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Purpose Planned interim analysis of GENESIS; a prospective pilot study investigating the role of genicular artery embolization (GAE) in patients with mild to moderate osteoarthritis of the knee using permanent microspheres. Methods Thirty-eight patients, median age = 60 (45–83), attended for GAE using 100–300 μm permanent microspheres. All patients had mild to moderate knee OA, resistant to conservative treatments over 6 months. Knee MRI was performed at baseline, and 12 months, enabling semi-quantitative analysis using Whole-Organ Magnetic Resonance Imaging Score (WORMS). Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS) (0–100 mm) were completed at baseline, 6 weeks, 3 months (n = 32), and 1-year (n = 16). Adverse events were recorded prospectively. Results Technical success of accessing and embolizing the target genicular arteries was 84%. Six patients were not embolized: four due to a presumed risk of non-target embolization, and two due to a lack of hyperaemic target. Mean VAS improved from 60 (SD = 20, 95% CI 53–66) at baseline to 36 (SD = 24, 95% CI 28–44) at 3 months (p p p = 0.06) at 1-year. Four patients experienced mild self-limiting skin discoloration over the embolized territory. One patient experienced a small self-limiting groin haematoma. WORMS scores at 1-year follow-up showed significant improvement in synovitis (p Conclusion GAE using permanent microspheres in patients with mild to moderate knee OA is safe, with potential efficacy at early follow-up.

PURPOSE Genicular artery embolisation (GAE) is a novel treatment for patients with knee osteoarthritis (OA). Cadaveric dissection was undertaken to provide a complete description of the relevant arterial anatomy in order to perform safe and effective GAE. MATERIALS Twenty human lower limb specimens were dissected. The morphology of the genicular arteries and presence of anastomotic connections was recorded and compared with angiographic images from patients having undergone GAE. Vessels were measured to investigate the risk of non-target embolisation (NTE), taking a diameter of 300 microns as the threshold for significance. RESULTS The descending genicular artery (DGA) is the dominant vessel in medial OA, with 95% of cases revealing vessel division into muscular, saphenous and osteoarticular branches from a single pedicle. The superior medial genicular artery (SMGA) had a shared origin with the middle genicular artery (MGA) in 25% of cases. NTE to the MGA may damage the cruciate ligaments. In 85% of cases, there was an anastomosis between the DGA and SMGA, often encountered at angiography. The mean diameter of the anastomoses was 850 micron, presenting a risk for NTE. An anastomosis between the Inferior Medial Genicular Artery (IMGA) and medial sural artery was found in 5% of cases; the medial sural artery supplies blood to the tibial nerve and should be avoided. The IMGA and inferior lateral genicular artery provided supply to the patellofemoral joint in 69% and 88% of cases, respectively. CONCLUSION An in-depth knowledge of genicular artery anatomy is required for interventional radiologists to perform safe and effective GAE in patients with knee osteoarthritis.

Objective To find a method of safely inserting a suprapubic catheter (SPC) under local anesthetic and under ultrasound guidance in patients who may not be fit for a general anesthetic but also are seen to have bowel overlying the anterior bladder wall which obscures a safe route to the bladder. Materials and Methods We used ultrasonography to visualize the bladder which was initially filled via the indwelling urethral catheter. A 22-gauge needle attached to a syringe filled with 30 mL of fluid (made up of 10 mL of 1% lidocaine plus 20 mL sterile water) was inserted transabdominally under ultrasound guidance into a space between the pubic symphysis and bowel. The fluid was then injected into the space to hydrodissect the bowel away from the bladder. Once the space had been created, an 18-guage needle was passed into the bladder and a SPC was inserted via the Seldinger technique. Results Successful SPC insertion was confirmed on ultrasound guidance with no associated bowel or other injury. Telephone follow-up with the patient 6 months later revealed that the patient had no complications and no infections. Conclusion Hydrodissection can be considered when inserting SPC under local anesthetic under ultrasound guidance when there is bowel obscuring any safe route to the bladder. This may be particularly useful in patients who may not be fit for a general an aesthetic.

