Cats3
Contributor
I am horrible at coding these Y90 procedures. Is there anyone who can help me? I have 37242, 36247, 36246-59, 36248, 75726, 75774, 79445, 76937. Thank you in advance!
Laura
Description: Written informed consent was obtained from patient. Maximum sterile barrier was used. The patient was placed supine. Preliminary ultrasound of the RIGHT inguinal region demonstrated patent RIGHT common femoral artery. Ultrasound machine was used to generate a permanent image to document vascular access.
After local anesthesia, access was obtained into the RIGHT common femoral artery under direct sonographic guidance and a 5 French vascular sheath was placed. Access was obtained into the celiac trunk using the Cobra 2 catheter. Angiogram was performed, demonstrating patency of the splenic artery, gastrohepatic trunk. The Cobra 2 catheter was exchanged for Sos Omni 0 catheter. Angiogram was was performed to confirm the position of the catheter. A coned beam CT was performed, demonstrating splenic artery and the gastrohepatic trunk originating from the celiac trunk. The gastrohepatic trunk gave rise to accessory LEFT hepatic artery supplying the partial LEFT hepatic lobe.
Using coaxial technique, a 2.8 French Progreat microcatheter in conjunction with microwire was advanced through the Sos Omni catheter. The access into the gastrohepatic trunk was unsuccessful. The microwire was exchanged for GT wire, and then, Fathom wire, and headliner wire. However, the attempt to access into the gastrohepatic trunk was unsuccessful. The Sos Omni 0 catheter was exchanged for a Sos Omni 1 catheter. The Progreat microcatheter was exchanged for 90 degree lantern microcatheter. The lantern microcatheter in conjunction with the GT wire was advanced into the gastrohepatic trunk and then the accessory LEFT hepatic artery. The angiogram was performed to confirm location. A cone beam CT was performed, demonstrating arterial supply from the accessory LEFT hepatic artery to the posterior portion of segments 2 and 3. There were at least 2 linear enhancement nodules in the posterior LEFT hepatic lobe. There was no enhancement of the stomach wall.
Subsequently, angiogram of the accessory LEFT hepatic artery confirmed the location of the tip of the catheter. Disposition was active enough for region of interest and the decision was made to proceed with MAA injection. A three-way stopcock was placed on the catheter. At this point, technetium-99m MAA was slowly injected by the nuclear medicine technologist using sterile technique followed by careful flushing of the MAA through the catheter with normal saline. None of the MAA or normal saline flush dripped out during administration. The syringes, three-way stop cock, catheter, underlying drapes and my outer gloves were placed in the yellow waste container to be disposed off according to nuclear waste regulations by the nuclear medicine technologist. A total of 2.44 mCi technetium-99m MAA was administered intra-arterially into accessory LEFT hepatic artery.
The host catheter and microcatheter were retracted from the celiac trunk, and engaged into the superior mesenteric artery. Angiogram was performed to confirm the location. A cone beam CT was performed, demonstrating wide patency of the superior mesenteric artery and branches. There was a replaced common hepatic artery originating from the proximal superior mesenteric artery. The replaced common hepatic artery gave rise to gastroduodenal artery, proper hepatic artery which bifurcated to LEFT hepatic artery and RIGHT hepatic artery. The microcatheter was engaged into the replaced common hepatic artery. Angiogram was performed to confirm the location. And then, microcatheter in conjunction with microwire was advanced into the proper hepatic artery. Angiogram was performed confirm location. A cone beam CT was performed, demonstrating patency of the LEFT hepatic artery and RIGHT hepatic artery with the multiple enhancing nodules scattered in LEFT and the RIGHT hepatic lobes. A cystic artery originated from the proximal RIGHT hepatic artery. A RIGHT gastric artery originated from the proper hepatic artery adjacent to the bifurcation of the LEFT and RIGHT hepatic arteries.
And then, the microcatheter in conjunction with microwire was advanced into the LEFT hepatic artery. Angiogram was performed to confirm location. A cone beam CT was performed, demonstrating arterial supply from the LEFT hepatic artery to the segments 4A, 4B, anterior portion of the segments 2 and 3. Multiple rim enhancing nodules were present in the LEFT hepatic lobe. There was no extrahepatic enhancement.
The microcatheter was retracted and engaged into the RIGHT hepatic artery. Angiogram was performed to confirm location, a cone beam CT was performed, demonstrating arterial supply from the RIGHT hepatic artery to the segments 5, 6, 7 and 8. Multiple rim enhancing nodules are present in the RIGHT hepatic lobe. The cystic artery originated from the proximal RIGHT hepatic artery.
Subsequently, the microcatheter was retracted into the proper hepatic artery. Angiogram of the proper hepatic artery confirmed the location of the tip of the catheter. Disposition was active enough for region of interest and the decision was made to proceed with MAA injection. A three-way stopcock was placed on the catheter. At this point, technetium-99m MAA was slowly injected by the nuclear medicine technologist using sterile technique followed by careful flushing of the MAA through the catheter with normal saline. None of the MAA or normal saline flush dripped out during administration. The syringes, three-way stop cock, catheter, underlying drapes and my outer gloves were placed in the yellow waste container to be disposed off according to nuclear waste regulations by the nuclear medicine technologist. A total of 2.26 mCi technetium-99m MAA was administered intra-arterially into the distal proper hepatic artery.
