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CAQ process for vascular and interventional radiology (VIR)
JVIR
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Posters and Exhibits
S183
for accurate visual estimation. Lesions were categorized by clinical significance (o60% insignificant, 60-80% significant, 480% severe). SVE was compared for agreement by weighted kappa statistics. Reliability was assessed by intraclass correlation. Results: Overall accuracy of SVE in grading stenosis was 28.3% and 27.4% for the two assessments. Errors in excess of þ/- 5% occurred in 71.7% and 72.6% respectively. Agreement with respect to clinical category was fair with a weighted kappa of 0.579 in the first testing session and 0.588 in the second. 92.6% and 93.8% of severe lesions, 40.9% and 41.5% of significant lesions and 71.5% and 73.3% of insignificant lesions were correctly identified in the first and second sessions respectively. In the first session 53.0% of significant and 4.4% of insignificant lesions were categorized as severe stenosis. 49.9% of significant lesions and 4.6% of insignificant lesions were overestimated as severe in the second session. Intra-rater reliability was good (0.990) and inter-rater reliability was fair for assessment of peripheral arteries (0.823, 0.809), and carotids (0.748, 0.708). Accuracy did not differ in relation to years of experience or specialty. Conclusion: Despite good intra-observer reliability, interobserver reliability was fair. Estimation of peripheral arterial stenosis often results in overestimation of stenosis, most pronounced in the 60-80% range. There were no significant differences based on years of experience in practice or specialty. Visual estimates of stenosis potentially lead to therapeutic decisions based on inaccurate information.
Abstract No. 419 Survey of SIR members on the certification/CAQ process for vascular and interventional radiology (VIR) C. Chao1, A.C. Roberts2, T. Kinney2; 1Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; 2Interventional Radiology, University of California, San Diego Medical Center, La Jolla, CA
Educational Exhibit
Abstract No. 420
Contemporary review of image-guided celiac plexus and splanchnic nerve blockade S.P. Zivin1, J. Minocha1, M. Ginsburg2, J.T. Bui1, R. C. Gaba1; 1Radiology, University of Illinois at Chicago (UIC), Chicago, IL; 2Radiology, University of Chicago, Chicago, IL Learning Objectives: 1. To describe the relevant anatomy, indications, contraindications, and different techniques for performing image-guided celiac plexus and splanchnic nerve blocks2. To critically review the scientific literature supporting the use of celiac and splanchnic blockade for various clinical indications Background: Percutaneous visceral plexus blockade under image guidance is a safe and effective procedure for pain palliation in patients who have chronic abdominal pain, with celiac plexus block applied most commonly. Procedure indications include pain related to advanced cancer, chronic pancreatitis, and analgesia for major biliary interventions. Multiple modalities may be utilized for the procedure, with computed tomography (CT) the most frequently used, and followed by ultrasound and fluoroscopy. The goal of this exhibit is to increase the Interventional Radiologist’s (IR’s) awareness regarding the potential role, current standards, and technical performance of celiac and splanchnic nerve blockade. Clinical Findings/Procedure Details: The relevant aspects of patient selection, procedural technique, medications and therapeutic agents utilized, and post-procedure expectations will be described, with detailed review of the scientific literature. Procedures will be illustrated with case examples. 1. Anatomy, including celiac ganglia, superior mesenteric ganglia, and aorticorenal ganglia for appropriate targeting 2. Procedure indications and contraindications. 3. Technique and drugs, including description of the posterior paraspinous approach and anterior approach, as well as medication regimens and neurolytic solution preparation and administration. 4. Complications and adverse side effects5. Procedure-specific efficacy of celiac and splanchnic nerve blocks. Conclusion and/or Teaching Points: There is increasing performance of nerve blocks by IRs for a wide variety of patients, requiring an up to date knowledge of the relevant anatomy, technical approaches, and expectations. This exhibit
Posters and Exhibits
Purpose: We surveyed the SIR membership for their opinion of the certification/CAQ process and recertification for Interventional Radiology including the benefits and burdens of the process. Materials and Methods: A 19 question anonymous electronic survey was sent to all active physicians of SIR via an SIR email. The survey was open from August 16 to September 24, 2013. The survey was approved by the SIR MOC Subcommittee and received an IRB exemption. The survey inquired as to background of the participant (CAQ holder, practice type), reason for taking or not taking the CAQ, benefit of the CAQ, plans on recertification and reasons for that decision and the value of the CAQ/MOC process. Results: We received 599 complete responses out of 3,165 emailed active members . The vast majority (80%) obtained the CAQ for VIR, spend on average 93% of their time on VIR and are in private practice (69%). The chief reason cited for taking the CAQ was its educational value (68%) followed by beneficial with turf issues (56%). Participants thought the CAQ helped with education (52%), but most thought it did not help with employment (62%), turf issues (85%) and reimbursement (90%). The most common reason for not taking the CAQ
was it was not required for their practice (58%) followed by did not help their practice (51%). The majority plan on recertifying (76%). Among those not planning on recertifying, the chief reason was it did not help with their practice (71%). The leading minority (40%) thought the CAQ/MOC was important for their practice and future of VIR. The respondents were almost evenly split as to whether the CAQ/MOC process appropriately evaluates knowledge in VIR. Conclusion: The vast majority of the SIR active physician members plan on recertifying, but most did not believe it helped with employment, turf issues or reimbursement. A majority thought the CAQ helped with education. The leading reason for not recertifying was it did not help with their practice. Respondents were divided as to whether the CAQ/ MOC process appropriately evaluates knowledge in VIR.
