Abstract Purpose Proximal reflux of liquid embolic agents remains a primary safety concern during endovascular embolization, yet the quantitative relationships governing reflux mechanics are poorly characterized. An analytical model was developed to determine the relative contributions of catheter geometry, agent viscosity, polymerization kinetics, and injection technique to reflux behavior of ethylene–vinyl alcohol copolymer (EVOH). Methods An annular Poiseuille flow model was constructed for a 1 mm vessel with coaxial microcatheters (1.3–2.8 French; catheter-to-vessel diameter ratio D* = 0.43–0.92). Carreau rheology was applied to EVOH-18 and EVOH-34; blood and iodinated contrast were modeled as Newtonian. Extensions incorporated vessel compliance, first-order EVOH polymerization kinetics, and intermittent injection parameterized by duty cycle δ. Results The annular geometry function φ(D*) spanned three orders of magnitude across the catheter range (0.179 to 0.0006), surpassing the maximum 2.4-fold inter-agent viscosity difference. At injection shear rates, EVOH-18 thinned to near-contrast viscosity (6.4 vs 6.1 mPa·s). EVOH polymerization reduced reflux up to 68% at low D* but was negligible at D* > 0.9. Under intermittent injection (δ = 0.20), effective reflux lengths fell up to tenfold, and the protective advantage of EVOH-34 over contrast increased from 1.35-fold to 4.1-fold. Conclusions Catheter-to-vessel geometry dominates reflux by orders of magnitude over viscosity; catheter selection is the primary modifiable safety determinant. EVOH polymerization provides geometrically selective secondary protection maximized by intermittent injection. The duty cycle δ is proposed as a standardizable parameter for reporting injection protocols.

Interventional oncology (IO) is a core component of modern cancer care, providing precise, minimally invasive treatments that preserve quality of life. Despite advances in robotic surgery, adoption of robotics in IO has been limited. This review evaluates the potential benefits of robotics in IO and the factors constraining wider use. Robotic platforms have shown improved needle placement accuracy, greater workflow standardization, and significant reductions in operator radiation exposure, particularly through remote operation. Robotics may also shorten learning curves and enable technically complex tasks such as multi-needle tumor ablation and advanced endovascular navigation. However, high costs, workflow disruption, limited imaging compatibility, and a narrow range of high-value applications remain key barriers. Robotics in IO represents an evolutionary advance. Wider adoption will require evidence of improved outcomes, seamless integration into image-guided workflows, and sustainable business models that support real-world clinical use.

To evaluate the preliminary feasibility of using generative artificial intelligence (GenAI) to determine optimal entry angles for CT-guided liver needle biopsies in a controlled retrospective setting. This retrospective IRB-approved pilot study analyzed 30 de-identified axial CT images from consecutive liver biopsies performed by 16 interventional radiologists at a single academic center. GenAI operated in 2D on the selected images without specific training, using standardized prompts and overlaid radial grid to generate theoretical trajectory recommendations. Two conditions were evaluated: one with lesions marked and structures to avoid explicitly delineated, and one with lesions marked without annotations. Theoretical trajectory safety assessments were performed by two independent reviewers using consensus methodology. GenAI trajectories were compared retrospectively with clinician-selected paths using intention-to-treat analysis for safety and per-protocol analysis for length. In condition one, median iterations were 2 (IQR, 1–3.8), with 27/30 (90

To propose a cumulative cold dose (CCD) model integrating spatial, temporal, and biological dosimetry for cryoablation protocol optimization. Systematic searches identified studies reporting freeze duration effects, cell-type-specific lethal thresholds, lethal isotherm ratio, or protocol-stratified outcomes. CCD was defined as the total time tissue is held at or below its cell-type-specific lethal threshold across all freeze cycles, targeting ≥ 80

En vingt ans, la robotique en radiologie interventionnelle a franchi un cap : les gestes sont plus précis dans des zones anatomiques complexes, et la sécurité et la reproductibilité sont renforcées. Son intégration aux modalités d’imagerie améliore la planificatiot, le guidage, et ses principales applications (biopsies, ablations, gestes musculosquelettiques) montrent des résultats prometteurs. Bien que des défis subsistent (standardisation, coûts, formation), l’intelligence artificielle pourrait à terme, augmenter l’autonomie et soutenir une médecine plus personnalisée.

To evaluate the safety, feasibility and imaging outcomes of percutaneous image-guided cryoablation as a minimally invasive treatment for umbilical endometriosis (UE). Between March 2017 and December 2024, 17 women (median age: 38 years; [IQR, 32–38]) underwent percutaneous cryoablation of UE at a single institution. Procedures were performed under ultrasound (US) alone or combined US/CT-scan guidance. Pain severity was assessed using the visual analog scale (VAS), imaging (US and MRI) and cosmetic outcomes were compared before and after treatment. Adverse events were reported according to the Society of Interventional Radiology classification (SIR). Median lesion volume was 2.42 cm3 [IQR, 0.82–4.70] on US and 2.98 cm3 [IQR, 1.14–5.49] on MRI. 12/17 procedures (70

