RPS 309 - More than needles and wires in the world of interventional radiology

Author Block: M. Schönfeld, E. Ulrich, J. Kottlors, T. Schömig, K. R. Laukamp; Köln/DE
Purpose: Structured documentation of interventional radiology procedures is critical for quality assurance, billing, and research. In routine practice documentation is often retrospective, time-consuming, and error-prone. We developed a modular digital solution that enables structured, real-time documentation directly during the procedure.
Methods or Background: The tools cover the full spectrum of interventional radiology, including neurovascular (mechanical thrombectomy, carotid stenting, vasospasm treatment, aneurysm, subdural hematoma embolization), oncological/embolization (fibroid, prostate, tumor embolization, TACE, SIRT, BBA, bleeding), percutaneous (biopsy, drainage, cryoablation, microwave ablation), and vascular access procedures (PICC, port, TIPS).
All modules run on sterile-clickable touchscreens in the angiography suite, capturing timestamps, techniques, materials, and findings in real time. From these inputs the system automatically generates: (1) a standardized editable report, (2) procedure codes, (3) structured quality assurance data, and (4) prepared registry entries. Data from the first 95 consecutive procedures documented with the system were analyzed and compared with 100 procedures performed before implementation.
Results or Findings: In the first 95 procedures, the mean time for report creation decreased from 12.2 ± 6.1 minutes before implementation to 1.3 ± 0.5 minutes, with reports now available immediately after the procedure instead of with an average delay of more than 48 hours.
The time required for procedure coding was reduced from 11.4 ± 3.2 minutes, including frequent corrections, to 1.2 ± 0.4 minutes.
The duration of quality assurance documentation decreased from 8.5 ± 2.8 minutes to 2.1 ± 1.3 minutes.
Registry entries also became significantly faster, dropping from 8.2 ± 3.6 minutes to 2.0 ± 1.2 minutes, while completeness increased from less than 20% to more than 90%.
Conclusion: Real-time digital documentation across the spectrum of interventional radiology is feasible and leads to substantial gains in efficiency, accuracy, and quality assurance.
Limitations: None
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: L. Heidemann, R. Schmidt, E. Y. Yilmaz, Y. He, J. Böhme, K. Harb, D. Müller, B. Gebauer, L. J. Savic; Berlin/DE
Purpose: To investigate local immunomodulatory effects of conventional transarterial chemoembolisation (cTACE) in hepatocellular carcinoma (HCC).
Methods or Background: This single-centre prospective study included HCC patients undergoing interstitial brachytherapy in afterloading technique (iBT) only or cTACE with consecutive iBT (10.2020-08.2023). IRB approval and informed consent were obtained. Biopsies were acquired from untreated HCC before iBT (iBT group) or 24 hours post-cTACE and before iBT (cTACE/iBT group). Based on histopathology and peri-interventional CT images, biopsies were graded as intra- and peritumoural. Immunohistochemistry staining was performed for CD3+, CD4+, CD8+, PD-1+ T cells, and Ki67. On digitized samples, T cell populations were quantified as a percentage of all counted cells using QuPath software. Cell counts were correlated with response according to RECIST version 1.1 assessed on MRI eight weeks post-treatment. Statistics included Shapiro-Wilk and Mann-Whitney U tests.
Results or Findings: This study cohort comprised 82 patients (66 male), with a mean age of 69.6 ± 9.9 years. CD3+ and CD4+ T-cell infiltration was higher in the cTACE/iBT group (n=39) compared to the iBT group (n=43; p=0.043 and p=0.03, respectively). CD3+ (p=0.02), CD4+ (p=0.01), and CD8+ T cell counts (p=0.01) were higher in the peritumoural compartment than intratumourally. In the cTACE/iBT group, responders (n=11) showed higher median CD3+ (p=0.49), CD4+ (p=0.19), and CD8+ T-cell counts (p=0.07) compared to non-responders (n=25).
Conclusion: This study demonstrates early effects of cTACE on T-cell infiltration into the tumour microenvironment, contributing to a greater understanding of peripheral lymphocyte depletion and migration following cTACE.
Limitations: Firstly, longitudinal effects post-cTACE are not captured. Secondly, findings of a single biopsy may not be representative of the entire tumour. Lastly, outcome was measured after iBT or cTACE/iBT, while biopsies were obtained before iBT from untreated tumours or post-cTACE.
Funding for this study: Guerbet
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional review board approval (Charité – Universitätsmedizin Berlin, EA2/091/19) and written informed consent were obtained from all patients.

