Cats3
Contributor
I have this note and I'm looking for help on the cath placement codes. I have 37243, 36247, 36248, 75726, 75774, 74175, 79445. Can anyone help? Thank you in advance!
Selective catheterization of celiac artery for celiac artery angiogram.
Selective catheterization of the common hepatic artery for common hepatic angiogram.
Superselective catheterization of left hepatic artery for left hepatic artery angiogram and cone beam CT.
Cone beam Dyna CT with catheter positioned in hepatic arteries with additional 3-D image postprocessing.
Transarterial delivering Y90 Sirshpheres in superselective LEFT hepatic artery.
Ultrasound guidance for arterial access.
Limited right common femoral artery angiogram and closure device deployment for hemostasis.
The pre-Y 90 mapping, including selective and superselective catheterization of the hepatic arteries, angiography, cone beam CT, MAA technetium99 delivery, and SPECT, was performed on 06/23/2023
The radiation dosimetry was calculated by authorized user based on patient liver volume, treatment volume and tumor burden (IntuitionTM version 4.5.0, Siemens VE20D.210615), hepatic to pulmonary shunting, arterial anatomy, and the desired dose to be delivered to the tumor/liver.
The case was discussed with medical oncology, surgical oncology, radiation oncology, nuclear medicine, radiation safety. And the complex treatment plan was decided based on the primary malignancy, dominated liver metastasis, liver function tests, performance status, physical examination, chemoradiation therapy, surgical history, potential surgical procedure, arterial anatomy.
Y90 Sirshpheres was drawn and prepared at Hotshot lab with the supervision of the physicist.
The physicist on-site supervised the entire procedure from Y90 Sirshpheres preparation, patient preparation, catheterization, Y90 Sirshpheres infusion, patient transportation to the recovery room, SPECT, discharge instruction, and discharging patient.
History: 66-year-old male with malignant carcinoid along the inferior mesenteric axis and the liver metastasis. The patient is on lanreotide. Primary service required Y 90 radioembolization of the liver metastasis. The pre-Y90 mapping was performed on 06/23/2023, Y90 radioembolization or RIGHT hepatic lobe on 07/14/2023. The patient was administered with the 500 mcg of Sandostatin infusion 1 day pre-Y90 treatment. Patient presented to IR for the visceral angiography and radioembolization.
Medications:
1. Versed 3 mg IV
2. Fentanyl 50 mcg IV
3. Lidocaine 2% for local anesthesia 8 ml
Upper extremity IV was used. Patient underwent continuous physiologic monitoring throughout the procedure. Conscious sedation was administered and monitored by me with total of 45 minutes monitoring time.
Contrast Data: IOPAMIDOL 76 % IV SOLN 75 mL
Fluoroscopy Time: 19 Minutes
Total Skin Dosage: 807.6 mGy
Complications: None
Estimated blood loss: Minimal
Description: Written informed consent was obtained from patient. Maximum sterile barrier was used. The patient was placed supine. Preliminary ultrasound of the LEFT inguinal region demonstrated patent LEFT common femoral artery. Ultrasound machine was used to generate a permanent image to document vascular access.
After local anesthesia, access was obtained into the LEFT common femoral artery under direct sonographic guidance and a 6 French vascular sheath was placed. Access was obtained into the Celiac trunk using a Sos Omni 1 catheter. Angiogram was performed, demonstrating patency of the splenic artery, LEFT gastric artery, common hepatic artery, GDA, LEFT and RIGHT hepatic arteries.
Using a coaxial technique, a 2.8 French Progreat microcatheter was advanced through the Sos Omni 1 catheter into the common hepatic artery. Angiogram was performed to confirm location. In conjunction with the Fathom wire, the Progreat microcatheter was advanced into the LEFT hepatic artery. Angiogram was performed demonstrating patency of the LEFT hepatic artery and the medial and lateral branches in the LEFT hepatic lobe. Cone beam CT was performed, demonstrating contrast infusion into the caudate lobe, medial aspect of segment 7, most portion of the segment 4A through the medial branch of the LEFT hepatic artery, and the contrast infusion into the segments 2, 3, 4B, and the anterior-inferior portion of the segment 4A through the lateral branch of the LEFT hepatic artery with numerous enhanced nodules and masses scattering in the LEFT hepatic lobe.
