INTRODUCTIONThe gold standard for evaluation of the lower extremity arterial tree is catheter angiography. Duplex arterial-occlusive imaging or duplex ultrasonography arteriography, a noninvasive technique, is used as the first-line investigation in patients with peripheral vascular disease at our centre. Based on the results of duplex imaging, patients who require angiographic intervention then proceed with simultaneous catheter arteriography and intervention. This study aimed to compare the results of duplex imaging alone as the first-line investigation against the eventual results of catheter angiography, and to assess the impact of the former on patients' clinical outcomes.

METHODSAll cases involving patients who underwent duplex imaging followed by angiographic intervention, from May 2008 to February 2009, were discussed at weekly interdisciplinary meetings. Only patients who underwent lower limb imaging were included in the study. Those who were involved in grafts and stent surveillance studies, as well as those with incomplete duplex images were excluded.

RESULTSDuring the study period, 113 duplex imaging studies of the lower limb followed by percutaneous transluminal angioplasty were performed at our hospital for peripheral vascular disease. The iliac artery was visualised in 40 images, but could not be visualised in 73 images. There was a potential change in management in three cases due to radiological differences between the duplex images and angiography films.

CONCLUSIONIn our series, duplex imaging was found to be accurate enough to guide initial clinical management of patients with peripheral vascular disease. This modality is the preferred first-line investigation for such patients at our centre.

Angiography ; methods ; Angioplasty ; methods ; Arterial Occlusive Diseases ; diagnosis ; diagnostic imaging ; Humans ; Leg ; blood supply ; diagnostic imaging ; Peripheral Vascular Diseases ; diagnosis ; diagnostic imaging ; Predictive Value of Tests ; Reproducibility of Results ; Ultrasonography ; methods ; Ultrasonography, Doppler, Duplex ; methods

INTRODUCTIONC-arm Cone Beam CT (CBCT) is a technology that is being integrated into many of the newer angiography systems in the interventional suite. Due to its ability to provide cross sectional imaging, it has opened a myriad of opportunities for creating new clinical applications. We review the technical aspects, current reported clinical applications and potential benefits of this technology.

MATERIALS AND METHODSSearches were made via PubMed using the string "CBCT", "Cone Beam CT", "Cone Beam Computed Tomography" and "C-arm Cone Beam Computed Tomography". All relevant articles in the results were reviewed.

RESULTSCBCT clinical applications have been reported in both vascular and non-vascular interventions. They encompass many aspects of a procedure including preprocedural planning, intraprocedural guidance and postprocedural assessment. As a result, they have allowed the interventionalist to be safer and more accurate in performing image guided procedures. There are however several technical limitations. The quality of images produced is not comparable to conventional computed tomography (CT). Radiation doses are also difficult to quantify when compared to CT and fluoroscopy.

CONCLUSIONCBCT technology in the interventional suite has contributed significant benefits to the patient despite its current limitations. It is a tool that will evolve and potentially become an integral part of imaging guidance for intervention.

Angiography ; Arm ; Cone-Beam Computed Tomography ; Humans ; Imaging, Three-Dimensional ; Tomography, X-Ray Computed

In response to the demands of an ageing nation, the postgraduate medical education in Singapore is currently in the early stage of transition into the American-styled residency programme. This study assessed the expectations of both radiology trainees and faculty on their ideal clinical learning environment (CLE) which facilitates the programme development. A modified 23-item questionnaire was administered to both trainees and faculty at a local training hospital. All items were scored according to their envisioned level of importance and categorised into 5 main CLE domains-supervision, formal training programme, work-based learning, social atmosphere and workload. 'Supervision' was identified as the most important domain of the CLE by both trainees and faculty, followed by 'formal training programmes', 'work-based learning' and 'social atmosphere'. 'Workload' was rated as the least important domain. For all domains, the reported expectation between both trainees and faculty respondents did not differ significantly. Intragroup comparison also showed no significant difference within each group of respondents. This study has provided valuable insights on both respondents' expectations on their ideal CLE that can best train competency in future radiologists. Various approaches to address these concerns were also discussed. The similarities in findings between ours and previous studies suggest that the 'supervision', 'formal training programmes' and 'work-based learning' domains are crucial for the success of a postgraduate medical training and should be emphasised in future curriculum. 'Workload' remains a challenge in postgraduate medical training, but attempts to address this will have an impact in future radiology training.
Attitude of Health Personnel ; Competency-Based Education ; Curriculum ; Education, Medical, Graduate ; methods ; organization & administration ; Faculty, Medical ; Female ; Humans ; Internship and Residency ; methods ; organization & administration ; Male ; Radiology ; education ; Singapore ; Students, Medical ; psychology ; Surveys and Questionnaires ; Workload