Author Block: S. Zhang, Z. Wang, Z. Jin; Beijing/CN
Purpose: This study developed an innovative immune-active peptide-based shear-thinning hydrogel loaded with sorafenib (AbSNP-CIR) as a multifunctional transcatheter arterial embolization (TAE) agent for treating VX2 kidney tumors, evaluating its therapeutic efficacy, immunomodulatory effects, and biocompatibility.
Methods or Background: We formulated a CIR host defense peptide hydrogel incorporating albumin-bound sorafenib nanoparticles (AbSNP). The material's shear-thinning properties, injectability, and embolic characteristics were validated in vitro. Twenty-four New Zealand white rabbits with VX2 kidney tumors were randomized into four TAE groups: AbSNP-CIR, CIR (drug-free), Lipiodol®, and control (angiography only). Tumor progression was monitored via contrast-enhanced CT at days 0, 7, and 14. Comprehensive blood analyses assessed systemic toxicity. Histopathological examination of major organs and tumors was performed at endpoint. Single-cell RNA sequencing analyzed immune microenvironment alterations between CIR and Lipiodol® groups. Survival benefits were evaluated using Kaplan-Meier analysis with Log-rank tests.
Results or Findings: Both CIR and AbSNP-CIR hydrogels demonstrated excellent injectability and effective vessel occlusion, inducing significant tumor necrosis. The AbSNP-CIR group exhibited superior tumor growth suppression. scRNA-seq revealed CIR-based hydrogels reversed immunosuppression by significantly downregulating LGALS3 and upregulating CD83 compared to Lipiodol®. Survival analysis demonstrated AbSNP-CIR significantly prolonged median survival (40.5 days) versus control (23 days, p=0.028), CIR (26.5 days, p=0.035), and Lipiodol® (27.5 days, p=0.049). Blood parameters showed no significant systemic toxicity.
Conclusion: The AbSNP-CIR hydrogel represents an advanced embolic strategy that integrates mechanical occlusion, localized sorafenib delivery, and active immunomodulation, significantly enhancing antitumor efficacy and survival in kidney tumor models.
Limitations: Small sample size and single animal model require validation in larger studies.
Funding for this study: This study has received funding from the National Natural Science Foundation of China (Nos. 22232006, Biomolecular Condensates: Phase Separation Modulation and Functionalization)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approval number: XHDW-2023-017

