Training in interventional radiology (IR) relies on a traditional apprenticeship; to protect patients, expert supervision is mandatory until knowledge, attitudes and practical skills have been certified as satisfactory. However, the current quality of IR training is threatened by reduced time for trainees to learn, as well as a loss of basic diagnostic, training cases to non-invasive imaging. At the same time, IR techniques are becoming a focus of interest to a range of other clinical specialities. To address this training shortfall there is a need to develop novel training alternatives such as simulator models. Few simulator models in any medical field have been successfully validated to show improved clinical skills in treating patients. To date no endovascular simulator has met this standard. A good simulator must be based around key performance measures (metrics) derived from careful analysis of the procedure to be replicated. Metrics can be determined by trained psychologists from a direct analysis of the content of the job or task to be tested. The identification of these critical measures of performance is a complex process which must be tailored to a training curriculum to be effective. Simulators based on flawed metrics will invariably lead to unsatisfactory assessment. It follows that simulator development must involve the statutory licensing authorities. Equally it is essential that we do not assume that training on a particular simulator will correlate with the ability to perform the task in the real world. This "transfer of training" must be rigorously proven by validation studies.

The Publisher apologizes for an error in D.O. Kessel's address. The address appears correctly above. Simulators in catheter-based interventional radiology: training or computer games?Clinical RadiologyVol. 61Issue 7PreviewTraining in interventional radiology (IR) relies on a traditional apprenticeship; to protect patients, expert supervision is mandatory until knowledge, attitudes and practical skills have been certified as satisfactory. However, the current quality of IR training is threatened by reduced time for trainees to learn, as well as a loss of basic diagnostic, training cases to non-invasive imaging. At the same time, IR techniques are becoming a focus of interest to a range of other clinical specialities. Full-Text PDF

Transjugular intrahepatic portosystemic shunt (TIPSS) is recognized as a useful technique in cases that fail to respond to two endoscopic sessions after acute variceal bleeds. TIPSS has been shown to be as effective in managing acute gastric bleeds as in managing acute oesophageal bleeds. The major complications of TIPSS procedures are shunt insufficiency and hepatic encephalopathy. New or worsened hepatic encephalopathy after TIPSS has been seen in up to 35% of cases, and it has been reported to be refractory to conservative medical treatment in up to 7% of cases, in whom further intervention has been necessary to reduce flow through the TIPSS. This may be performed by occluding the shunt completely or by using one of a variety of endovascular devices aimed at reducing the calibre of the stent lumen, which increases the portosystemic pressure gradient across the stent and improves intrahepatic portal bloodflow. Such techniques often improve the encephalopathy, but they may increase the risk of variceal bleeding, requiring a fine balance between the two. In this article, we describe a method to increase the portosystemic pressure gradient across the shunt in a controllable way, thus reducing encephalopathy but also minimizing the risks of further bleeding.

In the absence of either standard methods for trace element analysis of coal-derived chars and ash or standard reference materials for coal gasification samples, a comparative exercise has been undertaken to validate analyses of chars and fines recovered from a coal gasification pilot plant. Several sample digestion methods, used for converting solid samples to aqueous solutions for trace element analysis by i.c.p.–m.s. and i.c.p.–a.e.s., have been compared: peroxide fusion (sodium peroxide+sodium carbonate) and microwave digestion by AEA Technology and wet-ashing (open acid digestion) and microwave digestion by Imperial College (IC). The aim was to analyse samples from a pilot plant scale coal gasification rig. Digestions were carried out using a range of sample sizes, at times as small as 10mg and analyses of small quantities of these samples were compared with results on the same samples from a specialist contract laboratory (AEA Technology). Elements studied were As, B, Ba, Be, Cd, Co, Cr, Cu, Ga, Hg, Mn, Mo, Ni, Pb, Sb, Se, Sn, V and Zn. For the majority of the elements studied, elemental concentrations (1–150wppm range) were generally in agreement between the two laboratories within 50%. Limitations of the various digestion methods are discussed. All the digestion techniques appeared to lose mercury and therefore a Leco atomic absorption spectrophotometer based method was used to determine Hg. Output solid stream distributions of trace elements from the gasifier indicate that all of the Hg in the fuels was released to the fuel gas. The primary cyclone fines stream contained the major part of the trace elements from the fuels. The causes of apparent losses of As, Mo, Pb, Sn, Zn and Se are discussed.