Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU...Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU Section of Uro-Technology and the International Alliance of Urolithiasis members with particular interest in the stone treatment at all levels of expertise.The final version of the questionnaire included 31 questions,evaluated the level of knowledge on X-ray utilization and exposure,and identified correlations between geographic areas,levels of seniority,surgical volumes,and awareness on radiation protection.ResultsIn total,586 respondents were included.Knowledge of fluoroscopy settings appeared low,particularly among trainees(up to 87.5%were uninformed,p=0.008).Precautions to reduce exposure appeared poorly followed as up to 25.4%of respondents used regularly continuous fluoroscopy,and up to 20.5%used regularly high-frequency setting and this trend was more obvious among senior specialists(6.2%of trainees used high-frequency settings vs.21.3%of consultants,p<0.05).Additionally,only 24.9%of respondents would provide X-ray protection to patients too.ConclusionAlthough high and routinary utilization of X-rays,the level of awareness and adhesion to“as low as reasonably achievable”principles among endourologists seems suboptimal in 65.0%of all respondents.Highest volume surgeons,inevitably at higher risk,do not seem to adopt more precautions.More efforts should be addressed to improve these results,reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.展开更多
Objective:This study aimed to evaluate the feasibility of the fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy....Objective:This study aimed to evaluate the feasibility of the fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy.Methods:Forty patients with abnormal (Group A) and 80 patients with normal (Group B) renal anatomy who had 10–20 mm renal stones were included. They were treated with LithoVue single-use flexible ureteroscopy (Boston Scientific, Marlborough, MA, USA) after ureteric dilatation by two different size semi-rigid ureteroscopes. This technique was chosen as the aim was to exclude any ureteric pathology (e.g., stone or stricture), confirm the placement of a safe guidewire, avoid balloon dilatation of the ureter, and achieve safe insertion of a 12 Fr, 35/45 cm ureteric access sheath with optical and tactile sign and without fluoroscopy image for guidance.Results:The mean ages were 43 years and 45 years in Group A and Group B, respectively. The mean stone burden was 14.62 (standard deviation: 5.35) mm^(3) and 14.79 (standard deviation: 4.58) mm^(3) in Group A and Group B, respectively. There is no significant difference between both groups according to the mean operative time, hospital stay, or stone-free rate. The stone-free rate was about 93% in both groups when the stone size was between 10 mm and 15 mm, and less than 54% when the stone size was more than 15 mm to 20 mm. In the majority of cases (80.0% in Group A and 92.5% in Group B), we completed the procedure without fluoroscopy. The perioperative complication rates were comparable in the two groups.Conclusion:Fluoroscopy-free single-use flexible ureteroscopy, when performed by expert urologists, is a feasible treatment for pre-stented patients with kidney calculi of ≤15 mm with abnormal renal anatomy.展开更多
AIM: To estimate the fetal radiation exposure using thermoluminescent dosimeters (TLD's) in pregnant patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and assess its relevance. METHODS: Dat...AIM: To estimate the fetal radiation exposure using thermoluminescent dosimeters (TLD's) in pregnant patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and assess its relevance. METHODS: Data on thirty-five therapeutic ERCPs conducted in pregnant patients from 2001 to 2009 were retrieved from a prospective database. Techniques to minimize fluoroscopy time were implemented and the fluoroscopy times captured. TLD's were placed on the mother to estimate the fetal radiation exposure and the results were compared to the maximum allowed dose of radiation to the fetus [0.005 gray (Gy)]. Obstetrics consultations were obtained and the fetus was monitored before and after the ERCP. Fluoroscopy wasperformed at 75 kVp. ERCP was performed with the patients supine by dedicated biliary endoscopists performing more than 500 cases a year. RESULTS: A total of 35 pregnant patients underwent ERCP and biliary sphincterotomy (14 in first trimester, 11 in second trimester, and 10 in third trimester). Mean maternal age was 25 years (range 16-37 years) and mean gestational age was 18.9 wk (range 4-35 wk). Mean fluoroscopy time was 0.15 min (range 0-1 min). For 23 women, the estimated fetal radiation exposure was almost negligible (< 0.0001 Gy) while for 8 women, it was within the 0.0001-0.0002 Gy range. Three women had an estimated fetal radiation exposure between 0.0002 and 0.0005 Gy and 1 woman had an estimated fetal radiation exposure greater than 0.0005 Gy. Complications included 2 post-sphincterotomy bleeds, 2 post-ERCP pancreatitis, and 1 fatal acute respiratory distress syndrome. One patient developed cholecystitis 2 d after ERCP. CONCLUSION: ERCP with modified techniques is safe during pregnancy, and estimating the fetal radiation exposure from the fluoroscopy time or measuring it via TLD's is unnecessary.展开更多
AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis.
Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably themost crucial step of this procedure. A proper access is ...Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably themost crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access.展开更多
AIM To demonstrate the feasibility of the wearable smart glasses, Pico Linker, in guide wire insertion under fluoroscopic guidance. METHODS Under a fluoroscope, a surgeon inserted 3 mm guide wires into plastic femurs ...AIM To demonstrate the feasibility of the wearable smart glasses, Pico Linker, in guide wire insertion under fluoroscopic guidance. METHODS Under a fluoroscope, a surgeon inserted 3 mm guide wires into plastic femurs from the lateral cortex to the femoral head center while the surgeon did or did not wear Pico Linker, which are wearable smart glasses where the fluoroscopic video was displayed(10 guide wires each). RESULTS The tip apex distance, radiation exposure time and total insertion time were significantly shorter while wearing the Pico Linker smart glasses. CONCLUSION This study indicated that the Pico Linker smart glasses can improve accuracy, reduce radiation exposure time, and reduce total insertion time. This is due to the fact that the Pico Linker smart glasses enable surgeons to keep their eyes on the operation field.展开更多
Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by...Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.展开更多
The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities,including high-resolution computed tomography(CT),magnetic resonance imaging(MRI)and ultrasound.Fluo...The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities,including high-resolution computed tomography(CT),magnetic resonance imaging(MRI)and ultrasound.Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness,insufficient training of residents,fewer staff with adequate expertise,and poor reimbursements relative to other modalities.We revisit and build upon the prior literature and history of this decreased utilization.We then seek to prove continued value,through categorized examples and within multiple subspecialties,wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes.This is particularly true for motility and esophageal disorders,where structure and function with real-time evaluation is essential.We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent.The fluoroscopic radiologist also has the unique ability to vary patient positioning,as opposed to traditional CT or MRI,where orthogonal views are employed without positional or temporal changes.We turn attention to the modern era,with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities.Our cases stress the need to maintain expertise in fluoroscopy skill,and underline its continued importance in residency training programs.We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology.We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers,as well as to aid clinicians in the optimal treatment of patients.展开更多
Objective:The aim of this study was to assess whether the presence of a preformed percutaneous renal access(PCA)had any effects on fluoroscopy time(FT)during percutaneous nephrolithotomy(PCNL).Methods:After ethics app...Objective:The aim of this study was to assess whether the presence of a preformed percutaneous renal access(PCA)had any effects on fluoroscopy time(FT)during percutaneous nephrolithotomy(PCNL).Methods:After ethics approval was obtained,medical records of all patients who underwent PCNL between 2009 and 2013 at a tertiary stone referral centre were retrospectively reviewed.Patients with and without pre-formed PCA undergoing PCNL were compared.Patients who underwent second-look PCNL and those who had their access inserted by interventional radiology constituted the group with pre-formed PCA.Results:A total of 185 PCNLs were reviewed.The mean patient age was 55.2±1.0 years with mean body mass index(BMI)of 27.8±0.5 kg/m^2 and male gender of 63.8%.The mean stone size was 618.4±47.0 mm^2 with mean Guy’s grade of 2.3±0.7 and mean S.T.O.N.E.score of 7.6±0.1.The mean operative time was 98.7±2.6 min with mean FT of 113.4±4.5 s.The overall stone-free rate was 71.9%with complication rate of 16.2%.When compared with PCNLs without pre-formed PCA,PCNLs with pre-formed PCA were associated with significantly shorter FT(120.6±5.1 vs.77.5±6.7 s;p<0.001)and significantly lower estimated blood loss(EBL)(p=0.01).On multivariate analysis,PCNLs with pre-formed PCA were associated with significantly shorter FT(B.coefficient=-43.2(95%CI:-66.4 to-20);p<0.001)and lower EBL(p=0.02).Conclusion:PCNLs with pre-formed PCA were associated with significantly lower FT and EBL when compared with PCNLs without pre-formed PCA.展开更多
Background: The medical imaging world is currently changing with the introduction of advanced modalities to help with diagnosis. There is then the need for the application of Artificial Intelligence (AI) in areas such...Background: The medical imaging world is currently changing with the introduction of advanced modalities to help with diagnosis. There is then the need for the application of Artificial Intelligence (AI) in areas such as radiation protection to improve the safety as far as radiations are concerned. This review article discusses the principles, some of the challenges of radiation protection and the possible role of Artificial Intelligence (AI) regarding radiation protection in computed tomography and fluoroscopy exams. Methods: A literature search was done using Google Scholar, Science Direct and Pubmed to search for relevant articles concerning the review topic. Results: Some of the challenges identified were outdated and old X-ray machines, lack of QA programs on the machines amongst others. It was discovered that AI could be applied in areas like scan planning and positioning, patient positioning amongst others in CT imaging to reduce radiation doses. With fluoroscopy, an AI enabled system helped in reducing radiation doses by selecting the region of interest of pathology and exposing that region. Conclusion: The application of AI will improve safety and standards of practice in medical imaging.展开更多