Author Block: F. Calabrese¹, T. T. Makoto², E. Di Gaeta¹, A. Casadei-Gardini Andrea¹, C. Canevari¹, L. Strigari², F. Ratti¹, C. Mosconi², F. De Cobelli¹; ¹Milan/IT, ²Bologna/IT
Purpose: The aim of the study is to determine a tumor mean absorbed dose (Dmean) able to predict the therapeutic response to Yttrium-90 (Y-90) resin-microsphere transarterial radioembolization (TARE) in hepatocellular carcinoma (HCC), and evaluate its efficacy and safety profile.
Methods or Background: A retrospective analysis was conducted on HCC patients treated with TARE at two institutions between January 2020 and May 2024. Clinical, radiological and procedural data were collected. Outcomes included objective response rate (ORR) for target lesions (complete or partial), complete response (CR), overall response, time-to-local progression (TLP) and time-to-progression (TTP), assessed on contrast-enhanced CT. Receiver operating characteristic (ROC) analysis identified the optimal Dmean for achieving ORR and CR. ORR comparisons used Fisher’s exact test, survival was analyzed using Kaplan-Meier curves, and Cox regression was used for univariable and multivariable analysis.
Results or Findings: Seventy-six lesions from 64 patients (mean age 71.3 ± 9.6; 54 male) were analyzed, with an average tumor size of 54.8 ± 31.5 mm. CR at 3 months was obtained in 41 lesions. Mean TLP and overall survival (OS) were 26.7 ± 2.5 and 36.2 ± 2.9 months, respectively.
The calculated Dmean to obtain ORR was 296.74 Gy (specificity 100, PPV 100%). Patients receiving doses < 296.74 Gy experienced shorter TLP (p = 0.001) and a higher progression risk (HR 6.9; p = 0.009). No increase in complications was observed at Dmean >296.74 Gy. A Dmean > 435.11 Gy was associated to CR. OS was negatively influenced by BCLC stage C (HR 6.0; p = 0.003) and portal vein invasion (HR 3.5; p = 0.04).
Conclusion: A tumor Dmean of 296.74 Gy stands out as a powerful predictor of treatment success, delivering strong therapeutic results without compromising patient safety.
Limitations: Retrospective study
Funding for this study: Na
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: 64/Int/2021

Author Block: Y. Geng, J. Zhu, Y. Xu; Bin Zhou/CN
Purpose: Current classification systems for lower extremity deep vein thrombosis (DVT) lack precision in anatomical stratification, potentially compromising the specificity of therapeutic interventions. This study aims to establish a novel classification system based on venographic characteristics and pathoanatomical correlations to enhance clinical decision-making and research standardization.
Methods or Background: We conducted a retrospective analysis of 2,137 consecutive diagnostic digital subtraction venography (DSV) studies performed at our institution between January 2015 and December 2023 in patients with confirmed lower extremity DVT. Thrombus distribution patterns were systematically categorized through an initial independent review by two vascular specialists, followed by consensus discussion involving a third specialist for discordant cases. The classification framework was developed through iterative correlation of venographic findings (thrombus location, extent, morphology, collateral patterns) with established anatomical landmarks and hemodynamic principles.
Results or Findings: Analysis of the venographic data led to the proposal of a novel taxonomy stratifying lower extremity DVT into six distinct categories: Type I - Musculovenous thrombosis (soleal/gastrocnemius veins); Type II - Tibial and Peroneal Vein Thrombosis; Type III - Popliteal segment thrombosis ;Type IV - Femoral venous thrombosis; Type V - Ilio-caval thrombosis; Type VI - Free-floating thrombus. This system incorporates both anatomical localization and key pathophysiological features.
Conclusion: This anatomically precise classification system has the potential to enhance stratification for targeted therapeutic interventions, support standardized reporting in clinical trials, enable more accurate documentation of thrombotic progression patterns, and guide the implementation of standardized imaging reporting protocols. Its clinical utility requires prospective validation.
Limitations: This venography-based DVT classification needs prospective validation. While reliable for major veins, ultrasound struggles with muscular calf thrombi and complex subtypes. This retrospective single-center system lacks prognostic evidence, requiring further reliability and outcome studies.
Funding for this study: N/A
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. Oberparleiter, J. Vosshenrich, H-C. Breit, A. C. Seifert, P. J. Kaiser, P. Hehenkamp, D. Boll, C. J. Zech, M. Obmann; Basel/CH
Purpose: To compare diagnostic performance, confidence, and reading time between conventional and dual-energy CT (DECT) protocols in evaluating TIPS patency and assess the value of DECT-derived quantitative iodine measurements.
Methods or Background: This retrospective single-centre study included 57 patients with TIPS who underwent portal-venous DECT between 11/2014 and 07/2024. For each case, a conventional CT dataset and a DECT dataset (additional iodine maps and virtual non-contrast images [VNC]) were created. Two abdominal radiologists and three residents assessed TIPS patency and rated diagnostic confidence (5-point Likert scale). Sensitivity and specificity were compared using McNemar’s test; confidence and reading time with the Wilcoxon signed-rank test.

