Comparison of radiation exposure and surgery time between an intraoperative CT with automatic surface registration and a preoperative CT with manual surface registration in navigated spinal surgeries

Abstract BACKGROUND: The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture.METHODS: Here is a typical case. An 86-year-old woman suffered an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation was selected to optimize surgical invasiveness and proper implant placement.RESULTS: The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon.　Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. CONCLUSIONS: The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.

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Combined Image Guidance and Intraoperative Computed Tomography in Facilitating Endoscopic Orientation within and around the Paranasal Sinuses

American Journal of Rhinology ◽

10.2500/ajr.2008.22.3242 ◽

2008 ◽

Vol 22 (6) ◽

pp. 635-641 ◽

Cited By ~ 21

Author(s):

Sarah K. Wise ◽

Richard J. Harvey ◽

John C. Goddard ◽

Patrick O. Sheahan ◽

Rodney J. Schlosser

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Paranasal Sinus ◽

Image Guidance ◽

Sinus Surgery ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Significant Difference ◽

Preoperative Ct ◽

Anatomic Region

Background The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Methods Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Results Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Conclusion Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.

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Lumbar hemivertebra resection in congenital scoliosis utilizing cone-beam navigation: less radiation, more accuracy—proof of concept

Child s Nervous System ◽

10.1007/s00381-021-05055-5 ◽

2021 ◽

Author(s):

Christian Fisahn ◽

Chris Lindemann ◽

Brittni Burgess ◽

Patrick Strube ◽

Timo Zippelius

Keyword(s):

Cobb Angle ◽

Radiation Exposure ◽

Congenital Scoliosis ◽

Cone Beam ◽

Pediatric Case ◽

Case Presentation ◽

Hemivertebra Resection ◽

Preoperative Ct ◽

Whole Spine ◽

Spine Mri

Abstract Purpose To present the first known pediatric utilization of cone-beam navigation system (CBNS) for hemivertebra resection and spondylodesis Case presentation A 14-year-old female with congenital scoliosis, diagnosed at 8 years of age, presenting with progressive symptoms, a Cobb angle (L3-5) of 38° at time of surgery, treated historically with conservative measures. Presence of spinal intramedullary disease was excluded prior to operation via whole spine MRI. Results Patient successfully underwent surgical correction utilizing the CBNS (O-arm™, Medtronic®). Post-operative Cobb angle (L3-5) was restored to 8°. Following four different pediatric patient’s radiation exposures (two receiving correction via the O-arm platform and two via the traditional method employing fluoroscopy), we show a reduction in radiation exposure using the CBNS system. Conclusion We present the first known pediatric case of the utilization of the CBNS system for hemivertebra correction. We demonstrate that utilizing the CBNS platform can not only increase surgical accuracy but also decrease pediatric patient’s radiation exposure as a preoperative CT scan is not needed. Future studies should continue to explore additional benefits of implementing the system into surgical practice.

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Is There a Difference in Screw Accuracy, Robot Time Per Screw, Robot Abandonment, and Radiation Exposure Between the Mazor X and the Renaissance? A Propensity-Matched Analysis of 1179 Robot-Assisted Screws

Global Spine Journal ◽

10.1177/21925682211029867 ◽

2021 ◽

pp. 219256822110298

Author(s):

Nathan J. Lee ◽

Scott L. Zuckerman ◽

Ian A. Buchanan ◽

Venkat Boddapati ◽

Justin Mathew ◽

...

Keyword(s):

Radiation Exposure ◽

Spine Surgery ◽

Cohort Analysis ◽

Sensory Function ◽

Robot Assisted ◽

Included Patient ◽

Robot Systems ◽

Preoperative Ct ◽

Planning Processes ◽

Perioperative Planning

Study Design: Prospective single-cohort analysis. Objectives: To compare the outcomes/complications of 2 robotic systems for spine surgery. Methods: Adult patients (≥18-years-old) who underwent robot-assisted spine surgery from 2016-2019 were assessed. A propensity score matching (PSM) algorithm was used to match Mazor X to Renaissance cases. Preoperative CT scan for planning and an intraoperative O-arm for screw evaluation were preformed. Outcomes included screw accuracy, robot time/screw, robot abandonment, and radiation. Screw accuracy was measured using Vitrea Core software by 2 orthopedic surgeons. Screw breach was measured according to the Gertzbein/Robbins classification. Results: After PSA, a total of 65 patients (Renaissance: 22 vs. X: 43) were included. Patient/operative factors were similar between robot systems ( P > .05). The pedicle screw accuracy was similar between robots (Renaissance: 1.1%% vs. X: 1.3%, P = .786); however, the S2AI screw breach rate was significantly lower for the X (Renaissance: 9.5% vs. X: 1.2%, P = .025). Robot time per screw was not statistically different (Renaissance: 4.6 minutes vs. X: 3.9 minutes, P = .246). The X was more reliable with an abandonment rate of 2.3% vs. Renaissance:22.7%, P = .007. Radiation exposure were not different between robot systems. Non-robot related complications including dural tear, loss of motor/sensory function, and blood transfusion were similar between robot systems. Conclusion: This is the first comparative analyses of screw accuracy, robot time/screw, robot abandonment, and radiation exposure between the Mazor X and Renaissance systems. There are substantial improvements in the X robot, particularly in the perioperative planning processes, which likely contribute to the X’s superiority in S2AI screw accuracy by nearly 8-fold and robot reliability by nearly 10-fold.

