Journal of Vascular and Interventional Radiology, Feb 1, 2017
developed to predict and evaluate the profitability of the practice in the outpatient setting. To... more developed to predict and evaluate the profitability of the practice in the outpatient setting. To date, much of the focus has been put on predicting initial revenues and costs, while downstream revenues have been only theorized. We want to determine wholesale value from the outpatient VIR practice and if a walk-in clinic would be best if open in or off main hospital campus. Materials: Patients were sorted based on where initial contact with VIR was, and charges and payments were captured based on initial contact location as well as insurance carrier. Additionally, new patients during the last fiscal year were identified and sorted by whether they were soon in the inhospital clinic, or the off campus clinic. These patients were followed and downstream VIR revenues were captured in the form of both imaging and procedures. Results: From 4/1/15 to 3/31/16 groups of 90 patients from off campus clinics and 225 patients from in-hospital clinics were compared. Revenues were gathered and averaged within groups and compared. Average radiology professional revenue was $1126 on average for patients from off campus clinics, and $1717 for in-hospital clinics (po0.001). These values did not include procedural income at this time. These values are representative of where the patients made initial contact with the VIR department, and not where the revenue was specifically generated. Conclusions: There has been much debate as to the overall value of VIR clinics, and how they can add value to both the department and the hospital as a whole. Furthermore if they do add value, how can that value be maximized. Our early results show that more value is generated when patients establish care in in-hospital clinics. This may be from a multitude of factors including more consistent follow up, and quicker turnaround times for imaging and procedures. More research is needed to add procedural value and to further evaluate factors that make in-hospital clinics more value producing than off campus clinics. As VIR departments continue to grow and expand, creating a value producing clinic will be a crucial component.
Improved Physician Ergonomics Using the Attachable Radiation Reduction Extension Support Sheath for Endovascular Procedures
Journal of The American College of Surgeons, Oct 1, 2016
Limb salvage: thrombolysoangioplasty as an alternative to amputation
PubMed, Sep 1, 1993
Objective: This 5-year retrospective study evaluates the results of thrombolysoangioplasty (TLA) ... more Objective: This 5-year retrospective study evaluates the results of thrombolysoangioplasty (TLA) used as an alternative to major amputation in patients with severely debilitating, lower extremity, peripheral vascular disease. All patients in this study were originally designated for major amputation to treat their ischemic symptoms after all other surgical options were exhausted. Materials and methods: Twenty-one limbs in 20 patients with complete occlusions of the superficial femoral, popliteal and at least 2 of the 3 major branches below the popliteal trifurcation were attempted for thrombolysoangioplasty for limb salvage. The majority of patients had previous bypass procedures, and all patients had either nonhealing ischemic ulcers, tissue loss, and/or resting pain. Results: There were no primary failures. 17/21 patients were saved from major amputation. 4/21 patients were changed from an AKA to a BKA. 5/21 patients reoccluded within 1 year. 4/5 were successfully retreated via TLA. 1/5 required a major amputation. Life Table analysis demonstrated 63.6% (+/- 3.72)-12 months and 45.4% (+/- 3.78)-15 months primary patency rates. Limb salvage rates, however, were significantly better. Twenty-four month and 31 month rates of 75.5% (+/- 5.57) and 75.5% (+/- 6.44) were seen for complete limb salvage, respectively, while 24 and 40 months partial limb salvage rates of 94.7% (+/- 3.67) and 94.7% (+/- 4.27) were demonstrated. There were 2 complications; they were both retroperitoneal hemorrhages. Both patients recovered without sequelae. Discussion: In conclusion, these preliminary results indicate that TLA is an effective alternative to major amputation for patients with severely debilitating peripheral vascular disease.
Intraperitoneal barium: Clinical and radiological observations of its long-term effects in 10 patients
Academic Radiology, Dec 1, 1996
Radiofrequency Ablation: An Algorithm for the Treatment of Spinal Mets and Myeloma
Journal of Vascular and Interventional Radiology, Feb 1, 2017
Conclusions: Radiation protection eyewear contains detectable lead on the external surface of the... more Conclusions: Radiation protection eyewear contains detectable lead on the external surface of the lenses and is not encapsulated with any protective material. Caution and handwashing should be performed after direct contact is made with lead containing lenses.
average vertebral station of the bifurcation with IVUS and venography was 4.0 6 1.7 (lower L4) an... more average vertebral station of the bifurcation with IVUS and venography was 4.0 6 1.7 (lower L4) and 2.6 6 1.2 (mid L5) respectively (P < .001). On average, the location of the bifurcation differed by 1.9 6 1.4 (range, 0-7; median, 2) stations between IVUS and venography. IVUS recorded a higher bifurcation in 118 (78%) and lower in 18 (12%). Venography was unable to identify lesion existence in 25% of patients (n ¼ 40). When stenosis was identified on venography, the location of maximum disease (CIV, EIV, CFV) was correctly identified in only 52 patients (33%). In addition, the maximal degree of stenosis varied significantly, with a mean difference of 28.8% between venogram and IVUS (P < .001). The average degree of stenosis by venogram was 32.4 6 26.2 and by IVUS was 50.0 6 20.6. Overall, the degree of stenosis was underestimated by venogram in 68.8% of patients. Conclusions: The location of the iliocaval bifurcation varies substantially, averaging almost one full vertebral level between IVUS and venography. Relying on venography may result in the possibility of a missed proximal CIV lesion in up to 78% and inadvertent jailing of the contralateral limb in up to 12% of patients. In addition, the anatomical characteristics of venous lesions including degree and location of maximal disease were not accurately identified with venography. IVUS remains imperative for accurate diagnosis, disease characterization, and intraoperative treatment guidance.
