scholarly journals Intraoperative three-dimensional fluoroscopy-based computerized tomography guidance for percutaneous kyphoplasty

2005 ◽  
Vol 18 (3) ◽  
pp. 1-7 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Sigita Burneikiene ◽  
Ketan R. Bulsara ◽  
Jeffrey J. Thramann
Keyword(s):  
Radiation Exposure ◽  
Computerized Tomography ◽  
Image Guidance ◽  
Operating Time ◽  
Three Dimensional ◽  
Fluoroscopy Time ◽  
Percutaneous Kyphoplasty ◽  
3D Fluoroscopy ◽  
The Mean ◽  
Biplanar Fluoroscopy

Object Percutaneous kyphoplasty is an established method for the treatment of pathological vertebral compression fractures (VCFs). This procedure is usually performed with the aid of biplanar fluoroscopic image guidance. There are currently no published clinical studies in which the use of three-dimensional (3D) image guidance to facilitate this technique has been evaluated. The purpose of this study was to evaluate the efficacy of isocentric fluoroscopy-based navigation for the kyphoplasty procedure, with special reference to operating time and the amount of radiation exposure. Methods A prospective clinical study was performed in which 11 consecutive patients with painful pathological VCFs that did not respond to conservative treatment underwent the kyphoplasty procedure. During this procedure, cannulation of the pedicle and vertebral body was performed with the aid of isocentric 3D fluoroscopy visualization. Total operating time and intraoperative fluoroscopy time for this group was compared with a cohort of nine patients who underwent the procedure prior to the availability of isocentric fluoroscopy (only biplanar fluoroscopy was used). Possible complications such as cement extravasations were evaluated during the procedure and on postoperative computerized tomography scans. The mean duration of surgery for the 3D isocentric fluoroscopic guidance group was 60 minutes (range 36–89 minutes) for one-level and 68.5 minutes (range 65–75 minutes) for two-level cases. Because of a learning curve with the equipment, the operating time for the initial cases was significantly longer than with the later ones. Even with the initial cases included, the mean operating time was shorter compared with the biplanar fluoroscopy-assisted procedures, which averaged 69.2 minutes (range 44–113 minutes) for one-level procedures. This difference was not statistically significant. The mean fluoroscopy exposure time was 41.3 seconds (range 25–62 seconds) in the isocentric fluoroscopy-assisted procedures, with an additional 40 seconds of fluoroscopy time used for the 3D fluoroscopy “spin,” compared with 293.2 seconds (range 180–400 seconds) in the biplanar fluoroscopy-assisted procedures. The difference was statistically significant (p = 0.02). All pedicles were accessed without difficulty and no complications were encountered in either group of patients. Conclusions The main advantage of isocentric fluoroscopy is the significant reduction in radiation exposure for the patient and surgical staff without an increase in the mean operating time. This technique is a significant advancement over biplanar fluoroscopy in this setting.

scholarly journals A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

2021 ◽  
Author(s):  
Andrew G. Yun ◽  
Marilena Qutami ◽  
Kory B. Dylan Pasko
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Hip Arthroplasty ◽  
Fluoroscopy Time ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Preoperative Templating ◽  
The Mean ◽  
Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

scholarly journals Low-Cost Customized Cranioplasty with Polymethyl Methacrylate Using 3D Printer Generated Mold: An Institutional Experience and Review of Literature

2021 ◽  
Author(s):  
Ankit Chaudhary ◽  
Virendra Deo Sinha ◽  
Sanjeev Chopra ◽  
Jitendra Shekhawat ◽  
Gaurav Jain
Keyword(s):  
Polymethyl Methacrylate ◽  
Bone Fractures ◽  
Low Cost ◽  
Operating Time ◽  
Three Dimensional ◽  
Wound Dehiscence ◽  
3D Printer ◽  
Skull Defects ◽  
Aesthetic Appearance ◽  
The Mean

