvement was achieved from the fall of 2018 to the end of 2019. Our beginning percent of compliance in the fall of 2018 was 72.9% with current compliance of 97.23%. We currently remain above 97% in 2022.

Relevant History, Physical Exam & Test Results

Teaching points:

A clearly defined action plan, roles and responsibility of each stakeholder, an interdisciplinary collaborative team, and involvement of multiple departments, engagement of providers and ongoing education and monitoring are all factors that drove success in this project.

Julie Aguilar, Michelle Back

julie.aguilar@froedtert.com, Michelle.Back@Froedtert.com

414-690-2395, 920-207-4383

Froedtert Memorial Lutheran Hospital, Froedtert Memorial Lutheran Hospital

9200 W Wisconsin Ave
Milwaukee, WI 53226

Abstract Body:

Objectives
Identify barriers to first case on time starts in IR and methods to achieve timely starts.
Background
Leadership, physicians and staff identified that first cases were late. Data confirmed that 39% of first case starts between 0730 and 0930 were on time (within 5 minutes of scheduled start time). A project team was created in IR to address these concerns.
Clinical Findings
The team identified key stakeholders, created a charter and performed a perception survey. The goal was to improve the first case on time starts from the current rate by 50% within 6 months and then continuous improvement until reaching 85% within one year. This goal was added to all staff performance evaluations for 2020.
Data was pulled from the electronic medical record for patient arrival and in room time. In 01/2019 data sheets were created for the prep and the procedure areas. Data collected included time patient in the bay, consent signed, labs sent and resulted, time provider ready, anesthesia delays, staff and room availability and any comments as to what caused the delay.
Primary barriers were patient arrival time (late), staff schedules (needed an additional team earlier), and time allotted for prep of patients. Changes were made in scheduling templates, patient letters updated to include wayfinding materials, and staff schedules were adjusted in 02/2019. Steady improvements occurred and by 05/2019 we reached 75% on time.
By 10/2019, the team reached their goal of 85% on time. The pandemic affected this project and on time percentages fell into the 60’s during outbreaks. The team continues to track and make improvements to maintain our goal of 85%.
Conclusion
The team was able to validate the perception that we were not starting on time. Some simple changes produced effective change early on in the project. The pandemic surges impacted maintenance of our goal, but we continue to make improvements.

Relevant History, Physical Exam & Test Results

Teaching points:

Team Collaboration and simple workflow changes can improve awareness and timely procedures.

Debra Barnes, Julie Aguilar

debra.barnes@froedtert.com, julie.aguilar@froedtert.com

414-690-1039, 414-690-2395

Froedtert Memorial Lutheran Hospital, Froedtert Memorial Lutheran Hospital

9200 West Wisconsin Ave
Milwaukee, WI 53226

Abstract Body:

Objectives:
Create a new role to assist Interventional Technologists in Interventional Radiology (IR) during the technologist recruitment challenges.
Background:
Historically, Froedtert & the Medical College of Wisconsin (MCW) have hired technologists who are Registered Radiologic Technologists RT(R) in IR. The advanced radiologic software and techniques used requires specialized training. Our organization is a Level 3 Trauma Center, Comprehensive Stroke Center and rated number one in the area for cancer care, spine care and neurologic care of our patients. We treat over 9000 patients at Froedtert Memorial Lutheran Hospital (FMLH) IR every year.
With the pandemic, there has been a decrease in individuals entering the medical field. The market has become extremely competitive for RT(R)’s. As a leadership team, we needed to be creative.
Clinical Findings:
Management created a new role to assist the technologists. The job description does not require RTR licensure or certification but a minimum of 1 year direct patient care experience or completion of a certificate, diploma or degree program in healthcare. Recruitment is targeting EMT, Paramedic, Surgical Technician and Anesthesia Technician, but others may be eligible based on patient care experience.
This role will assist the technologist with room and patient preparation. They are responsible for inventory and circulating procedures. In addition, they will use the injectors, ultrasounds, and tray management to function as a scrub tech. The responsibility of advanced imaging techniques will remain with the technologists.
Our goal is to provide support to IR during this challenging recruitment time. In the future, call will be an expectation to support the current team of nurse and technologist.
Conclusion:
Leadership created a new role in IR to assist with staffing. This is an innovative solution to meet the needs of a fast growing department with limited staffing resources. As this new role is developed, educational techniques will be modified to benefit the specific learning style of each individual. Creation of educational resources to meet the needs will be particularly important to the success of this new role.

Relevant History, Physical Exam & Test Results

Teaching points:

Creative solutions are necessary for staffing in the current healthcare environment

Debra Barnes, Julie Aguilar

debra.barnes@froedtert.com, julie.aguilar@froedtert.com

414-690-1039, 414-690-2395

Froedtert Memorial Lutheran Hospital, Froedtert Memorial Lutheran Hospital

9200 West Wisconsin Ave
Milwaukee, WI 53226

Abstract Body:

Objectives:
Create a pathway for radiology interns to begin training in Interventional Radiology (IR) before earning American Registry of Radiologic Technologists (ARRT) certification and registration.
Background:
Historically, the pathway for a radiology intern to train in IR was to complete training in a radiology-accredited program and to become both certified and registered by the ARRT. This has caused delays in the start of IR training, which has been a successful method of cultivating new hires for IR technologist positions in the department. Staffing difficulties at this time in healthcare has required departments to look for creative methods for staffing and to identify barriers that cause delays in training.
Clinical Findings:
IR leadership worked with Human Resources and Compensation to review the current job description for radiology interns. The creation of this new pathway recognizes and promotes the individual for achieving a higher level of certification and allows training to begin earlier and thus graduate sooner for hire into open IR technologist positions.
A new job description was created to allow radiology interns who have completed requirements from their radiology program early to be hired as IR Externs. The candidate is required to acquire their registry and licensure within 6 months of hire. At the point the candidate achieves registration and licensure, the IR Extern will be promoted to IR Associate, which requires both certification and registration. This promotion recognizes the additional certification achievement both financially and with and change in job title.
After completion of the ten-month IR training program, the IR Associates will remain on staff for an additional two months. At this time, the IR Associate can accept an IR Technologist 1 position.
Conclusion:
The creation of a pathway for radiology interns to begin IR training before registration and certification has addressed delays in training. This pathway will also allow guaranteed technologist staffing after completion of the IR training program.

Relevant History, Physical Exam & Test Results

Teaching points:

Creation of a pathway for incoming IR interns to begin training sooner allows for training to begin earlier and thus hire