Fluoroscopy-Assisted C1–C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients

Background and Objectives: Posterior C1–C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. Materials and Methods: A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1–C2 fixation, using TAS or CRS, between 2005–2019. Results: Seventy-eight patients were included, with a median follow-up time of 6.8 years. Trauma was the most common injury mechanism (64%), and cervicalgia the predominant preoperative symptom (88%). TAS was used in 33%, and SRC in 67% of cases. Surgery was associated with a significant reduction in cervicalgia (from 88 to 26%, p < 0.001). The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). No patients deteriorated in their functional status following surgery. Conclusions: Fluoroscopy-assisted C1–C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases.

Navigation and non-navigation CT scan of the sinuses: comparison of the effective doses of radiation in children and adults

Background The advent of 3D navigation imaging has opened new borders to the endoscopic surgical approaches of naso-sinusal inflammatory and neoplastic disease. This technology has gained in popularity among otolaryngologists for endoscopic sinus and skull base surgeries in both adults and children. However, the increased tissue radiation required for data acquisition associated with 3D navigation protocols CT scans is a source of concern because of its potential health hazards. We aimed to compare the effective doses of radiation between 3D navigation protocols and standard protocols for sinus computed tomography (CT) scans for both the adult and pediatric population. Methods We performed a retrospective cohort study through electronic chart review of patients undergoing sinus CT scans (standard and 3D navigation protocols) from May 2019 to December 2019 using a Siemens Drive (VA62A) CT scanner. The effective dose of radiation was calculated in mSv for all exams. Average irradiation doses were compared using a Student’s T-Test or a Kruskall–Wallis test when appropriate. Results A total of 115 CT scans were selected for analysis, of which 47 were standard protocols and 68 were 3D navigation protocols CT scans. Among these, 31 exams were performed on children and 84 exams on adults. For the total population, mean effective dose in the non-navigation CT scans was 0.37 mSv (SD: 0.16, N = 47) and mean effective dose in the 3D navigation sinus CT group was 2.33 mSv (SD: 0.45, N = 68). The mean difference between the two groups was statistically significant 1.97 mSv (CI 95% − 2.1 to − 1.83; P < 0.0001). There was a sixfold increase in radiation with utilization of 3D navigation protocols. The ratio was identical when the pediatric as well as the adult subset of patients were analyzed. Conclusion In our center, utilization of 3D navigation sinus CT protocols significantly increases radiation exposure. Otolaryngologists should be aware of this significant increase and should attempt to decrease the radiation exposure of their patients by limiting unnecessary scan orders and by evaluating 3D acquisition protocols locally with radiation physicists. Level of evidence: Level IV. Graphical Abstract

A 3D Vision Cone Based Method for Collision Free Navigation of a Quadcopter UAV among Moving Obstacles

In the near future, it’s expected that unmanned aerial vehicles (UAVs) will become ubiquitous surrogates for human-crewed vehicles in the field of border patrol, package delivery, etc. Therefore, many three-dimensional (3D) navigation algorithms based on different techniques, e.g., model predictive control (MPC)-based, navigation potential field-based, sliding mode control-based, and reinforcement learning-based, have been extensively studied in recent years to help achieve collision-free navigation. The vast majority of the 3D navigation algorithms perform well when obstacles are sparsely spaced, but fail when facing crowd-spaced obstacles, which causes a potential threat to UAV operations. In this paper, a 3D vision cone-based reactive navigation algorithm is proposed to enable small quadcopter UAVs to seek a path through crowd-spaced 3D obstacles to the destination without collisions. The proposed algorithm is simulated in MATLAB with different 3D obstacles settings to demonstrate its feasibility and compared with the other two existing 3D navigation algorithms to exhibit its superiority. Furthermore, a modified version of the proposed algorithm is also introduced and compared with the initially proposed algorithm to lay the foundation for future work.

