Three-Dimensional Printed Targeting Device for Scaphoid Fracture Fixation

Hand ◽  
2020 ◽  
pp. 155894472090650 ◽  
Author(s):  
Matthew C. DeWolf ◽  
Alexander Hartov ◽  
Thomas A. Fortney ◽  
Lance G. Warhold
Keyword(s):  
Radiation Exposure ◽  
Guide Wire ◽  
Scaphoid Fracture ◽  
Kirschner Wire ◽  
Three Dimensional ◽  
Average Procedure ◽  
Procedure Time ◽  
Intraoperative Radiation ◽  
Freehand Technique ◽  
Average Procedure Time

Background: Percutaneous guide wire insertion for scaphoid screw fixation can be challenging and often requires multiple attempts with significant radiation exposure to the surgical team. A 3-dimensional (3D) printed targeting device has the potential to reduce procedure time and intraoperative radiation exposure. Methods: Our targeting device protocol included a preprocedure computed tomography (CT) scan of a casted cadaver wrist, followed by 3D printing of a customized targeting guide. In a comparison trial, seven orthopedic surgery residents performed percutaneous scaphoid guide wire insertion on different cadaver specimens by both freehand technique and using our targeting device. Radiation exposure and procedure times were compared. All specimens underwent postprocedure CT to assess Kirschner wire (K-wire) accuracy, determined by central third placement. Pre- and postprocedure CT scans from the targeting device group were co-registered to compare planned and actual K-wire trajectories. Results: Using the freehand technique, mean fluoroscopy time was 120 seconds (standard deviation: ±53 seconds) generating 2.45 milligray of radiation. Average procedure time was 21 minutes with a mean of 6.4 (range: 3-9) insertion attempts. A single insertion attempt was made using the targeting device with an average procedure time of 30 seconds and no fluoroscopy exposure. Four K-wires were placed within the central scaphoid in both groups. Using the targeting device, average linear deviation from the planned trajectory was 2.1 mm, while the maximum linear deviation was 3.75 mm. Conclusion: When compared to freehand scaphoid guide wire insertion, our targeting device provides similar accuracy while significantly reducing intraoperative radiation exposure and procedure time.

A customized percutaneous three-dimensional-printed guide for scaphoid fixation versus a freehand technique: a comparative study

2021 ◽  
pp. 175319342110491
Author(s):  
Francesc A Marcano-Fernández ◽  
Alexandre Berenguer ◽  
Ferran Fillat-Gomà ◽  
Sergi Corderch-Navarro ◽  
Jaume Cámara-Cabrera ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Conventional Technique ◽  
Fluoroscopy Time ◽  
Surgical Time ◽  
Level Of Evidence ◽  
Intraoperative Radiation ◽  
Scaphoid Fractures ◽  
Freehand Technique ◽  
Screw Position ◽  
Time Reduction

The aim of this study was to compare the accuracy and reliability of percutaneous fixation of minimally displaced scaphoid fractures using a customized three-dimensional (3-D)-printed guide with a conventional freehand method. A prospective cohort of ten patients underwent scaphoid fixation with the aid of a customized 3-D-printed guide. The final screw position, total surgery time (minutes) and fluoroscopy time (seconds) was compared with a retrospective cohort of ten patients who underwent fixation with a conventional technique. There were no differences in final screw position between both methods. The patients in which the 3-D guide was used had a surgery time reduction of 43% and a fluoroscopy time reduction of 52% compared with the control freehand group. The use of a customized 3-D-printed guide permits a fixation that is as accurate as the standard freehand technique, with reduction in surgical time and intraoperative radiation exposure. Level of evidence: III

scholarly journals Merger Control in Hungary

2021 ◽  
Vol 66 (2) ◽  
pp. 252-274
Author(s):  
Csaba Balázs Rigó ◽  
András Tóth ◽  
András Bodócsi ◽  
Judit Buránszki ◽  
Attila Dudra
Keyword(s):  
Data Processing ◽  
Full Scale ◽  
Time Limit ◽  
Political Transition ◽  
Merger Control ◽  
The Political ◽  
Competition Authority ◽  
Average Procedure ◽  
Procedure Time ◽  
Average Procedure Time