The position of the microcatheter was deemed satisfactory for Y90 radioembolization. The equipment for administration for Y90 radioembolization was then set up as per manufacturer guideline using the check list provided and under the supervision of the authorized user. The Y90 radioembolization was administered by Dr. Yu after confirmation on the fluoroscopy that the catheter was in the appropriate position. Following administration and the flushing of the microcatheter per protocol, the catheter and potentially contaminated administration products and drapes were placed into into a Nalgene container to be stored and eventually disposed of by Radiation safety. Monitoring of radioactive activity before, during and following administration was performed by a physicist of radiation safety. All participants (including the patient) were scanned for radioactivity prior to departure from the angiography suite by physicist. The angio room was ultimately scanned and cleared for future use by a physicist of radiation safety. A total of 2.4 GBq Y90 Sirspheres was administered intra-arterially into the LEFT hepatic artery. The Physicist supervised and assisted the entire processing.
Limited femoral arteriogram demonstrates satisfactory anatomy and puncture site for placement of a closure device. The catheter and sheath were then removed and hemostasis was obtained using the Angio-Seal. The patient tolerated the procedure well without immediate complications. Patient remained stable and transferred back to the recovery room.
Multiple hardcopy ultrasound and fluoroscopic images were obtained throughout the procedure and permanently stored in PACS system.
IMPRESSION:
1. Celiac angiogram demonstrating patency of the splenic artery, LEFT gastric artery, common hepatic artery, GDA, LEFT and RIGHT hepatic arteries.
2. Angiogram and cone beam CT of the LEFT hepatic artery demonstrating contrast infusion into the caudate lobe, medial aspect of segment 7, most portion of the segment 4A through the medial branch of the LEFT hepatic artery, and the contrast infusion into the segments 2, 3, 4B, and the anterior-inferior portion of the segment 4A through the lateral branch of the LEFT hepatic artery with numerous enhanced nodules and masses scattering in the LEFT hepatic lobe.
3. Successful Y90 Sirspheres injection into LEFT hepatic artery for anticipated radioembolization
4. The patient was comfortable and was transferred to the nuclear medicine lab in stable condition for SPECT to demonstrate the distribution of the Y90 Sirspheres. The patient was monitored by a RN during the transfer, the gamma scan and the return transfer to the interventional radiology recovery room. The report for the Y90 SPECT scan will be dictated separately by the Nuclear Medicine physician.
Selective catheterization of celiac artery for celiac artery angiogram.
Selective catheterization of the common hepatic artery for common hepatic angiogram.
Superselective catheterization of left hepatic artery for left hepatic artery angiogram and cone beam CT.
Cone beam Dyna CT with catheter positioned in hepatic arteries with additional 3-D image postprocessing.
Transarterial delivering Y90 Sirshpheres in superselective LEFT hepatic artery.
Ultrasound guidance for arterial access.
Limited right common femoral artery angiogram and closure device deployment for hemostasis.
The pre-Y 90 mapping, including selective and superselective catheterization of the hepatic arteries, angiography, cone beam CT, MAA technetium99 delivery, and SPECT, was performed on 06/23/2023
The radiation dosimetry was calculated by authorized user based on patient liver volume, treatment volume and tumor burden (IntuitionTM version 4.5.0, Siemens VE20D.210615), hepatic to pulmonary shunting, arterial anatomy, and the desired dose to be delivered to the tumor/liver.
The case was discussed with medical oncology, surgical oncology, radiation oncology, nuclear medicine, radiation safety. And the complex treatment plan was decided based on the primary malignancy, dominated liver metastasis, liver function tests, performance status, physical examination, chemoradiation therapy, surgical history, potential surgical procedure, arterial anatomy.
Y90 Sirshpheres was drawn and prepared at Hotshot lab with the supervision of the physicist.
The physicist on-site supervised the entire procedure from Y90 Sirshpheres preparation, patient preparation, catheterization, Y90 Sirshpheres infusion, patient transportation to the recovery room, SPECT, discharge instruction, and discharging patient.
History: 66-year-old male with malignant carcinoid along the inferior mesenteric axis and the liver metastasis. The patient is on lanreotide. Primary service required Y 90 radioembolization of the liver metastasis. The pre-Y90 mapping was performed on 06/23/2023, Y90 radioembolization or RIGHT hepatic lobe on 07/14/2023. The patient was administered with the 500 mcg of Sandostatin infusion 1 day pre-Y90 treatment. Patient presented to IR for the visceral angiography and radioembolization.