<strong>Background:</strong> The pure arterial malformation (PAM) lesion has been recently described as a vascular pathology characterized by the sole presence of coiled, sometimes ectatic, arterial loops....<strong>Background:</strong> The pure arterial malformation (PAM) lesion has been recently described as a vascular pathology characterized by the sole presence of coiled, sometimes ectatic, arterial loops. 2% of the fusiform aneurysms are located in the vertebral-posterior inferior cerebellar arteries. <strong>Case Presentation:</strong> A 60 years old female with subarachnoid hemorrhage was diagnosed with a fusiform aneurysm in the right PICA related with a PAM in the digital subtraction angiography (DSA). With a negative super-selective Wada test, the patient was treated with embolization of the two lesions and the PICA for being in the same arterial territory with adhesive embolic liquid under roadmap fluoroscopy technique. The patient had a satisfactory clinical evolution and no added neurological deficit, so she was discharged 3 days after the treatment. <strong>Conclusion:</strong> These two vascular lesions located in the same artery are very rare and more in the PICA territory. It is important to make the best decision to treat them because of the potential complications;that’s why the procedure was supported with super-selective Wada test and neuromonitoring of the PICA territory. The injection of the mixture of NBCA and Lipiodol<span style="white-space:nowrap;"><sup>®</sup></span> under roadmap fluoroscopy is very safe.展开更多
BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the ...BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the use of both anteroposterior(AP)and lateral views—on surgical outcomes remains insufficiently studied.Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre(URTT)within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.AIM To evaluate how intraoperative imaging adequacy influences unplanned returnto-theatre rates,focusing on AP and lateral fluoroscopic views.METHODS This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022.Data on intraoperative imaging adequacy,screw placement,and URTT events were collected and statistically analyzed using IBM SPSS v23.Imaging adequacy was assessed based on the presence of both AP and lateral views,and outcomes were compared between imaging groups.RESULTS A total of 9016 pedicle screws were inserted,with 82 screws identified as malplaced in 52 patients.Of these,46 patients required URTT due to screw malplacement,with 37 returning within 90 days(URTT90).Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved,demonstrating the critical role of imaging adequacy in improving surgical outcomes.CONCLUSION This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns,improves outcomes,enhances precision,and offers a cost-effective approach for better spinal surgery results.展开更多
BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regar...BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative,radiographic,and clinical outcomes.This systematic review synthesizes current evidence on these comparisons,focusing on the accuracy of screw placement,perioperative efficiency,radiographic and clinical outcomes,and complications.AIM To investigate the comparative effectiveness of RA vs conventional LIF techniques.METHODS A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines.Databases searched included PubMed,EMBASE,Web of Science,Scopus,and the Cochrane Library(through May 2025).Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy-or navigation-guided LIF(transforaminal lumbar interbody fusion,lateral lumbar interbody fusion,oblique lumbar interbody fusion)in adults.Two reviewers independently extracted data and assessed risk of bias.The Grading of Recommendations Assessment,Development and Evaluation framework was used to evaluate certainty of evidence.Meta-analyses were performed where data were sufficiently homogeneous.RESULTS Twenty-two studies were included,encompassing a total of 2313 patients-1046 who underwent RA-guided procedures and 1267 who received comparator techniques.Meta-analyses showed that RA significantly improved perfect pedicle screw placement[pooled odds ratio=2.93;95%confidence interval(CI):1.40-6.14;I2=78.2%]and reduced intraoperative blood loss(pooled standardized mean difference=-0.28;95%CI:-0.47 to-0.08;I2=0%).Operative time did not significantly differ between groups(pooled standardized mean difference=0.01;95%CI:-0.30 to 0.31;I2=66%).Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units.Narratively,RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration.Clinical and radiographic outcomes,fusion success,and complication rates were generally comparable across groups.CONCLUSION RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques.These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.展开更多
Objective:We aimed to study the effect of flexible ureteroscopy(FURS)for renal stones using a flexible and navigable suction ureteral access sheath(FANS)on intraoperative radiation dose and time.Methods:This was a mul...Objective:We aimed to study the effect of flexible ureteroscopy(FURS)for renal stones using a flexible and navigable suction ureteral access sheath(FANS)on intraoperative radiation dose and time.Methods:This was a multicenter study of adults who underwent FURS with FANS.The correlation analysis was done to identify factors affecting radiation dose and time measured by the C-arm fluoroscopy intraoperatively.Results:We analyzed 110 patients,with a median age of 50 years.Of them,72%were pre-stented prior to the procedure.The median stone volume was 1503 mm3 and the median operative time was 39 min.The median radiation dose was 7.4 mSv and median radiation time was 0.6 min.Totally,91%of patients achieved stone-free status(Grade A or B)on the non-contrast CT scan within 30 days postoperatively.There were no cases of postoperative sepsis.Body mass index,stone volume,and total operation time were associated with a higher radiation dose.Procedures performed under general anesthesia had a lower radiation dose and time than those performed under spinal anesthesia.Disposable scopes were associated with higher radiation time than reusable scopes but not dose.A low-power holmium laser had longer radiation time than other laser sources,but only the thulium fiber laser was associated with a significantly lower radiation dose.Conclusion:Our study is the first to highlight the multitude of factors affecting radiation exposure in FURS with FANS.Although not a direct measure of surgeons'actual exposure,it has important implications for the As Low As Reasonably Achievable principle which is commonly used to minimize radiation exposure to patients and operating room staff.展开更多