The present study presents the findings of the most comprehensive research that has ever been conducted in relation to the 30-year-old Hungarian merger authorisation process that has been in place since the political transition in Hungary. The aim of the research is, in particular, to present to the wider professional public the development of the authorisation process for mergers (or concentrations) in Hungary, which started in the last decade, and the resulting public value returns that have been achieved. The most important results to emerge from the research are that – compared to 2010 data – the average procedure time for full-scale merger proceedings in 2020 was reduced by 62%, and the administrative time limit for simplified cases decreased by 82.5%. Furthermore, the research revealed that today one-third of the Hungarian Competition Authority’s market interventions in connection with mergers take a verbal/informal form. This study was conducted using the methodology of data processing and analysing that are at the disposal of the Hungarian Competition Authority.

scholarly journals Applicability of Endobronchial Ultrasound and Virtual Bronchoscopic Navigation Combined with Rapid On-Site Evaluation in Diagnosing Peripheral Lung Lesions

2021 ◽  
Author(s):  
Jia-Chao Qi ◽  
Liping Liao ◽  
Zhiwei Zhao ◽  
HuiXue Zeng ◽  
Tiezhu Wang ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Endobronchial Ultrasound ◽  
Average Procedure ◽  
Procedure Time ◽  
Significant Difference ◽  
Positive Rate ◽  
Site Evaluation ◽  
Medical University ◽  
The Impact ◽  
Average Procedure Time

Abstract Background To investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs). Methods Between January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in 250 consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed. Results In the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, repectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, repectively, and the average expense was 4093.15 ± 4494.67 yuan. In the controls, the positive rate of brushing and biopsy were 44%, 74%, repectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, repectively. And the average expense during diagnosis was 6420.28 ± 4541.33 yuan. There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤2 cm in diameter was significant. Conclusion In combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.

scholarly journals Three-dimensional fusion computed tomography decreases radiation exposure, procedure time, and contrast use during fenestrated endovascular aortic repair

2015 ◽  
Vol 61 (2) ◽  
pp. 309-316 ◽  
Author(s):  
Michael M. McNally ◽  
Salvatore T. Scali ◽  
Robert J. Feezor ◽  
Daniel Neal ◽  
Thomas S. Huber ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Three Dimensional ◽  
Endovascular Aortic Repair ◽  
Procedure Time ◽  
Aortic Repair

scholarly journals Non-bronchoscopic Bronchoalveolar Lavage as a Refinement for Safely Obtaining High-quality Samples from Macaques

2020 ◽  
Vol 70 (6) ◽  
pp. 520-525
Author(s):  
Cassandra R Moats ◽  
Kurt T Randall ◽  
Tonya M Swanson ◽  
Hugh B Crank ◽  
Kimberly M Armantrout ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Vital Signs ◽  
Cost Effective ◽  
Average Procedure ◽  
Procedure Time ◽  
Safe Alternative ◽  
Volume Yield ◽  
Procedural Complications ◽  
Lower Airways ◽  
Average Procedure Time

Nonbronchoscopic bronchoalveolar lavage (NB-BAL) is a minimally invasive diagnostic and research tool used to sample the cells of lower airways and alveoli without using a bronchoscope. Our study compared NB-BAL and bronchoscopic bronchoalveolar lavage (B-BAL) in terms of costs, cell yields, and the number of post-procedural complications in macaques. We also analyzed procedure times, BAL fluid volume yields, and vital signs in a subset of animals that underwent NB-BAL. Compared with the B-BAL technique, NB-BAL was less expensive to perform, with fewer complications, fewer animals requiring temporary or permanent cessation of BALs, and higher cell yields per mL of recovered saline. The average procedure time for NB-BAL was 6.8 ± 1.6 min, and the average NB-BAL lavage volume yield was 76 ± 9%. We found no significant differences in respiration rate before, during, or after NB-BAL but did find significant differences in heart rate and oxygen saturation (SpO2). This study demonstrates that NB-BAL is a simple, cost-effective, and safe alternative to B-BAL that results in higher cell yields per mL, improved animal welfare, and fewer missed time points, and thus constitutes a refinement over the B-BAL in macaques.

