{"\ufeffMYSIR\u2019s Abstracts 1\nMalaysian Society of Interventional Radiology\n\nDOI: https://doi.org/10.32896/tij.v2n4.18-24\nPublished: 31.12.2022\nOP01\n\nCOMPARING EFFECTS OF C-ARM CONE BEAM CT AND HYBRID-CT/C-ARM SYSTEMS ON PATIENT RADIATION DOSE IN TRANSARTERIAL CHEMOEMBOLISATION PROCEDURES\nL. K. Jin1, W. F. K. Sheng2, C. J. M. S. Xavier2, L. Sum2\n1Lee Kong Chian School of Medicine, Nanyang Technological University-Imperial College London, Singapore 308232\n2Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore 169608\n\n\nBackground/Purpose:\nC-arm cone-beam computed tomography (CBCT) and hybrid-CT/C-arm are the two main systems used to perform transarterial chemoembolization (TACE). However, CBCT poses certain disadvantages compared to hybrid-CT/C-arm such as smaller field-of-view and inconsistent anatomical detail. The study aims to further evaluate the difference in patient radiation dose between usage of CBCT and hybrid-CT/C-arm in TACE procedures.\n\nMaterials and Methods:\nTACE procedures performed between July 2016 and July 2022 were collected and grouped by imaging modality (3D-guided vs only 2D) and imaging system (C-arm CBCT vs hybrid CT/C-arm). Differences in patient characteristics and patient radiation dose were analysed. Kerma-area product (PKA) and dose-length product (DLP) were converted to effective dose (ED) for comparison. Reference air-kerma (Ka,r) was also collected.\n\nResults:\nA total of 378 procedures was analysed with 348 undergoing 3D-guided procedures and 30 undergoing 2D-guided procedures. Of the 3D-guided procedures, 176 were performed using C-arm CBCT and 172 were performed using hybrid-CT/C-arm. The total ED in the hybrid-CT/C-arm group was 1.5 times lower than in C-arm group (median 37.9 vs 55.3mSv, p<.001). Total KAP and Ka,r were both lower in the hybrid-CT/C-arm 3D group than the C-arm group (median 123.3 vs 248.3Gycm2, p<.001 and 1030 vs 1153mGy p": null, " 21.8 vs 8.53mSv, p": null, " Andr\u00e9 Guerbet, France) and chemotherapeutic drugs (Epirubicin and Mitomycin) were used for chemoembolization in 16 of the patients (94%). Lipiodol deposition was seen at the head of the pancreas (1 patient), adrenal (1 patient), and diaphragm (1 patient) on post TACE CT with no significant sequelae. The diaphragmatic injury was seen in one patient for whom DC Beads were used for chemoembolization.  \n\nConclusion:\nRIPA supply of HCC was associated with a large, peripherally located tumour in Segment VII/VIII that was abutting the diaphragm.  Familiarity with the origin of RIPA is important in treating large right lobe HCC. The right renal artery is the most common RIPA origin in our series.\n\n\n\nOP03\n\nTREATMENT OUTCOMES OF SCLEROTHERAPY FOR LOW-FLOW VASCULAR MALFORMATIONS AT SOUTHERN PHILIPPINES MEDICAL CENTER\nN. L. B. dela Cruz1, M. T. T. Sanchez1, S. B. Bangoy1\n1Vascular and Interventional Radiology Section, Southern Philippines Medical Center, Philippine\n\nBackground/Purpose:\nVascular malformations are complex developmental disorders of angiogenesis that present formidable diagnostic and treatment challenges. In the past, surgical resection was the preferred treatment for low-flow vascular malformations. Recently, percutaneous sclerotherapy has shown many advantages over surgery and has emerged as the primary therapeutic approach. The main purpose of this study is to report the treatment outcomes of low-flow vascular malformations at Southern Philippines Medical Center (SPMC), a tertiary government hospital in the Philippines.\n\nMaterials and Methods:\nThis is a retrospective study assessing the treatment outcomes of patients who underwent percutaneous sclerotherapy for low-flow vascular malformations at SPMC over a 5-year period from Jan. 2017 to Jan. 2022. The main objective is to determine which among the sclerosing agents (ethanol, bleomycin or combination) used for low-flow vascular will be the most effective in terms of treatment imaging outcomes and the least procedure-related complications.\n\nResults:\nA total of 36 patients between 1 year old and 69 years old were treated (26 venous malformations and 10 lymphatic malformations). Sclerosing agents used were ethanol (15 cases), bleomycin (8 cases) and combination of ethanol / bleomycin (13 cases).  After a median follow-up at least 6 months after the last session, 35 cases (97.25%) had effective imaging outcomes defined as more than 50% reduction of the original size and only 1 case (2.8%) of bleomycin treatment was ineffective with reduction of less than 50%. 