Abstract Background Cranioplasty is performed to repair skull defects and to restore normal skull anatomy. Optimal reconstruction remains a topic of debate. Autologous bone flap is the standard option but it may not be available due to traumatic bone fractures, bone infection, and resorption. The authors present their experience with prefabrication of precise and low-cost polymethyl methacrylate (PMMA) mold using three-dimensional (3D) digital printing. Methods A total of 30 patients underwent cranioplasty between March 2017 and September 2019 at Sawai Man Singh Medical College Jaipur, India. Preoperative data included diagnosis for which decompressive craniectomy was done and Glasgow coma scale score. Intraoperative data included operating time. Postoperative data included cosmetic outcome in the form of cranial contour and margins, complications such as infection, seroma, implant failure, wound dehiscence, and hematoma. Results Patient age at cranioplasty ranged from 12 to 63 years with a mean age of 36.7 years. The mean operating time was 151.6 minutes (range 130–190 minutes). The mean follow-up period was 8 months (range 6–13 months). Postoperative wound dehiscence developed in one case (3.3%). Cranial contour and approximation of the margins were excellent and aesthetic appearance improved in all patients. Conclusion Low-cost PMMA implant made by digital 3D printer mold is associated with reconstruction of the deformed skull contour giving satisfactory results to the patient and his family members, at a low cost compared with other commercially available implants. This technique could be a breakthrough in cranioplasty.

Access Through the Anatomical Snuffbox for Neuroendovascular Procedures: A Single Institution Series

2020 ◽  
Vol 19 (5) ◽  
pp. 495-501 ◽  
Author(s):  
Joshua H Weinberg ◽  
Ahmad Sweid ◽  
Omaditya Khanna ◽  
Nikolaos Mouchtouris ◽  
Ashlee Asada ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Radial Artery ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Safe Alternative ◽  
Access Site Complication ◽  
Size Number ◽  
Therapeutic Procedures ◽  
The Mean ◽  
Transradial Catheterization

Abstract BACKGROUND Distal transradial catheterization in the anatomic snuffbox is an alternate route of access that has started to gain consideration for neuroendovascular procedures. OBJECTIVE To assess the feasibility and outcomes and present our institution's experience in performing neuroendovascular procedures via distal transradial access (dTRA). METHODS We conducted a retrospective analysis and identified 120 patients who underwent consecutive neuroendovascular procedures via dTRA in the anatomic snuffbox. Data collection was performed on indication for procedure, sheath size, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success. RESULTS Of 120 patients with an average age of 54.7 yr ± 14.7, 73 (60.8%) underwent diagnostic angiograms, 38 (31.7%) underwent follow-up angiograms, and 9 (7.5%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.5 ± 0.1 per procedure, the mean procedure time was 68.3 min ± 43.4, the mean fluoroscopy time was 10.8 min ± 7.6, the mean contrast dose was 70.6 mL ± 39.1, and the mean radiation exposure was 27 672.2 mGycm2 ± 42 728.4. Successfully completed therapeutic procedures included aneurysm 1 (0.8%), arteriovenous malformation (AVM)/arteriovenous fistula/carotid cavernous fistula 7 (5.8%), and 1 (0.8%) other treatment. Three patients (2.5%) required adjunct transfemoral endovenous access for AVM embolization. Two minor complications (1.67%) were a local wrist hematoma and a radial artery vasospasm without any sequelae. CONCLUSION Distal radial artery catheterization in the anatomic snuffbox is a safe and effective access site to perform neuroendovascular procedures. Complications and conversion rate are low making it a safe alternative.

scholarly journals Does a fluoro-assisted direct anterior approach for total hip arthroplasty pose an excessive risk of radiation exposure to the surgeon?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 6
Author(s):  
Yuta Jinnai ◽  
Tomonori Baba ◽  
Xu Zhuang ◽  
Hiroki Tanabe ◽  
Sammy Banno ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Proximal Femoral Fracture ◽  
Fluoroscopy Time ◽  
Exposure Level ◽  
Intraoperative Fluoroscopy ◽  
Significant Difference ◽  
The Mean