The diagnosis of urinary tract infection (UTI) in adults is primarily based on a typical presentation with urinalysis findings suggestive of UTI. In general, routine radiologic imaging is not required for diagnosis and treatment of uncomplicated cases in adult patients. Appropriate imaging not only defines the extent of disease but also identifies significant complications. This may help in treatment adjustment. It can also guide the interventional radiologist in planning the management of pyonephrosis and abscess.

Objective. The purpose of this study was to evaluate the potential importance and need for further investigation of thyroid lesions detected during imaging investigations unrelated to the thyroid gland (thyroid incidentalomas). The management of these lesions is controversial because most malignancies detected will be papillary microcarcinomas, which will not manifest as overt disease. Methods. A systematic literature search was performed, including the MEDLINE (1951 to date) and EMBASE (1974 to date) databases, using the Dialog DataStar and PubMed search engines and the Cochrane database. Results. Relevant studies were reviewed, together with consensus documents, looking at the prevalence of thyroid incidentalomas and associated malignancy and the use of ultrasound and fine-needle aspiration cytologic examination in further investigation of incidentalomas. Conclusions. The management and importance of the thyroid incidentaloma remain controversial, although problems relating to these issues are likely to become increasingly common in radiologic practice. Once an incidentaloma has been observed, formal clinical and sonographic assessment should be considered, with fine-needle aspiration cytologic examination as appropriate, after an informed discussion with patient.

INTRODUCTIONHaemobilia is a rare complication of acute cholecystitis and may present as upper gastrointestinal bleeding.PRESENTATION OF CASEWe describe two patients with acute cholecystitis presenting with upper gastrointestinal bleeding due to haemobilia. Bleeding from the duodenal papilla was seen at endoscopy in one case but none in the other. CT demonstrated acute cholecystitis with a pseudoaneurysm of the cystic artery in both cases. Definitive control of intracholecystic bleeding was achieved in both cases by embolisation of the cystic artery. Both patients remain symptom free. One had subsequent laparoscopic cholecystostomy and the other no surgery.DISCUSSIONPseudoaneurysms of the cystic artery are uncommon in the setting of acute cholecystitis. OGD and CT angiography play a key role in diagnosis. Transarterial embolisation (TAE) is effective in controlling bleeding. TAE followed by interval cholecystectomy remains the treatment of choice in surgically fit patients.CONCLUSIONWe highlight an unusual cause of upper GI haemorrhage. Surgeons need to be aware of this rare complication of acute cholecystitis. Immediate non-surgical management in these cases proved to be safe and effective.

Our aims were to first assess uptake of the modified safety checklist (SC) for interventional radiology (IR), identify obstacles to using the SC, and then apply changes to local policy to reach maximum compliance. Retrospective data collection was performed of all patients who underwent an interventional procedure in the interventional suite at the Royal Berkshire Hospital in February, March and May 2014. Barriers to a SC: a lack of awareness about the SC; lack of training in how to complete the SC; lack of leadership—no team member had been given the role of promoting the SC and collecting and collating the SC; attitude of staff—some team members felt that the SCs were time consuming and further bureaucracy; out-of-hours procedures involved staff from outside departments who were not familiar with the SC; paper copies of the completed SCs were being misplaced. Results: February 2014 = 79%; staff education of the importance of the modified World Health Organization (WHO) checklist disseminated in the interventional suite and at clinical governance; each day a designated ‘SC champion’ in the interventional suite has the responsibility for overseeing the WHO checklist is completed for each patient; the use of a clipboard for storing checklists, amalgamated and scored at the end of each day. Any checklists not completed are highlighted and discussed with the consultant. March 2014 = 95%; junior nurse involvement in auditing to improve awareness and engagement; out-of-hours interventional radiologist ensuring that the checklist is completed for each patient. May 2014 = 100%.

Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.