This study aimed to examine the distribution of lower limb atherosclerotic lesions in a multi-ethnic Asian cohort with chronic limb threatening ischemia (CLTI) from Singapore. The Society for Vascular Surgery Vascular Quality Initiative registry database was used to identify 265 CLTI patients who underwent percutaneous angioplasty between June 2019 and December 2019, of whom 171 (64.5%) were male, and the mean age was 67.9±11.0 years. The majority were diabetic (84.5%) and 145 (54.7%) had chronic kidney disease (CKD). The majority of the lower limb atherosclerotic lesions were de novo lesions (598/797, 75.0%), predominantly TransAtlantic Inter-Society Consensus II C/D (451/797, 56.6%), and were moderately to severely calcified (76.3%). The anterior tibial artery and femoral-popliteal artery were the most commonly affected vessels. The mean length of the treated lesions was 14.5±13.7 cm. There was a tendency, albeit insignificant, of multi-level disease in those who were diabetic or had CKD.

This study aimed to examine the distribution of lower limb atherosclerotic lesions in a multi-ethnic Asian cohort with chronic limb threatening ischemia (CLTI) from Singapore. The Society for Vascular Surgery Vascular Quality Initiative registry database was used to identify 265 CLTI patients who underwent percutaneous angioplasty between June 2019 and December 2019, of whom 171 (64.5%) were male, and the mean age was 67.9±11.0 years. The majority were diabetic (84.5%) and 145 (54.7%) had chronic kidney disease (CKD). The majority of the lower limb atherosclerotic lesions were de novo lesions (598/797, 75.0%), predominantly TransAtlantic Inter-Society Consensus II C/D (451/797, 56.6%), and were moderately to severely calcified (76.3%). The anterior tibial artery and femoral-popliteal artery were the most commonly affected vessels. The mean length of the treated lesions was 14.5±13.7 cm. There was a tendency, albeit insignificant, of multi-level disease in those who were diabetic or had CKD.

INTRODUCTIONCone beam computed tomography (CBCT) is a relatively new technological innovation that utilises fl at-panel detector technology to obtain CT-like images. The key strength of a CBCT system is that cross-sectional imaging can be obtained using the angiographic fl at panel unit without having to move the patient, allowing the radiologist to obtain soft tissue imaging during the procedure. This allows treatment planning, guidance, and assessment of outcome to be performed in one interventional suite.

MATERIALS AND METHODSFrom December 2008 to June 2009, 24 CBCT scans were performed during vascular interventional procedures on our department's newly installed multi-axis fl at panel angiographic unit.

RESULTSTen cases were performed for hepatic trans-arterial chemoembolisation, 9 cases for hepatic arterial Yttrium-90 infusion, while 5 cases were for other indications. CBCT was found to be useful in 20 of the 24 cases.

CONCLUSIONOur early experience showed that CBCT was useful in impacting decisions during selected vascular interventional procedures. As CBCT technology improves, we can foresee wider applications of this technology.

Aged ; Angiography ; Cone-Beam Computed Tomography ; standards ; Embolization, Therapeutic ; Female ; Humans ; Male ; Medical Audit ; Middle Aged ; Radiology, Interventional ; methods ; Retrospective Studies

Adult ; Arteriovenous Malformations ; therapy ; Embolization, Therapeutic ; methods ; Enbucrilate ; therapeutic use ; Female ; Humans ; Kidney ; blood supply ; Male ; Middle Aged

Enteral Nutrition ; instrumentation ; methods ; Female ; Fluoroscopy ; methods ; Gastrostomy ; adverse effects ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications ; classification ; diagnosis ; therapy ; Reproducibility of Results ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted ; methods ; Treatment Outcome