Dear Editor,We read with great interest the article by Aboutaleb et al.[1]titled“Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?”and would lik...Dear Editor,We read with great interest the article by Aboutaleb et al.[1]titled“Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?”and would like to commend the authors for their insightful study on the feasibility of fluoroscopy-free single-use flexible ureteroscopy in the treatment of kidney stones,particularly in patients with abnormal renal anatomy.This area of research is highly relevant,given the increasing concerns about radiation exposure to both patients and healthcare providers.The increasing attention to fluoroscopy-free procedures in recent years is justified,as we seek to minimize the risks associated with prolonged radiation use[2].展开更多
Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The a...Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47） （grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN is a safe, accurate, and effective tool for posterior C2 fixation. Chin Med J 2014;127 （14）： 2654-2658展开更多
Background：Nonfluoroscopic three-dimensional electroanatomical system is widely used nowadays,but X-ray remains indispensable for complex electrophysiology procedures.This study aimed to evaluate the value of optimiz...Background：Nonfluoroscopic three-dimensional electroanatomical system is widely used nowadays,but X-ray remains indispensable for complex electrophysiology procedures.This study aimed to evaluate the value of optimized parameter setting and different projection position to reduce X-ray radiation dose rates.Methods：From June 2013 to October 2013,105 consecutive patients who underwent complex ablation were enrolled in the study.After the ablation,the radiation dose rates were measured by two different settings （default setting and optimized setting） with three projection positions （posteroanterior [PA] projection;left anterior oblique [LAO] 30° projection;and LAO 45° projection）.The parameter of preset voltage,pulse width,critical voltage,peak voltage,noise reduction,edge enhancement,pulse rate,and dose per frame was modified in the optimized setting.Results：The optimized setting reduced radiation dose rates by 87.5％ （1.7 Gy/min vs.13.6 Gy/min,P ＜ 0.001） in PA,87.3％ （2.5 Gy/min vs.19.7 Gy/min,P＜0.001） in LAO 30°,85.9％ （3.1 Gy/min vs.22.1 Gy/min,P ＜ 0.001） in LAO 45°.Increase the angle of projection position will increase the radiation dose rate.Conclusions：We can reduce X-ray radiation dose rates by adjusting the parameter setting of X-ray system.Avoiding oblique projection of large angle is another way to reduce X-ray radiation dose rates.展开更多
Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroy...Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroyed pedicles.Intraoperative three-dimensional fluoroscopy-based navigation （ITFN） system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration.The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.Methods：Fifty-one patients diagnosed with PISTs were retrospectively analyzed,and 157 pedicles screws were implanted in 23 patients using the free-hand technique （free-hand group） and 197 pedicle screws were implanted in 28 patients using the ITFN system （ITFN group）.Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP,and McCormick classification was applied for assessment of neurological function.Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.Results：Of 51 patients,39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same.In the free-hand group,145 screws （92.4%） were Grade Ⅰ,9 screws （5.7%） were Grade Ⅱ,and 3 screws （1.9%） were Grade Ⅲ.In the ITFN group,192 screws （97.4%） were Grade Ⅰ,5 screws （2.6%） were Grade Ⅱ,and no Grade Ⅲ screw was detected.Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different （χ^2 =4.981,P =0.026）.Conclusions：The treatments of PISTs include total tumor resection and reconstruction of spine stability.The ITFN system provides a high accuracy of pedicle screw placement.展开更多
Congenital left ventricular diverticulum is a very rare cardiac abnormality and it is not completely understood about its etiology, clinical manifestation, diagnosis, treatment and prognosis. This article presents a c...Congenital left ventricular diverticulum is a very rare cardiac abnormality and it is not completely understood about its etiology, clinical manifestation, diagnosis, treatment and prognosis. This article presents a case of large congenital diverticulum of the left ventricle. The clinical manifestation included paroxysmal supraventricular tachycardia. The diagnosis was made by chest fluoroscopy observation and confirmed by 64-slice CT-angiography. The arrhythmia alleviated instead of antiarrhythmic drugs but by radiofrequency catheter ablation. Due to the rapid growth of the diverticulum, the patient underwent surgical resection finally. Owing to the fatal risks, clinicians should improve the understanding of this disease by deeply studving more cases, in order to standardize the treatment.展开更多