’
Posters and Exhibits
S183
for accurate visual estimation. Lesions were categorized by clinical significance (o60% insignificant, 60-80% significant, 480% severe). SVE was compared for agreement by weighted kappa statistics. Reliability was assessed by intraclass correlation. Results: Overall accuracy of SVE in grading stenosis was 28.3% and 27.4% for the two assessments. Errors in excess of þ/- 5% occurred in 71.7% and 72.6% respectively. Agreement with respect to clinical category was fair with a weighted kappa of 0.579 in the first testing session and 0.588 in the second. 92.6% and 93.8% of severe lesions, 40.9% and 41.5% of significant lesions and 71.5% and 73.3% of insignificant lesions were correctly identified in the first and second sessions respectively. In the first session 53.0% of significant and 4.4% of insignificant lesions were categorized as severe stenosis. 49.9% of significant lesions and 4.6% of insignificant lesions were overestimated as severe in the second session. Intra-rater reliability was good (0.990) and inter-rater reliability was fair for assessment of peripheral arteries (0.823, 0.809), and carotids (0.748, 0.708). Accuracy did not differ in relation to years of experience or specialty. Conclusion: Despite good intra-observer reliability, interobserver reliability was fair. Estimation of peripheral arterial stenosis often results in overestimation of stenosis, most pronounced in the 60-80% range. There were no significant differences based on years of experience in practice or specialty. Visual estimates of stenosis potentially lead to therapeutic decisions based on inaccurate information.
Abstract No. 419 Survey of SIR members on the certification/CAQ process for vascular and interventional radiology (VIR) C. Chao1, A.C. Roberts2, T. Kinney2; 1Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; 2Interventional Radiology, University of California, San Diego Medical Center, La Jolla, CA
Educational Exhibit
Abstract No. 420
Contemporary review of image-guided celiac plexus and splanchnic nerve blockade S.P. Zivin1, J. Minocha1, M. Ginsburg2, J.T. Bui1, R. C. Gaba1; 1Radiology, University of Illinois at Chicago (UIC), Chicago, IL; 2Radiology, University of Chicago, Chicago, IL Learning Objectives: 1. To describe the relevant anatomy, indications, contraindications, and different techniques for performing image-guided celiac plexus and splanchnic nerve blocks2. To critically review the scientific literature supporting the use of celiac and splanchnic blockade for various clinical indications Background: Percutaneous visceral plexus blockade under image guidance is a safe and effective procedure for pain palliation in patients who have chronic abdominal pain, with celiac plexus block applied most commonly. Procedure indications include pain related to advanced cancer, chronic pancreatitis, and analgesia for major biliary interventions. Multiple modalities may be utilized for the procedure, with computed tomography (CT) the most frequently used, and followed by ultrasound and fluoroscopy. The goal of this exhibit is to increase the Interventional Radiologist’s (IR’s) awareness regarding the potential role, current standards, and technical performance of celiac and splanchnic nerve blockade. Clinical Findings/Procedure Details: The relevant aspects of patient selection, procedural technique, medications and therapeutic agents utilized, and post-procedure expectations will be described, with detailed review of the scientific literature. Procedures will be illustrated with case examples. 1. Anatomy, including celiac ganglia, superior mesenteric ganglia, and aorticorenal ganglia for appropriate targeting 2. Procedure indications and contraindications. 3. Technique and drugs, including description of the posterior paraspinous approach and anterior approach, as well as medication regimens and neurolytic solution preparation and administration. 4. Complications and adverse side effects5. Procedure-specific efficacy of celiac and splanchnic nerve blocks. Conclusion and/or Teaching Points: There is increasing performance of nerve blocks by IRs for a wide variety of patients, requiring an up to date knowledge of the relevant anatomy, technical approaches, and expectations. This exhibit
Posters and Exhibits
Purpose: We surveyed the SIR membership for their opinion of the certification/CAQ process and recertification for Interventional Radiology including the benefits and burdens of the process. Materials and Methods: A 19 question anonymous electronic survey was sent to all active physicians of SIR via an SIR email. The survey was open from August 16 to September 24, 2013. The survey was approved by the SIR MOC Subcommittee and received an IRB exemption. The survey inquired as to background of the participant (CAQ holder, practice type), reason for taking or not taking the CAQ, benefit of the CAQ, plans on recertification and reasons for that decision and the value of the CAQ/MOC process. Results: We received 599 complete responses out of 3,165 emailed active members . The vast majority (80%) obtained the CAQ for VIR, spend on average 93% of their time on VIR and are in private practice (69%). The chief reason cited for taking the CAQ was its educational value (68%) followed by beneficial with turf issues (56%). Participants thought the CAQ helped with education (52%), but most thought it did not help with employment (62%), turf issues (85%) and reimbursement (90%). The most common reason for not taking the CAQ
was it was not required for their practice (58%) followed by did not help their practice (51%). The majority plan on recertifying (76%). Among those not planning on recertifying, the chief reason was it did not help with their practice (71%). The leading minority (40%) thought the CAQ/MOC was important for their practice and future of VIR. The respondents were almost evenly split as to whether the CAQ/MOC process appropriately evaluates knowledge in VIR. Conclusion: The vast majority of the SIR active physician members plan on recertifying, but most did not believe it helped with employment, turf issues or reimbursement. A majority thought the CAQ helped with education. The leading reason for not recertifying was it did not help with their practice. Respondents were divided as to whether the CAQ/ MOC process appropriately evaluates knowledge in VIR.