Utilising electroanatomic mapping during ablation in patients with CHD to reduce radiation exposure

2021 ◽  
pp. 1-5
Author(s):  
Maryam Rahman ◽  
Jeremy P. Moore ◽  
John Papagiannis ◽  
Grace Smith ◽  
Chris Anderson ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Three Dimensional ◽  
Fluoroscopy Time ◽  
Electroanatomic Mapping ◽  
Complication Rates ◽  
Procedure Time ◽  
Reduce Radiation Exposure ◽  
Three Dimensional Mapping ◽  
Procedural Success

Abstract Background: Patients with CHD can be exposed to high levels of cumulative ionising radiation. Utilisation of electroanatomic mapping during catheter ablation leads to reduced radiation exposure in the general population but has not been well studied in patients with CHD. This study evaluated the radiation sparing benefit of using three-dimensional mapping in patients with CHD. Methods: Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy multi-institutional registry. Patients with CHD were selected. Those with previous ablations, concurrent diagnostic or interventional catheterisation and unknown arrhythmogenic foci were excluded. The control cohort was matched for operating physician, arrhythmia mechanism, arrhythmia location, weight and age. The procedure time, rate of fluoroscopy use, fluoroscopy time, procedural success, complications, and distribution of procedures per year were compared between the two groups. Results: Fifty-six patients with congenital heart disease and 56 matched patients without CHD were included. The mean total procedure time was significantly higher in patients with CHD (212.6 versus 169.5 minutes, p = 0.003). Their median total fluoroscopy time was 4.4 minutes (compared to 1.8 minutes), and their rate of fluoroscopy use was 23% (compared to 13%). The acute success and minor complication rates were similar and no major complications occurred. Conclusions: With the use of electroanatomic mapping during catheter ablation, fluoroscopy use can be reduced in patients with CHD. The majority of patients with CHD received zero fluoroscopy.

scholarly journals RADIATION EXPOSURE IN ACCESSORY PATHWAY ABLATION PROCEDURES IN CARDIAC ELECTROPHYSIOLOGY: A RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 7 (1) ◽  
pp. 28-34
Author(s):  
M. Ali ◽  
B. Banavalikar ◽  
M. K. Ghadei ◽  
A. Kottayan ◽  
D. Padmanabhan ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cardiac Electrophysiology ◽  
Accessory Pathway ◽  
Three Dimensional ◽  
Frame Rate ◽  
Procedure Time ◽  
Dose Area Product ◽  
Electroanatomic Mapping System ◽  
Common Location ◽  
The Impact

Background. Radiofrequency catheter ablation (CA) has been the treatment of choice in patients with accessory pathway (AP)-mediated tachycardias. Most of these procedures are done under fluoroscopic guidance, leading to significant radiation exposure to the patient and the laboratory personnel. In this analysis, we have looked at the amount of radiation exposure in AP CA procedures performed without the support of a three-dimensional electroanatomic mapping system. We have analyzed changes in exposure indices over the study period and the impact of change in fluoroscopy frame rate (FFR). Objectives. The objectives of this study are to quantify radiation exposure in accessory pathway ablation procedures; to analyze the radiation exposure trend over time; and to evaluate the effect of fluoroscopy frame rate reduction on the radiation exposure indices in these procedures. Methods. All the AP ablation procedures performed at our institute from January 2016 to December 2019 were retrospectively analyzed. The collected data were age, sex, location of APs based on successful site of ablation on fluoroscopy, procedure time, fluoroscopy time, and dose-area product (DAP). Effective dose (ED) was estimated from DAP. The data of procedures performed before January 2018 (“pre” group) were compared with those of the procedures performed after that date (“post” group). Pre-group procedures were performed at an FFR of 7.5 frames per second (fps), and post-group procedures – at an FFR of 3.75 fps. Results. The total number of procedures included in the analysis was 635. The mean age of the patients was 39±14 years, and 401 of them (63%) were males. The most common location of the APs was left lateral (38%). Procedure time and radiation indices showed a significant decrease over the study period (p < 0.001). Post group procedures had significantly shorter procedure time and lower radiation exposure than pre group procedures. Conclusions. A decrease in the FFR was associated with a significant reduction in radiation exposure in AP ablation procedures

Intraoperative Radiation Exposure for Patients with Double-Curve Idiopathic Scoliosis in Freehand-Technique in Comparison to Fluoroscopic- and CT-Based Navigation

2020 ◽  
Author(s):  
Clara Berlin ◽  
Markus Quante ◽  
Björn Thomsen ◽  
Mark Köszegvary ◽  
Uwe Platz ◽  
...  
Keyword(s):  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Radiation Exposure ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Total Radiation ◽  
Intraoperative Radiation ◽  
Assisted Navigation ◽  
Freehand Technique ◽  
Time Of Operation