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. Angiogram and cone beam CT demonstrating an accessory LEFT hepatic artery originating from the gastrohepatic trunk of the celiac trunk with blood supply to the posterior portion of the segments 2 and 3 including at least 2 large rim enhancement nodules which possibly can be treated with Y 90 radiation segmentectomy.
2. Angiogram and cone beam CT demonstrating a replaced common hepatic artery originating from the proximal superior mesenteric artery, giving rise into GDA, RIGHT gastric artery, proper hepatic artery, LEFT and RIGHT hepatic arteries.
3. Angiogram and cone beam CT demonstrated arterial supply from the LEFT hepatic artery to the segments 4A, 4B, anterior portion of the segments 2 and 3 with multiple enhanced nodules in the LEFT hepatic lobe, which possibly could be treated with lobar Y 90 radioembolization.
4. Angiogram and cone beam CT demonstrating arterial supply from the RIGHT hepatic artery to the segments 5, 6, 7 and 8 with multiple enhanced nodules in the RIGHT hepatic lobe, which possibly could be treated with lobar Y 90 radioembolization.
5. The cystic artery originating from the proximal RIGHT hepatic artery. Occlusion microcatheter or bland embolization of the cystic artery should be considered during the RIGHT hepatic lobe Y 90 radioembolization.
6. Intra-arterial technetium 99 MAA injection into accessory LEFT hepatic artery was performed for procedural evaluation as a potential candidate for anticipated Y90 radioembolization. #
7. Intra-arterial technetium 99 MAA injection into proper hepatic artery originating from the replaced common hepatic artery was performed for procedural evaluation as a potential candidate for anticipated Y90 radioembolization.
8. The patient was comfortable and was transferred to the nuclear medicine lab in stable condition for a gamma scan to demonstrate the distribution of the MAA and calculate the lung shunt fraction. The patient was monitored by an IR nurse during the transfer, the gamma scan and the return transfer to the interventional radiology recovery room. The report for the T99m MAA scan will be dictated separately by the Nuclear Medicine physician.
9. The patient's liver volume, treatment volume and tumor burden were calculated using IntuitionTM version 4.5.0, Siemens VE20D.210615.
10. The radiation dosimetry was calculated by authorized user using patient liver volume, treatment volume and tumor burden, hepatic to pulmonary shunting, arterial anatomy, and the desired dose to be delivered to the tumor/liver.
Laura
Description: Written informed consent was obtained from patient. Maximum sterile barrier was used. The patient was placed supine. Preliminary ultrasound of the RIGHT inguinal region demonstrated patent RIGHT common femoral artery. Ultrasound machine was used to generate a permanent image to document vascular access.
After local anesthesia, access was obtained into the RIGHT common femoral artery under direct sonographic guidance and a 5 French vascular sheath was placed. Access was obtained into the celiac trunk using the Cobra 2 catheter. Angiogram was performed, demonstrating patency of the splenic artery, gastrohepatic trunk. The Cobra 2 catheter was exchanged for Sos Omni 0 catheter. Angiogram was was performed to confirm the position of the catheter. A coned beam CT was performed, demonstrating splenic artery and the gastrohepatic trunk originating from the celiac trunk. The gastrohepatic trunk gave rise to accessory LEFT hepatic artery supplying the partial LEFT hepatic lobe.
Using coaxial technique, a 2.8 French Progreat microcatheter in conjunction with microwire was advanced through the Sos Omni catheter. The access into the gastrohepatic trunk was unsuccessful. The microwire was exchanged for GT wire, and then, Fathom wire, and headliner wire. However, the attempt to access into the gastrohepatic trunk was unsuccessful. The Sos Omni 0 catheter was exchanged for a Sos Omni 1 catheter. The Progreat microcatheter was exchanged for 90 degree lantern microcatheter. The lantern microcatheter in conjunction with the GT wire was advanced into the gastrohepatic trunk and then the accessory LEFT hepatic artery. The angiogram was performed to confirm location. A cone beam CT was performed, demonstrating arterial supply from the accessory LEFT hepatic artery to the posterior portion of segments 2 and 3. There were at least 2 linear enhancement nodules in the posterior LEFT hepatic lobe. There was no enhancement of the stomach wall.
Subsequently, angiogram of the accessory LEFT hepatic artery confirmed the location of the tip of the catheter. Disposition was active enough for region of interest and the decision was made to proceed with MAA injection. A three-way stopcock was placed on the catheter. At this point, technetium-99m MAA was slowly injected by the nuclear medicine technologist using sterile technique followed by careful flushing of the MAA through the catheter with normal saline. None of the MAA or normal saline flush dripped out during administration. The syringes, three-way stop cock, catheter, underlying drapes and my outer gloves were placed in the yellow waste container to be disposed off according to nuclear waste regulations by the nuclear medicine technologist. A total of 2.44 mCi technetium-99m MAA was administered intra-arterially into accessory LEFT hepatic artery.
