PMID- 31348005
OWN - NLM
STAT- MEDLINE
DCOM- 20200218
LR  - 20200225
IS  - 1305-3612 (Electronic)
IS  - 1305-3825 (Print)
IS  - 1305-3825 (Linking)
VI  - 25
IP  - 5
DP  - 2019 Sep
TI  - Operator learning curve for transradial liver cancer embolization: implications 
      for the initiation of a transradial access program.
PG  - 368-374
LID - 10.5152/dir.2019.18437 [doi]
AB  - PURPOSE: We aimed to analyze transradial access (TRA) learning curve on patients 
      undergoing hepatic chemoembolization, investigating the relationship between 
      procedural volumes and various benchmarks of procedural success. METHODS: We 
      enrolled 60 consecutive patients who received two unilobar hepatic 
      chemoembolizations within a 4-week interval performed by a single interventional 
      radiologist, highly-trained in conventional transfemoral access (TFA) procedures, 
      but without any previous practical experience in TRA procedures and with a 
      preliminary 2-day theoretical training only. Consecutive patients were 
      prospectively enrolled and analyzed in 3 groups: A (cases 1 to 20), B (cases 21 
      to 40), and C (cases 41 to 60). All patients underwent one hepatic 
      chemoembolization using TRA and the other one using TFA in random order. All TFA 
      procedures performed by the same operator in the same series of patients were 
      considered as the control group. Primary endpoint was to analyze the relationship 
      between TRA procedure operator experience and benchmarks of procedural success, 
      to define the optimal procedural learning curve. RESULTS: Technical success was 
      obtained in all patients, with a crossover rate (radial to femoral access) of 0%. 
      An association between incremental TRA operator experience (in terms of performed 
      procedures) and decrease of preparation, puncture, fluoroscopy, and total 
      examination times was observed. Similarly, inverse associations between 
      incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) 
      and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 
      0.001) were also observed. Compared with TFA, CM volumes and RD values were 
      significantly higher only in group A (cases 1-20). Procedure success remained 
      high in all TRA groups and no significant association between TRA incremental 
      experience and postprocedural outcomes was found. Higher postprocedural 
      complaints at the access route and more limitations in performing basic 
      activities were recorded after TFA vs. TRA (P < 0.001). CONCLUSION: TRA 
      catheterizations can be safely performed in patients treated for liver cancer 
      embolization after a relatively short training in controlled conditions and with 
      a better performance in comparison with TFA. Operator proficiency improves with 
      greater TRA experience, with a threshold needed to overcome the learning curve 
      represented by about 20 procedures.
FAU - Iezzi, Roberto
AU  - Iezzi R
AD  - Department of Bioimaging and Radiological Sciences, Candiolo Cancer 
      Institute-IRCCS, Rome, Italy; Department of Radiological Sciences, Catholic 
      University School of Medicine, Rome, Italy.
FAU - Posa, Alessandro
AU  - Posa A
AD  - Department of Radiology, IRCCS Fatebenefratelli Hospital Foundation for Health 
      Research and Education, Rome, Italy.
FAU - Merlino, Biagio
AU  - Merlino B
AD  - Department of Bioimaging and Radiological Sciences, Candiolo Cancer 
      Institute-IRCCS, Rome, Italy; Department of Radiological Sciences, Catholic 
      University School of Medicine, Rome, Italy.
FAU - Pompili, Maurizio
AU  - Pompili M
AD  - Department of Internal Medicine, Catholic University School of Medicine, Rome, 
      Italy.
FAU - Annicchiarico, Eleonora
AU  - Annicchiarico E
AD  - Department of Internal Medicine, Catholic University School of Medicine, Rome, 
      Italy.
FAU - Rodolfino, Elena
AU  - Rodolfino E
AD  - Department of Bioimaging and Radiological Sciences, Candiolo Cancer 
      Institute-IRCCS, Rome, Italy.
FAU - Basso, Michele
AU  - Basso M
AD  - Department of Oncology, Catholic University School of Medicine, Rome, Italy.
FAU - Cassano, Alessandra
AU  - Cassano A
AD  - Department of Oncology, Catholic University School of Medicine, Rome, Italy.
FAU - Gasbarrini, Antonio
AU  - Gasbarrini A
AD  - Department of Internal Medicine, Catholic University School of Medicine, Rome, 
      Italy.
FAU - Manfredi, Riccardo
AU  - Manfredi R
AD  - Department of Bioimaging and Radiological Sciences, Candiolo Cancer 
      Institute-IRCCS, Rome, Italy; Department of Radiological Sciences, Catholic 
      University School of Medicine, Rome, Italy.
LA  - eng
PT  - Journal Article
PL  - Turkey
TA  - Diagn Interv Radiol
JT  - Diagnostic and interventional radiology (Ankara, Turkey)
JID - 101241152
SB  - IM
MH  - Aged
MH  - Chemoembolization, Therapeutic/*methods
MH  - Clinical Competence/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - *Learning Curve
MH  - Liver Neoplasms/*therapy
MH  - Male
MH  - Radiology, Interventional/*education
PMC - PMC6727820
COIS- Conflict of interest disclosure The authors declared no conflicts of interest.
EDAT- 2019/07/28 06:00
MHDA- 2020/02/19 06:00
PMCR- 2019/09/01
CRDT- 2019/07/27 06:00
PHST- 2019/07/28 06:00 [pubmed]
PHST- 2020/02/19 06:00 [medline]
PHST- 2019/07/27 06:00 [entrez]
PHST- 2019/09/01 00:00 [pmc-release]
AID - dir-25-5-368 [pii]
AID - 10.5152/dir.2019.18437 [doi]
PST - ppublish
SO  - Diagn Interv Radiol. 2019 Sep;25(5):368-374. doi: 10.5152/dir.2019.18437.