Abstract Background In the operative treatment of idiopathic scoliosis, posterior correction and fusion in freehand technique is a proven procedure and is frequently performed. Malpositioned pedicle screws can result in serious neurovascular complications. Intraoperative fluoroscopy and neurophysiological measurements are performed to ensure the correct position of pedicle screws. Newer procedures with fluoroscopic- and computertomographic-assisted navigation are advertised as less dangerous and with a more accurate screw position. Hypothesis Is the freehand technique used in the surgical treatment of idiopathic scoliosis safer than other methods with regard to complications caused by screw malposition and intraoperative radiation exposure? Material and Methods Register data of 34 consecutive idiopathic scoliosis patients with two structural curves (Lenke 3 and 6) were collected prospectively in our scoliosis center and were retrospectively analyzed. The following parameters were evaluated: total radiation product, time of fluoroscopy, number of fused segments, time of operation, blood loss, screw-related complications and number of instrumented pedicle screws. All values were given as mean ± standard deviation and statistically analyzed. Finally, our data were compared on accuracy of screw placement and radiation exposure to data from literature with screw placement under navigation. Results Average age at the time of surgery was 23.6 ± 12 years. The average thoracic curve was 69.2 ± 14.2° preoperatively and 21.7 ± 12.8° postoperatively (correction 69.9%), the average lumbar curve was 64.3° ± 10.8° preoperatively and corrected to 15.6 ± 10.4° postoperatively (correction 76.2%). The total radiation product per patient was 145.7 ± 86.1 cGy*cm², the time of fluoroscopy 31.7 ± 23.5 s (11.5 segments), the time of operation 267.2 ± 64.1 min and the blood loss 700.4 ± 522.3 ml. A total of 803 pedicle screws were placed. No screw-associated complications were detected in the entire collective. The comparison of our data with freehand placement of pedicle screws to literature data showed a noticeable higher radiation exposure for the patient during fluoroscopic- and computertomographic-assisted navigation. Discussion The results showed that positioning of pedicle screws with freehand technique in patients with idiopathic scoliosis is accompanied with considerably lower intraoperative radiation exposure compared to fluoroscopic- or computertomographic-assisted navigation. An increased radiation exposure of these typically young patients is associated with an increased long-term risk for the occurrence of radiation-induced malignant diseases. With appropriate surgical experience, placement of pedicle screws in freehand technique is safe and effective and with similar accuracy than screws placed under navigation, but produces significantly less radiation exposure to the patients.

scholarly journals Combining 3D Structured Light Imaging and Spine X-ray Data Improves Visualization of the Spinous Lines in the Scoliotic Spine

2020 ◽  
Vol 11 (1) ◽  
pp. 301
Author(s):  
Sławomir Paśko ◽  
Wojciech Glinkowski
Keyword(s):  
Radiation Exposure ◽  
Surface Topography ◽  
Structured Light ◽  
Spinous Process ◽  
Three Dimensional ◽  
Diagnostic System ◽  
Measurement Tool ◽  
Adequate Treatment ◽  
X Ray ◽  
Spinous Processes

Scoliosis is a three-dimensional trunk and spinal deformity. Patient evaluation is essential for the decision-making process and determines the selection of specific and adequate treatment. The diagnosis requires a radiological evaluation that exposes patients to radiation. This exposure reaches hazardous levels when numerous, repetitive radiographic studies are required for diagnostics, monitoring, and treatment. Technological improvements in radiographic devices have significantly reduced radiation exposure, but the risk for patients remains. Optical three-dimensional surface topography (3D ST) measurement systems that use surface topography (ST) to screen, diagnose, and monitor scoliosis are safer alternatives to radiography. The study aimed to show that the combination of plain X-ray and 3D ST scans allows for an approximate presentation of the vertebral column spinous processes line in space to determine the shape of the spine’s deformity in scoliosis patients. Twelve patients diagnosed with scoliosis, aged 13.1 ± 4.5 years (range: 9 to 20 years) (mean: Cobb angle 17.8°, SD: ±9.5°) were enrolled in the study. Patients were diagnosed using full-spine X-ray and whole torso 3D ST. The novel three-dimensional assessment of the spinous process lines by merging 3D ST and X-ray data in patients with scoliosis was implemented. The method’s expected uncertainty is less than 5 mm, which is better than the norm for a standard measurement tool. The presented accuracy level is considered adequate; the proposed solution is accurate enough to monitor the changes in the shape of scoliosis’s spinous processes line. The proposed method allows for a relatively precise calculation of the spinous process lines based on a three-dimensional point cloud obtained with a four-directional, three-dimensional structured light diagnostic system and a single X-ray image. The method may help reduce patients’ total radiation exposure and avoid one X-ray in the sagittal projection if biplanar radiograms are required for reconstructing the three-dimensional line of the spinous processes line.

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