Background:Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections(PFCs).An electrocautery-enhanced coaxial lumen-apposing,self-expanding metal stent(ELAMS)facilitates a single-step pr...Background:Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections(PFCs).An electrocautery-enhanced coaxial lumen-apposing,self-expanding metal stent(ELAMS)facilitates a single-step procedure and may avoid the need for fluoroscopy.This study compares the treatment outcomes using ELAMS with and without fluoroscopy.Methods:Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled.Two groups were studied based on fluoroscopy use.Technical success was defined as uneventful insertion of ELAMS at time of procedure.Clinical success was defined as(i)clinical resolution of symptoms after the procedure and(ii)>75%reduction in cyst size on computed tomography 8 weeks after stent placement.Adverse events including bleeding,stent migration,and infection were recorded.Results:A total of 21 patients(13 males)had PFCs drainage with ELAMS in the study period.The mean age was 51.6614.2 years.Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst.The mean size of the PFCs was 11.363.3 cm.Fluoroscopy was used in seven cases(33%)and was associated with a longer procedure time compared to non-fluoroscopy(43.1610.4 vs 33.3610.5 min,P=0.025).This association was independent of the size,location,or type of PFCs.Fluoroscopy had no effect on the technical success rates.In fluoroless procedures,the clinical resolution was 91%as compared to 71%in fluoroscopy procedures(P=0.52)and the radiologic resolution was 57%as compared to 71%in fluoroscopy procedures(P=0.65).Three cases of stent migration/displacement occurred in the fluoroless procedures.Conclusions:ELAMS may avoid the need for fluoroscopy during cystogastrostomy.Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.展开更多
文摘Objective This study aimed to investigate the level of knowledge among urologists of usage of fluoroscopy during percutaneous nephrolithotomy.MethodsWe conducted an anonymous internet-based survey addressed to the EAU Section of Uro-Technology and the International Alliance of Urolithiasis members with particular interest in the stone treatment at all levels of expertise.The final version of the questionnaire included 31 questions,evaluated the level of knowledge on X-ray utilization and exposure,and identified correlations between geographic areas,levels of seniority,surgical volumes,and awareness on radiation protection.ResultsIn total,586 respondents were included.Knowledge of fluoroscopy settings appeared low,particularly among trainees(up to 87.5%were uninformed,p=0.008).Precautions to reduce exposure appeared poorly followed as up to 25.4%of respondents used regularly continuous fluoroscopy,and up to 20.5%used regularly high-frequency setting and this trend was more obvious among senior specialists(6.2%of trainees used high-frequency settings vs.21.3%of consultants,p<0.05).Additionally,only 24.9%of respondents would provide X-ray protection to patients too.ConclusionAlthough high and routinary utilization of X-rays,the level of awareness and adhesion to“as low as reasonably achievable”principles among endourologists seems suboptimal in 65.0%of all respondents.Highest volume surgeons,inevitably at higher risk,do not seem to adopt more precautions.More efforts should be addressed to improve these results,reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.
文摘Objective:This study aimed to evaluate the feasibility of the fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy.Methods:Forty patients with abnormal (Group A) and 80 patients with normal (Group B) renal anatomy who had 10–20 mm renal stones were included. They were treated with LithoVue single-use flexible ureteroscopy (Boston Scientific, Marlborough, MA, USA) after ureteric dilatation by two different size semi-rigid ureteroscopes. This technique was chosen as the aim was to exclude any ureteric pathology (e.g., stone or stricture), confirm the placement of a safe guidewire, avoid balloon dilatation of the ureter, and achieve safe insertion of a 12 Fr, 35/45 cm ureteric access sheath with optical and tactile sign and without fluoroscopy image for guidance.Results:The mean ages were 43 years and 45 years in Group A and Group B, respectively. The mean stone burden was 14.62 (standard deviation: 5.35) mm^(3) and 14.79 (standard deviation: 4.58) mm^(3) in Group A and Group B, respectively. There is no significant difference between both groups according to the mean operative time, hospital stay, or stone-free rate. The stone-free rate was about 93% in both groups when the stone size was between 10 mm and 15 mm, and less than 54% when the stone size was more than 15 mm to 20 mm. In the majority of cases (80.0% in Group A and 92.5% in Group B), we completed the procedure without fluoroscopy. The perioperative complication rates were comparable in the two groups.Conclusion:Fluoroscopy-free single-use flexible ureteroscopy, when performed by expert urologists, is a feasible treatment for pre-stented patients with kidney calculi of ≤15 mm with abnormal renal anatomy.
文摘AIM: To estimate the fetal radiation exposure using thermoluminescent dosimeters (TLD's) in pregnant patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and assess its relevance. METHODS: Data on thirty-five therapeutic ERCPs conducted in pregnant patients from 2001 to 2009 were retrieved from a prospective database. Techniques to minimize fluoroscopy time were implemented and the fluoroscopy times captured. TLD's were placed on the mother to estimate the fetal radiation exposure and the results were compared to the maximum allowed dose of radiation to the fetus [0.005 gray (Gy)]. Obstetrics consultations were obtained and the fetus was monitored before and after the ERCP. Fluoroscopy wasperformed at 75 kVp. ERCP was performed with the patients supine by dedicated biliary endoscopists performing more than 500 cases a year. RESULTS: A total of 35 pregnant patients underwent ERCP and biliary sphincterotomy (14 in first trimester, 11 in second trimester, and 10 in third trimester). Mean maternal age was 25 years (range 16-37 years) and mean gestational age was 18.9 wk (range 4-35 wk). Mean fluoroscopy time was 0.15 min (range 0-1 min). For 23 women, the estimated fetal radiation exposure was almost negligible (< 0.0001 Gy) while for 8 women, it was within the 0.0001-0.0002 Gy range. Three women had an estimated fetal radiation exposure between 0.0002 and 0.0005 Gy and 1 woman had an estimated fetal radiation exposure greater than 0.0005 Gy. Complications included 2 post-sphincterotomy bleeds, 2 post-ERCP pancreatitis, and 1 fatal acute respiratory distress syndrome. One patient developed cholecystitis 2 d after ERCP. CONCLUSION: ERCP with modified techniques is safe during pregnancy, and estimating the fetal radiation exposure from the fluoroscopy time or measuring it via TLD's is unnecessary.