Introduction: Intraoperative fluoroscopy can be easily used because patients are placed in the supine position during total hip arthroplasty via direct anterior approach (DAA-THA) to reduce complications. However, the cumulative level of radiation exposure by intraoperative fluoroscopy increases as the annual number of cases increases, increasing the risk of influencing the health of both the patients and medical workers. The objective of the study was to compare the radiation exposure time of DAA-THA with osteosynthesis and to determine if the level of radiation exposure exceeded safety limits. Material and methods: DAA-THA was performed in 313 patients between January 2016 and July 2018 and 60 patients with proximal femoral fracture were treated with osteosynthesis. The intraoperative fluoroscopy time was retrospectively surveyed and compared between these two groups. A total of eight surgeons operated DAA-THA employing the same procedure using a traction table. A total of nine surgeons operated osteosynthesis and fluoroscopy was appropriately used during reduction and implant insertion. Results: The mean operative time of DAA-THA was 103.3 min and that of osteosynthesis was 83.3 min, showing a significant difference (p < 0.05). The mean intraoperative fluoroscopy time was 0.83 min (SD ± 0.68) in DAA-THA and 8.91 min (SD ± 8.34) in osteosynthesis showing a significant difference (p < 0.05). Conclusions: The intraoperative exposure level was significantly lower and the fluoroscopy time was significantly shorter in DAA-THA than in osteosynthesis for proximal femoral fracture. It was clarified that the annual cumulative radiation exposure level in DAA-THA does not exceed the tissue dose limit.

scholarly journals Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

2014 ◽  
Vol 8 (9-10) ◽  
pp. 347 ◽  
Author(s):  
Andrea G Lantz ◽  
Padraic O'Malley ◽  
Michael Ordon ◽  
Jason Y Lee
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Percutaneous Nephrolithotomy ◽  
Treatment Success ◽  
Fluoroscopy Time ◽  
Success Rates ◽  
Stone Size ◽  
Lower Treatment ◽  
The Mean ◽  
Stone Characteristics

Introduction: Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopytime, effective dose) and investigates variables that may predict increased exposure.Methods: A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure.Results: In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m2 and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose.Conclusions: Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI.

scholarly journals Low-Cost Customized Cranioplasty with Polymethyl Methacrylate Using 3D Printer Generated Mold: An Institutional Experience and Review of Literature

2020 ◽  
Vol 17 (02) ◽  
pp. 104-109
Author(s):  
Ankit Chaudhary ◽  
Virendra Deo Sinha ◽  
Sanjeev Chopra ◽  
Jitendra Shekhawat ◽  
Gaurav Jain
Keyword(s):  
Polymethyl Methacrylate ◽  
Bone Fractures ◽  
Low Cost ◽  
Operating Time ◽  
Three Dimensional ◽  
Wound Dehiscence ◽  
3D Printer ◽  
Skull Defects ◽  
Aesthetic Appearance ◽  
The Mean

Abstract Background Cranioplasty is performed to repair skull defects and to restore normal skull anatomy. Optimal reconstruction remains a topic of debate. Autologous bone flap is the standard option but it may not be available due to traumatic bone fractures, bone infection, and resorption. The authors present their experience with prefabrication of precise and low-cost polymethyl methacrylate (PMMA) mold using three-dimensional (3D) digital printing. Methods A total of 30 patients underwent cranioplasty between March 2017 and September 2019 at Sawai Man Singh Medical College Jaipur, India. Preoperative data included diagnosis for which decompressive craniectomy was done and Glasgow coma scale score was observed. Intraoperative data included operating time. Postoperative data included cosmetic outcome in the form of cranial contour and margins, complications such as infection, seroma, implant failure, wound dehiscence, and hematoma. Results Patient age at cranioplasty ranged from 12 to 63 years with a mean age of 36.7 years. The mean operating time was 151.6 minutes (range 130–190 minutes). The mean follow-up period was 8 months (range 6–13 months). Postoperative wound dehiscence developed in one case (3.3%). Cranial contour and approximation of the margins were excellent and aesthetic appearance improved in all patients. Conclusion Low-cost PMMA implant made by digital 3D printer mold is associated with reconstruction of the deformed skull contour giving satisfactory results to the patient and his family members, at a low cost compared with other commercially available implants. This technique could be a breakthrough in cranioplasty.