Iodine concentrations were measured in the inferior vena cava, portal vein, and TIPS using three circular ROIs each. Diagnostic performance of absolute iodine values and iodine ratios (TIPS/portal vein, TIPS/inferior vena cava) was assessed with ROC analysis. Thresholds were defined via Youden index.
Results or Findings: TIPS occlusion was present in 14 patients. Sensitivity was similar for conventional CT and DECT (93% vs. 97%, p=.219), while specificity increased from 93% to 98% with DECT (p<.01). Diagnostic confidence improved (median 4 [IQR 3–4] vs. 4 [IQR 4–5], p<.01), and reading time decreased (109 s vs. 98 s, p<.001).

Mean iodine concentrations (mg/ml) were: IVC 3.99, portal vein 4.65, open TIPS 4.49, occluded TIPS 0.67. ROC-AUCs were 0.998 (absolute iodine), 1.000 (TIPS/portal vein), and 0.995 (TIPS/IVC). Optimal thresholds were 1.40 mg/ml, 0.262, and 0.263, yielding sensitivities/specificities of 95%/100%, 100%/100%, and 98%/100%, respectively.
Conclusion: Adding iodine maps and VNC images to DECT improves diagnostic specificity, confidence, and efficiency in assessing TIPS patency. Quantitative iodine measurements allow for accurate, objective evaluation and may be useful in inconclusive cases.
Limitations: This was a single-centre retrospective study with a limited sample size.
Funding for this study: This study did not receive any external funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The need for informed consent was waived.

Author Block: Z. FU, Y. LIU, E. Xu; Guangdong/CN
Purpose: This study aimed to identify independent risk factors for post-MWA infections and develop a risk stratification system to guide prophylactic antibiotic use.
Methods or Background: In this retrospective study of 359 patients who underwent MWA for liver malignancies (2019-2025), we collected comprehensive perioperative data including baseline characteristics, preoperative indicators, imaging features, procedural parameters, and infection-related outcomes. Risk factors were identified through univariate and multivariate analyses, and a risk stratification system was established (low-risk: <5%; intermediate-risk: 5%-15%; high-risk: >15%).
Results or Findings: Post-procedural infections occurred in 46 patients (12.8%). Multivariate analysis identified three independent risk factors: history of biliary tract procedures (OR=5.79, 95% CI: 1.53-21.97), presence of five or more tumors (OR=3.69, 95% CI: 1.17-11.63), and larger tumor size (OR=1.03 per mm, 95% CI: 1.00-1.05). The risk stratification model demonstrated good discrimination (AUC=0.82), with infection rates showing significant gradient distribution across risk groups (1.4% vs. 7.8% vs. 34.8%, P<0.001).
Conclusion: Three independent risk factors for post-MWA infections were identified. The risk prediction model may guide rational prophylactic antibiotic use in clinical practice.
Limitations: The single-center design and sample size may limit generalizability, requiring external validation.
Funding for this study: 2025 Futian District Health System Research Project Approval
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee of the Eighth Affiliated Hospital of Sun Yat-sen University