文摘AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis.
文摘Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably themost crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access.
文摘AIM To demonstrate the feasibility of the wearable smart glasses, Pico Linker, in guide wire insertion under fluoroscopic guidance. METHODS Under a fluoroscope, a surgeon inserted 3 mm guide wires into plastic femurs from the lateral cortex to the femoral head center while the surgeon did or did not wear Pico Linker, which are wearable smart glasses where the fluoroscopic video was displayed(10 guide wires each). RESULTS The tip apex distance, radiation exposure time and total insertion time were significantly shorter while wearing the Pico Linker smart glasses. CONCLUSION This study indicated that the Pico Linker smart glasses can improve accuracy, reduce radiation exposure time, and reduce total insertion time. This is due to the fact that the Pico Linker smart glasses enable surgeons to keep their eyes on the operation field.
基金This study was supported by Beijing Municipal Hospital Scientific Research Cultivation Program(No.PX2016057).We thank Xiaoping Kang for her help in data analysis.
文摘Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.
文摘The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities,including high-resolution computed tomography(CT),magnetic resonance imaging(MRI)and ultrasound.Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness,insufficient training of residents,fewer staff with adequate expertise,and poor reimbursements relative to other modalities.We revisit and build upon the prior literature and history of this decreased utilization.We then seek to prove continued value,through categorized examples and within multiple subspecialties,wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes.This is particularly true for motility and esophageal disorders,where structure and function with real-time evaluation is essential.We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent.The fluoroscopic radiologist also has the unique ability to vary patient positioning,as opposed to traditional CT or MRI,where orthogonal views are employed without positional or temporal changes.We turn attention to the modern era,with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities.Our cases stress the need to maintain expertise in fluoroscopy skill,and underline its continued importance in residency training programs.We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology.We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers,as well as to aid clinicians in the optimal treatment of patients.
文摘Objective:The aim of this study was to assess whether the presence of a preformed percutaneous renal access(PCA)had any effects on fluoroscopy time(FT)during percutaneous nephrolithotomy(PCNL).Methods:After ethics approval was obtained,medical records of all patients who underwent PCNL between 2009 and 2013 at a tertiary stone referral centre were retrospectively reviewed.Patients with and without pre-formed PCA undergoing PCNL were compared.Patients who underwent second-look PCNL and those who had their access inserted by interventional radiology constituted the group with pre-formed PCA.Results:A total of 185 PCNLs were reviewed.The mean patient age was 55.2±1.0 years with mean body mass index(BMI)of 27.8±0.5 kg/m^2 and male gender of 63.8%.The mean stone size was 618.4±47.0 mm^2 with mean Guy’s grade of 2.3±0.7 and mean S.T.O.N.E.score of 7.6±0.1.The mean operative time was 98.7±2.6 min with mean FT of 113.4±4.5 s.The overall stone-free rate was 71.9%with complication rate of 16.2%.When compared with PCNLs without pre-formed PCA,PCNLs with pre-formed PCA were associated with significantly shorter FT(120.6±5.1 vs.77.5±6.7 s;p<0.001)and significantly lower estimated blood loss(EBL)(p=0.01).On multivariate analysis,PCNLs with pre-formed PCA were associated with significantly shorter FT(B.coefficient=-43.2(95%CI:-66.4 to-20);p<0.001)and lower EBL(p=0.02).Conclusion:PCNLs with pre-formed PCA were associated with significantly lower FT and EBL when compared with PCNLs without pre-formed PCA.
文摘Background: The medical imaging world is currently changing with the introduction of advanced modalities to help with diagnosis. There is then the need for the application of Artificial Intelligence (AI) in areas such as radiation protection to improve the safety as far as radiations are concerned. This review article discusses the principles, some of the challenges of radiation protection and the possible role of Artificial Intelligence (AI) regarding radiation protection in computed tomography and fluoroscopy exams. Methods: A literature search was done using Google Scholar, Science Direct and Pubmed to search for relevant articles concerning the review topic. Results: Some of the challenges identified were outdated and old X-ray machines, lack of QA programs on the machines amongst others. It was discovered that AI could be applied in areas like scan planning and positioning, patient positioning amongst others in CT imaging to reduce radiation doses. With fluoroscopy, an AI enabled system helped in reducing radiation doses by selecting the region of interest of pathology and exposing that region. Conclusion: The application of AI will improve safety and standards of practice in medical imaging.