Radiation exposure during non-thrombotic iliac vein stenting

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 617-622 ◽  
Author(s):  
Jesse Chait ◽  
Nikolay Davis ◽  
Yuriy Ostrozhynskyy ◽  
Sareh Rajaee ◽  
Natalie Marks ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Intravascular Ultrasound ◽  
Stent Placement ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Vena Cava ◽  
Iliac Vein ◽  
Fluoroscopy Time ◽  
Air Kerma ◽  
The Mean

Objective Fluoroscopic-guided interventions have become a major part of the modern vascular surgeon’s practice. Imaging is typically required to safely and effectively perform both simple and complex endovascular interventions. With an ever-increasing volume of fluoroscopic-guided interventions being performed each year, the minimization of harmful radiation exposure has become of paramount concern for both patients and providers. The purpose of this study was to identify the extent of radiation exposure associated with venography and iliac vein stenting, an intervention utilized in the management of chronic venous insufficiency. Methods This was a single-center, retrospective analysis of 40 venograms performed on 29 unique patients over a three-month period. Patients with signs and symptoms of chronic venous insufficiency who failed conservative therapy underwent evaluation of the vena cava and iliofemoral veins with venography and intravascular ultrasound. Stent placement was performed if a >50% cross-sectional area or diameter reduction was identified via intravascular ultrasound. All patients were found to have non-thrombotic iliac vein lesions. All patients wore two individual film badge dosimeters – one on their chest and the other on the abdomen. The same mobile C-arm system was used for all interventions. Results There were 15 males and 14 females, with an average age of 70.6 years old (SD ± 9.5; range 53–89) and a mean body mass index of 33.9 kg/m2. Sixteen limbs had C6 disease, 10 had C4 disease, and 14 had C3 disease. Thirty-eight of the 40 procedures resulted in stent placement, with an average of 1.13 stents placed per intervention. The average fluoroscopy time was 76.5 s (SD ± 36.9; range 7.8–209.5), and the mean cumulative air kerma was 1.08 mGy (SD ± 0.55; range 0.362–2.24). Average cumulative air kerma was higher in procedures resulting >1 stent placement compared to those with placement of ≤1 stent (1.44 vs. 1.02 mGy; p = 0.04). Fluoroscopy time was also higher in procedures with >1 stent placed (120.1 vs. 68.8 s; p = 0.0004). The mean deep dose equivalent per procedure from the patient-worn abdominal badge was 0.221 mSv. Conclusion With the adjunctive use of intravascular ultrasound, iliac vein stenting can be safely and effectively performed with very low utilization of fluoroscopy, and therefore radiation exposure can be minimized for both patients and surgeons. Placement of >1 iliac vein stent resulted in higher cumulative air kerma and fluoroscopy time.

3D mapping versus cardiac computed tomography guided cryoballoon ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Varnavas ◽  
K De Schouwer ◽  
JP Abugattas ◽  
M Wolf ◽  
Y De Greef ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Radiation Exposure ◽  
Cardiac Computed Tomography ◽  
Fluoroscopy Time ◽  
Cryoballoon Ablation ◽  
3D Mapping ◽  
Procedural Time ◽  
The Mean ◽  
Patient Radiation Exposure

