The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production.Technical documents specifying the exact consensus and literature review methodologies as well as the institutional affiliations and professional credentials of the authors of this document are available upon request from SIR, 3975 Fair Ridge Dr., Suite 400 N., Fairfax, VA 22033.
METHODOLOGYSIR produces its Standards of Practice documents using the following process. Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the standard. Additional authors may be assigned dependent upon the magnitude of the project.An in-depth literature search is performed using electronic medical literature databases. Then, a critical review of peer-reviewed articles is performed with regard to the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds (Fig E1 and Table E1, available online at www.jvir.org).When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members using a modified Delphi consensus method (Appendix A). For purposes of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter.The draft document is critically reviewed by the Standards of Practice Committee members by telephone conference calling or face-to-face meeting. The finalized draft from the Committee is sent to the SIR membership for further input/criticism during a 30-day comment period. These comments are discussed by the Standards of Practice Committee, and appropriate revisions are made to create the finished standards document. Prior to its publication, the document is endorsed by the SIR Executive Council.
In cases in which it is suspected that polyhydramnios is due to anomalies of the digestive tract, the absence of fluid in the fetal gastrointestinal tract suggests the diagnosis of esophageal atresia. This diagnosis can be made by observing the alternating filling and emptying of the esophagus proximal to the site of atresia.
CASE 1A 28-year-old woman gravida 111, para 11, was referred to our hospital because of a uterus too big for dates, which by palpation was 37-weeks size. The ultrasound scan showed polyhydramnios and a biparietal diameter (BPD) of 86 mm, equivalent to 33 weeks, which corresponded to her last menstrual period. Absence of fluid in the stomach and intestine ( Fig. 1) was noted in the fetus. As the study was performed with real-time and recorded on video tape, an alternating filling and emptying of a large proximal esophagus was seen (Figs. 2 and 3), suggesting esophageal atresia Type I as the most probable diagnosis (Type I Ladd's classification: esophageal atresia without tracheoesophageal fistula). 'I2 The umbilical cord contained two vessels and the alpha feto protein in amniotic fluid was just above the upper limit of normal. No other fetal abnormality was found.Spontaneous vaginal delivery took place 5 days after the ultrasound study was performed, resulting in the birth of a female baby weighing 2120 g. After birth the esophageal atresia was clinically confirmed and a thoracoabdominal radiograph showed a distended gastric chamber with air and a gasless intestine (Fig. 4). This finding changed the diagnosis made before delivery from Type I esophageal atresia to esophageal atresia with
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