Sophia Freya Ulrike Blum

Purpose: To investigate early laboratory changes following Transjugular Intrahepatic Portosystemic Shunt (TIPS) and their associations with hepatic vessel diameters. Additionally, to develop a model to predict patients at high-risk for excessive liver parameter increase. Materials and methods: A total of 256 TIPS procedures performed between 2017 and 2024 were retrospectively enrolled and divided into a development ( n = 208) and temporally separated internal validation cohort ( n = 48). Diameters of portal vein and hepatic arteries were measured in pre-procedural computed tomography scans. Laboratory parameters (INR, ALAT, ASAT, GGT, and bilirubin) were assessed pre-procedurally, on post-procedural days 1–2, and between days 4–7. Patients with ≥ 2 parameters exceeding the 85th percentile of percentage change on days 1–2 were classified as high-risk. A prediction model for the identification of high-risk patients was developed and validated. Results: All laboratory parameters significantly increased post-procedurally ( p < 0.001), with 41 patients classified as high-risk. ALAT and ASAT showed the highest increase (up to +392 +/- 1118% and +474 +/- 1125%, respectively). Hepatic artery and portal vein diameters were predominantly negatively correlated with laboratory changes ( p < 0.05). The prediction model identified common hepatic artery diameter, portal vein thrombosis, and baseline bilirubin as independent high-risk predictors, achieving an AUC of 0.782 and 0.748 in the development and internal validation cohort, respectively. Conclusion: TIPS significantly impacts liver metabolism, with marked early alterations in liver parameters that inversely correlate with hepatic vessel diameters. A prediction model based on common hepatic artery diameter, portal vein thrombosis status, and baseline bilirubin may support identification of high-risk patients and potentially help optimize post-procedural management.

Received: 02 December 2024 Accepted after revision: 31 January 2025 Article published online: 30 April 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Repeated whole-spine imaging in children and adolescents with scoliosis causes significant cumulative radiation exposure. Low-dose slot-scanning imaging can reduce radiation exposure. The aim of this study was to compare whole-spine imaging using the slot-scanning technique (SST) with conventional stitched radiography (SR) with regard to image quality and radiation dose. We recruited 30 patients with a clinical indication for whole-spine imaging by SST, who had prior whole-spine imaging by SR available. 41 images acquired using both techniques were analyzed. The dose area product (DAP) and patient age, weight, height, and body-mass index were recorded. Image quality was assessed for 28 anatomical landmarks on a 4-point Likert scale by 4 raters. Group-wise comparisons were performed using paired t-tests. Interrater rating reliability was assessed using the interrater correlation coefficient. The mean DAP was significantly lower for SST than for SR (SST 8.0 ± 5.7 cGy · cm², SR 32.5 ± 34.5 cGy · cm², p < 0.001). The image quality was rated good for both modalities (means: SST 2.8 ± 0.6, SR 2.7 ± 0.5, p = 0.38). There was no significant difference in image quality ratings between both modalities. The inter-rater reliability was excellent with an inter-rater correlation coefficient of 0.86. Orthopedic surgeons rated the image quality of SST significantly better than that of SR. This study shows a significant reduction in radiation exposure for slot-scanning whole-spine imaging compared to stitched radiography with equal image quality, which facilitates the reduction of radiation exposure for repeated whole-spine imaging in children and adolescents to 25%.

