Physicians' diagnoses and admission decisions changed frequently after CT, and diagnostic uncertainty was alleviated.

Coronary artery perforation as a complication of PCI is still rare as demonstrated in our series with an incidence of 0.48%. The predominant cause of coronary perforations in the current era of PCI is wire injury.

Despite growing concerns regarding medical radiation exposure, there is still limited awareness of radiation-induced cancer risks among patients and physicians. There is also no consensus regarding who should provide patients with relevant information, as well as in what specific situations and exactly what information should be communicated. Radiologists should prioritize development of consensus statements and novel educational initiatives with regard to radiation-induced cancer risk awareness and communication.

Purpose:To demonstrate a limitation of lifetime radiation-induced cancer risk metrics in the setting of testicular cancer surveillance-in particular, their failure to capture the delayed timing of radiation-induced cancers over the course of a patient's lifetime. Materials and Methods:Institutional review board approval was obtained for the use of computed tomographic (CT) dosimetry data in this study. Informed consent was waived. This study was HIPAA compliant. A Markov model was developed to project outcomes in patients with testicular cancer who were undergoing CT surveillance in the decade after orchiectomy. To quantify effects of early versus delayed risks, life expectancy losses and lifetime mortality risks due to testicular cancer were compared with life expectancy losses and lifetime mortality risks due to radiation-induced cancers from CT. Projections of life expectancy loss, unlike lifetime risk estimates, account for the timing of risks over the course of a lifetime, which enabled evaluation of the described limitation of lifetime risk estimates. Markov chain Monte Carlo methods were used to estimate the uncertainty of the results. Results:As an example of evidence yielded, 33-year-old men with stage I seminoma who were undergoing CT surveillance were projected to incur a slightly higher lifetime mortality risk from testicular cancer (598 per 100 000; 95% uncertainty interval [UI]: 302, 894) than from radiation-induced cancers (505 per 100 000; 95% UI: 280, 730). However, life expectancy loss attributable to testicular cancer (83 days; 95% UI: 42, 124) was more than three times greater than life expectancy loss attributable to radiationinduced cancers (24 days; 95% UI: 13, 35). Trends were consistent across modeled scenarios. Conclusion:Lifetime radiation risk estimates, when used for decision making, may overemphasize radiation-induced cancer risks relative to short-term health risks.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Percutaneous renal artery stenting is a common means of treating atherosclerotic renal artery stenosis. However, renal artery restenosis remains a frequent problem. The optimal treatment of restenosis has not been established and may involve percutaneous renal artery angioplasty or deployment of a second stent. Other modalities include cutting balloon angioplasty, repeat stenting with drug-eluting stents or endovascular brachytherapy. Most recently, use of polytetrafluoroethylene (PTFE)-covered stents may offer a new and innovative way to treat recurrent renal artery stenosis. We describe a case in a patient who initially presented with renal insufficiency and multi-drug hypertension in the setting of severe bilateral renal artery stenosis. Her renal artery stenosis was initially successfully treated by percutaneous deployment of bilateral bare metal renal artery stents. After initial improvement of her hypertension and renal insufficiency, both parameters declined and follow-up duplex evaluation confirmed renal artery in-stent restenosis. Owing to other medical co-morbidities she was felt to be a poor surgical candidate and was subsequently treated first with bilateral cutting balloon angioplasty and second with drug-eluting stent deployment. Each procedure was associated with initial improvement of renal function and blood pressure control, which then later deteriorated with the development of further significant in-stent restenosis. It was then decided to treat the restenosis using PTFE-covered stents. At 12 months of follow-up, the blood pressure had remained stable and renal function had normalized. The covered stents remained free of any significant neointimal tissue or obstruction.

Purpose To evaluate the influence of patient-level radiation exposure histories on radiologists’ imaging decisions. Materials and Methods We conducted an IRB exempt, HIPAA compliant, physician survey study in three academic medical centers. Radiologists were asked to make a prospective imaging recommendation for a hypothetical patient with a history of multiple CT scans. We queried radiologists’ decision-making, evaluating whether they: incorporated cancer risks from previous imaging; reported acceptance (or rejection) of the linear no-threshold (LNT) model; and understood LNT model implications in this setting. Consistency between radiologists’ decisions and their LNT model beliefs was evaluated – those acting in accordance with the LNT model were expected to disregard previously incurred cancer risks. Fisher’s exact test was used to verify the generalizability of results across institutions and training levels (residents, fellows, and attendings). Results Fifty-six percent (322/578) of radiologists completed the survey. Most (92% (295/322)) incorporated risks from the patient’s exposure history during decision-making. Most (61% (196/322) also reported acceptance of the LNT model. Fewer (25% (79/322)) rejected the LNT model, and 15% (47/322) could not judge. Among radiologists reporting LNT model acceptance or rejection, the minority (36% (98/275)) made decisions in a manner consistent with their LNT model beliefs. This finding was not statistically different across institutions (p=0.070) or training levels (p=0.183). Few radiologists (4% (13/322)) demonstrated an accurate understanding of LNT model implications. Conclusion Most radiologists, when faced with patient exposure histories, make decisions that contradict their self-reported acceptance of the LNT model and the LNT model itself. These findings underscore a need for related educational initiatives.