文摘<strong>Background:</strong> The pure arterial malformation (PAM) lesion has been recently described as a vascular pathology characterized by the sole presence of coiled, sometimes ectatic, arterial loops. 2% of the fusiform aneurysms are located in the vertebral-posterior inferior cerebellar arteries. <strong>Case Presentation:</strong> A 60 years old female with subarachnoid hemorrhage was diagnosed with a fusiform aneurysm in the right PICA related with a PAM in the digital subtraction angiography (DSA). With a negative super-selective Wada test, the patient was treated with embolization of the two lesions and the PICA for being in the same arterial territory with adhesive embolic liquid under roadmap fluoroscopy technique. The patient had a satisfactory clinical evolution and no added neurological deficit, so she was discharged 3 days after the treatment. <strong>Conclusion:</strong> These two vascular lesions located in the same artery are very rare and more in the PICA territory. It is important to make the best decision to treat them because of the potential complications;that’s why the procedure was supported with super-selective Wada test and neuromonitoring of the PICA territory. The injection of the mixture of NBCA and Lipiodol<span style="white-space:nowrap;"><sup>®</sup></span> under roadmap fluoroscopy is very safe.
文摘BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery,offering effective stabilization for various spinal conditions.However,the impact of intraoperative imaging quality—specifically the use of both anteroposterior(AP)and lateral views—on surgical outcomes remains insufficiently studied.Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre(URTT)within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.AIM To evaluate how intraoperative imaging adequacy influences unplanned returnto-theatre rates,focusing on AP and lateral fluoroscopic views.METHODS This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022.Data on intraoperative imaging adequacy,screw placement,and URTT events were collected and statistically analyzed using IBM SPSS v23.Imaging adequacy was assessed based on the presence of both AP and lateral views,and outcomes were compared between imaging groups.RESULTS A total of 9016 pedicle screws were inserted,with 82 screws identified as malplaced in 52 patients.Of these,46 patients required URTT due to screw malplacement,with 37 returning within 90 days(URTT90).Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved,demonstrating the critical role of imaging adequacy in improving surgical outcomes.CONCLUSION This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns,improves outcomes,enhances precision,and offers a cost-effective approach for better spinal surgery results.
文摘BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative,radiographic,and clinical outcomes.This systematic review synthesizes current evidence on these comparisons,focusing on the accuracy of screw placement,perioperative efficiency,radiographic and clinical outcomes,and complications.AIM To investigate the comparative effectiveness of RA vs conventional LIF techniques.METHODS A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines.Databases searched included PubMed,EMBASE,Web of Science,Scopus,and the Cochrane Library(through May 2025).Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy-or navigation-guided LIF(transforaminal lumbar interbody fusion,lateral lumbar interbody fusion,oblique lumbar interbody fusion)in adults.Two reviewers independently extracted data and assessed risk of bias.The Grading of Recommendations Assessment,Development and Evaluation framework was used to evaluate certainty of evidence.Meta-analyses were performed where data were sufficiently homogeneous.RESULTS Twenty-two studies were included,encompassing a total of 2313 patients-1046 who underwent RA-guided procedures and 1267 who received comparator techniques.Meta-analyses showed that RA significantly improved perfect pedicle screw placement[pooled odds ratio=2.93;95%confidence interval(CI):1.40-6.14;I2=78.2%]and reduced intraoperative blood loss(pooled standardized mean difference=-0.28;95%CI:-0.47 to-0.08;I2=0%).Operative time did not significantly differ between groups(pooled standardized mean difference=0.01;95%CI:-0.30 to 0.31;I2=66%).Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units.Narratively,RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration.Clinical and radiographic outcomes,fusion success,and complication rates were generally comparable across groups.CONCLUSION RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques.These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.
文摘Objective:We aimed to study the effect of flexible ureteroscopy(FURS)for renal stones using a flexible and navigable suction ureteral access sheath(FANS)on intraoperative radiation dose and time.Methods:This was a multicenter study of adults who underwent FURS with FANS.The correlation analysis was done to identify factors affecting radiation dose and time measured by the C-arm fluoroscopy intraoperatively.Results:We analyzed 110 patients,with a median age of 50 years.Of them,72%were pre-stented prior to the procedure.The median stone volume was 1503 mm3 and the median operative time was 39 min.The median radiation dose was 7.4 mSv and median radiation time was 0.6 min.Totally,91%of patients achieved stone-free status(Grade A or B)on the non-contrast CT scan within 30 days postoperatively.There were no cases of postoperative sepsis.Body mass index,stone volume,and total operation time were associated with a higher radiation dose.Procedures performed under general anesthesia had a lower radiation dose and time than those performed under spinal anesthesia.Disposable scopes were associated with higher radiation time than reusable scopes but not dose.A low-power holmium laser had longer radiation time than other laser sources,but only the thulium fiber laser was associated with a significantly lower radiation dose.Conclusion:Our study is the first to highlight the multitude of factors affecting radiation exposure in FURS with FANS.Although not a direct measure of surgeons'actual exposure,it has important implications for the As Low As Reasonably Achievable principle which is commonly used to minimize radiation exposure to patients and operating room staff.