The increasing number of women working in medical surgical professions involving ionizing radiation creates new challenges for the safety of both pregnant and breastfeeding employees and the management of prenatal radiation exposure. The aim of this manuscript is to discuss the biological effects of loosely-ionizing radiation, evaluate the associated risks, and discuss the principles of German radiation protection law in the context of pregnancy and breastfeeding. To assess the effects of prenatal radiation exposure, we reviewed relevant sources such as reports from the German Commission on Radiological Protection, United Nations Scientific Commission on Effects of Atomic Radiation (UNSCEAR), and publications from the International Commission on Radiological Protection (ICRP). Additionally, the current German legislation, with focus on radiation protection and maternity protection laws, was outlined in context. The analysis shows that adhering to regulatory dose limits minimizes the risks of pregnancy complications, congenital malformations, developmental delays, mutagenic and carcinogenic effects. Special attention is required during the first trimester, in which radiation sensitivity is highest. Adherence to legal framework and associated protective measures in Germany provides under certain conditions a safe working environment for pregnant and breastfeeding women in surgical professions that involve ionizing radiation. This work highlights that careful risk assessment and strict adherence to radiation protection and occupational safety regulations enable pregnant and lactating women to work safely in areas associated with ionizing radiation and interventional aspects of their occupation. The need for continuous monitoring and adjustment of protective measures as well as the provision of confidential counseling services, are essential to ensure the safety of pregnant and breastfeeding workers and their children.

Purpose: The aim was to characterize the framework conditions in academic interventional radiology (IR) in Germany with focus on differences between genders. Materials and methods: After IRB approval, all members of The German Society for Interventional Radiology and Minimally Invasive Therapy (n = 1,632) were invited to an online survey on work and research. Statistical comparisons were undertaken with the Fisher’s exact test, Wilcoxon rank sum test or Pearson’s Chi-squared test. Results: From 267 available questionnaires (general response rate 16.4%), 200 were fully completed. 40% of these (78/200) were involved in research (71% men vs. 29% women, p < 0.01) and eligible for further analysis. Of these, 6% worked part-time (2% vs. 17%, p < 0.05). 90% of the respondents spent less than 25% of their research during their paid working hours, and 41% performed more than 75% of their research during. leisure time. 28% received exemption for research. 88% were (rather) satisfied with their career. One in two participants successfully applied for funding, with higher success rates among male applicants (90% vs. 75%) and respondents with protected research time (93% vs. 80%). Compared to men, women rated their entrance in research as harder (p < 0.05), their research career as more important (p < 0.05), felt less noticed at congresses (93% vs. 53%, p < 0.01), less confident (98% vs. 71%, p < 0.01), and not well connected (77% vs. 36%, p < 0.01). Conclusion: Women and men did research under the same circumstances; however, women were underrepresented. Future programs should generally focus on protected research time and gather female mentors to advance academic IR in Germany.

Purpose The aim was to characterize the framework conditions in academic interventional radiology (IR) in Germany with focus on differences between genders. Materials and Methods After IRB approval, all members of The German Society for Interventional Radiology and Minimally Invasive Therapy (n = 1,632) were invited to an online survey on work conditions in clinical and academic practice. The academic practice subset contained questions about research challenges: networking, funding, working hours and time spent with research. Statistical comparisons were undertaken with the Fisher's exact test, Wilcoxon rank sum test or Pearson's Chi-squared test. Results 267 questionnaires were available resulting in a general response rate of 16.4%. Two-hundred of them were fully completed. 40% of these (78/200) were involved in academic IR (71% men vs. 29% women, p < .01) and were therefore eligible for further analysis. Of these, 6% worked part-time (2% vs. 17%, p < .05). 90% of them spent less than 25% of their research during their paid working hours, and 41% performed more than 75% of their research during leisure time. 28% received exemption for research. 88% were (rather) satisfied with their career. One in two participants successfully applied for funding, with higher success rates among male applicants (90% vs. 75%) and respondents with protected research time (93% vs. 80%). Compared to men, women rated their entrance in academic IR as harder (p < .05), their academic IR-career as more important (p < .05), felt less noticed at congresses (93% vs. 53%, p < .01), less confident (98% vs. 71%, p < .01), and not well connected (77% vs. 36%, p < .01). Conclusion Women and men did research under the same framework conditions; however, women were underrepresented. Future programs should generally focus on protected research and gather female mentors to advance academic IR in Germany.