AIM: To establish how often off-label device and drug use occurs in interventional radiology (IR) in a UK tertiary referral hospital and consider the wider implications for the interventional radiologist.MATERIALS AND METHODS: Prospective data were collected during interventional procedures for 1 working week in a university hospital. Out-of-hours procedures and procedures outside the department were excluded. Operators were asked to record the drugs and devices used, the indication, and method of use. The instructions for use/summary of product characteristics were then studied for each device/drug used to assess if the use was on or off-label.RESULTS: During the study period 52 cases were performed and data were available on 26 cases (50%). In 22 of the 26 cases (84%) there was evidence of off-label use of devices or drugs. Off-label use of drugs included treatment of venous malformations with Fibrovein (c) (sodium tetradecyl sulphate), which is licensed for the treatment of varicose veins in the leg, and intra-arterial injection of heparin, which is licensed for intravenous and subcutaneous use. Off-label device use included placing vascular sheaths in the urinary tract, using angiographic catheters to guide wires in the urinary tract, using sheaths for thrombosuction, reshaping of the tip of most guidewires, and using angioplasty balloons to dislodge the arterial plug at fistula thrombectomy.CONCLUSION: Off-label device and drugs use is common in a UK tertiary hospital IR department and literature suggests this is common in the wider IR community. There are important clinical and legal implications for off-label use for patients and physicians. (C) 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE. The purpose of this study is to describe the role of interventional radiology in palliation and maintenance of nutritional support in children with epidermolysis bullosa, with a focus on safety and required procedural modifications.MATERIALS AND METHODS. This was a retrospective study of all patients diagnosed with epidermolysis bullosa who underwent interventional radiology procedures between January 1991 and December 2008 at a pediatric tertiary care institution. The type of epidermolysis bullosa, the patient's age, the indication and type of interventional radiology procedure, modifications used, and complications were recorded.RESULTS. Fifteen patients (9 boys and 6 girls) with a diagnosis of epidermolysis bullosa underwent a total of 87 procedures during 82 different patient interventional radiology visits. Twenty-seven esophageal dilatations for symptoms of dysphagia, 11 percutaneous gastrostomy tube placements resulting from failure to thrive, 30 maintenance procedures, 15 central venous access device insertions, and three other procedures (nasojejunal tube insertion, liver biopsy, and inferior vena cava filter insertion) were performed. Modifications were related to anesthetic management, access, tissue handling, and dressings. Complications were categorized according to Society of Interventional Radiology grades: Minor A (n = 6), Minor B (n = 4), Major C (n = 7), Major D (n = 2), Major E (n = 0), and Major F (n = 0).CONCLUSION. Our experience suggests that interventional radiology procedures can be done successfully and safely when utmost care is given to skin and mucosal protection. Wound healing is adequate and should not deter intervention.

Change is often seen as threatening and is usually met with some resistance. Old methods are perceived to be 'safe' with change often disruptive in the short term. Patient choice, combined with appropriately trained and dedicated staff working as part of an integrated team, can vastly improve service provision for ultrasound patients. Simple changes can sometimes drastically improve outcomes without necessarily involving an increase in resources. This article illustrates steps that can be taken to identify problems, using the model of a dialysis fistula ultrasound service, and demonstrates how implemented change can improve services to patients and to referring clinicians.

AIM:To identify, describe and detail the cognitive thought processes, decision-making, and physical actions involved in the preparation and successful performance of core interventional radiology procedures. MATERIALS AND METHODS:Five commonly performed core interventional radiology procedures were selected for cognitive task analysis. Several examples of each procedure being performed by consultant interventional radiologists were videoed. The videos of those procedures, and the steps required for successful outcome, were analysed by a psychologist and an interventional radiologist. Once a skeleton algorithm of the procedures was defined, further refinement was achieved using individual interview techniques with consultant interventional radiologists. Additionally a critique of each iteration of the established algorithm was sought from non-participating independent consultant interventional radiologists. RESULTS:Detailed task descriptions and decision protocols were developed for five interventional radiology procedures (arterial puncture, nephrostomy, venous access, biopsy-using both ultrasound and computed tomography, and percutaneous transhepatic cholangiogram). Identical tasks performed within these procedures were identified and standardized within the protocols. CONCLUSIONS:Complex procedures were broken down and their constituent processes identified. This might be suitable for use as a training protocol to provide a universally acceptable safe practice at the most fundamental level. It is envisaged that data collected in this way can be used as an educational resource for trainees and could provide the basis for a training curriculum in interventional radiology. It will direct trainees towards safe practice of the highest standard. It will also provide performance objectives of a simulator model.

This paper addresses the problem of integrated design of autonomous underwater vehicle (A UV) plant parameters and feedback controllers to meet mission performance requirements with minimum energy expenditure. This research topic has been motivated by the fact that significant energy savings and increased dynamic performance can in principle be obtained if the process of control system design is integrated with the design of the vehicle itself, thus departing considerably front the classical approach whereby the plant structure is essentially fixed a priori. As a first step towards the solution of this general problem, the following simpler problem is addressed and solved: given an AUV(with a fixed baseline configuration) that is required to operate over a finite set of representative trim conditions in the vertical plane in the course of a given mission scenario, determine the optimal size of the bow and stern planes so that the average propulsion power required to execute that mission is minimized. The minimization process is subject to open-loop stability requirements, and to the existence of stabilizing feedback controllers that can meet time and frequency closed-loop requirements about each trim condition. The paper introduces a methodology to solve this combined plant-controller optimization problem in the framework of convex optimization theory and describes its application to the selection of the optimal size of bow and stern planes for a prototype autonomous vehicle.