BACKGROUND AND OBJECTIVES:Separation surgery followed by stereotactic body radiation therapy (SBRT) for solid tumor malignancies metastatic to the spine has excellent durable 2-year local control rates. Preoperative embolization (PEm) is used as an adjunct to decrease operative blood loss for known hypervascular tumor histologies. Recent studies suggest potential benefits of PEm on local control and overall survival, but they involved heterogeneous tumor populations over time periods where systemic therapy was evolving rapidly. Therefore, we set out to determine the impact of PEm for metastatic spine tumors on a 2-year local control and overall survival in a histologically homogeneous cohort of patients with hypervascular tumor histologies. METHODS:This was a single-center, retrospective chart review from 2011 to 2022 at a quaternary cancer center for all patients with renal cell carcinoma, hepatocellular carcinoma, or thyroid cancer diagnosed with spinal metastatic disease who underwent surgical treatment followed by SBRT with or without PEm. RESULTS:Overall, 161 patients were included with 71 undergoing PEm (63 successful and 8 unsuccessful) and 90 not receiving PEm. The 8 who underwent angiogram but were not embolized were considered in the no PEm cohort. Between PEm and no PEm groups, there was no significant difference in age, sex, Eastern Cooperative Oncology Group, preoperative American Spinal Injury Association score, tumor histologies, number of adjacent segments involved, Spinal Instability Neoplastic Scale score, hospital length of stay, time from surgery to SBRT, radiation treatment dose (biological effective dose and equivalent dose in 2-gray fractions), or number of fractions ( P > .05 for all). The median overall survival was 18 months for both groups with no significant difference between PEm and no PEm ( P = .8). There was no significant difference in 12- and 24-month local control with rates of 94.8% and 91.7% for no PEm and 96.8% and 95.2% for the PEm group, respectively ( P = .7). CONCLUSION:PEm demonstrated no impact on local control or overall survival in patients with hypervascular spine metastases undergoing separation surgery followed by SBRT.

PURPOSE:To evaluate the safety and effectiveness of coil-only middle meningeal artery embolization (MMAE) for the treatment of subacute to chronic subdural hematoma (SDH) in patients with cancer. MATERIALS AND METHODS:A single-center retrospective analysis was performed of 30 patients with cancer with SDH, 12 of whom had bilateral hematomas, who underwent MMAE of the affected side(s) using coils alone between 2022 and 2025. Clinical and radiographic outcomes were evaluated, including hematoma resolution, change in SDH thickness, need for reoperation, and overall survival. RESULTS:Median SDH thickness declined from 12 mm (interquartile range [IQR], 9 mm) before embolization to 3.6 mm (IQR, 8.8 mm) on final imaging (Wilcoxon signed-rank z = 4.59, P < .001). A ≥50% reduction was observed in 56% of SDHs, and complete radiographic resolution was observed in 37%. One patient (3%) required surgical evacuation after MMAE. Seventeen patients (59%) died due to cancer progression during follow-up. Median survival was significantly longer among patients with reduced hematoma thickness at initial follow-up imaging (148 vs 29 days, log-rank P = .0002). CONCLUSIONS:Coil-only MMAE may be a safe and effective treatment option for SDH in patients with cancer. Reduction in hematoma thickness was associated with longer survival in this high-risk population.

This study evaluates the accuracy and safety of needle virtual reconstruction (NVR) software for assessing needle position during percutaneous procedures. A retrospective analysis of 40 cancer patients who underwent 40 procedures using NVR software (Needle ASSIST with Stereo 3D, GE HealthCare, Chicago, IL) was undertaken. Needle accuracy and safety was assessed by comparing the virtually reconstructed needle tip position with the actual tip position on post-procedure CBCT. Median needle tip discrepancy was 1.3 mm. Median fluoroscopy time and dose area product were 128 s and 28.9 Gy·cm2, respectively. All virtual and actual needle trajectories avoided critical structures. NVR software accurately assesses needle position and could reduce need for additional imaging, minimizing radiation exposure and procedural time while maintaining procedural safety.

PURPOSE:To evaluate the safety and performance of a disposable robotic system for arterial peripheral vascular procedures. MATERIALS AND METHODS:This institutional review board (IRB)-approved prospective, multicenter, single-arm study enrolled 20 patients requiring arterial peripheral vascular interventions across 3 U.S. CENTERS:The primary endpoint was successful robotic navigation to predetermined targets without conversion to manual technique. Secondary endpoints included device-related adverse events, procedural efficiency, and operator radiation exposure. RESULTS:The robotic system achieved 100% technical success (95% CI, 83.2%-100%) in all 20 patients. No device-related serious adverse events or procedural complications occurred. Mean procedure time was 120.1 minutes (SD ± 34.5) with a median of 117 minutes (range, 67.0-186.0 minutes). Mean robotic navigation time was 6.3 minutes (SD ± 7.6) with a median of 3 minutes (range, 1.0-32.0 minutes). Median fluoroscopy time was 7.9 minutes (range, 1.0-18.10 minutes). Median operator radiation dose was 1.4 μSv (range, 0.0-6.7 μSv). All operators rated the system as intuitive and satisfactory (5.0 out of 5.0 on all performance metrics). CONCLUSIONS:This disposable endovascular robotic system exhibited technical success while achieving minimal operator radiation exposure and favorable user satisfaction scores, indicating its potential viability for broader implementation in arterial peripheral vascular interventional procedures.

Over the past two decades, robotics in interventional radiology has advanced significantly, enabling more precise procedures in complex areas and improving safety and reproducibility. Integration with imaging modalities enhances planning and guidance. Applications in biopsies, ablations, and musculoskeletal procedures show promising results. Challenges remain, including standardization, cost, training, and AI integration. In the future, AI could enhance autonomy and foster more personalized, precision-based medicine.

To develop expert consensus recommendations for patient selection and procedural techniques in cryoneurolysis for chronic pain management using a Delphi process. A panel of 22 international interventionists participated in a two-round Delphi process. Participants rated 42 statements on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). Consensus was predefined as ≥ 75