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac computed tomography (CCT) is an essential tool for an efficient ablation for atrial fibrillation. 3D mapping guided ablation could also deliver sufficient results in the setting of cryoballoon ablation (CBA) with additional advantages regarding total patient radiation exposure, fluoroscopy and procedural time. Purpose To compare the 3D mapping with the Achieve® catheter versus the CCT on the procedural characteristics and acute outcome during CBA. Methods Consecutive patients who underwent CBA with the second-generation cryoballoon (CB) were retrospectively enrolled from a single centre registry. Baseline and procedural characteristics of patients with pre-procedural CCT (CT-Group) were compared to those with peri-procedural 3D mapping (Ensite PrecisionTM ) with the 1st generation Achieve® catheter (3D-Group). Results A total of 696 patients were enrolled, 327 (47%) in the CT-Group and 369 (53%) in the 3D-Group. Baseline characteristics were comparable between the two groups. Similar pulmonary vein (PV) anatomical variations were identified in both groups and all PVs were acutely isolated. The mean CB temperature (T) at 60s, the nadir T, the time to PV isolation, the T of isolation and the mean thaw time did not differ significantly. However, the total procedural and fluoroscopy time were significantly shorter as well as the dose area product was significantly less  in the 3D-Group. Conclusion 3D mapping guided CBA using the Achieve® catheter is associated with significantly shorter fluoroscopy and procedural time and less patient radiation exposure. The anatomical acquisition of the PVs and the acute ablation outcome is non inferior to the CCT guided CBA. Procedural characteristics CT-Group n = 327 3D- Groupn = 369 p-value Paroxysmal AF 214 244 0.87 Total procedure time (min) 73.3 ± 23.1 65.1 ± 18.9 &lt; 0.01 Fluoroscopy time (min) 14.9 ± 7.7 12.6 ± 7 0.02 DAP (Gy·cm2) 5924 ± 4991 4890 ± 3790 0.04 LCPV 37 41 1.00 RMPV 20 21 0.87 Mean T at 60s(oC) -41.9 ± 8.5 -40.6 ± 10.7 0.10 Mean nadir T(oC) -49.5 ± 6.4 -48.4 ± 7.8 0.18 Mean PVI time(s) 42.4 ± 26.3 38.1 ± 24.3 0.11 Mean PVI temperature(oC) -33.4 ± 11.6 -31.1 ± 22 0.16 Mean thaws time(s) 51.5 ± 20.5 51.8 ± 20.3 0.85

scholarly journals The effect of paraspinal muscle-splitting microscopic-assisted discectomy versus percutaneous endoscopic lumbar discectomy on patients in the treatment of far-lateral lumbar disc herniation

2020 ◽  
Author(s):  
LEI KONG ◽  
Hong Guang Xu
Keyword(s):  
Radiation Exposure ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operating Time ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Far Lateral ◽  
The Mean ◽  
Endoscopic Lumbar Discectomy

Abstract Background Minimally invasive surgery includes percutaneous endoscopic lumbar discectomy and the microscopic tubular technique. This study aimed to compare the two techniques and evaluate the outcome of the procedure. Methods We retrospectively analyzed patients with far-lateral lumbar disc herniation (FLLDH) from June 2015 to October 2018. Twenty-six patients underwent paraspinal muscle-splitting microscopic-assisted discectomy (MD), and 30 underwent percutaneous endoscopic lumbar discectomy (PELD) surgery. Data included the duration of the operation, duration of intraoperative radiation exposure and average hospitalization. Pre- and postoperative pain scores and neurological functions were recorded using visual analogue scale (VAS) score and Oswestry disability index (ODI). Results A total of 56 patients remained in the study over the 12–24 months. The mean operating time was 65.83 ± 16.64 min in the PELD group, the mean duration of radiation exposure was 2.87±1.19 min and average hospitalization was 3.43 days. The mean operating time was 44.96 ± 16.87 min in the MD group, the mean duration of radiation exposure was 0.78±0.32 min and average hospitalization was 4.12 days. All patients in both groups showed significant improvement of VAS and ODI scores after surgery and until final follow-up. Conclusion Both techniques are minimally invasive, effective, and safe for treating far-lateral lumbar disc herniation in selected patients. Compared with the PELD technique, the MD procedure affords a wider field of vision during operation, shorter operation time, fewer postoperative complications, and a shorter learning curve.

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