Joe Khoury's research while affiliated with Connecticut Children's Medical Center and other places

Radiation induced cholecystitis is a known but rare complication of Yttrium90 (Y90) radioembolization of hepatic tumors due to nontarget embolization. Many documented cases of radiation induced cholecystitis have been treated with cholecystectomy, which is significant given the typical patient population undergoing radioembolization tends to be of higher surgical risk. Here, we present a case of a 68 year old male who developed radiation induced cholecystitis status post hepatic radioembolization that resolved with conservative management alone. This case highlights that radiation induced cholecystitis may be successfully and safely treated conservatively.

Catheter-based interventions are relatively rare in the neonate population but serve as an invaluable tool in managing many pathologies. Here we present a case report of a neonate with a vascular hepatic tumor managed by embolization via transumbilical access. In neonates, the small size of the common femoral artery makes cannulation difficult and is thought to increase the risk of catheter-associated thrombosis and ischemia. Often, these patients reside in the neonatal intensive care unit (NICU) and already have an umbilical artery catheter (UAC) in place, which can be used as an effective alternative route of vascular access to carry out life-saving interventions.

Purpose: Hemorrhoidal disease is a prevalent anorectal condition causing rectal bleeding with bowel movements, resulting in a significant reduction in quality of life. Hemorrhoids involve a dense anastomotic network known as the corpus cavernosum recti, which is primarily supplied by the superior rectal artery (SRA), a branch of the inferior mesenteric artery. Conservative treatments and surgical procedures have limitations and associated complications. Endovascular embolization of the SRA has emerged as an alternative, but its safety and efficacy with 500- to 700-µm Embospheres remain underexplored. It is theorized that the smaller beads, compared with larger beads and coils, embolize deeper into the capillary bed and result in complete occlusion of the vessel and more effective improvement. Material and Methods: We retrospectively analyzed patients who underwent hemorrhoid embolization between 2018 and 2022 at two different institutions. Collected data include age, gender, hemorrhoid grade, number of embolized vessels, Hemorrhoidal Symptom Severity (HSS) scores, amount of embolics injected, and adverse events. HSS scores were assessed before and 6 months after hemorrhoid embolization. Results: Fourteen patients (8 males, 6 females), with a mean age of 67 years, were included in the study. The study population had a mean of grade 3 hemorrhoids, and on average, 3.29 vessels were embolized with coils before Embosphere injection. HSS scores were significantly reduced from 12.64 (standard deviation [SD], 3.05) to 6.64 (SD, 3.05) at 6-month follow-up (P < .05). No complications were reported by the patients. Conclusions: Endovascular embolization using 500- to 700-µm Embospheres for hemorrhoid treatment demonstrates promising outcomes. Further studies with larger cohorts are warranted to confirm these findings and establish the safety and efficacy of this approach in the management of hemorrhoidal disease. The use of Embospheres in endovascular embolization presents an exciting avenue for future research and may offer a less invasive and more effective treatment option for patients with hemorrhoidal disease

Purpose: Interventional radiology (IR) is a niche field that lacks significant exposure opportunities for medical students. Thus, extracurricular involvement in IR-specific workshops plays an important role in introducing the field to medical students. To quantify the effectiveness of such workshops, a detailed evaluation of the educational impact on medical students after an IR-focused, hands-on ultrasound workshop was conducted. The objective of this study was to investigate the impact of this workshop on medical students’ knowledge and interest in IR. Material and Methods: Medical students voluntarily participated in an IR-focused, hands-on ultrasound skills workshop at North Shore University Hospital. Directly before and after the workshop, the students were asked the same five questions related to their knowledge and interest in IR, with answers provided along a 5-point Likert scale. A two-sample, two-tailed t-test was performed using the pre- and postworkshop responses to detect significant improvements along these five criteria. Results: The students in this study (n = 18) attended the Zucker School of Medicine (n = 15) and NYIT College of Osteopathic Medicine (n = 3). Fifteen students were MS1 students, two were MS2 students, and one was an MS3 student. A two-sample, two-tailed t-test was performed with an acceptable false-positive rate (α) of 0.05. Confidence about knowledge on vascular access sites used in IR improved from a presurvey mean of 1.33 to 3.94 postsurvey (P < .05). Comfortability in identifying anatomic structures on ultrasound examination improved from a presurvey mean of 2.61 to 3.72 postsurvey (P < .05). Comfortability in performing ultrasound-guided procedures improved from a presurvey mean of 1.67 to 4 postsurvey (P < .05). Knowledge of the Seldinger technique improved from a presurvey mean of 1.11 to 3.72 postsurvey (P < .05). The likelihood of applying to residency in IR improved from a presurvey mean of 2.5 to 3.33 postsurvey (P < .05). Conclusions: A significant improvement was observed in the knowledge and interest in IR among the cohort of students across five metrics. This study demonstrates that an IR-focused workshop can effectively educate medical students in IR and seed interest in the field. These results support the utility of such workshops in educating medical students in a field that is sparsely discussed in the conventional medical curriculum.

Interventional radiology (IR) plays a unique and often invaluable role in the care of pregnant patients. Special considerations regarding radiation exposure and medication choice must be taken into account when evaluating a pregnant patient for an interventional procedure. In addition, the physiologic changes that occur during pregnancy can pose special challenges for an interventionalist when treating this patient population and should be appropriately recognized. Still, the majority of standard IR procedures can be safely performed in the pregnant population, often with additional precautions and proper patient education about the risks, benefits, and alternatives. In many cases, interventional radiologists can provide lifesaving and fertility-preserving alternatives to more invasive surgical intervention. The authors summarize radiation exposure effects and guidelines and medication choice during pregnancy. The physiologic changes that occur during pregnancy are discussed, with specific interest in the pathologic consequences that can be treated with IR. The authors also describe a wide variety of minimally invasive image-guided procedures offered by IR in pregnant, peripartum, or postpartum patients. The areas where IR can help in the treatment of pregnant patients include venous access, biopsies, genitourinary and biliary interventions, venous thromboembolism treatments, ectopic pregnancy management, aneurysm intervention, and management of trauma patients. IR is also involved in management during the peripartum or postpartum periods, with roles in treatment of invasive placenta spectrum, postpartum hemorrhage after vaginal delivery, and postcesarean delivery complications. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.