of attempts, confirming the feasibility of EM-guided tar-geted vessel puncture for intrahepatic shunt creation in ananimal model.

Abstract No. 437

In Vitro Evaluation and Comparison of Y-ConnectorHemostatic Flow Devices.G. Bartal, Meir MC, Kfar Saba, Israel � E. Haytman � A.Belenky

PURPOSE: Complex endovascular procedures require useof hemostatic flow-control devices during insertion, han-dling at high pressure and removal of diagnostic and inter-ventional tools. Y-connectors allow intraprocedural flushingwith heparin and saline in order to avoid in-catheter clottingand potential emboli. Our aim was in vitro evaluation andcomparison of 3 new generation Y-connector hemostaticflow devices.

MATERIALS AND METHODS: We compared a new Y-connector hemostatic flow-valve system (Y-Click, ElcamMedical, BarAm, Israel) with two commercially availablecomparable devices CoPiloT® (Guidant) and SuperKetch(MinVasys). Each device has various degrees of sealing.We evaluated high pressure withstand (Medrad automaticinjector at 1200 psi, 20 mL/sec) and low pressure withstand(CompuFlow-1000 using positive sinus blood pressurewaves of 50-200 mmHg). The assessment was made usinga 6-F guiding catheter, without and with 0.014 inch and0.025 inch guide wires.

RESULTS: There was no leakage at maximum backpressurewithout guide wire in closed position from any device. Withguide wire: Y-click device did not leak at any pressureincluding semi-open position, while SuperKetch leaked atclosed position and CoPilot leaked if not tightly screwed.All evaluated devices performed well at low pressure with-stand. Y-Click allowed easy handling when semi-open, andclear indication of valve position.

CONCLUSION: All three evaluated devices withstood thein vitro evaluation well. Y-Click had an advantage at high-pressure in semi-open position. Y-connector hemostaticflow devices allow safe continuous flushing, coaxial guidewire and microcatheter manipulation and exchange withoutleakage of saline or blood. Clinical evaluation is underway.

Other: Education and Training

Abstract No. 438 EE

Third Party Payor Audits: Strategic Approaches to Au-dits and Compliance Strategies to Avoid Third PartyPayor Audits.A.B. Wachler, Wachler & Associates, P.C., Royal Oak, MI,USA

PURPOSE: The presentation will address new develop-ments in the area of third party payor audits. Specifically,the presentation will focus on compliance risk areas facingradiology providers and will address recent areas of auditactivity initiated by third party payors. Additionally, thepresentation will address successful appeal strategies thatcan be used when a provider is faced with a third partypayor audit. This portion of the presentation will include adiscussion of the recent changes to the Medicare appealsregulations, which impact the appeals process for Medicareproviders. The presentation will also address proactive com-

pliance strategies a provider should adopt to avoid thirdparty payor audits.

MATERIALS AND METHODS: The presentation formatwill be lecture, PowerPoint presentation and discussion.

TEACHING POINTS: Attendees to this presentation willlearn: The primary compliance risk areas facing radiologyproviders; successful appeals strategies that can be usedshould a provider be faced with a third party payor audit;and proactive compliance strategies to adopt to avoid thirdparty payor audits.

Abstract No. 439

Alternative IR Education: Different Perspectives be-tween IR Fellowship and Radiology Residency ProgramDirectors.W. Swee, University of Virginia Health System, Charlottes-ville, VA, USA � J.F. Angle � A.H. Matsumoto � K.D. Hag-spiel � U.C. Turba � S.B. Gay, et al.

PURPOSE: To identify differences in attitude between IR-PDs (IR Fellowship Program Directors) and RRPDs (Radi-ology Residency Program Directors) toward the role ofalternative pathways in IR Education.

MATERIALS AND METHODS: An online survey was dis-tributed to all IRPDs and RRPDs in the U.S. and Canada.Descriptions of the Traditional, Clinical, and DIRECT Path-ways as well as a proposed Primary Certificate in IR wereprovided. Most responses were scored on a 5-point ordinalscale. The mean score and 95% CI were calculated for eachvariable. Differences between groups were analyzed usingone way analysis of variance.

RESULTS: The IRPD response rate was 78% (69/89) andthe RRPD response rate was 49% (92/188). IRPDs believethat traditional training is ineffective in preparing IRs tocompete in the open market, whereas RRPDs believe that itis sufficient. IRPDs feel more strongly that traditional train-ing provides too little clinical management and too muchdiagnostic imaging. (p � 0.05 for all) Both groups agreethat the alternative pathways provide more appropriateamounts of clinical management, however, RRPDs are farmore concerned that there is inadequate diagnostic imaging.(p � 0.05) Both groups agree that major barriers to imple-menting alternative pathways include funding, administra-tive support, and integration with diagnostic radiology. IR-PDs believe that alternative pathways should play a majorrole in IR education and that promotion of alternative path-ways should be a priority, whereas RRPDs remain neutral.IRPDs remain neutral regarding the creation of a primarycertificate in IR, whereas RRPDs strongly oppose it (p �0.05 for all). Both groups agree that IR should not separatefrom diagnostic radiology. Finally, IRPDs believe that themajor portion of IR recruiting efforts should be directedtowards medical students in contrast to RRPDs who believethat most efforts should be directed toward radiology resi-dents (p � 0.05).

CONCLUSION: Significant differences in opinion exist re-garding the adequacy of traditional IR training and the roleof alternative pathways which emphasize clinical manage-ment. These differences may hinder advancements in IReducation and should be actively addressed.