Medications:
1. Versed 3 mg IV
2. Fentanyl 50 mcg IV
3. Lidocaine 2% for local anesthesia 8 ml
Upper extremity IV was used. Patient underwent continuous physiologic monitoring throughout the procedure. Conscious sedation was administered and monitored by me with total of 45 minutes monitoring time.
Contrast Data: IOPAMIDOL 76 % IV SOLN 75 mL
Fluoroscopy Time: 19 Minutes
Total Skin Dosage: 807.6 mGy
Complications: None
Estimated blood loss: Minimal
Description: Written informed consent was obtained from patient. Maximum sterile barrier was used. The patient was placed supine. Preliminary ultrasound of the LEFT inguinal region demonstrated patent LEFT common femoral artery. Ultrasound machine was used to generate a permanent image to document vascular access.
After local anesthesia, access was obtained into the LEFT common femoral artery under direct sonographic guidance and a 6 French vascular sheath was placed. Access was obtained into the Celiac trunk using a Sos Omni 1 catheter. Angiogram was performed, demonstrating patency of the splenic artery, LEFT gastric artery, common hepatic artery, GDA, LEFT and RIGHT hepatic arteries.
Using a coaxial technique, a 2.8 French Progreat microcatheter was advanced through the Sos Omni 1 catheter into the common hepatic artery. Angiogram was performed to confirm location. In conjunction with the Fathom wire, the Progreat microcatheter was advanced into the LEFT hepatic artery. Angiogram was performed demonstrating patency of the LEFT hepatic artery and the medial and lateral branches in the LEFT hepatic lobe. Cone beam CT was performed, demonstrating contrast infusion into the caudate lobe, medial aspect of segment 7, most portion of the segment 4A through the medial branch of the LEFT hepatic artery, and the contrast infusion into the segments 2, 3, 4B, and the anterior-inferior portion of the segment 4A through the lateral branch of the LEFT hepatic artery with numerous enhanced nodules and masses scattering in the LEFT hepatic lobe.
The position of the microcatheter was deemed satisfactory for Y90 radioembolization. The equipment for administration for Y90 radioembolization was then set up as per manufacturer guideline using the check list provided and under the supervision of the authorized user. The Y90 radioembolization was administered by Dr. Yu after confirmation on the fluoroscopy that the catheter was in the appropriate position. Following administration and the flushing of the microcatheter per protocol, the catheter and potentially contaminated administration products and drapes were placed into into a Nalgene container to be stored and eventually disposed of by Radiation safety. Monitoring of radioactive activity before, during and following administration was performed by a physicist of radiation safety. All participants (including the patient) were scanned for radioactivity prior to departure from the angiography suite by physicist. The angio room was ultimately scanned and cleared for future use by a physicist of radiation safety. A total of 2.4 GBq Y90 Sirspheres was administered intra-arterially into the LEFT hepatic artery. The Physicist supervised and assisted the entire processing.
Limited femoral arteriogram demonstrates satisfactory anatomy and puncture site for placement of a closure device. The catheter and sheath were then removed and hemostasis was obtained using the Angio-Seal. The patient tolerated the procedure well without immediate complications. Patient remained stable and transferred back to the recovery room.
Multiple hardcopy ultrasound and fluoroscopic images were obtained throughout the procedure and permanently stored in PACS system.
IMPRESSION:
1. Celiac angiogram demonstrating patency of the splenic artery, LEFT gastric artery, common hepatic artery, GDA, LEFT and RIGHT hepatic arteries.
2. Angiogram and cone beam CT of the LEFT hepatic artery demonstrating contrast infusion into the caudate lobe, medial aspect of segment 7, most portion of the segment 4A through the medial branch of the LEFT hepatic artery, and the contrast infusion into the segments 2, 3, 4B, and the anterior-inferior portion of the segment 4A through the lateral branch of the LEFT hepatic artery with numerous enhanced nodules and masses scattering in the LEFT hepatic lobe.
3. Successful Y90 Sirspheres injection into LEFT hepatic artery for anticipated radioembolization
4. The patient was comfortable and was transferred to the nuclear medicine lab in stable condition for SPECT to demonstrate the distribution of the Y90 Sirspheres. The patient was monitored by a RN during the transfer, the gamma scan and the return transfer to the interventional radiology recovery room. The report for the Y90 SPECT scan will be dictated separately by the Nuclear Medicine physician.