Author Block: J. Wu, J. Tu, W. Li; Lishui/CN
Purpose: This study aims to investigate the correlation between progressive muscle loss (progressive sarcopenia), progressive myoadiposis, and the efficacy of bronchial artery chemoembolization (BACE) in lung cancer patients
Methods or Background: A total of 97 lung cancer patients who received BACE treatment at Lishui Central Hospital from December 2016 to August 2021 were selected. The skeletal muscle index (SMI) and skeletal muscle density (SMD) were measured at the level of the fourth thoracic vertebra using CT images. Progressive sarcopenia was defined as a reduction in SMI of ≥ 5%, and progressive myoadiposis was defined as a reduction in SMD of ≥ 5%. The Kaplan-Meier method and COX regression analysis were used to evaluate differences and risk factors for overall survival (OS) and progression-free survival (PFS).
Results or Findings: The median PFS was 7.1 months in the non-progressive sarcopenia group and 3.4 months in the progressive sarcopenia group, with a significant difference between them (χ² = 4.209, P = 0.040). The median OS was 10.7 months in the non-progressive myoadiposis group and 20.2 months in the progressive myoadiposis group, also showing a significant difference (χ² = 5.583, P = 0.018). COX regression analysis identified progressive sarcopenia as an independent risk factor for PFS and progressive myoadiposis as an independent risk factor for OS.
Conclusion: rogressive sarcopenia and progressive myoadiposis are independent risk factors for PFS and OS, respectively, in lung cancer patients undergoing BACE.
Limitations: This study has limitations, including a limited sample size and a single-center retrospective design that may introduce selection bias. These findings warrant further validation in larger, prospective studies.
Funding for this study: There is no funding for this study
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee Approval Letter of Biomedical Research Involving Humans：Approval Number: Research Ethics Review 2025 (I) No. 043

Author Block: N. A. Almaymani, A. Al Balushi, S. C. Kheruka, N. Al-Makhmari, H. Al Saidi, S. Al Rashdi, T. Al Raii, R. Al Sukaiti, B. Abdi; Muscat/OM
Purpose: To quantify annual occupational dose among interventional radiology (IR) staff—interventionalists, nurses, and radiologic technologists—using dual dosimetry and identifying role-specific optimisation targets for routine practice.
Methods or Background: Prospective one-year audit at a comprehensive cancer center, including 2 interventionalists, 4 nurses, and 3 technologists. Under apron chest TLDs measured Hp (10) (effective dose); ring TLDs measured Hp (0.07) (hand dose); eye TLDs measured Hp (3) (interventionalists and nurses). Real-time PDMs worn over the apron recorded outside the apron Hp (10). Fluoroscopy time, DAP, and Ka,r were recorded for each procedure.
Results or Findings: Under apron chest TLD Hp (10) was effectively < 0.01 mSv across IR staff in 2024. Extremity and eye lens doses remained measurable: hand (interventionalists) 3.51 ± 0.45 mSv (range 3.07–3.21) and eye lens 3.37 ± 0.69 mSv (2.69–4.06), hand (nurses) 3.9± 0.45 mSv (range 3.07–3.90) and eye lens 2.40 ± 0.28 mSv (2.12–2.78). Role stratified outside apron Hp (10) from PDMs was 0.13± 0.06 mSv (interventionalists), 0.47± 0.06 mSv (nurses), and 0.29 ± 0.06 mSv (technologists), yielding the exposure ordering nurses > technologists > interventionalists.
Conclusion: All doses were within regulatory limits; however, pairing under apron TLDs with outside apron PDMs shows that hand and eye lens exposures—not effective dose—are the optimisation drivers, and that nurses experience the highest outside apron exposure in our IR suite. These role-specific signals support targeted actions: strict, documented use of ceiling/table shields and lead eyewear, reinforcement of staff positioning, and dual badge monitoring (collar + under apron) to ensure accurate assessment and continuous quality improvement.
Limitations: A small amount of data was involved in the study
Funding for this study: All doses were within regulatory limits; however, pairing under apron TLDs with outside apron PDMs shows that hand and eye lens exposures—not effective dose—are the optimisation drivers, and that nurses experience the highest outside apron exposure in our IR suite. These role-specific signals support targeted actions: strict, documented use of ceiling/table shields and lead eyewear, reinforcement of staff positioning, and dual badge monitoring (collar + under apron) to ensure accurate assessment and continuous quality improvement.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Sultan Qaboos Comprehensive Cancer Care and Research Centre Research Committee