Lean to Fly: Leaning-Based Embodied Flying can Improve Performance and User Experience in 3D Navigation

When users in virtual reality cannot physically walk and self-motions are instead only visually simulated, spatial updating is often impaired. In this paper, we report on a study that investigated if HeadJoystick, an embodied leaning-based flying interface, could improve performance in a 3D navigational search task that relies on maintaining situational awareness and spatial updating in VR. We compared it to Gamepad, a standard flying interface. For both interfaces, participants were seated on a swivel chair and controlled simulated rotations by physically rotating. They either leaned (forward/backward, right/left, up/down) or used the Gamepad thumbsticks for simulated translation. In a gamified 3D navigational search task, participants had to find eight balls within 5 min. Those balls were hidden amongst 16 randomly positioned boxes in a dark environment devoid of any landmarks. Compared to the Gamepad, participants collected more balls using the HeadJoystick. It also minimized the distance travelled, motion sickness, and mental task demand. Moreover, the HeadJoystick was rated better in terms of ease of use, controllability, learnability, overall usability, and self-motion perception. However, participants rated HeadJoystick could be more physically fatiguing after a long use. Overall, participants felt more engaged with HeadJoystick, enjoyed it more, and preferred it. Together, this provides evidence that leaning-based interfaces like HeadJoystick can provide an affordable and effective alternative for flying in VR and potentially telepresence drones.

Lung Thermal Ablation: Comparison between an Augmented Reality Computed Tomography (CT) 3D Navigation System (SIRIO) and Standard CT-Guided Technique

(1) Background: The aim of this retrospective study is to assess safety and efficacy of lung radiofrequency (RFA) and microwave ablation (MWA) using an augmented reality computed tomography (CT) navigation system (SIRIO) and to compare it with the standard CT-guided technique. (2) Methods: Lung RFA and MWA were performed with an augmented reality CT 3D navigation system (SIRIO) in 52 patients. A comparison was then performed with a group of 49 patients undergoing the standard CT-guided technique. All the procedures were divided into four groups based on the lesion diameter (>2 cm or ≤2 cm), and procedural time, the number of CT scans, radiation dose administered, and complications rate were evaluated. Technical success was defined as the presence of a “ground glass” area completely covering the target lesion at the immediate post-procedural CT. (3) Results: Full technical success was achieved in all treated malignant lesions for all the considered groups. SIRIO-guided lung thermo-ablations (LTA) displayed a significant decrease in the number of CT scans, procedure time, and patients’ radiation exposure (p < 0.001). This also resulted in a dosage reduction in hypnotics and opioids administrated for sedation during LTA. No significant differences were observed between the SIRIO and non-SIRIO group in terms of complications incidence. (4) Conclusions: SIRIO is an efficient tool to perform CT-guided LTA, displaying a significant reduction (p < 0.001) in the number of required CT scans, procedure time, and patients’ radiation exposure.

Facet Violation With Percutaneous Pedicle Screw Placement: Impact of 3D Navigation and Facet Orientation

Background: The gold standard for percutaneous pedicle screw placement is 2-dimensional (2D) fluoroscopy. Data are sparse on the accuracy of 3-dimensional (3D) navigation percutaneous screw placement in minimally invasive spine procedures. Objective: We sought to compare a single surgeon’s percutaneous pedicle screw placement accuracy using 2D fluoroscopy versus 3D navigation, as well as to investigate the effect of facet orientation on facet violation when using 2D fluoroscopy. Methods: We conducted a retrospective radiographic study of consecutive cohort of patients who underwent percutaneous lumbar instrumentation using either 2D fluoroscopy or 3D navigation. All procedures were performed by a single surgeon at 2 academic institutions between 2011 and 2018. Radiographic measurement of screw accuracy was assessed using a postoperative computed tomographic scan. The primary outcome was facet violation, and secondary outcomes were endplate/tip breaches, the Gertzbein-Robbins classification for cortical breaches, and the Simplified Screw Accuracy grade. Statistical comparisons were made between screws placed using 2D fluoroscopy versus 3D navigation. Axial facet angles were also measured to correlate with facet violation rates. Results: In the 138 patients included, 376 screws were placed with fluoroscopy and 193 with navigation. Superior (unfused) level facet violation was higher with 2D fluoroscopy than with 3D navigation (9% vs 0.5%), which comprises the main cause for poor screw placement. Axial facet angles exceeding 45° at L4 and 60° at L5 were correlated with facet violations. Conclusion: This retrospective study found that 3D navigation is associated with lower facet violation rates in percutaneous lumbar pedicle screw placement when compared with 2D fluoroscopy. These findings suggest that 3D navigation may be of particular value when facet joints are coronally oriented.