Journal of Vascular and Interventional Radiology, 1995
Abbreviations: CIA = common iliac artery, EIA =external iliac artery, IIA =internal iliac artery,... more Abbreviations: CIA = common iliac artery, EIA =external iliac artery, IIA =internal iliac artery, PTT = partial thromboplastin time, SVS = Society for Vascular Surgery, UK = urokinase The role of percutaneous angioplasty in the management of chronic iliac artery occlusions is controversial. This article reviews 7 years of experience in treating patients with complete chronic iliac artery occlusions (n = 99) by using thrombolysis and angioplasty. Patients were not excluded due to age or length of the lesion, or severity of underlying peripheral vascular disease. Thrombolysis was conducted with infusion of urokinase at a rate of 60,000-80,000 IUIh for 24 hours. Angioplasty was then performed irrespective of the results of thrombolysis. Seventy-nine percent of patients responded to urokinase, with complete lysis achieved in 55%. Angioplasty was successful in all patients with complete thrombolysis and in 88% of those with partial thrombolysis. The overall success rate was 86%, and more than 80% of surviving patients were symptom free at 5 years. There were seven complications, and the 30-day mortality rate was 2%. Our present results confirm the efficacy of thrombolysislangioplasty for chronic arterial occlusions.
PURPOSE: To evaluate observers' ability to identify simulated nodules placed electronically on no... more PURPOSE: To evaluate observers' ability to identify simulated nodules placed electronically on normal contrast enhanced liver CT backdrops. Specifically, we sought to assess the impact of lesion size and polarity on detection and localization performance.
average vertebral station of the bifurcation with IVUS and venography was 4.0 6 1.7 (lower L4) an... more average vertebral station of the bifurcation with IVUS and venography was 4.0 6 1.7 (lower L4) and 2.6 6 1.2 (mid L5) respectively (P < .001). On average, the location of the bifurcation differed by 1.9 6 1.4 (range, 0-7; median, 2) stations between IVUS and venography. IVUS recorded a higher bifurcation in 118 (78%) and lower in 18 (12%). Venography was unable to identify lesion existence in 25% of patients (n ¼ 40). When stenosis was identified on venography, the location of maximum disease (CIV, EIV, CFV) was correctly identified in only 52 patients (33%). In addition, the maximal degree of stenosis varied significantly, with a mean difference of 28.8% between venogram and IVUS (P < .001). The average degree of stenosis by venogram was 32.4 6 26.2 and by IVUS was 50.0 6 20.6. Overall, the degree of stenosis was underestimated by venogram in 68.8% of patients. Conclusions: The location of the iliocaval bifurcation varies substantially, averaging almost one full vertebral level between IVUS and venography. Relying on venography may result in the possibility of a missed proximal CIV lesion in up to 78% and inadvertent jailing of the contralateral limb in up to 12% of patients. In addition, the anatomical characteristics of venous lesions including degree and location of maximal disease were not accurately identified with venography. IVUS remains imperative for accurate diagnosis, disease characterization, and intraoperative treatment guidance.
Catheterization and Cardiovascular Interventions, 2019
Objectives: Investigation of novel vertical radiation shield (VRS) in reducing operator radiation... more Objectives: Investigation of novel vertical radiation shield (VRS) in reducing operator radiation exposure. Background: Radiation exposure to the operator remains an occupational health hazard in the cardiac catheterization laboratory (CCL). Methods: A mannequin simulating an operator was placed near a computational phantom, simulating a patient. Measurement of dose equivalent and Air Kerma located the angle with the highest radiation, followed by a common magnification (8 in.) and comparison of horizontal radiation absorbing pads (HRAP) with or without VRS with two different: CCL, phantoms, and dosimeters. Physician exposure was subsequently measured prospectively with or without VRS during clinical procedures. Results: Dose equivalent and Air Kerma to the mannequin was highest at left anterior oblique (LAO)-caudal angle (p < .005). Eight-inch magnification increased mGray by 86.5% and μSv/min by 12.2% compared to 10-in. (p < .005). Moving 40 cm from the access site lowered μSv/min by 30% (p < .005). With LAO-caudal angle and 8-in. magnification, VRS reduced μSv/min by 59%, (p < .005) in one CCL and μSv by 100%
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Papers by Gregory Gordon