文摘Dear Editor,We read with great interest the article by Aboutaleb et al.[1]titled“Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?”and would like to commend the authors for their insightful study on the feasibility of fluoroscopy-free single-use flexible ureteroscopy in the treatment of kidney stones,particularly in patients with abnormal renal anatomy.This area of research is highly relevant,given the increasing concerns about radiation exposure to both patients and healthcare providers.The increasing attention to fluoroscopy-free procedures in recent years is justified,as we seek to minimize the risks associated with prolonged radiation use[2].
文摘Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47） （grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN is a safe, accurate, and effective tool for posterior C2 fixation. Chin Med J 2014;127 （14）： 2654-2658
文摘Background：Nonfluoroscopic three-dimensional electroanatomical system is widely used nowadays,but X-ray remains indispensable for complex electrophysiology procedures.This study aimed to evaluate the value of optimized parameter setting and different projection position to reduce X-ray radiation dose rates.Methods：From June 2013 to October 2013,105 consecutive patients who underwent complex ablation were enrolled in the study.After the ablation,the radiation dose rates were measured by two different settings （default setting and optimized setting） with three projection positions （posteroanterior [PA] projection;left anterior oblique [LAO] 30° projection;and LAO 45° projection）.The parameter of preset voltage,pulse width,critical voltage,peak voltage,noise reduction,edge enhancement,pulse rate,and dose per frame was modified in the optimized setting.Results：The optimized setting reduced radiation dose rates by 87.5％ （1.7 Gy/min vs.13.6 Gy/min,P ＜ 0.001） in PA,87.3％ （2.5 Gy/min vs.19.7 Gy/min,P＜0.001） in LAO 30°,85.9％ （3.1 Gy/min vs.22.1 Gy/min,P ＜ 0.001） in LAO 45°.Increase the angle of projection position will increase the radiation dose rate.Conclusions：We can reduce X-ray radiation dose rates by adjusting the parameter setting of X-ray system.Avoiding oblique projection of large angle is another way to reduce X-ray radiation dose rates.
文摘Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroyed pedicles.Intraoperative three-dimensional fluoroscopy-based navigation （ITFN） system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration.The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.Methods：Fifty-one patients diagnosed with PISTs were retrospectively analyzed,and 157 pedicles screws were implanted in 23 patients using the free-hand technique （free-hand group） and 197 pedicle screws were implanted in 28 patients using the ITFN system （ITFN group）.Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP,and McCormick classification was applied for assessment of neurological function.Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.Results：Of 51 patients,39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same.In the free-hand group,145 screws （92.4%） were Grade Ⅰ,9 screws （5.7%） were Grade Ⅱ,and 3 screws （1.9%） were Grade Ⅲ.In the ITFN group,192 screws （97.4%） were Grade Ⅰ,5 screws （2.6%） were Grade Ⅱ,and no Grade Ⅲ screw was detected.Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different （χ^2 =4.981,P =0.026）.Conclusions：The treatments of PISTs include total tumor resection and reconstruction of spine stability.The ITFN system provides a high accuracy of pedicle screw placement.
文摘Congenital left ventricular diverticulum is a very rare cardiac abnormality and it is not completely understood about its etiology, clinical manifestation, diagnosis, treatment and prognosis. This article presents a case of large congenital diverticulum of the left ventricle. The clinical manifestation included paroxysmal supraventricular tachycardia. The diagnosis was made by chest fluoroscopy observation and confirmed by 64-slice CT-angiography. The arrhythmia alleviated instead of antiarrhythmic drugs but by radiofrequency catheter ablation. Due to the rapid growth of the diverticulum, the patient underwent surgical resection finally. Owing to the fatal risks, clinicians should improve the understanding of this disease by deeply studving more cases, in order to standardize the treatment.
文摘Background:Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections(PFCs).An electrocautery-enhanced coaxial lumen-apposing,self-expanding metal stent(ELAMS)facilitates a single-step procedure and may avoid the need for fluoroscopy.This study compares the treatment outcomes using ELAMS with and without fluoroscopy.Methods:Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled.Two groups were studied based on fluoroscopy use.Technical success was defined as uneventful insertion of ELAMS at time of procedure.Clinical success was defined as(i)clinical resolution of symptoms after the procedure and(ii)>75%reduction in cyst size on computed tomography 8 weeks after stent placement.Adverse events including bleeding,stent migration,and infection were recorded.Results:A total of 21 patients(13 males)had PFCs drainage with ELAMS in the study period.The mean age was 51.6614.2 years.Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst.The mean size of the PFCs was 11.363.3 cm.Fluoroscopy was used in seven cases(33%)and was associated with a longer procedure time compared to non-fluoroscopy(43.1610.4 vs 33.3610.5 min,P=0.025).This association was independent of the size,location,or type of PFCs.Fluoroscopy had no effect on the technical success rates.In fluoroless procedures,the clinical resolution was 91%as compared to 71%in fluoroscopy procedures(P=0.52)and the radiologic resolution was 57%as compared to 71%in fluoroscopy procedures(P=0.65).Three cases of stent migration/displacement occurred in the fluoroless procedures.Conclusions:ELAMS may avoid the need for fluoroscopy during cystogastrostomy.Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.