The host catheter and microcatheter were retracted from the celiac trunk, and engaged into the superior mesenteric artery. Angiogram was performed to confirm the location. A cone beam CT was performed, demonstrating wide patency of the superior mesenteric artery and branches. There was a replaced common hepatic artery originating from the proximal superior mesenteric artery. The replaced common hepatic artery gave rise to gastroduodenal artery, proper hepatic artery which bifurcated to LEFT hepatic artery and RIGHT hepatic artery. The microcatheter was engaged into the replaced common hepatic artery. Angiogram was performed to confirm the location. And then, microcatheter in conjunction with microwire was advanced into the proper hepatic artery. Angiogram was performed confirm location. A cone beam CT was performed, demonstrating patency of the LEFT hepatic artery and RIGHT hepatic artery with the multiple enhancing nodules scattered in LEFT and the RIGHT hepatic lobes. A cystic artery originated from the proximal RIGHT hepatic artery. A RIGHT gastric artery originated from the proper hepatic artery adjacent to the bifurcation of the LEFT and RIGHT hepatic arteries.
And then, the microcatheter in conjunction with microwire was advanced into the LEFT hepatic artery. Angiogram was performed to confirm location. A cone beam CT was performed, demonstrating arterial supply from the LEFT hepatic artery to the segments 4A, 4B, anterior portion of the segments 2 and 3. Multiple rim enhancing nodules were present in the LEFT hepatic lobe. There was no extrahepatic enhancement.
The microcatheter was retracted and engaged into the RIGHT hepatic artery. Angiogram was performed to confirm location, a cone beam CT was performed, demonstrating arterial supply from the RIGHT hepatic artery to the segments 5, 6, 7 and 8. Multiple rim enhancing nodules are present in the RIGHT hepatic lobe. The cystic artery originated from the proximal RIGHT hepatic artery.
Subsequently, the microcatheter was retracted into the proper hepatic artery. Angiogram of the proper hepatic artery confirmed the location of the tip of the catheter. Disposition was active enough for region of interest and the decision was made to proceed with MAA injection. A three-way stopcock was placed on the catheter. At this point, technetium-99m MAA was slowly injected by the nuclear medicine technologist using sterile technique followed by careful flushing of the MAA through the catheter with normal saline. None of the MAA or normal saline flush dripped out during administration. The syringes, three-way stop cock, catheter, underlying drapes and my outer gloves were placed in the yellow waste container to be disposed off according to nuclear waste regulations by the nuclear medicine technologist. A total of 2.26 mCi technetium-99m MAA was administered intra-arterially into the distal proper hepatic artery.
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. Angiogram and cone beam CT demonstrating an accessory LEFT hepatic artery originating from the gastrohepatic trunk of the celiac trunk with blood supply to the posterior portion of the segments 2 and 3 including at least 2 large rim enhancement nodules which possibly can be treated with Y 90 radiation segmentectomy.
2. Angiogram and cone beam CT demonstrating a replaced common hepatic artery originating from the proximal superior mesenteric artery, giving rise into GDA, RIGHT gastric artery, proper hepatic artery, LEFT and RIGHT hepatic arteries.
3. Angiogram and cone beam CT demonstrated arterial supply from the LEFT hepatic artery to the segments 4A, 4B, anterior portion of the segments 2 and 3 with multiple enhanced nodules in the LEFT hepatic lobe, which possibly could be treated with lobar Y 90 radioembolization.
4. Angiogram and cone beam CT demonstrating arterial supply from the RIGHT hepatic artery to the segments 5, 6, 7 and 8 with multiple enhanced nodules in the RIGHT hepatic lobe, which possibly could be treated with lobar Y 90 radioembolization.
5. The cystic artery originating from the proximal RIGHT hepatic artery. Occlusion microcatheter or bland embolization of the cystic artery should be considered during the RIGHT hepatic lobe Y 90 radioembolization.
6. Intra-arterial technetium 99 MAA injection into accessory LEFT hepatic artery was performed for procedural evaluation as a potential candidate for anticipated Y90 radioembolization. #
7. Intra-arterial technetium 99 MAA injection into proper hepatic artery originating from the replaced common hepatic artery was performed for procedural evaluation as a potential candidate for anticipated Y90 radioembolization.
8. The patient was comfortable and was transferred to the nuclear medicine lab in stable condition for a gamma scan to demonstrate the distribution of the MAA and calculate the lung shunt fraction. The patient was monitored by an IR nurse during the transfer, the gamma scan and the return transfer to the interventional radiology recovery room. The report for the T99m MAA scan will be dictated separately by the Nuclear Medicine physician.
9. The patient's liver volume, treatment volume and tumor burden were calculated using IntuitionTM version 4.5.0, Siemens VE20D.210615.
10. The radiation dosimetry was calculated by authorized user using patient liver volume, treatment volume and tumor burden, hepatic to pulmonary shunting, arterial anatomy, and the desired dose to be delivered to the tumor/liver.