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Abstract No. 440 EE

Protective Strategies to Limit Collateral Injury duringThermal Tumor Ablation in the Abdomen.C. Anaya, UCLA Medical Center, Los Angeles, CA, USA �A.M. Gomez � S. Raman � D. Lu

PURPOSE: Radiofrequency ablation is a minimally inva-sive therapeutic modality that continues to gain acceptabil-ity in the medical community due to its proven efficacy andsafety. In the abdomen, its main current uses are primaryand metastatic non-resectable hepatic and renal tumors.Appropriate lesion characterization and patient selectioncontinue to represent the main instrument of clinical suc-cess. As experience grows, new techniques are developedthat allow the treatment of lesions previously unsuitable forpercutaneous therapy due to their proximity to critical struc-tures. The gallbladder, bile ducts, small bowel and colon areparticularly susceptible to non-target thermal damage. Otherstructures such as diaphragm, stomach, renal collecting sys-tem, ureters and peripheral nerves (genitofemoral nerve) arealso at risk for such thermal injuries. We present our initialexperience performing these protective strategies duringRFA.

MATERIALS AND METHODS: We present a comprehen-sive illustrated review of the various techniques that havebeen described to protect the non-target adjacent abdominalorgans, making possible the safe treatment of difficult totreat tumors due to their sensitive location. The techniquesdiscussed and illustrated include: Patient positioning; hy-drodisplacement; intra-ureteral and intra-biliary hydroinfu-sion; use of curved electrodes; balloon catheter interposi-tion; temperature monitioring and the combination ofablative therapies. These techniques are applied when thetarget tumor is immediately adjacent to a non target organ.Our series includes the use of the above mentioned tech-niques to protect the diaphragm, stomach, colon, smallbowel, gallbladder, renal pelvis and calyces, ureters andbiliary ducts.

TEACHING POINTS: 1. Review the utilization of varioustechniques to protect adjacent organs from non-target ther-mal damage during radiofrequency ablation. 2. Demonstratethe utilization and applicability of these various techniqueswith emphasis on our own experience. 3. Demonstrate thepotential of novel techniques such as bowel hydro-displace-ment, balloon interposition, temperature monitoring withThermister, and ureteral cold fluid infusion.

Abstract No. 441 EE

Healthcare Legal Issues Impacting Radiology Providers.A.B. Wachler, Wachler & Associates, P.C., Royal Oak, MI,USA

PURPOSE: The proposed presentation will address the fol-lowing points of topic: A discussion of the federal statutesimpacting radiology practices, including the Federal Anti-Kickback statute and Federal Stark law; An overview of thecorporate practice of medicine doctrine and its applicabilityto radiology practices; and Other compliance issues facingradiology practices.

MATERIALS AND METHODS: The proposed presentationwill be given via lecture, PowerPoint presentation, anddiscussion.

TEACHING POINTS: The proposed presentation will ad-dress the following points of topic: A discussion of thefederal statutes impacting radiology practices, including the

Federal Anti-Kickback statute and Federal Stark law; Anoverview of the corporate practice of medicine doctrine andits applicability to radiology practices; and Other compli-ance issues facing radiology practices.

Abstract No. 442 EE

Online Interventional Radiology Training Manual forFellows and Residents: A Modern Approach to an OldSolution.M.W. Kringlen, University of Virginia, Charlottesville, VA,USA � J.R. Ramkaransingh � P.T. Norton � J.F. Angle

PURPOSE: The practice of interventional radiology re-quires a set of skills different from those learned in adiagnostic radiology residency. Rapid assimilation of thisnew skill set is critical for interventional residents andfellows. Clinical and technical references are often neces-sary at the bed side or in the procedure room. Commercial-ly-available handbooks serve as a valuable resource but lackinstitution-specific information. A single-institution hand-book can be helpful in educating the trainees about site-specific practices, but the cost and time required for creatingand updating such a manual are nearly prohibitive. In ad-dition, there is a notable lack of images within these hand-books. We developed an educational web site which hasovercome the shortcomings in traditional written hand-books.

MATERIALS AND METHODS: A website was createdbased on an existing institutional-specific IR handbook. Theinterface is easily navigable allowing the user to rapidlylocate information regarding procedures. Information avail-able on-line also includes clinical protocols, device descrip-tions, and key images for learning procedure technique. Thesite provides links to our teaching file, current relevantarticles, and other on-line material.

TEACHING POINTS: 1) There is increasing demand forup-to-date on-line educational materials. 2) The practice ofIR is increasingly protocol driven with a need for a methodto easily distribute protocols. 3) Current handbooks lacksite-specific content and relevant images needed to masterthe practice of IR. 4) Interactive, multi-modality educationis valuable and desirable in interventional radiology.

Abstract No. 443 EE

A Low Cost Teaching Phantom for Image-guided Inter-ventions.M. Eesa, All India Institue of Medical Sciences, New Delhi,Delhi, India � D.N. Srivastava

PURPOSE: To describe the utility of a low cost homemadephantom for training in image-guided interventional tech-niques.

MATERIALS AND METHODS: A phantom for trainingresidents in intervention techniques was constructed usingcommonly available household materials such as gelatinand corn flour. Materials simulating focal lesions such astarget lesions (stuffed olives) and cysts (water-filled, tiedglove fingers) were introduced into the substance of thephantom. The properties of the phantom with respect tostability, optimum visualization of background substance aswell as the simulated focal lesions were studied using ul-trasound as well as CT. The signal characteristics of thephantom were studied on routine abdominal MR sequences.The applicability of interventional procedures such as bi-opsy as well as cyst aspiration in the phantom was studied.

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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.

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