5 minor complications (13.8%) were observed (4 cases [11.1%] for ethanol and 1 case [2.7%] for combination of bleomycin and ethanol). No major complications were noted.\n\nConclusion:\nPercutaneous sclerotherapy is an effective treatment for low flow vascular malformations with least complications when using bleomycin and combined bleomycin/ethanol as sclerosing agents, compared to ethanol alone.\n\nOP04\n\nEFFECTIVENESS OF AN INSTITUTIONAL ANTIBIOTIC PROPHYLAXIS GUIDELINE IN PATIENTS UNDERGOING RADIOFREQUENCY AND MICROWAVE ABLATION OF LIVER TUMORS: \nA RETROSPECTIVE COHORT STUDY\nW. X. Pang1, K. C. Hung2, N. G. S. Chua2, S. J. Chung3, L. Sum4\n1Lee Kong Chian School of Medicine, Nanyang Technological University-Imperial College London, Singapore\n2Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore\n3Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore\n4Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore\n\nBackground/Purpose:\nAt our institution, patients undergoing liver ablation were receiving antibiotic prophylaxis (AP) heterogeneously. An in-house antibiotic prophylaxis guideline was developed in May 2019 by the antimicrobial stewardship unit and the department of vascular and interventional radiology to standardize AP prescription. This study evaluated the effectiveness and clinical outcomes of the newly launched AP guideline on patients undergoing radiofrequency (RFA) and microwave (MWA) ablation of the liver.\n\nMaterials and Methods:\nThis was a retrospective cohort study of patients who underwent RFA and MWA at Singapore General Hospital before and after the implementation of guidelines from November 2018 to April 2019 and October 2019 to March 2020 respectively. Patients with prior infection or on antibiotics treatment before liver ablation were excluded. Patients without high risk of biliary tree contamination were recommended a single dose of 2g IV cefazolin (or 600mg IV clindamycin in cases of beta-lactam allergy). Any deviation in antibiotic choice or duration without suspected post-procedural infections was considered inappropriate. Univariate analysis was conducted to evaluate the clinical outcomes.\n\nResults:\nThe study included 87 patients who underwent 93 procedures consisting of 18 RFAs and 75 MWAs for liver tumours. Concordance with AP guidelines improved significantly (38.5% vs. 87.0%": null, " p<0.001). Prescription of the recommended single dose 2g IV cefazolin for patients without high-risk factors increased after the guideline was implemented (40.0% vs. 97.8%). There were no ablation-related infections and mortality within 30 days post-ablation, and post-procedural nausea and vomiting were significantly reduced (15.4% vs. 1.9%": null, " p": "0.020). No significant difference in post-procedural fever (7.7% vs. 5.6%", " NATIONAL CANCER INSTITUTE\u2019S EXPERIENCE\nS. Ain1, A. R. Ridzuan1\n1Department of Radiology, National Cancer Institute, Putrajaya, Wilayah Persekutuan Putrajaya\n\nIntroduction:\nAdrenal Venous Sampling (AVS) is the gold standard test to identify sources of excess aldosterone. It is highly advisable to perform this procedure for a patient with Primary Aldosteronism. It can determine the overproduction of the aldosterone whether it is unilateral or bilateral. The test will provide a decisive treatment plan for the patient. A unilateral secretion can be surgically treated.\n\nCase Report:\nAVS procedure has a reputation as a challenging procedure and demands great skills of the Interventional Radiologist (IR). Sampling is performed from each adrenal vein together with peripheral  samples  using  variation  of  catheter   in   sequential   or   simultaneous   manner. Anatomically, the right adrenal vein originates directly from the inferior vena cava while the left adrenal vein originates from the left renal vein. Due to the anatomical structure, it is difficult to recognise the adrenal veins for selective cannulations. Technically, the right adrenal vein is more challenging to cannulate than the left adrenal vein. Multiple techniques and strategies are used by the IR to perform AVS procedure. In National Cancer Institute (NCI), Cone Beam CT is used during AVS procedure to aid the selective cannulation of the adrenal veins.\n\nConclusion:\nA conclusion of a successful AVS can be drawn by the level of the cortisol from the derived bloods. Since cortisol is only produced by adrenal glands, it is assumed that there is an increment of cortisol level in the adrenal veins compared with peripheral veins. The result will then be further used to calculate the lateralisation index. We are using this method since the year of 2020, the success rate of AVS sampling is 100%.": null}