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The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-022-02920-0 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Akihiko Hiyama ◽

Taku Ukai ◽

Satoshi Nomura ◽

Masahiko Watanabe

Keyword(s):

Radiation Exposure ◽

Pelvic Ring ◽

Technical Note ◽

Pelvic Ring Fracture ◽

X Rays ◽

Ring Fracture ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Screw Insertion ◽

Rod System

Abstract Background The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture. Methods A typical case is presented in this study. An 86-year-old woman suffered from an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation were selected to optimize surgical invasiveness and proper implant placement. Results The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon. Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. Conclusions The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.

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A retrospective comparison of intraoperative CT and fluoroscopy evaluating radiation exposure in posterior spinal fusions for scoliosis

Patient Safety in Surgery ◽

10.1186/s13037-017-0142-0 ◽

2017 ◽

Vol 11 (1) ◽

Cited By ~ 12

Author(s):

Jacob Riis ◽

Rebecca R. Lehman ◽

Robert A. Perera ◽

John Ryan Quinn ◽

Patricia Rinehart ◽

...

Keyword(s):

Radiation Exposure ◽

Intraoperative Ct ◽

Retrospective Comparison ◽

Spinal Fusions

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Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz292 ◽

2019 ◽

Author(s):

Yin-Kai Chao ◽

Hsin-Yueh Fang ◽

Kuang-Tse Pan ◽

Chih-Tsung Wen ◽

Ming-Ju Hsieh

Keyword(s):

Radiation Exposure ◽

General Anaesthesia ◽

Cone Beam Ct ◽

Operating Time ◽

Pulmonary Nodules ◽

Complication Rates ◽

Navigation Systems ◽

Ct Guided ◽

Preoperative Ct ◽

Procedural Time

Abstract OBJECTIVES Computed tomography (CT)-guided localization of multiple ipsilateral pulmonary nodules remains challenging. Hybrid operating rooms equipped with cone-beam CT and laser navigation systems have the potential for improving clinical workflows and patient outcomes. METHODS Patients with multiple ipsilateral pulmonary nodules requiring localization were divided according to the localization method [preoperative CT-guided (POCT group) localization versus intraoperative CT-guided (IOCT group) localization]. The 2 groups were compared in terms of procedural efficacy, safety and radiation exposure. RESULTS Patients in the IOCT (n = 12) and POCT (n = 42) groups did not differ in terms of demographic and tumour characteristics. Moreover, the success and complication rates were similar. Notably, the IOCT approach allowed multiple nodules to be almost simultaneously localized—resulting in a shorter procedural time [mean difference (MD) −15.83 min, 95% confidence interval (CI) −7.97 to −23.69 min] and lower radiation exposure (MD −15.59 mSv, 95% CI −7.76 to −23.42 mSv) compared with the POCT approach. However, the total time under general anaesthesia was significantly longer in the IOCT group (MD 34.96 min, 95% CI 1.48–68.42 min), despite a similar operating time. The excess time under anaesthesia in the IOCT group can be attributed not only to the procedure per se but also to a longer surgical preparation time (MD 21.63 min, 95% CI 10.07–33.19 min). CONCLUSIONS Compared with the POCT approach, IOCT-guided localization performed in a hybrid operating room is associated with a shorter procedural time and less radiation exposure, albeit at the expense of an increased time under general anaesthesia.

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Preoperative CT Simulation of Iliosacral Screws for Treating Unstable Posterior Pelvic Ring Injury

10.21203/rs.3.rs-1058330/v1 ◽

2021 ◽

Author(s):

Peishuai Zhao ◽

Xiaopan Wang ◽

Xiaotian Chen ◽

Jianzhong Guan ◽

Min Wu

Keyword(s):

Radiation Exposure ◽

Exposure Time ◽

Pelvic Ring ◽

Pelvic Ring Injury ◽

Posterior Pelvic Ring ◽

Iliosacral Screws ◽

Preoperative Ct ◽

Ct Simulation ◽

Posterior Pelvic Ring Injury

Abstract BackgroundPercutaneous iliosacral screw placement is an important surgical method for the treatment of pelvic unstable fractures, but either intraoperative X-ray screws or navigational screws may be misplaced. This study aimed to demonstrate a safe, effective, and rapid medthod for placing iliosacral screws for the treatment of unstable posterior pelvic ring injury according to preoperative computed tomography (CT) planning using simulated screws. MethodsAfter preoperative CT simulation of iliosacral screws planning screw insertion point and trajectory, intraoperative percutaneous iliosacral screws were used to treat unstable pelvic posterior ring injury.The mechanism of injury, Tile classification, number of screw implants, operative time of each screw implantation, radiation exposure time of each screw implantation screw position, complications, and postoperative follow-up time were collected.Screw position grading was evaluated by Smith grading. ResultsA total of 24 screws were implanted in 21 patients (9 men and 12 women;mean age 41.3 years:range 14-71 years). Tile classification included:Tile B:15 patients;Tile C:6 patients. The mean placement time of each screw was 19.5 minutes (range 14-32min); Radiation exposure time: 0.6 min (range 0.5-0.9min); Two screws were inserted in 3 patients; One screw was inserted in 18 patients; According to Smith grading standard, grade0:20 cases; and Grade1:1 case; Mean postoperative follow-up time was 17.1months (range12-25 months); None of the patients showed nonunion. ConclusionsPreoperative CT simulation of iliosacral screws for placement planning, screw trajectory, and intraoperative placement of screws is a safe method that can be used to reduce surgical time, radiation exposure, and accurate screw placement.

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